Leukotriene receptor antagonist use and cognitive decline in normal cognition, mild cognitive impairment, and Alzheimer’s dementia

Background Leukotriene receptor antagonists (LTRAs) alleviate Alzheimer’s disease (AD) pathology and improve cognition in animal models; however, clinical evidence is limited. This study aimed to explore the associations between the use of LTRAs (montelukast or zafirlukast) and cognitive performance in people with normal cognition, mild cognitive impairment (MCI), or AD dementia. We hypothesized that LTRA use would be associated with better cognitive performance over time. Methods This longitudinal observational study used data from the National Alzheimer’s Coordinating Center. Within groups of participants with normal cognition, MCI, or AD dementia, LTRA users were matched 1:3 to non-users using propensity score matching. Cognitive domains including immediate and delayed memory (Wechsler Memory Scale Revised-Logical Memory IA and IIA), psychomotor processing speed (Digit Symbol Substitution Test), and language (animal naming, vegetable naming, and Boston Naming Test) were compared between users and non-users in mixed-effects linear or Poisson regression models. Results In AD dementia, LTRA use was associated with a slower decline in psychomotor processing speed, as measured by the Digit Symbol Substitution Test (Β = 1.466 [0.253, 2.678] symbols/year, n = 442), and language, as measured by animal naming (Β = 0.541 [0.215, 0.866] animals/year, n = 566), vegetable naming (B = 0.309 [0.056, 0.561] vegetables/year, n = 565), and the Boston Naming Test (B = 0.529 [0.005, 1.053] items/year, n = 561). Effect sizes were small but persisted after controlling for a 10% false discovery rate. LTRA use was not associated with changes in memory performance in AD, nor was it associated with changes in cognitive performance in people with normal cognition or MCI. In a post hoc analysis, LTRA use was associated with a slower decline in clinical progression in MCI (B = −0.200 [−0.380, −0.019] points/year, n = 800) and AD dementia (B = −0.321 [−0.597, −0.046] points/year, n = 604) as measured by CDR Sum of Boxes. Conclusions The use of LTRAs was associated with preserved function in non-amnestic cognitive domains in AD dementia. The role of leukotrienes and their receptors in cognitive decline warrants further investigation and the leukotriene pathway may represent a target for AD treatment.

A-163 Utility of the 7/24 Spatial Recall Test in Temporal Lobe Epilepsy

Objective To examine the utility of the 7/24 Spatial Recall Test (7/24) in the assessment of temporal lobe epilepsy (TLE) patients who have not undergone surgical resection. We hypothesized that patients with right TLE (RTLE) would perform significantly worse on the 7/24 than patients with left TLE (LTLE), but better on measures of verbal memory and naming. Participants and Methods Twenty-one patients with RTLE and 17 patients with LTLE were identified from a larger dataset of 152 epilepsy patients who underwent comprehensive neuropsychological evaluations at Brigham and Women’s Hospital. Exclusion criteria included: 1) Extratemporal, bitemporal, or unclear seizure onset, 2) Post-surgical evaluations, and 3) Co-morbid neurodegenerative or neurological conditions. The Rey Auditory Verbal Learning Test (RVLT) and Boston Naming Test (BNT) and were selected as outcome measures of verbal memory and naming, respectively. Results Independent samples t-tests revealed that patients with RTLE performed significantly worse on the 7/24 delayed recall than LTLE patients (p = 0.026), but there were no significant differences between groups in their 7/24 immediate recall across trials (p = 0.118). As predicted, patients with LTLE performed significantly worse than RTLE patients on the BNT (p = 0.005), however no significant differences were found between groups on the RVLT total learning, short delay, or long delay. Conclusions These findings support the use of the 7/24 for assessing nonverbal memory in patients with TLE, and more specifically, suggest that the 7/24 may be a sensitive measure for detecting lateralized dysfunction of the right temporal lobe in TLE patients.

A-100 Examining Spanish-English Bilingual Boston Naming Test Norms in Traumatic Brain Injury Survivors

Objective We examined two established Spanish-English bilingual norms to assess if traumatic brain injury (TBI) deficits were still found if language was no longer a variable influencing Boston Naming Test (BNT) performance. Method The sample consisted of 47 healthy comparison (HC; 24 English-Monolinguals; 23 Spanish-English Bilinguals), 33 acute TBI (ATBI; 20 English-Monolinguals; 13 Spanish-English Bilinguals), and 25 Chronic TBI (CTBI: 13 English-Monolinguals; 12 Spanish-English Bilinguals) participants. Raw scores and adjusted demographic T-scores (Roberts et al., 2002; Rosselli et al., 1997) were used to evaluate BNT performance. Results An ANCOVA controlling for age, revealed the HC group outperformed the TBI group on the BNT (raw score), p = 0.003, ηp2 = 0.11. We also found monolinguals outperformed bilinguals on the BNT, p = 0.000, ηp2 = 0.24. Using the Roberts et al., (2002) norms, we found the HC group outperformed the TBI group, p = 0.003, ηp2 = 0.11, but no language differences were found. Next, using Rosselli et al., (1997) norms, we found the HC group outperformed the TBI group on the BNT, p = 0.003, ηp2 = 0.11, and monolingual speakers outperformed bilingual speakers, p = 0.014, ηp2 = 0.06. No interactions were found. Conclusions As expected, the TBI group demonstrated worse BNT performance compared to HC group on both language norms. However, when using Roberts et al., (2002) Spanish-English bilingual norms, no language group differences were found. Our data indicates that when examining BNT performance in a Spanish-English bilingual and English-monolingual TBI sample, Roberts et al., (2002) normative data may be better suited to evaluate BNT deficits in a TBI while taking language into account.

