- Email: [email protected]
Association between cognitive dysfunction and serum thyroid-stimulating hormone levels in elderly patients at a general practitioner clinic
S462
Poster Presentations P3
Background: Late-life depression has been associated with increased dementia risk, but it is unclear whether this association is consistent across all types of dementia. To address this question, we examined associations between depression symptoms and development of clinical Alzheimer’s disease (AD), vascular, mixed (due to multiple etiologies), and other (non-AD, non-vascular) dementias in participants of the Adult Changes in Thought study, a community-based prospective study. Methods: A combined cohort of 3, 410 cognitively normal participants aged 65 years (60% female, mean age-at-entry 74.9 years [range 65 - 101]) underwent biennial assessments for dementia using DSM-IV criteria for dementia of the Alzheimer’s, vascular, mixed, and other types. Depression was assessed using the 11-item version of the Center for Epidemiologic Studies Depression Scale (CESD11, total score: 0 - 33). The primary exposure of interest for this study was depression at baseline, with significant depression symptoms designated as CESD-11 score > 10. Self-reported history and age at onset of depression episodes were also collected at baseline interview. Cox proportional hazards regression with delayed entry and age as the time axis was used to assess the association between baseline CESD-11 > 10 and hazard of each dementia subtype. Results: Mean follow-up was 7.1 years. During follow-up, 386 participants were diagnosed with AD, 89 vascular, 109 mixed, and 73 with other dementia. CESD-11 score > 10 at baseline was present in 14% of participants who developed dementia. Compared with participants with a baseline CESD-11 score of 0-10, the hazard ratio of depression symptoms at baseline for AD was 1.43 (95% CI 1.05, 1.94), vascular dementia 1.78 (95% CI 0.98, 3.22), mixed dementia 2.30 (95% CI 1.39, 3.79), and other dementia 2.42 (1.32, 4.43) after adjusting for ageat-entry categories, gender, education, and cohort. Self reported past history of depression at baseline was only associated with the ‘‘other dementia’’ subtype (adjusted hazard ratio 1.95 [1.17, 3.26]) but not with AD, vascular, or mixed dementia. Conclusions: These data suggest that depression symptoms in late life may be associated with increased dementia risk across all dementia subtypes, but possibly particularly with subtypes other than AD and vascular dementia. P3-045
OBESITY AND DEMENTIA: PROTECTION OR RISK?
Elisa Rosin, Amanda L. Costa, Juliana S. Varela, Luciane M. F. Restelatto, Karine Bombardelli, Rodolfo S. Silva, Alan Palmero, Pedro Abrahim, Marcia L. Chaves, Universidade Federal do Rio Grande do Sul/Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil. Contact e-mail: julianasv@ gmail.com Background: Obesity is a worldwide phenomenon that has direct consequences in the public health systems. One of these consequences is the increase of the prevalence of cardiovascular diseases. It is still not clear in the literature the relation of obesity with dementia and depression, the two most frequent mental health disorders of the elderly. The objective of this work is to evaluate the relation of obesity, cognitive impairment and depressive symptoms in patients with high cardiovascular risk. Methods: It was selected a sample of 93 patients from the Center of Dyslipidemia and High Cardiovascular Risk from Hospital de Clı´nicas de Porto Alegre (HCPA) aged 50 years or more. Patients with stroke were excluded. For the cognitive evaluation, it was used the MMSE (Mini Mental State Examination). A score of 24 or less was considered as cognitive impairment, and in case the patient had 4 years or less of education, the cut off point was 17. It was also used the GDS-15 (Geriatric Depression Scale), and the cut off point considered for the presence of depressive symptoms was 6 points. Results: Obese patients showed lower values in the MMSE when compared to non-obese patients (p ¼ 0,0012). It was also noted that for each point of increase in BMI (Body-Mass Index) above 30 there was an increase of 27% in the chance that the patient will have cognitive impairment. The obese patients have 31% of chance to have cognitive impairment when compared to overweight subjects. Conclusions: The findings of this study corroborate the presence of an association between obesity and cognitive impairment with high cardiovascular risk but this is association was not noted with depressive symptoms. Further research about this topic is needed.
