- Email: [email protected]
ADHERENCE TO TYPE 2 DIABETES MEDICATIONS IS ASSOCIATED WITH BETTER COGNITIVE FUNCTION
Podium Presentations: Wednesday, July 27, 2016
cognitive assessment was effective in screening for delirium in this setting. Data collection is ongoing, with follow up and confirmation of dementia diagnoses due to be completed in May 2016. Further analysis on completion of the study and evaluation of the IDEA brief cognitive assessment against DSM-V diagnosis of delirium by a specialist are awaited.
O4-12-05
REGULAR PARTICIPATION IN PRESTROKE LEISURE ACTIVITIES REDUCED RISKS OF DEMENTIA AND IMPROVED COGNITIVE FUNCTIONS AFTER STROKE OR TRANSIENT ISCHEMIC ATTACK: RESULTS FROM THE STRIDE STUDY
Adrian Wong1, Alexander Y. L. Lau1, Eugene S. K. Lo1, Michael Tang1, Zhaolu Wang1, Wenyan Liu1, Nicole Tanner1, Natalie Chau1, Lorraine S. N. Law1, Lin Shi1, Winnie C. W. Chu1, Jie Yang2, Yun-Yun Xiong3, Bonnie Y. K. Lam1, Lisa Au1, Yannie O. Y. Soo1, Thomas W. H. Leung1, Lawrence K. S. Wong1, Linda C. W. Lam1, Vincent C. T. Mok1, 1The Chinese University of Hong Kong, Hong Kong, Hong Kong; 2Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Guangzhou, China; 3Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. Contact e-mail: [email protected] Background: To examine the effects of recent past leisure activ-
ities participation upon cognitive functions and risk of incident dementia after stroke. Methods: In the Stroke Registry Investigating Cognitive Decline (STRIDE) study, 88 of 1,013 patients with stroke or transient ischemic attack (TIA) having no prestroke dementia were diagnosed to have incident poststroke dementia (PSD) 3-6 months after the index event. Regular participation was defined as participation of 30 minutes within 24 hours for 3 times a week in intellectual, recreational, social and physical activities over the year before the index event. Results: Logistic regression analyses showed that regular participation in intellectual (RR 0.36, 95%CI 0.20-0.63) and stretching & toning physical exercise (0.37, 0.21-0.64) was significantly associated with a reduced risk of PSD after controlling for age, education, prestroke cognitive decline, stroke subtype, prior strokes and chronic brain changes including white matter changes, old infarcts and global atrophy. Results were similar in patients with past strokes in unadjusted models. Participation in increased number of activities in general (r¼0.41, p<0.01) and in intellectual (r¼0.40, p<0.01), recreational (r¼0.24, p<0.01), strenuous aerobic (r¼0.23, p<0.01) and mind-body (r¼0.10, p<0.01) activities was associated with higher Mini-mental State Examination scores poststroke in models adjusted for prestroke cognitive decline. Conclusions: Regular participation in intellectual activities and stretching & toning exercise was associated with a significantly reduced short-term risk of PSD in stroke or TIA patients with and without prior strokes. Participation in greater number of recent past leisure activities was associated with better poststroke cognitive performance.
