- Email: [email protected]
P3-118
S408
Poster P3:: Tuesday Posters
VaD patients (M: 37.2%; F: 62.8%; mean age: 81.8⫹/-5.3) and 157 control subjects (M: 36.3%; F: 63.7%; mean age: 83.3⫹/-3.3). Patients were enrolled according to the NINDS-AIREN criteria and all of them underwent MRI. Controls showed no evidence of dementia and absence of vascular lesion in MRI. The ApoE genotype was studied as described by Hixson and Vernier (J Lipid Res 1990). Results: VaD patients showed a higher rate of ApoE4 allele (32.9%) compared to controls (12.1%). Our data indicate that the presence of ApoE4 genotype is associated with an increased risk of developing VaD (2⫽17,032; d.f.:2; p⬍10-3). Furthermore, we analyzed the contribution of vascular risk factors by multiple logistic regression analysis. Our data indicates that hypercholesterolemia, hypertension, and smoking, but not “non-insulin-dependent diabetes mellitus” (NIDDM), are statistically associated to VaD. However, presence of ApoE4 allele showed the strongest association with VaD (p⫽0.003). Conclusions: These data suggest the ApoE4 allele may represent an additional risk factor for VaD, probably affecting cholesterol transport mechanisms in the brain. P3-117
PREVENTION OF CIND BY PHYSICAL ACTIVITY: DIFFERENT IMPACT ON VCI-ND COMPARED WITH MCI
Laura E. Middleton, Susan Kirkland, Kenneth Rockwood, Dalhousie University, Halifax, NS, Canada. Contact e-mail: [email protected] Background: Cognitive impairment that does not meet the criteria for dementia (“Cognitive Impairment, No Dementia” - CIND) is a heterogeneous category, but people with CIND are at increased risk of dementia. While greater physical activity is associated with a lower incidence of both dementia and CIND in general, whether this effect applies across subgroups is not known. Objective(s): To investigate the association between physical activity and the risk of CIND sub-types (vascular CIND (VCIND) and mild cognitive impairment (MCI)). Methods: The Canadian Study of Health and Aging is a cohort study of dementia. Of 6709 community-dwelling people not cognitively impaired and with risk factor questionnaires at baseline (1991-1992), 4683 completed a 5-year follow up (1996-1997). Of these 4863, 3945 remained without cognitive impairment, 454 were diagnosed with CIND, and 284 with dementia. Incident CIND and VCI-ND and MCI subtypes were investigated by levels of physical activity at baseline. Results: Compared with no physical activity, high levels of physical activity were associated with reduced risks of CIND (age-, sex-, education-, and vascular risk factor index- adjusted odds ratio, 0.73; 95% confidence interval, 0.53-0.99) and of VCI-ND (0.50; 0.270.92). When stratified, there was a linear trend for decreasing incident CIND and VCI-ND with increasing physical activity only in women (p⫽0.008 and p⫽0.001 respectively) or in VRFI below 0.15 (p⫽0.03 and p⫽0.01 respectively). No association was found for men or VRFI above 0.30 or for MCI. Discussion: Increased physical activity has been associated with a reduced incidence of Alzheimer’s Disease, but less so with Vascular Dementia. In contrast, we showed a reduced incidence of VCIND, but not MCI, with high levels of physical activity. People with MCI who exercised may represent a heterogeneous group, compared to those who do not exercise. Some people who ‘only’ developed MCI might have developed dementia had they not participated in high levels of physical activity. Conclusions: Exercise appears to reduce the risk of some types of CIND, especially VCI-ND. Whether the lack of an effect of exercise on MCI incidence reflects that ‘prevented AD’ is indistinguishable from MCI is an intriguing possibility that merits further study. P3-118
VALIDITY OF ICD 10 DIAGNOSES IN CLINICAL PRACTICE: A REGISTRY-BASED STUDY
Kieu T.T. Phung1, Birgitte B. Andersen1, Lars V. Kessing2, Preben B. Mortensen3, Gunhild Waldemar1, 1Memory Disorders Research Group, Neurological Department, Copenhagen University