P3-046
THE SLOVAKIA ASSISTED LIVING STUDY: PREVALENCE, RECOGNITION AND TREATMENT OF DEMENTIA AND DEPRESSION IN THE ASSISTED LIVING POPULATION OF SLOVAKIA
Stanislav Sutovsky, Katarina Klobucnikova, Viera Volarikova, Ronnie Traubnerova, Michaela Rasochova, Peter Turcani, Department of Neurology, University Hospital, Bratislava, Slovakia. Contact e-mail: [email protected] Background: Cognitive decline and depression are frequent accompaniment of ageing. Prevalence of both disorders rises together with age. In residents of assisted living facilities there is presumption of higher occurrence of these disorders. This study was carried out in order to obtain a direct estimate of the prevalence of dementia and depression in residents of assisted living in Slovakia and their rates of recognition and treatment. Methods: 866 people living in assisted living facilities (mean age 77,7 years) were examined in order to review the occurrence of cognitive deficit, depression and other monitored diseases. Patients were evaluated by neurologists professionally focused on neurodegenerative disorders and dementias. Cognitive functions were evaluated by means of MMSE and depression was evaluated by means of GDS (Geriatric depression scale). Results: Out of the total there were 116 patients (13%) without any cognitive deficit, 256 (29%) patients had mild cognitive impairment and 494 (56,7%) patients had dementia. Mild dementia was ascertained in case of 276 patients (31%), medium severe dementia was ascertained in case of 112 (12,9 %) patients and severe dementia was detected in case of 106 (12%) patients. There were 417 (54%) patients suffering from depression and its occurrence increase was directly proportional together with level of cognitive deficit. Conclusions: By means of this review we were monitoring two basic problems that affect people living in assisted living facilities - cognitive deficit and depression. Following our review, there are 87% of people living in such facilities who suffer from cognitive deficit, whereby 57% people suffer from dementia. 54% of people suffer from depression and its occurrence rises with accretive cognitive deficit. Cognitive deficit and depression are significantly under-diagnosed and under-treated in assisted living facilities setting. There are only 7,2 % of Alzheimer’s disease patients treated with acetylcholinesterase inhibitors and only 12,7 % of patients with depression treated by antidepressants. This finding emphasizes the need for accurate detection and treatment of mentioned disorders also in assisted living facilities and nursing homes. P3-047
ASSOCIATION BETWEEN COGNITIVE DYSFUNCTION AND SERUM THYROIDSTIMULATING HORMONE LEVELS IN ELDERLY PATIENTS AT A GENERAL PRACTITIONER CLINIC
Yasuyo Mimori1,2, Masafumi Katou2, Genshi Egusa2, Ryou Maeda2, Noriko Inoue2, Gouji Ushio2, Koutarou Nagasaki2, 1Hiroshima International University, Higashihiroshima, Japan; 2Clinical Thyroid Research Group, Hiroshima City Medical Association Clinical Laboratory, Hiroshima, Japan. Contact e-mail: [email protected] Background: Hypothyroidism has been considered as a risk factor for Alzheimer’s disease and dementia syndrome. However the association between cognitive dysfunction and the serum thyroid-stimulating hormone (TSH) levels remains uncertain. To study whether high TSH concentration is related to cognitive dysfunction in the elderly, we examined the association between the cognitive function, mood status and the serum TSH concentration among the outpatients from a general practitioner clinic in Hiroshima City, Japan. Methods: From October 2007 to August 2008, 281 patients aged 65 years and over (98 men and 183 women; mean age, 76.6) who complained memory problems were recruited from 39 clinics. Cognitive function was assessed using a self-checked assessment test of memory deficits (Medical Care Corporation, Japan). Geriatric Depression Scale (GDS) and serum concentrations of TSH and vitamin B12 were also evaluated. Results: The patients could be divided into three groups: (1) normal cognition (N ¼ 158), (2) slight impairment of cognition (N ¼ 11) and (3) significant impairment of cognition (N ¼ 112). Depressive state was suspected in 137 patients and they showed a higher percentage of significant memory deficits. Number of patients with