O4-12-06
P365
ADHERENCE TO TYPE 2 DIABETES MEDICATIONS IS ASSOCIATED WITH BETTER COGNITIVE FUNCTION
Michal Schnaider Beeri1,2, Ramit Ravona-Springer3, Erin Moshier4, James Schmeidler4, Jeremy M. Silverman5, Anthony Heymann6,7, 1 Department of Psychiatry Mount Sinai School of Medicine, New York, NY, USA; 2The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel; 3Sheba Medical Center, Ramat Gan, Israel; 4The Icahn School of Medicine at Mount Sinai, New York, NY, USA; 5Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA; 6Maccabi Health Services, Jerusalem, Israel; 7Department of Family Medicine, University of Tel Aviv, Tel Aviv, Israel. Contact e-mail: Michal. [email protected] Background: The vast majority of type 2 diabetes (T2D) patients
are treated with T2D medications; it is difficult to tease out the contribution to cognitive impairment of the medications from that of T2D. This is especially relevant due to evidence suggesting deleterious effects on cognition of metformin, the most commonly prescribed T2D medication. We investigated whether adherence to T2D medications was associated with cognitive function. Methods: Subjects participated in the Israel Diabetes and Cognitive Decline Study and pertained to the Maccabi Health Services (a large HMO in Israel) Diabetes registry, with data since 1998; 731 were prescribed T2D medications and 149 were controlled by diet. The proportion of days covered (PDC) was used as the measure of medication adherence and calculated as the ratio of the days for which medications were supplied to the number of days in the Diabetes Registry. Cognitive outcomes were based on a broad neuropsychological battery and consisted of four domain summaries (episodic memory, semantic categorization, attention/working memory, and executive functions) and an overall cognitive score. ANCOVA controlling for age, sex, education, total cholesterol, HDL, LDL, systolic and diastolic blood pressure, and glomerular filtration rate was performed. Results: 96% of medicated subjects had metformin, 11% insulin. PDC was dichotomized at 80% (n¼322 PDC<80%; n¼409 PDC>80%), a well-accepted cutoff in the medication adherence literature. The mean T2D duration (measured as number of years in the Registry) was 9.0 years (SD¼2.5). Subjects with PDC<80% had poorer cognitive function than subjects with PDC>80%. Subjects on no medications had the highest cognitive scores. These differences were significant for executive functions (p¼0.004), attention/working memory (p¼0.03), and overall cognition (p¼0.03). Additionally controlling for T2D duration attenuated the associations, but the differences for executive functions (p¼0.02) and attention/working memory (p¼0.04) remained significant. Conclusions: Results suggest that T2D medications use may have cognitive benefits. However, reverse causality, poorer adherence due to incipient cognitive decline, cannot be ruled out. Not receiving T2D medications was associated with better cognition, perhaps because such patients had a shorter duration of T2D and consequently less exposure to the T2D deleterious effects on the brain. Analyses of adherence to specific T2D medications are ongoing.
cognitive assessment was effective in screening for delirium in this setting. Data collection is ongoing, with follow up and confirmation of dementia diagnoses due to be completed in May 2016. Further analysis on completion of the study and evaluation of the IDEA brief cognitive assessment against DSM-V diagnosis of delirium by a specialist are awaited.
O4-12-05
REGULAR PARTICIPATION IN PRESTROKE LEISURE ACTIVITIES REDUCED RISKS OF DEMENTIA AND IMPROVED COGNITIVE FUNCTIONS AFTER STROKE OR TRANSIENT ISCHEMIC ATTACK: RESULTS FROM THE STRIDE STUDY
Adrian Wong1, Alexander Y. L. Lau1, Eugene S. K. Lo1, Michael Tang1, Zhaolu Wang1, Wenyan Liu1, Nicole Tanner1, Natalie Chau1, Lorraine S. N. Law1, Lin Shi1, Winnie C. W. Chu1, Jie Yang2, Yun-Yun Xiong3, Bonnie Y. K. Lam1, Lisa Au1, Yannie O. Y. Soo1, Thomas W. H. Leung1, Lawrence K. S. Wong1, Linda C. W. Lam1, Vincent C. T. Mok1, 1The Chinese University of Hong Kong, Hong Kong, Hong Kong; 2Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University and Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and Ministry of Education of China, Guangzhou, China; 3Jinling Hospital, Nanjing University School of Medicine, Nanjing, China. Contact e-mail: [email protected] Background: To examine the effects of recent past leisure activ-
ities participation upon cognitive functions and risk of incident dementia after stroke. Methods: In the Stroke Registry Investigating Cognitive Decline (STRIDE) study, 88 of 1,013 patients with stroke or transient ischemic attack (TIA) having no prestroke dementia were diagnosed to have incident poststroke dementia (PSD) 3-6 months after the index event. Regular participation was defined as participation of 30 minutes within 24 hours for 3 times a week in intellectual, recreational, social and physical activities over the year before the index event. Results: Logistic regression analyses showed that regular participation in intellectual (RR 0.36, 95%CI 0.20-0.63) and stretching & toning physical exercise (0.37, 0.21-0.64) was significantly associated with a reduced risk of PSD after controlling for age, education, prestroke cognitive decline, stroke subtype, prior strokes and chronic brain changes including white matter changes, old infarcts and global atrophy. Results were similar in patients with past strokes in unadjusted models. Participation in increased number of activities in general (r¼0.41, p<0.01) and in intellectual (r¼0.40, p<0.01), recreational (r¼0.24, p<0.01), strenuous aerobic (r¼0.23, p<0.01) and mind-body (r¼0.10, p<0.01) activities was associated with higher Mini-mental State Examination scores poststroke in models adjusted for prestroke cognitive decline. Conclusions: Regular participation in intellectual activities and stretching & toning exercise was associated with a significantly reduced short-term risk of PSD in stroke or TIA patients with and without prior strokes. Participation in greater number of recent past leisure activities was associated with better poststroke cognitive performance.
