- Email: [email protected]
P4-031 Moderate coffee consumption is associated with a less rapid cognitive decline in elderly men. The fine study
Poster Session P4: Epidemiology and Risk Factors of Frontotemporal Dementia and Heidelberg/Mannheim) born between 1930 and 1932. Participants were carefully screened for physical and mental health and reexamined four years later. Neuropsychological testing addressed attention and concentration, language, thinking, learning and memory, and visuospatial functioning. Resuits: At baseline, 13.6% of the subjects fulfilled the AACD criteria. Four years later, AACD prevalence rates rose to 24.9%. 54.1% of the subjects initially classified as AACD retained the diagnosis at follow-up. None of the AACD subjects developed dementia within the 4-year follow-up period. When contrasted with the controls, subjects with AACD showed a significant (p < 0.05) decline in neuropsychological tests of verbal fluency, secondary memory, and thinking. A significant effect of depressed mood on these findings could not be confirmed, although AACD subjects showed slightly more depressed symptoms than the controls. Conclusions: In "young-old" community-dwelling individuals, AACD is a frequent condition with a high temporal stability. AACD was associated with a significant decreased performance in neuropsychological tests addressing language, mnestic, and thinking. However, our results suggest that age and length of follow-up intervall are of crucial relevance when the predicitve validity of different concepts of mild cognitive impairment is assessed.
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COSTS OF FORMAL DEMENTIA CARE IN EUROPE
Arthur S. Zbrozek *1 , Ann-Sofie Brandt 2, Linus Jrnsson 2. 1Wyeth Research, Philadelphia, PA, USA; 2Stockholm Health Economics, Stockholm, Sweden. Contact e-mail: ZBROZEA @wyeth.corn
Background: Dementia is a leading cause of disability in the elderly, causing loss of independence, high strain on caregivers and enormous costs for society. The most frequent cause of dementia is Alzheimer's disease (5070%), followed by vascular dementia (25-30%). New treatment strategies are being introduced, setting focus on the need to make informed decisions on the allocation of resources to and within dementia care. Cost-of-illness studies describe the resource milisation and costs for patients with a defined condition or disorder over a specified time frame. Objective: To estimate the total costs of formal care for patients with dementia in eleven European countries (United Kingdom, Germany, France, the Netherlands, Belgium, Spain, Italy, Sweden, Norway, Finland and Denmark), and to produce estimates of total costs for Europe. Informal care costs were not considered. Methods: A literature review (including the Medline and HEED databases as well as 'grey literature') was conducted to identify studies estimating costs of dementia care in the included countries. Only publications based on patient-level data (using bottom-up approach to cost-of-illness analysis) were included. Results were summarized, converted to a common currency (C 2003) and combined with prevalence figures to estimate total care costs for Europe. Results: Mean formal care costs per patient and year were estimated to on average 15 431t~, including costs for outpatient and inpatient medical care, pharmaceuticals, community services and special accommodation. Estimates varied between 4 916 t~ (Spain) and 26 793 (Germany); this variability reflects a higher reliance on informal care resources in Italy compared with Germany. The total number of demented in Europe has been estimated to 5.6 million patients in the year 2000. Cost of formal care for demented in Europe
Spain Italy France Nordic region Belgium United Kingdom Netherlands Germany
Europe
Annum cost per demented
Dementia prevalence
Total cost (billion t~)
4 916 (~ 8 949 £ 9 378 £ 13 780 (~ I4 047 g 19 182 e 21 957 E 26 793 C 15 439 t~
488956 791205 758229 314157 129389 741042 164910 1032969 5649304
2.40 7.08 7.11 4.33 1.82 14.21 3.62 27.68 87.22
Conclusions: Costs of formal care for patients with dementia in Europe are substantial, in total almost 90 billion t~ annually. Estimates are highly variable depending on differences in health- and social care systems, but also due to differences in study design and methodology.
