- Email: [email protected]
BUILDING CAPACITY FOR DEMENTIA RISK REDUCTION: THE PREVENTING DEMENTIA MOOC
Poster Presentations: Monday, July 17, 2017
the DSE group during the intervention period. During 5 years spanning the intervention’s end and post-intervention follow-up, repeated cognitive assessments were obtained in 1,091 individuals who had been assigned to ILI or DSE. Results: Compared with DSE, assignment to ILI was associated with a mean 0.082 standard deviation (SD) relative deficit in global cognitive function (p¼0.010) over time. However, overweight (body mass index <30 kg/m2) ILI participants had mean [95% confidence interval] 0.099 [-0.006,0.259] SD better composite cognitive function scores across follow-up while obese (body mass index >30 kg/m2) ILI participants had -0.117 [-0.185, -0.049] worse mean composite cognitive function scores (interaction p¼0.014). For both overweight and obese participants, cognitive decline was steeper for ILI compared with DSE participants, with differences reaching nominal significance for tests of attention (p¼0.037) and memory (p¼0.031), and marginal significance for composite cognitive function (p¼0.068). Conclusions:Long-term behavioral weight loss intervention was not associated with lasting cognitive benefits in adults with type 2 diabetes, and potentially small relative mean deficits among individuals who are obese.
P2-584
COMPARING CLINICALLY BASED VERSUS ALGORITHM-GENERATED INTERVENTIONS IN THE CONTEXT OF ALZHEIMER’S DISEASE (AD) PREVENTION
John Q. Walker, II1, Dorothy Keine1, Emily E. Caesar2, Hollie Hristov2, Katherine Hackett2, Richard Isaacson2, 1Muses Labs, Inc., Raleigh, NC, USA; 2Weill Cornell Medicine, New York, NY, USA. Contact e-mail: johnq@ museslabs.com Background: The Alzheimer’s Prevention Clinic (APC) at Weill Cornell Medicine utilizes precision medicine interventions to reduce individual risk towards developing AD. The APC provides direct clinical care to people who undergo a comprehensive assessment and receive evidence-based, individualized interventions applying principles of pharmacogenomics and nutrigenomics, with the goal of stabilizing or improving cognition and blood bio-
P871
markers. Muses Labs follows a similar paradigm in the absence of an in-person clinical visit, using an informatics platform that receives and processes multi-sourced data to provide a targeted intervention plan known as the AD1 Protocol. Methods: In this pilot study, five subjects (ages 51-65) from the APC prospective cohort (n¼377) were recruited to submit their clinical data to Muses Labs. Recommendations given by the APC neurologist were compared to artificial-intelligence generated recommendations from AD1. Results: For each APC subject, an average of 334 data points (e.g., clinical history, labs, biometrics, cognition) were assessed compared with 1,029 data points assessed by Muses Labs for interpretation (sourced from genome, medical history – including comorbidities, medications, allergies, and vaccines – labs, and cognitive testing). The APC analyzed 58 blood biomarkers and 4 genetic risk factors, while Muses Labs processed an average of 107 blood biomarkers and w1,000 single nucleotide polymorphisms (SNPs). APC recommendations averaged 3.8 supplements/vitamins, 13.6 dietary modifications, and 8.4 lifestyle changes per subject, while AD1 averaged 16.8 supplements/ vitamins, 5.2 potential supplements/vitamins, 9.2 dietary modifications, 5.8 lifestyle changes, and 4.4 additional diagnostic tests. AD1 reports averaged 7,504.2 words per person, while APC interventions averaged 1,272.8 words, both excluding laboratory results. Conclusions: Given the complexity of emerging precision medicine interventions for AD prevention, novel and collaborative efforts using both clinical informatics and physician-based approaches may offer a more comprehensive set of potential therapeutic recommendations for those seeking to reduce risk. Using consistent software-based decision trees that utilize emerging evidence could facilitate the application of precision medicine in the clinic, expand the number of potential interventions, and make complex protocols readily accessible to a large number of physicians and patients worldwide. Further study is warranted to evaluate the longitudinal effectiveness of these augmented preventative approaches.