Poster Presentations P3 high TSH (>5mIU/ml) or low vitamin B12 (<180pg/ml) levels were 37 and 11, respectively. Non-depressive patients with significant memory deficits had a trend of a higher percentage of high TSH levels as compared to those with normal or slight memory deficits, and this tendency was observed only in men, but not in women. Eight out of eleven patients with low vitamin B12 levels showed significant memory deficits. Conclusions: We have to consider the possibility of depression for the elderly patients complaining memory problems at a general practitioner clinic. When restricted to patients without depression, men with cognitive dysfunction had a tendency of elevated serum TSH levels, indicating the complication of subclinical hypothyroidism. P3-048
HIGHER CAREGIVER AGREEABLENESS PREDICTS SLOWER COGNITIVE DECLINE IN PERSONS WITH ALZHEIMER’S DISEASE: THE DEMENTIA PROGRESSION STUDY
Maria C. Norton1, Elizabeth Fauth1, Kathy Piercy1, Chris Corcoran1, Kyle Hess1, Ann Morrison2, Peter V. Rabins2, Constantine G. Lyketsos2, JoAnn Tschanz1, 1Utah State University, Logan, UT, USA; 2The Johns Hopkins University, Baltimore, MD, USA. Contact e-mail: maria.norton@ usu.edu Background: Caregiver personality has been linked to mental and physical health outcomes in the caregiver, however, little is known as to how caregiver personality may affect the clinical progression of the care recipient. We recently reported findings of slower cognitive and functional decline in persons whose caregivers reported closer relationships with their care recipients, in a population-based study of incident Alzheimer’s disease (AD). We now investigate the association between caregiver personality and cognitive trajectory in this cohort. Methods: Cognitive status of 111 individuals with incident AD (41 males, 70 females with age M ¼ 85.7, SD ¼ 5.2 years) was assessed at a maximum of 12 semi-annual visits (median follow-up time 2.4 years) with the Mini-Mental State Exam. Primary caregivers were 43 spouses, and 68 non-spouses. Self-report personality dimensions of Neuroticism, Extraversion, Openness, Conscientiousness, and Agreeableness in the caregiver were assessed with the NEO-FFI. Mixed effects linear models were conducted separately for each personality domain, with time measured as a random effect, based on years since dementia onset. Covariates included subject’s dementia duration, age and education. Results: The only personality domain significantly related to cognitive trajectory in the care recipient was caregiver Agreeableness. Moderation by care recipient gender and caregiver relationship (p ¼ .057, and p ¼ .071 for interaction effects, respectively) was examined in stratified analyses. After covariate adjustments, a one SD increase in Agreeableness was associated with .78 point per year less decline on the MMSE among male care recipients (p ¼ 0.0093), but not for female care recipients (p ¼ .8421). A similar increase in Agreeableness was associated with 0.57 point per year less decline with spouse caregivers (p ¼ .0089), but not for others (p ¼ .7643). Conclusions: Caregiver personality is associated with rate of clinical progression in AD. Agreeableness includes such characteristics as straightforwardness, helpfulness, generosity, optimism, and empathy. Such traits may be important for adaptive caregiving strategies, which are linked to more positive outcomes for care recipient. Results are preliminary and replication will be needed. Future work will examine the relative importance of Closeness vs. Agreeableness, as well as care management strategies used by caregivers high in Agreeableness. P3-049
GRIP STRENGTH AS A PREDICTOR OF MORTALITY AND DEMENTIA: RADIATION EFFECTS RESEARCH FOUNDATION ADULT HEALTH STUDY
Michiko Yamada1, Fumiyoshi Kasagi1, Yasuyo Mimori2, Takafumi Miyachi3, Tomohiko Ohshita3, Hideo Sasaki4, 1Radiation Effects Research Foundation, Hiroshima, Japan; 2Hiroshima International University, Hiroshima, Japan; 3Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan; 4Hiroshima Atomic Bomb Casualty