~4f~
$481
M O D E R A T E COFFEE CONSUMPTION IS ASSOCIATED W I T H A LESS RAPID C O G N I T I V E DECLINE IN ELDERLY MEN. THE FINE STUDY
Boukje M. van Gelder .1 , Brian Buijsse 1,2, Sandra Kalmijn 3, Marja Tijhuis 1, Simona Giampaoli 4 , Aulikki Nissinen 5, Daan Kromhout 1'2. t National Institute for Public Health and the
Environment, Bilthoven, Netherlands; 2Wageningen University, Wageningen, Netherlands; 3Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands; 4National Institute of Health, Rome, Italy; 5National Public Health Institute, Helsinki, Finland. Contact e-mail: [email protected]
Background: Coffee is a daily consumed drink in most Western countries and is the primary source of caffeine. Caffeine intake seems to be beneficial for cognitive function on the short term, however results are controversial and longitudinal information on this association is lacking. Objective(s): This study investigated whether coffee consumption is associated with 10year age-related cognitive decline in elderly men. Methods: Seven hundred and seven healthy men born between 1900 and 1920 of Finland, Italy and the Netherlands participated in this longitudinal study between 1990 and 2000. Cognitive functioning was assessed using the Mini Mental State Examination (MMSE). The maximum score on the MMSE is 30 points, with a higher score indicating better cognitive performance. Coffee consumption was estimated in cups per day. A mixed longitudinal random coefficient model was used to determine the association between baseline coffee consumption and 10-year cognitive decline. Adjustments were made for the potential confounding factors age, education, alcohol consumption, smoking status, serum cholesterol, cohort, anti-hypertensive drug use, anticoagulant use, body mass index, physical activity and baseline cognitive functioning (if applicable). Results: Cognitive functioning did not differ between coffee consumers and non-consumers in 1990. However, men who did not drink coffee had a 10 year cognitive decline of 2.5 points (8.3%), which is stronger (p < 0.05) than the cognitive decline of men who did drink one to four cups of coffee a day. Men who consumed three cups of coffee a day had the least cogllitive decline of 0.6 points (2.0%), which was 4.2 times less rapid than men who did not drink coffee (p < 0.001). The cognitive decline of men who consumed more than four cups of coffee per day did not differ from men who did not drink coffee. Conclusions: Our findings suggest that drinking 1-4 cups of coffee a day may reduce cognitive decline in elderly men. However, confirmation by other longitudinal studies is necessary.
Poster Session P4: E p i d e m i o l o g y and R i s k Factors o f Frontotemporal Dementia
•0•
HOMOCYSTEINE LEVELS ARE ELEVATED IN FRONTOTEMPORAL LOBAR DEGENERATION
Anne M. Lipton *l , Kyle B. Womack 1, Carol S. Moore i, Teodoro Bottiglieri 2, Ramon Diaz-Arrastia 1 1Univ of TX Southwestern,
Dallas, TX, USA; 2Baylor University Medical Center, Dallas, TX, USA. Contact e-mail: anne.lipton @utsouthwestern, edu
Background: Plasma homocysteine (Hcy) levels rise with age, and hyperhomocysteinemia is a risk factor for cognitive impairment and dementia, including vascular dementia and Alzheimer s disease (AD). It is not known, however, whether Hcy plays a role in Frontotemporal lobar degeneration (FTLD), a dementia with an earlier age of onset (< 65 years) than AD. This investigation included measurement and comparison of plasma total Hcy levels in patients with FTLD, patients with AD, and non-demented controls. Objective(s): To determine whether plasma total Hcy levels are elevated in patients with VFLD. Methods: Plasma Hcy levels were measured in three groups: 1) Subjects meeting the Neary et ai. criteria for FTLD (n = 21), 2) Subjects with clinically probable AD by NINCDS-ADRDA criteria (n = 27), and 3) Normal control subjects who had MMSE scores > 28 and no memory complaints or neurological illness (n = 30). (Power analysis showed that a minimum of 21 subjects per group were required to detect a 20% difference in homocysteine levels with = 0.05, power = 80%.) Plama total Hcy
•
COSTS OF FORMAL DEMENTIA CARE IN EUROPE
Arthur S. Zbrozek *1 , Ann-Sofie Brandt 2, Linus Jrnsson 2. 1Wyeth Research, Philadelphia, PA, USA; 2Stockholm Health Economics, Stockholm, Sweden. Contact e-mail: ZBROZEA @wyeth.corn
Background: Dementia is a leading cause of disability in the elderly, causing loss of independence, high strain on caregivers and enormous costs for society. The most frequent cause of dementia is Alzheimer's disease (5070%), followed by vascular dementia (25-30%). New treatment strategies are being introduced, setting focus on the need to make informed decisions on the allocation of resources to and within dementia care. Cost-of-illness studies describe the resource milisation and costs for patients with a defined condition or disorder over a specified time frame. Objective: To estimate the total costs of formal care for patients with dementia in eleven European countries (United Kingdom, Germany, France, the Netherlands, Belgium, Spain, Italy, Sweden, Norway, Finland and Denmark), and to produce estimates of total costs for Europe. Informal care costs were not considered. Methods: A literature review (including the Medline and HEED databases as well as 'grey literature') was conducted to identify studies estimating costs of dementia care in the included countries. Only publications based on patient-level data (using bottom-up approach to cost-of-illness analysis) were included. Results were summarized, converted to a common currency (C 2003) and combined with prevalence figures to estimate total care costs for Europe. Results: Mean formal care costs per patient and year were estimated to on average 15 431t~, including costs for outpatient and inpatient medical care, pharmaceuticals, community services and special accommodation. Estimates varied between 4 916 t~ (Spain) and 26 793 (Germany); this variability reflects a higher reliance on informal care resources in Italy compared with Germany. The total number of demented in Europe has been estimated to 5.6 million patients in the year 2000. Cost of formal care for demented in Europe
Spain Italy France Nordic region Belgium United Kingdom Netherlands Germany
Europe
Annum cost per demented
Dementia prevalence
Total cost (billion t~)
4 916 (~ 8 949 £ 9 378 £ 13 780 (~ I4 047 g 19 182 e 21 957 E 26 793 C 15 439 t~
488956 791205 758229 314157 129389 741042 164910 1032969 5649304
2.40 7.08 7.11 4.33 1.82 14.21 3.62 27.68 87.22
Conclusions: Costs of formal care for patients with dementia in Europe are substantial, in total almost 90 billion t~ annually. Estimates are highly variable depending on differences in health- and social care systems, but also due to differences in study design and methodology.