Hospital Rigshospitalet, Copenhagen, Denmark; 2Department of Psychiatry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; 3National Centre for Register-Based Research, Aarhus, Denmark. Contact e-mail: [email protected] Background: For two to three decades, all somatic and psychiatric hospital contacts in Denmark have been registered in the National Patient Registry (NPR) and the Psychiatric Central Registry (PCR), respectively. These registries offer exceptional opportunities for epidemiological research in dementia: large longitudinal population-based studies over decades with minimal selection bias or loss to follow-up and registry linkage to study multiple risk factors from early to late life. Dementia diagnoses are registered in NPR and PCR by WHO International Classification of Diseases (ICD) codes. The validity of ICD 10 dementia diagnoses has not been systematically evaluated. Objective: To evaluate the validity of ICD 10 dementia diagnoses in the NPR and PCR. Methods: 200 patients were randomly selected from 4682 in- and outpatients from the whole of Denmark, who were registered for the first time with a dementia diagnosis in NPR and PCR from June 1st to December 31st, 2003. ICD 10 codes for Alzheimer’s disease (AD), vascular dementia (VaD), frontotemporal dementia (FTD), and unspecified dementia were used. The patients’ medical journals were reviewed to evaluate whether ICD 10 and/or DSM IV criteria for dementia syndrome and criteria for dementia subtypes (ICD 10 and/or NINCDS-ADRDA for AD, ICD 10 and/or NINDS-AIREN for VaD, ICD 10 and/or McKhann’s criteria for FTD) were met. The patients who were still alive were invited to participate in a face-to-face or telephone interview and MMSE, IADL, TICS, IQCODE, Geriatric Depression Scale, Global Deteriorating Scale, and Hachinski ischemic scores were done (ongoing). Results: The random sample consisted of 73 (36.5%) male and 127 (63.5%) female patients. The patients’ mean age was 83 ⫾ 9 years. 53 (26.5 %) patients were registered with AD, 29 (14.5%) with VaD, 3 (1.5%) with FTD, and 115 (57.5%) with unspecified dementia. 197 (98.5%) medical journals were obtained. 75.0% of the medical journals contained sufficient clinical information to conclude that criteria for dementia syndrome have been met. Conclusion: Validation of the dementia diagnoses registered in national hospital registries can be done by review of randomly selected medical journals. P3-119
THE MINI MENTAL STATE TEST (MMS) FOR FIELD STUDIES OF COGNITIVE DISORDERS
Antonio Cruz1, Donald Silberberg2, Pierre-Marie Preux3, Michel Dumas4, Ivan Cruz5, Marcelo E. Cruz6, 1Neurology Service, Ramon y Cajal Hospital, Madrid, Spain; 2University of Pennsylvania, Philadelphia, USA; 3School of Medicine, University of Limoges, Limoges, France; 4Institute of Neuroepidemiology and Tropical Neurology, Limoges, France; 5Global Network for Research in Mental and Neurological Health, Quito, Ecuador; 6Global Network for Research in Mental and Neurological Health, Quito, Ecuador. Contact e-mail: [email protected] The Mini Mental State Test (MMS) was administered to a rural population of northern Ecuador, South America, and was found to be effective in discriminating those affected by cognitive disorders. The survey was part of a larger neuroepidemiological study conducted in the village of San Pablo del Lago, 100 km north of the capital city, Quito. Two-thousand seven hundred and twenty-three inhabitants answered the WHO questionnaire for epidemiological studies of neurological disorders in developing countries. Of these, 631 subjects aged 40 and above, capable of reading and writing, were invited to answer a mini mental test (MMS) and to have a general clinical evaluation, and a detailed neurological and psychiatric examination. A total of 227 individuals (36%) agreed to participate in the study, and 19 (8.4%) scored 24 points or less, the cut-off point below which the subject is considered to suffer from cognitive deterioration, following the DSMIII criteria. In rural areas of developing countries, where more complex psychometric testing is not available, the MMS test is a useful