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Council Health Promotion Center, Hiroshima, Japan. Contact e-mail: [email protected] Background: Aging is characterized by deterioration of biological function, resulting in increased morbidity and mortality, but few studies have examined association between midlife grip strength and risk of mortality or dementia incidence. Methods: We investigated whether midlife grip strength is associated with risk of death and dementia in the population-based cohort of the Radiation Effects Research Foundation’s Adult Health Study (AHS). AHS biennial health examinations have been conducted since 1958. Grip strength was measured for 1,785 participants born between 1917 and 1932, at clinical examinations during the period from 1970 to 1972. Vital status was followed until the end of 2007. By the end of August 1992, 487 subjects had died or dropped out of the follow-up. The remaining 1,298 subjects were assessed in terms of cognitive function and presence of dementia biennially between 1992 and 2007. Vital status and dementia occurrence at age 75 were assessed by tertile of midlife grip strength. Relative risk of mortality and dementia incidence associated with midlife grip strength was estimated after adjustment was made for other potential risk factors by Cox proportional hazard model. Results: A lower percentage of dying subjects and a higher percentage of dementia-free subjects at age 75 were observed in the highest tertile of midlife grip strength. Low midlife grip strength was found to be a risk factor for mortality and dementia incidence after adjustment was made for other potential risk factors. Conclusions: In this prospective study of middle-aged to elderly Japanese subjects, midlife grip strength was found to be a predictor of mortality and dementia incidence. The findings suggest that grip strength is useful not only as a marker of biological function but also as an indicator of clinical and subclinical pathology or genomic factors and that physical exercise may contribute to extension of the duration of dementia-free life. P3-050
EDUCATION, BASELINE AGE AND APOE4 GENOTYPES ARE ASSOCIATED WITH THE TIME FOR AN ACCELERATED RATE OF DECLINE IN VISUOSPATIAL ABILITY PRIOR TO THE DIAGNOSIS OF ALZHEIMER’S DISEASE
Chengjie Xiong, Yuan Xu, J. Philip Miller, John Morris, Washington University, St. Louis, MO, USA. Contact e-mail: [email protected] Background: Accelerated cognitive decline occurs years before a clinical diagnosis of AD can be rendered. Preclinical AD is a hypothesized stage during which AD pathology has been accumulating prior to the clinical symptoms. The concept of cognitive reserve posits that individual differences in how tasks are processed provide differential reserve against brain pathology or age-related changes. Methods: We examined the longitudinal patterns of a visuospatial factor score prior to the diagnosis of AD on a sample of 556 nondemented individuals who went through annual clinical and cognitive assessment for as many as 23 years at Washington University Alzheimer’s Disease Research Center. Through a joint model of the longitudinal cognitive scores and the time to the onset of AD, we fitted a changepoint model to associate the times prior to the onset when the rate of decline in the visuospatial score was accelerated with education, baseline age, and APOE4 genotypes. Results: Of 556 nondemented participants at baseline, 139 subsequently developed AD. Earlier times when the rate of decline was accelerated are significantly associated with a higher risk of developing AD (log hazard ratio ¼ -1.18, p < 0.0001). For individuals at least 75 years of age at baseline, the mean (and the median) time that the rate of decline was accelerated is shifted early by 60.59% (p < 0.0001) when compared to those younger than 75 at baseline. For individuals with at least one APOE e4 alleles, the mean (and the median) time that the rate of decline was accelerated is shifted early by 17.38% (p < 0.0001) when compared to those with none. For individuals with at least 12 years of education, the mean (and the median) time that the rate of decline was accelerated is shifted late by 7.2% (p < 0.0001) when compared to those otherwise. Conclusions: These results suggest differential paths of cognitive decline as a function of two major risk factors (age and APOE4 genotypes) and a proxy of cognitive reserve (education) prior to the onset of AD, thereby supporting the cognitive reserve hypothesis and the hypothesis of preclinical AD.
