M73. DRIVING ABILITIES IN PATIENTS WITH SCHIZOPHRENIA

Background Driving ability is a relevant factor of individual autonomy for patients suffering from psychiatric diseases. The aim of this naturalistic study was to determine the driving ability of clinically stable outpatients with schizophrenia and to determine relevant parameters for possible deficits. Methods We included 50 outpatients with schizophrenia (ICD-10) between the ages of 18 and 65 who were on stable psychopharmacological treatment for at least three months. By means of the Wiener Testsystem (Schuhfried), reaction behaviour, the ability to observe and gain overview, reaction time, certainty in decision making as well as concentration and attention were tested. Symptomatology and extrapyramidal motor symptoms (EPS) were investigated by using the Positive and Negative Syndrome Scale (PANSS) and the Modified Simpson Angus Scale (MSAS), respectively. Results The mean PANSS score of 55.3 ± 16.2 indicated that patients were merely mildly ill at the time of study inclusion. 48% had a MSAS score ≥3. 44% had adequate driving-specific abilities. 20% showed slight psychomotor impairments, and 36 % were considered as unfit to drive. 41.1% of the patients with a valid driver’s license were not able to drive. There was a strong correlation between EPS and driving ability, while residual symptomatology was not relevant in this context. Discussion Personal mobility is an important aspect of quality of life in people with schizophrenia. Possible danger for the general public may be conflicting with this point of view. Our investigation suggests that EPS have a major influence on the ability to drive. The missing correlation between residual symptomatology and driving abilities, on the other hand, may be explained by low mean PANSS scores. Further studies with larger sample sizes are urgently needed to address this issue.

Differentiating Dementias in Long-Term Care Patients

Many long-term care residents are diagnosed with dementia, but dementia appears in many forms. Alzheimer's disease, the most common, is typified by a slow onset and relentless progression to complete incapacitation. Vascular dementia usually appears somewhat abruptly, is associated with vascular comorbidities, and has an unpredictable progression pattern. Lewy body dementia shares features of both Alzheimer's and Parkinson's disease; its hallmarks include fluctuating cognitive performance, visual hallucinations, and extrapyramidal motor symptoms. Frontotemporal dementias are associated less with memory disorders and more with behavioral and language aberrations. Mixed dementia covers those patients who do not have an apparent singular cause of dementia. Pseudodementia is a dementia resulting from underlying causes and is reversible, unlike the aforementioned dementias.

Diffuse Lewy Body Disease without Amyloid Plaques in a Patient Homozygous for Apolipoprotein E Allele Epsilon 4: A Case Report

A middle-aged woman developed extrapyramidal motor symptoms, personality and behavioral changes, and rapidly progressive dementia. Apolipoprotein E genotyping revealed that she was homozygous for the epsilon 4 allele. At autopsy, there were numerous cortical and subcortical Lewy bodies but no neuritic plaques (NPs) or neurofibrillary tangles (NFTs). This case, the first explicitly reported patient homozygous for the epsilon 4 allele having dementia of the Lewy body type (DLBT) without NPs and NFTs, reinforces the distinction between DLBT and dementia of the Alzheimer type. It calls into question the pivotal role of the epsilon 4 allele in the pathogenesis of NPs and NFTT but raises the possibility of its being an independent risk factor for the development of DLBT.