~4f~
$481
M O D E R A T E COFFEE CONSUMPTION IS ASSOCIATED W I T H A LESS RAPID C O G N I T I V E DECLINE IN ELDERLY MEN. THE FINE STUDY
Boukje M. van Gelder .1 , Brian Buijsse 1,2, Sandra Kalmijn 3, Marja Tijhuis 1, Simona Giampaoli 4 , Aulikki Nissinen 5, Daan Kromhout 1'2. t National Institute for Public Health and the
Environment, Bilthoven, Netherlands; 2Wageningen University, Wageningen, Netherlands; 3Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, Netherlands; 4National Institute of Health, Rome, Italy; 5National Public Health Institute, Helsinki, Finland. Contact e-mail: [email protected]
Background: Coffee is a daily consumed drink in most Western countries and is the primary source of caffeine. Caffeine intake seems to be beneficial for cognitive function on the short term, however results are controversial and longitudinal information on this association is lacking. Objective(s): This study investigated whether coffee consumption is associated with 10year age-related cognitive decline in elderly men. Methods: Seven hundred and seven healthy men born between 1900 and 1920 of Finland, Italy and the Netherlands participated in this longitudinal study between 1990 and 2000. Cognitive functioning was assessed using the Mini Mental State Examination (MMSE). The maximum score on the MMSE is 30 points, with a higher score indicating better cognitive performance. Coffee consumption was estimated in cups per day. A mixed longitudinal random coefficient model was used to determine the association between baseline coffee consumption and 10-year cognitive decline. Adjustments were made for the potential confounding factors age, education, alcohol consumption, smoking status, serum cholesterol, cohort, anti-hypertensive drug use, anticoagulant use, body mass index, physical activity and baseline cognitive functioning (if applicable). Results: Cognitive functioning did not differ between coffee consumers and non-consumers in 1990. However, men who did not drink coffee had a 10 year cognitive decline of 2.5 points (8.3%), which is stronger (p < 0.05) than the cognitive decline of men who did drink one to four cups of coffee a day. Men who consumed three cups of coffee a day had the least cogllitive decline of 0.6 points (2.0%), which was 4.2 times less rapid than men who did not drink coffee (p < 0.001). The cognitive decline of men who consumed more than four cups of coffee per day did not differ from men who did not drink coffee. Conclusions: Our findings suggest that drinking 1-4 cups of coffee a day may reduce cognitive decline in elderly men. However, confirmation by other longitudinal studies is necessary.
Poster Session P4: E p i d e m i o l o g y and R i s k Factors o f Frontotemporal Dementia
•0•
HOMOCYSTEINE LEVELS ARE ELEVATED IN FRONTOTEMPORAL LOBAR DEGENERATION
Anne M. Lipton *l , Kyle B. Womack 1, Carol S. Moore i, Teodoro Bottiglieri 2, Ramon Diaz-Arrastia 1 1Univ of TX Southwestern,
Dallas, TX, USA; 2Baylor University Medical Center, Dallas, TX, USA. Contact e-mail: anne.lipton @utsouthwestern, edu
Background: Plasma homocysteine (Hcy) levels rise with age, and hyperhomocysteinemia is a risk factor for cognitive impairment and dementia, including vascular dementia and Alzheimer s disease (AD). It is not known, however, whether Hcy plays a role in Frontotemporal lobar degeneration (FTLD), a dementia with an earlier age of onset (< 65 years) than AD. This investigation included measurement and comparison of plasma total Hcy levels in patients with FTLD, patients with AD, and non-demented controls. Objective(s): To determine whether plasma total Hcy levels are elevated in patients with VFLD. Methods: Plasma Hcy levels were measured in three groups: 1) Subjects meeting the Neary et ai. criteria for FTLD (n = 21), 2) Subjects with clinically probable AD by NINCDS-ADRDA criteria (n = 27), and 3) Normal control subjects who had MMSE scores > 28 and no memory complaints or neurological illness (n = 30). (Power analysis showed that a minimum of 21 subjects per group were required to detect a 20% difference in homocysteine levels with = 0.05, power = 80%.) Plama total Hcy