P2-585
BUILDING CAPACITY FOR DEMENTIA RISK REDUCTION: THE PREVENTING DEMENTIA MOOC
Maree Farrow, David D. Ward, Shannon Z. Klekociuk, James C. Vickers, University of Tasmania, Hobart, Australia. Contact e-mail: [email protected] Background: Evidence suggests that reducing population exposure to modifiable risk factors may prevent millions of dementia cases. Increased community education about this potential is needed to enable individuals, health professionals and policy makers to adopt dementia risk reduction strategies. The Preventing Dementia Massive Open Online Course (PD-MOOC) was developed by the University of Tasmania’s Wicking Centre as a public health initiative. The course aims to educate people with an interest in reducing their own risk of dementia, as well as those involved in providing services to others at risk, on the scientific basis of dementia risk reduction. Methods: The five-week PD-MOOC explores key modifiable risk factors, including those estimated to account for almost onethird of Alzheimer’s disease cases: diabetes, hypertension, obesity, physical inactivity, depression, smoking and low educational
P872
Poster Presentations: Monday, July 17, 2017
attainment. It also addresses the non-modifiable risk factors for dementia, myths about dementia risk and causes, and barriers and enablers of health-behaviour change. Information is presented using interviews with international experts, animated video material, infographics, and interactive discussion boards. Completion of the PD-MOOC was defined as a passing grade of 70% on 3 quizzes. Participants provided demographic information at enrolment and completed a feedback survey on completion. Results: The first offering of the PD-MOOC attracted 11,286 international participants (89% female; M age ¼ 49 years; 75% with post-school education; 68% Australian residents). 49% completed the MOOC and 2,149 completed the feedback survey. Most participants (>90%) agreed that the MOOC was easy to understand, provided useful information, and increased their motivation to reduce dementia risk, and that the content, quizzes and discussions helped their learning. 83% agreed the MOOC had an impact on their behaviour and lifestyle choices. Conclusions: The large enrolment and high completion rate for this first PD-MOOC highlight the scale of unmet need for quality, evidence-based and in-depth dementia risk reduction education. Participant feedback supports the appropriateness of this MOOC to increase knowledge and motivation, and its potential ability to modify dementia risk. Whether completion of the PD-MOOC is associated with prolonged engagement in activities associated with lower dementia risk will be explored in future research. P2-586
VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND THE RISK OF DEMENTIA IN OLDER PEOPLE
Tessa van Middelaar1,2, Jan-Willem van Dalen2, Willem A. van Gool2, Bert-Jan H. van den Born2, Lonneke A. van Vught2, Eric P. Moll van Charante2, Edo Richard1,2, 1Radboud University Medical Center, Nijmegen, Netherlands; 2Academic Medical Center, Amsterdam, Netherlands. Contact e-mail: tessa. [email protected] Background: Blood pressure variability (BPV) is associated with ce-
rebrovascular damage. Whether it is associated with dementia is unclear. Our aim was to investigate whether visit-to-visit BPV is associated with incident all-cause dementia. Secondarily we studied the association with cognitive decline and cardiovascular disease (CVD). Methods: We included community-dwelling older people from the ‘Prevention of Dementia by Intensive Vascular Care’ (preDIVA) trial with three or more 2-yearly blood pressure (BP) measurements during 6-8 years follow-up. BPV was defined using coefficient of variation (CV; SD/mean 3 100) of systolic BP. Cognitive decline was assessed using the Mini-Mental State Examination (MMSE). CVD was defined as incident myocardial infarction or stroke. The association with dementia and CVD was assessed with a Cox proportional hazard regression adjusted for number of BP measurements, sociodemographic factors and cardiovascular risk factors. The association with cognition was assessed with a mixed-model analysis. Results: In 2305 participants (age, 74.262.5 year) systolic BP over all available visits was 150.1 mmHg (SD 13.6), yielding a CV of 9.0. After 6.4 year (SD 0.8) follow-up, 110 (4.8%) participants developed dementia and 140 (6.1%) incident CVD. BPV was not associated with increased risk of dementia (hazard ratio [HR] 1.02; 95% confidence interval [CI] 0.98-1.06). The highest quartile of BPV was associated with a stronger decline in MMSE (b -0.09, 95% CI -0.17 – -0.01). BPV was associated with more CVD (HR 1.07; 95% CI 1.04-1.11). Conclusions: Visit-to-visit BPV is not associated with incident all-cause dementia in older people, but is associated with cognitive decline and incident CVD.