Poster Presentations P3
Background: Late-life depression has been associated with increased dementia risk, but it is unclear whether this association is consistent across all types of dementia. To address this question, we examined associations between depression symptoms and development of clinical Alzheimer’s disease (AD), vascular, mixed (due to multiple etiologies), and other (non-AD, non-vascular) dementias in participants of the Adult Changes in Thought study, a community-based prospective study. Methods: A combined cohort of 3, 410 cognitively normal participants aged 65 years (60% female, mean age-at-entry 74.9 years [range 65 - 101]) underwent biennial assessments for dementia using DSM-IV criteria for dementia of the Alzheimer’s, vascular, mixed, and other types. Depression was assessed using the 11-item version of the Center for Epidemiologic Studies Depression Scale (CESD11, total score: 0 - 33). The primary exposure of interest for this study was depression at baseline, with significant depression symptoms designated as CESD-11 score > 10. Self-reported history and age at onset of depression episodes were also collected at baseline interview. Cox proportional hazards regression with delayed entry and age as the time axis was used to assess the association between baseline CESD-11 > 10 and hazard of each dementia subtype. Results: Mean follow-up was 7.1 years. During follow-up, 386 participants were diagnosed with AD, 89 vascular, 109 mixed, and 73 with other dementia. CESD-11 score > 10 at baseline was present in 14% of participants who developed dementia. Compared with participants with a baseline CESD-11 score of 0-10, the hazard ratio of depression symptoms at baseline for AD was 1.43 (95% CI 1.05, 1.94), vascular dementia 1.78 (95% CI 0.98, 3.22), mixed dementia 2.30 (95% CI 1.39, 3.79), and other dementia 2.42 (1.32, 4.43) after adjusting for ageat-entry categories, gender, education, and cohort. Self reported past history of depression at baseline was only associated with the ‘‘other dementia’’ subtype (adjusted hazard ratio 1.95 [1.17, 3.26]) but not with AD, vascular, or mixed dementia. Conclusions: These data suggest that depression symptoms in late life may be associated with increased dementia risk across all dementia subtypes, but possibly particularly with subtypes other than AD and vascular dementia. P3-045
OBESITY AND DEMENTIA: PROTECTION OR RISK?
Elisa Rosin, Amanda L. Costa, Juliana S. Varela, Luciane M. F. Restelatto, Karine Bombardelli, Rodolfo S. Silva, Alan Palmero, Pedro Abrahim, Marcia L. Chaves, Universidade Federal do Rio Grande do Sul/Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil. Contact e-mail: julianasv@ gmail.com Background: Obesity is a worldwide phenomenon that has direct consequences in the public health systems. One of these consequences is the increase of the prevalence of cardiovascular diseases. It is still not clear in the literature the relation of obesity with dementia and depression, the two most frequent mental health disorders of the elderly. The objective of this work is to evaluate the relation of obesity, cognitive impairment and depressive symptoms in patients with high cardiovascular risk. Methods: It was selected a sample of 93 patients from the Center of Dyslipidemia and High Cardiovascular Risk from Hospital de Clı´nicas de Porto Alegre (HCPA) aged 50 years or more. Patients with stroke were excluded. For the cognitive evaluation, it was used the MMSE (Mini Mental State Examination). A score of 24 or less was considered as cognitive impairment, and in case the patient had 4 years or less of education, the cut off point was 17. It was also used the GDS-15 (Geriatric Depression Scale), and the cut off point considered for the presence of depressive symptoms was 6 points. Results: Obese patients showed lower values in the MMSE when compared to non-obese patients (p ¼ 0,0012). It was also noted that for each point of increase in BMI (Body-Mass Index) above 30 there was an increase of 27% in the chance that the patient will have cognitive impairment. The obese patients have 31% of chance to have cognitive impairment when compared to overweight subjects. Conclusions: The findings of this study corroborate the presence of an association between obesity and cognitive impairment with high cardiovascular risk but this is association was not noted with depressive symptoms. Further research about this topic is needed.
