Dementia, Cognitive Decline, Aging s157 13-l 2-17 1 Treatment of patients with vascular dementia N. Malashkhia, R. Sepiashvili, Yu. Malashkhia. institute of Clinical lmmunol~ and Allergology, Tskhaltubo, Republic of Georgia 44 patients with vascular dementia (VD) at age of 64-85 were selected for treatment. The selection was made with the application of psychometric scales (NINDS-AIREN) criterion. The level of dementia was determined with MMSE. 22 patients took 30 mg of Nirnodipin 3 times a day for 3 months (I group). The rest 22 took 30 mg of Nimodipin + antidepressant Amitriptilin in the dose of 12 mg with gradual dose increase up to 25 mg twice a day for 3 months. Among I group of patients the considerable improvement of psychometric indices was noted in 4 (IS%), the improvement in 2 (9%) of patients. The statement of the rest 16 remained without changes. In the II group the considerable improvement was observed in 16 (73%), the improvement - in 2 (9%), the changes were not revealed in 4 (18%) of patients. The carried investigations showed that in the II group the number of patients with considerable improvement of psychometric indices were positively higher than in the I group (p 0.001). Thus, the selective blockator of calcic canals Nimodipin together with an- tidepressants (Amitriptilin) considerably improve the statement of patients with VD. 13-l 2-18 1 A specific pattern of frontal impairment clearly discriminates between Datkmts with vascular dementia (VAD) and Al&imer’s disease (AD) A.P. Cannati, E. Farina, E. Magni, C. Mariani. Neurorehabilitation Unit, “S. Maria Nascente” IRCCS, “Don C. Gnocchi” Foundation, University of Milan, Italy In order to differentiate the cognitive profile between VaD and AD, 12 patients affected by probable VaD (according to ADDTC criieria) and 9 patients affected by probable AD (according to NINCS-ADRDA criteria) were assessed with an extensive neuropsychological battery, exploring memory, language, praxis, visuoperceptive and constructional abilities, attention and frontal lobe functions. The two groups were not statistically diierent in age, level of education, gender, and Hamilton Depression Rating Scale score (mean age of VaD patients: 71.2 f 10.0 years; mean age of AD patients 67.2 f 7.6 years). AD patients were slightly more impaired in Mini Mental State Examination (MMSE) (VaD patients: mean 22.7 f 5.4; AD patients: mean 17.7 f 2.3). VaD patients showed a significant greater extent of impairment in a task assessing categorization of pictures (Number of categories in VaD group: mean 4.5 f 2.5; in AD group: mean 7.1 f 2.7; ANOVA of diagnostic group for number of categories, covariing for MMSE score, sig of F = 0.011. Number of uncategorized items in VaD group: mean 14.0 f 13.4; in AD group: mean 11.6.0 f 8.6; ANOVA of diagnostic group for uncategorized items, covariing for MMSE score, sig of F = 0.041). No significant difference was found between the two groups in any other task, comprised two tests assessing different cognitive aspects of frontal functions. Our results confirm that it is possible to discriminate VaD from AD patients on the basis of cognitive profile. For this purpose the neuropsychological tests employed must be accurately selected because not all “frontal” tasks are equally sensitive to detect the greater frontal impairment in VaD. 13-l 2-19 1 Low body mass index and cachexia as predictors of mortality in Alzheimer’s disease CA. Merchant, Y. Stern, S. Albert, R. Mayeux. College of Physicians & Surgeons Columbia UniversiQ Alzheimer’s Disease Research Cnrr New York, New York, USA Objectlve: Although increased mortality risk in Alzheimer’s disease [AD] has been described, risk factors for mortality in AD have been less clearly ad- dressed. This study compares anthropometric measures of malnutrition and subjective assessments of cachexia as risk factors for mortality in AD. Methods: Cox proportional hazards survival models were used to estab- lish relative risk (RR) of low body mass index (weight/heighp) and physician judgment of cachexia for mortality. Body mass index [BMI] frequencies were di- vided into quartiles with the lowest quartile designated low BMI. Adjustments for gender, clinical severity rating, age, and APOE genotype were included. Four hundred and fifty-four participants of a prospective population-based study in New York City were identified with possible or probable AD. Results: Both low BMI and cachexia were risk factors for mortality in AD (RR = 2.18 [1.02; 4.651 and RR = 3.10 [1.44; 6.661, respectively. The nutritional parameters were mildly correlated (r = 0.16, p < 0.01). APOE ~4 was not associated with an increased risk of mortality (RR = 1 .Ol [O&l; 2.571). Conctuslons: Baseline anthropometric measurements and subjective as- sessments of cachexia are significant risk factors for mortality in AD. 3-12-20 Vascular autoregulation tested with transcraniai Doppler in a population of elderly subjects with white matter lesions