O4-12-06
P365
ADHERENCE TO TYPE 2 DIABETES MEDICATIONS IS ASSOCIATED WITH BETTER COGNITIVE FUNCTION
Michal Schnaider Beeri1,2, Ramit Ravona-Springer3, Erin Moshier4, James Schmeidler4, Jeremy M. Silverman5, Anthony Heymann6,7, 1 Department of Psychiatry Mount Sinai School of Medicine, New York, NY, USA; 2The Joseph Sagol Neuroscience Center, Sheba Medical Center, Ramat Gan, Israel; 3Sheba Medical Center, Ramat Gan, Israel; 4The Icahn School of Medicine at Mount Sinai, New York, NY, USA; 5Department of Psychiatry, The Icahn School of Medicine at Mount Sinai, New York, NY, USA; 6Maccabi Health Services, Jerusalem, Israel; 7Department of Family Medicine, University of Tel Aviv, Tel Aviv, Israel. Contact e-mail: Michal. [email protected] Background: The vast majority of type 2 diabetes (T2D) patients
are treated with T2D medications; it is difficult to tease out the contribution to cognitive impairment of the medications from that of T2D. This is especially relevant due to evidence suggesting deleterious effects on cognition of metformin, the most commonly prescribed T2D medication. We investigated whether adherence to T2D medications was associated with cognitive function. Methods: Subjects participated in the Israel Diabetes and Cognitive Decline Study and pertained to the Maccabi Health Services (a large HMO in Israel) Diabetes registry, with data since 1998; 731 were prescribed T2D medications and 149 were controlled by diet. The proportion of days covered (PDC) was used as the measure of medication adherence and calculated as the ratio of the days for which medications were supplied to the number of days in the Diabetes Registry. Cognitive outcomes were based on a broad neuropsychological battery and consisted of four domain summaries (episodic memory, semantic categorization, attention/working memory, and executive functions) and an overall cognitive score. ANCOVA controlling for age, sex, education, total cholesterol, HDL, LDL, systolic and diastolic blood pressure, and glomerular filtration rate was performed. Results: 96% of medicated subjects had metformin, 11% insulin. PDC was dichotomized at 80% (n¼322 PDC<80%; n¼409 PDC>80%), a well-accepted cutoff in the medication adherence literature. The mean T2D duration (measured as number of years in the Registry) was 9.0 years (SD¼2.5). Subjects with PDC<80% had poorer cognitive function than subjects with PDC>80%. Subjects on no medications had the highest cognitive scores. These differences were significant for executive functions (p¼0.004), attention/working memory (p¼0.03), and overall cognition (p¼0.03). Additionally controlling for T2D duration attenuated the associations, but the differences for executive functions (p¼0.02) and attention/working memory (p¼0.04) remained significant. Conclusions: Results suggest that T2D medications use may have cognitive benefits. However, reverse causality, poorer adherence due to incipient cognitive decline, cannot be ruled out. Not receiving T2D medications was associated with better cognition, perhaps because such patients had a shorter duration of T2D and consequently less exposure to the T2D deleterious effects on the brain. Analyses of adherence to specific T2D medications are ongoing.