P3-046
THE SLOVAKIA ASSISTED LIVING STUDY: PREVALENCE, RECOGNITION AND TREATMENT OF DEMENTIA AND DEPRESSION IN THE ASSISTED LIVING POPULATION OF SLOVAKIA
Stanislav Sutovsky, Katarina Klobucnikova, Viera Volarikova, Ronnie Traubnerova, Michaela Rasochova, Peter Turcani, Department of Neurology, University Hospital, Bratislava, Slovakia. Contact e-mail: [email protected] Background: Cognitive decline and depression are frequent accompaniment of ageing. Prevalence of both disorders rises together with age. In residents of assisted living facilities there is presumption of higher occurrence of these disorders. This study was carried out in order to obtain a direct estimate of the prevalence of dementia and depression in residents of assisted living in Slovakia and their rates of recognition and treatment. Methods: 866 people living in assisted living facilities (mean age 77,7 years) were examined in order to review the occurrence of cognitive deficit, depression and other monitored diseases. Patients were evaluated by neurologists professionally focused on neurodegenerative disorders and dementias. Cognitive functions were evaluated by means of MMSE and depression was evaluated by means of GDS (Geriatric depression scale). Results: Out of the total there were 116 patients (13%) without any cognitive deficit, 256 (29%) patients had mild cognitive impairment and 494 (56,7%) patients had dementia. Mild dementia was ascertained in case of 276 patients (31%), medium severe dementia was ascertained in case of 112 (12,9 %) patients and severe dementia was detected in case of 106 (12%) patients. There were 417 (54%) patients suffering from depression and its occurrence increase was directly proportional together with level of cognitive deficit. Conclusions: By means of this review we were monitoring two basic problems that affect people living in assisted living facilities - cognitive deficit and depression. Following our review, there are 87% of people living in such facilities who suffer from cognitive deficit, whereby 57% people suffer from dementia. 54% of people suffer from depression and its occurrence rises with accretive cognitive deficit. Cognitive deficit and depression are significantly under-diagnosed and under-treated in assisted living facilities setting. There are only 7,2 % of Alzheimer’s disease patients treated with acetylcholinesterase inhibitors and only 12,7 % of patients with depression treated by antidepressants. This finding emphasizes the need for accurate detection and treatment of mentioned disorders also in assisted living facilities and nursing homes. P3-047
ASSOCIATION BETWEEN COGNITIVE DYSFUNCTION AND SERUM THYROIDSTIMULATING HORMONE LEVELS IN ELDERLY PATIENTS AT A GENERAL PRACTITIONER CLINIC
Yasuyo Mimori1,2, Masafumi Katou2, Genshi Egusa2, Ryou Maeda2, Noriko Inoue2, Gouji Ushio2, Koutarou Nagasaki2, 1Hiroshima International University, Higashihiroshima, Japan; 2Clinical Thyroid Research Group, Hiroshima City Medical Association Clinical Laboratory, Hiroshima, Japan. Contact e-mail: [email protected] Background: Hypothyroidism has been considered as a risk factor for Alzheimer’s disease and dementia syndrome. However the association between cognitive dysfunction and the serum thyroid-stimulating hormone (TSH) levels remains uncertain. To study whether high TSH concentration is related to cognitive dysfunction in the elderly, we examined the association between the cognitive function, mood status and the serum TSH concentration among the outpatients from a general practitioner clinic in Hiroshima City, Japan. Methods: From October 2007 to August 2008, 281 patients aged 65 years and over (98 men and 183 women; mean age, 76.6) who complained memory problems were recruited from 39 clinics. Cognitive function was assessed using a self-checked assessment test of memory deficits (Medical Care Corporation, Japan). Geriatric Depression Scale (GDS) and serum concentrations of TSH and vitamin B12 were also evaluated. Results: The patients could be divided into three groups: (1) normal cognition (N ¼ 158), (2) slight impairment of cognition (N ¼ 11) and (3) significant impairment of cognition (N ¼ 112). Depressive state was suspected in 137 patients and they showed a higher percentage of significant memory deficits. Number of patients with