G. Micieli, D. Bosone, L. Sibilla, A. Cavallini, S. Marcheselli, G. Roman, G. Nappi. Neurovaswlar Unit, ‘C. Mondino” Foundation, University of Pavia, /ta/,! ’ Clinical Neurophysiol. Dept, University of S. Antonio, Taxas, USA In recent years, vascular dementia (VD) has been recognized to be the ultimate consequence of chronic damage of small cerebral arteries (microangiopathy). To date, there are no predictive factors of subjects at high risk for develop- ing vascular dementia, despite the occasional findings of lesions in the white matter of elderly subjects. A vast survey, carried out in the U.S.A by the Car- diovascular Heart Study has determined that the three factors more frequently associated to lesions of the white matter in the elderly are hypertensive or ar- teriosclerotic microangiopathy and orthostatic hypotension. The latter, in fact, could drastically reduce cerebral blood flow (and subsequently oxygenation) in subjects affected by cerebrovascular disease with impaired or total loss of autoregulatory mechanisms. The hemodynamic mechanism could therefore offer an explanation for the phenomenon of vascular dementia which could be adequately investigated by exploring autoregulatory mechanisms in the elderly affected by lesions of the white matter. In this preliminary work we propose the use of transcranial Doppler TCD) to study cerebral autoregulation to tilting test in a group of subjects with white matter lesions, to identify cerebral hemodynamic conditions characterizing elderly patients with a greater risk of developing VD. The study include 23 subjects considered at risk for VD aging 69.8 (& 9.45) years with history of cerebrovascular pathology, normal or slightly impaired neuropsychological assessment, TC scan positive for leukoarariosis or white matter lacunar lesions. Patients were submitted to TCD during Tilting (700 for 10’) and continuous monitoring of Mean Arterial Pressure (MAP) was perfoned. During tilting results showed a slight decrease of MAP, more evident at the 5th minute (p = 0.530) and a signiicant trend versus reduction of Vm, 30” (p = 0.122), 5’ (p = 0.058) and 10’ (p = 0.080) after tilting; resistence index (MAPNm) was significantly increase& These results may suggest a possible failure of the cerebrovascular autoregulatory mechanisms in our selected study population, being more at risk to develop white matter lesions and possibly VD. 3-12-21 Risk factors and neurological findings in multi-infarct dementia A. Milovic, D. Pavlovic, G. Ocic, P. Smiljkovic, E. Stefanova, J. Djordjevic, S. Zugic, T. Smiljkovic, G. Tomic. institute of Neuro/ogy. CCS, Dr Subotica 6, Belgrade, Yugoilavia -. Multi-infarct dementia (MID) refers to cognitive deterioration due to multiple strokes. Correlation between risk factors for cardiovascular disease and MID are well known. The aim of this investigation was the attempt to determine the impact of the most frequent risk factors for MID in population of our patients as well as to estimate their importance, analyzing the frequency of risk factors on cognitive functioning; the study comprised neurological state respectively. Cognitive deterioration was, in all cases, assessed through achievements on Mini Mental State Examinations (MMSE). Decline of global cognitive abilities was graded in three stages - mild, moderate and severe. Using Hachinski ischemia score, risk factors varied from 6 to 14. The sample consisted of 28 indoor patients in the Institute of Neurology, Clinical Center of Serbia, during 1995/96 period with diagnosis of MID. Data analysis displayed that the most prominent risk factor for MID was arterial hypertension, followed by generalized atherosclerosis, cardiomyopathy, diabetes mellitus etc. Although atrtal fibrillation was noted in only three patients, in all MMSE scoring 0, the finding requires further analysis of the importance of this factor. Among other neurological findings, the emphasis would be given to the registered progressive ,decrease of MMSE scores associated with the increase of the number of @ositive primitive reflexes. I 3-12-22’1 Fatal familial insomnia: Two ciinicopathoiogicai phenotypes related to a polymorphism at codon 129 of the prion protein gene P. Montagna, P. Parchi ‘, P. Cortelli, P. Tinuper, P. Avoni, S. Capellari I, G. Plazzi, R. Gallassi, S. Cevoli, P. Gambetti ‘, E. Lugaresi. institute of Neurology University of Bologna, Bologna, Ha/)! ’ Department of Parhologx Case Western Reserve Universir): Cleveland, Ohio, USA Fatal Familial Insomnia (FFI) is a familial prton disease characterized clinically by prominent disturbances of sleep, dysautonomia and somatomotor distur- bances (dysarthria, ataxia, myoclonus) and pathologically by severe neuronal loss and gliosis in the dorsomedian and anterior thalamic nuclei, mild spongio- sis of the cerebral cortex and olivary atrophy. FFI is due to a mutation at codon 178 of the prion protein gene, which cosegregates with the methionine at posi- tion 129 of the mutant allele. Codon 129 on the normal allele has been shown