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Relationships between cognitive functions, gait and balance in

patients with Alzheimer

s disease

V. Alekna, R. Leisyte, M. Tamulaitiene, A. Juocevicius.

Faculty of

Medicine of Vilnius University, Vilnius, Lithuania


As gait and balance disturbance is common in patients

with Alzheimer

s disease (AD), the aim of study was to investigate

relationships between cognitive functions, gait and balance.


Cross-sectional study was performed including patients

with AD and control group, aged >65 years. Exclusion criteria were

other causes of mobility disorders and severe cognitive impairment.

Mini-Mental State Examination (MMSE) was used to examine the

cognitive functions. The gait was assessed by number of steps per

minute, dual step length, step length, step width and calculated

dynamic gait index. Balancewas analyzed by Static balance and Tinetti



In total, 95 subjects were involved: 42 patients with AD (mean

age 79.45 ± 6.2; 78.6% female) and 53 controls (mean age 76.96 ± 6.99;

67.9% female). It was found that the gait parameters were lower

(p < 0.001) in patients with AD compared to controls. Moderate

correlation was found between MMSE and dual step length (r = 0.45;

p = 0.003), step length (r = 0.462; p = 0.002), step width (r =


p = 0.025), dynamic gait index (r = 0.593; p < 0.001), and the Tinetti

test score (r = 0.521, p < 0.001). Dynamic gait index was strongly

associated with Tinetti test score (r = 0.785; p < 0.001). Static balance

moderately correlated with the dual step length (r = 0.419; p = 0.006),

step length (r = 0.422; p = 0.005) and dynamic gait index (r = 0.547;

p < 0.001).


In people with Alzheimer

s disease, the moderate

correlation was found between cognitive impairment and dynamic

gait index and the Tinetti test score. Dynamic gait index was strongly

associated with Tinetti test score, and static balance moderately

correlated with the dual step length.


Rapidly progressive dementia; a case of corticobasal degeneration

with atypical presentation

B. Alvira Rasal, E. Martín de Francisco, García Gomez.

Woman of 72 years old with history of hypertension and atrial

fibrillation. At baseline she needed partial help for bathing and

dressing, walked without aids and was double continent. Last year, she

began symptoms of impaired recent memory, disorientation, anomy,

praxias and impaired executive function. Blood tests were normal

and cranial CT only showed periventricular leukoencephalopathy.

We started Rivastigmine. After four months she was dependent for all

basic activities of daily living, had impoverished language and gait

disturbance with falls syndrome. Cognitive performance in neuro-

psychological tests declined dramatically. Cholinesterase inhibitor

was stopped and we prescribed Memantine. No other studies were

developed because of family decision. Two months later she was

admitted to hospital with fever, urinary tract infection and pressure

ulcers. By this time she also suffered from mutism, fluctuating level

of consciousness and axial stiffness, no involuntary movements. In

spite of broad spectrum antibiotic therapy based on cultures there was

no response, remaining fever of unknown origin and hypoactive

delirium. Cranial MRI showed multiple hyperintense lesions on both

hemispheres and pons, also corticosubcortical diffuse atrophy.

EEG had slowed brain activity in fronto-temporal regions and

lumbar puncture result without cells, with normal levels of glucose

and proteins.14-3-3 protein was negative. Echocardiogram wasn


finally realized because of death. Necropsy was performed reporting

Corticobasal degeneration. Our patient developed and atypical pre-

sentation of this entity, since CBD is a rare disease characterized by an

asymmetric progressive parkinsonism with later impared memory

(recently being discussed). The average life spectancy is 8 years since



The association of hippocampal subfield volumes with episodic

memory and general cognitive functioning in mild cognitive

impairment and early Alzheimer

s disease

M.A.J. Assink


, H.L. Koek


, K. Blom


, L.E.M. Wisse


, G.J. Biessels



M.I. Geerlings




Internal Medicine, UMC Utrecht,


Geriatrics, UMC



Julius Centre, UMC Utrecht,


Neurology, UMC Utrecht, The



Atrophy of the hippocampus is associated with

cognitive functioning in patients with Mild Cognitive Impairment

(MCI) and Alzheimer

s disease (AD). Due to the recent development

of ultra-high field MRI, new possibilities have emerged to study

subfields of the hippocampus. We aimed to examine the cross-

sectional association of subfields of the hippocampus with episodic

memory and Mini-Mental State Examination (MMSE) score in patients

with MCI or early AD.


Via memory clinics of a university and peripheral hospital

we recruited 25 patients, with a mean age of 73 years (SD = 7.6)

diagnosed with MCI or AD. Inclusion criteria were an MMSE score >20

and Clinical Dementia Rating (CDR) scale of 0.5 or 1.0. Hippocampal

subfield volumes were manually delineated on T2-weighted images at

7 tesla MRI with a slice thickness of 0.7 mm. Volumes were converted

in z-scores. Entorhinal cortex, subiculum, cornu ammonis (CA)1,2,3,

CA4+dentate gyrus, and tail subfields were measured. Linear regres-

sion analyses adjusted for age, sex and intracranial volume were used

to estimate the associations of subfield volumes with scores on the

15-word learning test and MMSE.


Hippocampal subfield volumes were not significantly asso-

ciated with episodic memory. Larger volume of the entorhinal cortex

was significantly associated with better MMSE score (b = 1.60; 95%CI


2.65), as was the subiculum (b = 1.34; 95%CI 0.18

2.50) and CA1

(b = 1.79; 95%CI 0.66

2.90), while the other subfields were not.


In MCI and early AD, volumes of the entorhinal cortex,

subiculum, and CA1 are significantly associated with general cognitive

functioning, but not with episodic memory performance.


The effect of D-serine administration on cognition and mood in

older adults

M. Avellar


, L. Scoriels


, C. Madeira


, C. Vargas-Lopes


, P. Marques



C. Dantas


, A. Manhães


, H. Teixeira-Leite


, R. Panizzutti





Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil;



of Cambridge, Cambridge, United Kingdom;


UERJ Universidade do Estado

do Rio de Janeiro,


HAS Hospital Adventista Silvestre, Rio de Janeiro, Brazil


D-serine is an endogenous co-agonist of the N-Methyl D-

Aspartate Receptor (NMDAR) that plays a crucial role in cognition

including learning processes and memory. Decreased D-serine levels

have been associated with age-related decline in mechanisms

of learning and memory in animal studies. Here, we asked whether

D-serine administration in older adults improves cognition.


Fifty healthy older adults received D-serine and placebo in a

randomized, double blind, placebo-controlled, crossover design study.

We studied the effect of D-serine administration on the performance

of cognitive tests and an analogue mood scale. We also collected blood

samples tomeasureD-serine, L-serine, glutamate and glutamine levels.


D-serine administration improved performance in the Groton

Maze learning test of spatial memory and learning and problem

solving (F(3, 38) = 4.74, p = 0.03). Subjects that achieved higher

increases in plasma D-serine levels after administration improved

more in test performance (r2 =

0.19 p = 0.009). D-serine administra-

tion was not associated with any significant changes in the other

cognitive tests or in the mood of older adults (p > 0.05).


D-serine administration may be a strategy to improve

spatial memory, learning and problem solving in healthy older adults.

Future studies should evaluate the impact of long-term D-serine

administration on cognition in older adults.

Poster presentations / European Geriatric Medicine 7S1 (2016) S29