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Abstract Details

Peripheral Nerve Degeneration is Associated with Cognitive Impairment
Aging, Dementia, and Behavioral Neurology
Behavioral and Cognitive Neurology Posters (7:00 AM-5:00 PM)
016
To test if peripheral nervous system axonal loss (PNSAL) associates with cognitive impairment (CI)
CI, stemming from central nervous system (CNS) degeneration, shares risk factors with PNS degeneration, including diabetes, B12 deficiency, and age. However, PNS and CNS degeneration traditionally are considered distinct processes. Nerve conduction studies (NCS) demonstrating axonal loss identifies PNSAL, but CNS degeneration is difficult to measure, and CI manifests late in the disease process. If PNSAL reflects accumulated shared pathology, PNSAL may identify individuals at risk for CI.  This cross-sectional pilot study tested the association between PNSAL and CI.

We enrolled participants >50 years with CI probably reflecting Alzheimer’s pathology (AD/MCI; n=19), and age-matched controls without memory concerns (n=14). Polyneuropathy, B12 deficiency, diabetes, or another CI etiology (e.g. Parkinsonism) were exclusion criteria. Participants underwent interview, chart review, the Self-Administered Gerocognitive Examination, and NCS. Non-normally distributed variables were transformed for regression analyses. We constructed logistic regression models to test whether CI independently correlates with PNSAL.

Polyneuropathy symptoms were uncommon, yet many participants had asymptomatic PNSAL. 7/33 participants (21.2%) had tibial compound motor action potential (CMAP) amplitude <3.5 mV; all 7 had AD/MCI. 6/7 participants with distal peroneal CMAP amplitude <2.5 mV had AD/MCI.  Adjusted for age and sex, distal peroneal CMAP amplitude and log(tibial CMAP amplitude) were significantly associated with AD/MCI (O.R.[95% CI] = 0.6[0.4-1.0];p=0.02, and 0.0[0.0-0.7];p<0.01). Neuropathy symptoms did not differ between participants with absent action potentials (tibial, peroneal, and/or sural; n=6) and participants with recordable waveforms (Chi-squared, p-values>0.10), arguing that the relationship between PNS function and AD/MCI was not due to differential symptom reporting.
PNSAL associates with CI, and abnormal NCS in the elderly may be a biomarker of common neurodegenerative etiology. Given shared risk factors between PNS and CNS degeneration, a larger study prospectively investigating PNS integrity as a biomarker for CI is warranted.
Authors/Disclosures
Thomas Palladino
PRESENTER 		Mr. Palladino has nothing to disclose.
Krzysztof Bujarski, MD (DartmouthHitchcock Medical Center) Dr. Bujarski has nothing to disclose.
Aleksandra C. Stark-Laudate, MD (Dartmouth Hitchcock Medical Center) Dr. Stark-Laudate has nothing to disclose.
Elijah Stommel, MD, FAAN (Dartmouth-Hitchock Med Ctr/Dept of Neuro) Dr. Stommel has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Suslick Attorney. The institution of Dr. Stommel has received research support from CDC.
Victoria Lawson, MD, FAAN (Department of Neurology, Dartmouth-Hitchcock Medical Center) Dr. Lawson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi.
Nathaniel M. Robbins, MD (MGB) Dr. Robbins has received personal compensation in the range of $0-$499 for serving as a Consultant for Red Nucleus. Dr. Robbins has received personal compensation in the range of $0-$499 for serving as a Consultant for TDG Health. Dr. Robbins has received personal compensation in the range of $0-$499 for serving as a Consultant for Jupiter Life Science Consulting. Dr. Robbins has received personal compensation in the range of $50,000-$99,999 for serving as an Expert Witness for Vaccine Injury Compensation Program. The institution of Dr. Robbins has received research support from Diamond Endowment Fund. The institution of Dr. Robbins has received research support from Reeves Endowment Fund. The institution of Dr. Robbins has received research support from Institute for Ethnomedicine. The institution of Dr. Robbins has received research support from Theravance. The institution of Dr. Robbins has received research support from Dysautonomia International. The institution of Dr. Robbins has received research support from National Institute of Health. The institution of Dr. Robbins has received research support from Vertex pharmaceutical. Dr. Robbins has received personal compensation in the range of $50,000-$99,999 for serving as a Locums neurohospitalist with Hayes Locums. Dr. Robbins has received personal compensation in the range of $500-$4,999 for serving as a Speaker with The Dysautonomia Project.