Poster Presentations P3 high TSH (>5mIU/ml) or low vitamin B12 (<180pg/ml) levels were 37 and 11, respectively. Non-depressive patients with significant memory deficits had a trend of a higher percentage of high TSH levels as compared to those with normal or slight memory deficits, and this tendency was observed only in men, but not in women. Eight out of eleven patients with low vitamin B12 levels showed significant memory deficits. Conclusions: We have to consider the possibility of depression for the elderly patients complaining memory problems at a general practitioner clinic. When restricted to patients without depression, men with cognitive dysfunction had a tendency of elevated serum TSH levels, indicating the complication of subclinical hypothyroidism. P3-048
HIGHER CAREGIVER AGREEABLENESS PREDICTS SLOWER COGNITIVE DECLINE IN PERSONS WITH ALZHEIMER’S DISEASE: THE DEMENTIA PROGRESSION STUDY
Maria C. Norton1, Elizabeth Fauth1, Kathy Piercy1, Chris Corcoran1, Kyle Hess1, Ann Morrison2, Peter V. Rabins2, Constantine G. Lyketsos2, JoAnn Tschanz1, 1Utah State University, Logan, UT, USA; 2The Johns Hopkins University, Baltimore, MD, USA. Contact e-mail: maria.norton@ usu.edu Background: Caregiver personality has been linked to mental and physical health outcomes in the caregiver, however, little is known as to how caregiver personality may affect the clinical progression of the care recipient. We recently reported findings of slower cognitive and functional decline in persons whose caregivers reported closer relationships with their care recipients, in a population-based study of incident Alzheimer’s disease (AD). We now investigate the association between caregiver personality and cognitive trajectory in this cohort. Methods: Cognitive status of 111 individuals with incident AD (41 males, 70 females with age M ¼ 85.7, SD ¼ 5.2 years) was assessed at a maximum of 12 semi-annual visits (median follow-up time 2.4 years) with the Mini-Mental State Exam. Primary caregivers were 43 spouses, and 68 non-spouses. Self-report personality dimensions of Neuroticism, Extraversion, Openness, Conscientiousness, and Agreeableness in the caregiver were assessed with the NEO-FFI. Mixed effects linear models were conducted separately for each personality domain, with time measured as a random effect, based on years since dementia onset. Covariates included subject’s dementia duration, age and education. Results: The only personality domain significantly related to cognitive trajectory in the care recipient was caregiver Agreeableness. Moderation by care recipient gender and caregiver relationship (p ¼ .057, and p ¼ .071 for interaction effects, respectively) was examined in stratified analyses. After covariate adjustments, a one SD increase in Agreeableness was associated with .78 point per year less decline on the MMSE among male care recipients (p ¼ 0.0093), but not for female care recipients (p ¼ .8421). A similar increase in Agreeableness was associated with 0.57 point per year less decline with spouse caregivers (p ¼ .0089), but not for others (p ¼ .7643). Conclusions: Caregiver personality is associated with rate of clinical progression in AD. Agreeableness includes such characteristics as straightforwardness, helpfulness, generosity, optimism, and empathy. Such traits may be important for adaptive caregiving strategies, which are linked to more positive outcomes for care recipient. Results are preliminary and replication will be needed. Future work will examine the relative importance of Closeness vs. Agreeableness, as well as care management strategies used by caregivers high in Agreeableness. P3-049
GRIP STRENGTH AS A PREDICTOR OF MORTALITY AND DEMENTIA: RADIATION EFFECTS RESEARCH FOUNDATION ADULT HEALTH STUDY
Michiko Yamada1, Fumiyoshi Kasagi1, Yasuyo Mimori2, Takafumi Miyachi3, Tomohiko Ohshita3, Hideo Sasaki4, 1Radiation Effects Research Foundation, Hiroshima, Japan; 2Hiroshima International University, Hiroshima, Japan; 3Hiroshima University Graduate School of Biomedical Sciences, Hiroshima, Japan; 4Hiroshima Atomic Bomb Casualty
S463