Poster P3:: Tuesday Posters
VaD patients (M: 37.2%; F: 62.8%; mean age: 81.8⫹/-5.3) and 157 control subjects (M: 36.3%; F: 63.7%; mean age: 83.3⫹/-3.3). Patients were enrolled according to the NINDS-AIREN criteria and all of them underwent MRI. Controls showed no evidence of dementia and absence of vascular lesion in MRI. The ApoE genotype was studied as described by Hixson and Vernier (J Lipid Res 1990). Results: VaD patients showed a higher rate of ApoE4 allele (32.9%) compared to controls (12.1%). Our data indicate that the presence of ApoE4 genotype is associated with an increased risk of developing VaD (2⫽17,032; d.f.:2; p⬍10-3). Furthermore, we analyzed the contribution of vascular risk factors by multiple logistic regression analysis. Our data indicates that hypercholesterolemia, hypertension, and smoking, but not “non-insulin-dependent diabetes mellitus” (NIDDM), are statistically associated to VaD. However, presence of ApoE4 allele showed the strongest association with VaD (p⫽0.003). Conclusions: These data suggest the ApoE4 allele may represent an additional risk factor for VaD, probably affecting cholesterol transport mechanisms in the brain. P3-117
PREVENTION OF CIND BY PHYSICAL ACTIVITY: DIFFERENT IMPACT ON VCI-ND COMPARED WITH MCI
Laura E. Middleton, Susan Kirkland, Kenneth Rockwood, Dalhousie University, Halifax, NS, Canada. Contact e-mail: [email protected] Background: Cognitive impairment that does not meet the criteria for dementia (“Cognitive Impairment, No Dementia” - CIND) is a heterogeneous category, but people with CIND are at increased risk of dementia. While greater physical activity is associated with a lower incidence of both dementia and CIND in general, whether this effect applies across subgroups is not known. Objective(s): To investigate the association between physical activity and the risk of CIND sub-types (vascular CIND (VCIND) and mild cognitive impairment (MCI)). Methods: The Canadian Study of Health and Aging is a cohort study of dementia. Of 6709 community-dwelling people not cognitively impaired and with risk factor questionnaires at baseline (1991-1992), 4683 completed a 5-year follow up (1996-1997). Of these 4863, 3945 remained without cognitive impairment, 454 were diagnosed with CIND, and 284 with dementia. Incident CIND and VCI-ND and MCI subtypes were investigated by levels of physical activity at baseline. Results: Compared with no physical activity, high levels of physical activity were associated with reduced risks of CIND (age-, sex-, education-, and vascular risk factor index- adjusted odds ratio, 0.73; 95% confidence interval, 0.53-0.99) and of VCI-ND (0.50; 0.270.92). When stratified, there was a linear trend for decreasing incident CIND and VCI-ND with increasing physical activity only in women (p⫽0.008 and p⫽0.001 respectively) or in VRFI below 0.15 (p⫽0.03 and p⫽0.01 respectively). No association was found for men or VRFI above 0.30 or for MCI. Discussion: Increased physical activity has been associated with a reduced incidence of Alzheimer’s Disease, but less so with Vascular Dementia. In contrast, we showed a reduced incidence of VCIND, but not MCI, with high levels of physical activity. People with MCI who exercised may represent a heterogeneous group, compared to those who do not exercise. Some people who ‘only’ developed MCI might have developed dementia had they not participated in high levels of physical activity. Conclusions: Exercise appears to reduce the risk of some types of CIND, especially VCI-ND. Whether the lack of an effect of exercise on MCI incidence reflects that ‘prevented AD’ is indistinguishable from MCI is an intriguing possibility that merits further study. P3-118
VALIDITY OF ICD 10 DIAGNOSES IN CLINICAL PRACTICE: A REGISTRY-BASED STUDY
Kieu T.T. Phung1, Birgitte B. Andersen1, Lars V. Kessing2, Preben B. Mortensen3, Gunhild Waldemar1, 1Memory Disorders Research Group, Neurological Department, Copenhagen University