Phonological Errors in Posterior Cortical Atrophy

<b><i>Background:</i></b> Posterior cortical atrophy (PCA) is an atypical variant of Alzheimer’s disease (AD) that presents with visuospatial/perceptual deficits. PCA is characterized by atrophy in posterior brain regions, which overlaps with atrophy occurring in logopenic variant of primary progressive aphasia (lvPPA), another atypical AD variant characterized by language difficulties, including phonological errors. Language abnormalities have been observed in PCA, although the prevalence of phonological errors is unknown. We aimed to compare the frequency and severity of phonological errors in PCA and lvPPA and determine the neuroanatomical correlates of phonological errors and language abnormalities in PCA. <b><i>Methods:</i></b> The presence and number of phonological errors were recorded during the Boston Naming Test and Western Aphasia Battery repetition subtest in 27 PCA patients and 27 age- and disease duration-matched lvPPA patients. Number of phonological errors and scores from language tests were correlated with regional gray matter volumes using Spearman correlations. <b><i>Results:</i></b> Phonological errors were evident in 55% of PCA patients and 70% of lvPPA patients, with lvPPA having higher average number of errors. Phonological errors in PCA correlated with decreased left inferior parietal and lateral temporal volume. Naming and fluency were also associated with decreased left lateral temporal lobe volume. <b><i>Conclusions:</i></b> Phonological errors are common in PCA, although they are not as prevalent or severe as in lvPPA, and they are related to involvement of left temporoparietal cortex. This highlights the broad spectrum of clinical symptoms associated with AD and overlap between PCA and lvPPA.

EFFECT OF OBSTRUCTIVE SLEEP APNEA (OSA) RISK LEVELS ON BOSTON NAMING TEST SCORES TO THE POPULATION IN MATARAM

Background: Obstructive Sleep Apnea (OSA) is one of the most common respiratory disorders found in society. This condition is often found in men with obesity, men with hypertension history, and elderly. In relation to this, it is found that the researches on the effect of OSA risk level on language functions is rarely done. Therefore, this study is aimed at investigating the effect of OSA risk levels on Boston Naming Test score to the population in Mataram. Objective: to investigate the effect of OSA risk levels on language functions used the Boston Naming Test to the population in Mataram. Methods: This study belongs to analytic descriptive study with cross sectional approach. Held in Udayana Park, Dasan Sari, Mataram in May 2017 and September 2018. This study involved 132 respondents by ages among 40-74 years old. They are Chosen based on inclusion criteria. The OSA risk level was measured using The STOP-Bang questionnaire while language functions was measured using the Boston Naming Test. After That, the Mann-whitney comparative test was employed to analyzed the data. Results: The result of this study showed that, from 132 respondents, it was found that there were 66 (50%) respondents had a high risk level of OSA, and 82 (62%) respondents had language function disorders. Besides, the Mann-Whitney comparative analysis showed no effect on the risk level of OSA on Boston Naming Test score (p > 0.05). Conclusion: The risk level of OSA has no effect on Boston Naming Test score to the population aged 40-74 years in Mataram.

Expanded Exploration of the Auditory Naming Test in Patients with Dementia

Background: Auditory naming tests are superior to visual confrontation naming tests in revealing word-finding difficulties in many neuropathological conditions. Objective: To delineate characteristics of auditory naming most likely to reveal anomia in patients with dementia, and possibly improve diagnostic utility, we evaluated a large sample of patients referred with memory impairment complaints. Methods: Patients with dementia (N = 733) or other cognitive impairments and normal individuals (N = 69) were evaluated for frequency of impairment on variables of the Auditory Naming Test (ANT) of Hamberger & Seidel versus the Boston Naming Test (BNT). Results: Naming impairment occurred more frequently using the ANT total score (φ= 0.41) or ANT tip-of-the tongue score (TOT; φ= 0.19) but not ANT mean response time compared to the BNT in patients with dementia (p < 0.001). Significantly more patients were impaired on ANT variables than on the BNT in Alzheimer’s disease (AD), vascular dementia (VaD), mixed AD/VaD, and multiple domain mild cognitive impairment (mMCI) but not in other dementias or amnestic MCI (aMCI). This differential performance of patients on auditory versus visual naming tasks was most pronounced in older, well-educated, male patients with the least cognitive impairment. Impaired verbal comprehension was not contributory. Inclusion of an ANT index score increased sensitivity in the dementia sample (92%). Poor specificity (41%) may be secondary to the inherent limitation of using the BNT as a control variable. Conclusion: The ANT index score adds diagnostic utility to the assessment of naming difficulties in patients with suspected dementia.