Council Health Promotion Center, Hiroshima, Japan. Contact e-mail: [email protected] Background: Aging is characterized by deterioration of biological function, resulting in increased morbidity and mortality, but few studies have examined association between midlife grip strength and risk of mortality or dementia incidence. Methods: We investigated whether midlife grip strength is associated with risk of death and dementia in the population-based cohort of the Radiation Effects Research Foundation’s Adult Health Study (AHS). AHS biennial health examinations have been conducted since 1958. Grip strength was measured for 1,785 participants born between 1917 and 1932, at clinical examinations during the period from 1970 to 1972. Vital status was followed until the end of 2007. By the end of August 1992, 487 subjects had died or dropped out of the follow-up. The remaining 1,298 subjects were assessed in terms of cognitive function and presence of dementia biennially between 1992 and 2007. Vital status and dementia occurrence at age 75 were assessed by tertile of midlife grip strength. Relative risk of mortality and dementia incidence associated with midlife grip strength was estimated after adjustment was made for other potential risk factors by Cox proportional hazard model. Results: A lower percentage of dying subjects and a higher percentage of dementia-free subjects at age 75 were observed in the highest tertile of midlife grip strength. Low midlife grip strength was found to be a risk factor for mortality and dementia incidence after adjustment was made for other potential risk factors. Conclusions: In this prospective study of middle-aged to elderly Japanese subjects, midlife grip strength was found to be a predictor of mortality and dementia incidence. The findings suggest that grip strength is useful not only as a marker of biological function but also as an indicator of clinical and subclinical pathology or genomic factors and that physical exercise may contribute to extension of the duration of dementia-free life. P3-050
EDUCATION, BASELINE AGE AND APOE4 GENOTYPES ARE ASSOCIATED WITH THE TIME FOR AN ACCELERATED RATE OF DECLINE IN VISUOSPATIAL ABILITY PRIOR TO THE DIAGNOSIS OF ALZHEIMER’S DISEASE
Chengjie Xiong, Yuan Xu, J. Philip Miller, John Morris, Washington University, St. Louis, MO, USA. Contact e-mail: [email protected] Background: Accelerated cognitive decline occurs years before a clinical diagnosis of AD can be rendered. Preclinical AD is a hypothesized stage during which AD pathology has been accumulating prior to the clinical symptoms. The concept of cognitive reserve posits that individual differences in how tasks are processed provide differential reserve against brain pathology or age-related changes. Methods: We examined the longitudinal patterns of a visuospatial factor score prior to the diagnosis of AD on a sample of 556 nondemented individuals who went through annual clinical and cognitive assessment for as many as 23 years at Washington University Alzheimer’s Disease Research Center. Through a joint model of the longitudinal cognitive scores and the time to the onset of AD, we fitted a changepoint model to associate the times prior to the onset when the rate of decline in the visuospatial score was accelerated with education, baseline age, and APOE4 genotypes. Results: Of 556 nondemented participants at baseline, 139 subsequently developed AD. Earlier times when the rate of decline was accelerated are significantly associated with a higher risk of developing AD (log hazard ratio ¼ -1.18, p < 0.0001). For individuals at least 75 years of age at baseline, the mean (and the median) time that the rate of decline was accelerated is shifted early by 60.59% (p < 0.0001) when compared to those younger than 75 at baseline. For individuals with at least one APOE e4 alleles, the mean (and the median) time that the rate of decline was accelerated is shifted early by 17.38% (p < 0.0001) when compared to those with none. For individuals with at least 12 years of education, the mean (and the median) time that the rate of decline was accelerated is shifted late by 7.2% (p < 0.0001) when compared to those otherwise. Conclusions: These results suggest differential paths of cognitive decline as a function of two major risk factors (age and APOE4 genotypes) and a proxy of cognitive reserve (education) prior to the onset of AD, thereby supporting the cognitive reserve hypothesis and the hypothesis of preclinical AD.