Hospital Rigshospitalet, Copenhagen, Denmark; 2Department of Psychiatry, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; 3National Centre for Register-Based Research, Aarhus, Denmark. Contact e-mail: [email protected] Background: For two to three decades, all somatic and psychiatric hospital contacts in Denmark have been registered in the National Patient Registry (NPR) and the Psychiatric Central Registry (PCR), respectively. These registries offer exceptional opportunities for epidemiological research in dementia: large longitudinal population-based studies over decades with minimal selection bias or loss to follow-up and registry linkage to study multiple risk factors from early to late life. Dementia diagnoses are registered in NPR and PCR by WHO International Classification of Diseases (ICD) codes. The validity of ICD 10 dementia diagnoses has not been systematically evaluated. Objective: To evaluate the validity of ICD 10 dementia diagnoses in the NPR and PCR. Methods: 200 patients were randomly selected from 4682 in- and outpatients from the whole of Denmark, who were registered for the first time with a dementia diagnosis in NPR and PCR from June 1st to December 31st, 2003. ICD 10 codes for Alzheimer’s disease (AD), vascular dementia (VaD), frontotemporal dementia (FTD), and unspecified dementia were used. The patients’ medical journals were reviewed to evaluate whether ICD 10 and/or DSM IV criteria for dementia syndrome and criteria for dementia subtypes (ICD 10 and/or NINCDS-ADRDA for AD, ICD 10 and/or NINDS-AIREN for VaD, ICD 10 and/or McKhann’s criteria for FTD) were met. The patients who were still alive were invited to participate in a face-to-face or telephone interview and MMSE, IADL, TICS, IQCODE, Geriatric Depression Scale, Global Deteriorating Scale, and Hachinski ischemic scores were done (ongoing). Results: The random sample consisted of 73 (36.5%) male and 127 (63.5%) female patients. The patients’ mean age was 83 ⫾ 9 years. 53 (26.5 %) patients were registered with AD, 29 (14.5%) with VaD, 3 (1.5%) with FTD, and 115 (57.5%) with unspecified dementia. 197 (98.5%) medical journals were obtained. 75.0% of the medical journals contained sufficient clinical information to conclude that criteria for dementia syndrome have been met. Conclusion: Validation of the dementia diagnoses registered in national hospital registries can be done by review of randomly selected medical journals. P3-119
THE MINI MENTAL STATE TEST (MMS) FOR FIELD STUDIES OF COGNITIVE DISORDERS
Antonio Cruz1, Donald Silberberg2, Pierre-Marie Preux3, Michel Dumas4, Ivan Cruz5, Marcelo E. Cruz6, 1Neurology Service, Ramon y Cajal Hospital, Madrid, Spain; 2University of Pennsylvania, Philadelphia, USA; 3School of Medicine, University of Limoges, Limoges, France; 4Institute of Neuroepidemiology and Tropical Neurology, Limoges, France; 5Global Network for Research in Mental and Neurological Health, Quito, Ecuador; 6Global Network for Research in Mental and Neurological Health, Quito, Ecuador. Contact e-mail: [email protected] The Mini Mental State Test (MMS) was administered to a rural population of northern Ecuador, South America, and was found to be effective in discriminating those affected by cognitive disorders. The survey was part of a larger neuroepidemiological study conducted in the village of San Pablo del Lago, 100 km north of the capital city, Quito. Two-thousand seven hundred and twenty-three inhabitants answered the WHO questionnaire for epidemiological studies of neurological disorders in developing countries. Of these, 631 subjects aged 40 and above, capable of reading and writing, were invited to answer a mini mental test (MMS) and to have a general clinical evaluation, and a detailed neurological and psychiatric examination. A total of 227 individuals (36%) agreed to participate in the study, and 19 (8.4%) scored 24 points or less, the cut-off point below which the subject is considered to suffer from cognitive deterioration, following the DSMIII criteria. In rural areas of developing countries, where more complex psychometric testing is not available, the MMS test is a useful