P2-587
FACTORS ASSOCIATED WITH POOR PERFORMANCE OF MINI-MENTAL STATE EXAMINATION IN COMMUNITYDWELLING ELDERY KOREANS
Young Hun Yun1, Eun Jung Lee2, 1Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of South Korea; 2KimLee Clinic, Bucheon, Republic of South Korea. Contact e-mail: [email protected] Background: This study aimed to determine the associated factors with the cognitive function of elderly Korean population. Methods:
Data was collected in a single urban district-dwelling 13,275 Koreans over 60 years old from November 2013 to December 2016. Korean version of the Mini-mental State Exam (K-MMSE) was administrated to all subjects. We collected demographic variables from subjects and caregivers by questionnaire including age, sex, height, weight, level of education, past medical histories and habitual histories. The levels of cognition were divided into ‘normal’, ‘intermediate’, and ‘poor’ cognitive performance groups based on their K-MMSE scores adjusted. Multinomial logistic regression was used for the assessment of correlation between risk factors and the cognition levels. Results: Prevalence of intermediate group was estimated to be 9.1% and that of poor group was 14.3%. The subjects with older age (OR 1.06, 95% CI 1.05-1.07), stroke (OR 1.24, 95% CI 1.03-1.56) and smoking (OR 1.35, 95% CI 1.06-1.65) had higher risk for intermediate group while increased years of schooling was protective (OR 0.92, 95% CI 0.91-0.93). The risk for poor group was increased with older age (OR 1.09, 95% CI 1.08-1.1), stroke (OR 1.62, 95% CI (1.39-1.9), smoking (OR 1.20, 95% CI 1.03-1.42), diabetes mellitus (OR 1.23, 95% CI 1.09-1.35), alcohol drinking (OR 1.26, 95% CI 1.07-1.45) and underweight (OR 1.43, 95% CI 1.13-1.77). However, the subjects with female (OR 0.66, 95% CI 0.59-0.75), high educational attainment (OR 0.88, 95% CI 0.88-0.91) and Dyslipidemia (OR 0.73, 95% CI 0.69-0.85) had decreased risk for poor group. Vascular risk factors were not differently affected between both sexes. Among three age groups, the association between poor cognitive performance and previous stroke was higher in sixties than other age groups (OR 2.31, 95% CI 1.71-3.18). Conclusions: The associated factors with poor cognitive performance were older age, previous stroke, smoking, diabetes mellitus, alcohol drinking and underweight in community-dwelling elderly Koreans. The vascular risk factors for cognitive decline were not varied according to sex or age groups. This study could warrant a further prospective cohort to establish the risk factors for cognitive decline and dementia in Korean population.
P2-588
CASE STUDY OF A WELL-KNOWN SWEDISH VISUAL ARTIST SUFFERING FROM ALZHEIMER’S DISEASE
Axel Holmbom Larsen1, Lennart Minthon2, Elisabet Londos2, 1 Clinical Memory Research Unit, Malm€o, Sweden; 2Clinical Memory Research Unit, Dept of Clinical Sciences, Malm€o, Lund University, Malm€o, Sweden. Contact e-mail: axel.holmbom. [email protected] Background: Visual artistic creativity is an outcome of complex inter-
actions between large numbers of structures within the brain, such as cooperation within the occipital and temporal cortex as well as the ventral and dorsal visual stream and areas responsible for motor function and execution. Utilizing these complex interactions is necessary in order to produce art, create representative art and
the DSE group during the intervention period. During 5 years spanning the intervention’s end and post-intervention follow-up, repeated cognitive assessments were obtained in 1,091 individuals who had been assigned to ILI or DSE. Results: Compared with DSE, assignment to ILI was associated with a mean 0.082 standard deviation (SD) relative deficit in global cognitive function (p¼0.010) over time. However, overweight (body mass index <30 kg/m2) ILI participants had mean [95% confidence interval] 0.099 [-0.006,0.259] SD better composite cognitive function scores across follow-up while obese (body mass index >30 kg/m2) ILI participants had -0.117 [-0.185, -0.049] worse mean composite cognitive function scores (interaction p¼0.014). For both overweight and obese participants, cognitive decline was steeper for ILI compared with DSE participants, with differences reaching nominal significance for tests of attention (p¼0.037) and memory (p¼0.031), and marginal significance for composite cognitive function (p¼0.068). Conclusions:Long-term behavioral weight loss intervention was not associated with lasting cognitive benefits in adults with type 2 diabetes, and potentially small relative mean deficits among individuals who are obese.
P2-584
COMPARING CLINICALLY BASED VERSUS ALGORITHM-GENERATED INTERVENTIONS IN THE CONTEXT OF ALZHEIMER’S DISEASE (AD) PREVENTION
John Q. Walker, II1, Dorothy Keine1, Emily E. Caesar2, Hollie Hristov2, Katherine Hackett2, Richard Isaacson2, 1Muses Labs, Inc., Raleigh, NC, USA; 2Weill Cornell Medicine, New York, NY, USA. Contact e-mail: johnq@ museslabs.com Background: The Alzheimer’s Prevention Clinic (APC) at Weill Cornell Medicine utilizes precision medicine interventions to reduce individual risk towards developing AD. The APC provides direct clinical care to people who undergo a comprehensive assessment and receive evidence-based, individualized interventions applying principles of pharmacogenomics and nutrigenomics, with the goal of stabilizing or improving cognition and blood bio-
P871
markers. Muses Labs follows a similar paradigm in the absence of an in-person clinical visit, using an informatics platform that receives and processes multi-sourced data to provide a targeted intervention plan known as the AD1 Protocol. Methods: In this pilot study, five subjects (ages 51-65) from the APC prospective cohort (n¼377) were recruited to submit their clinical data to Muses Labs. Recommendations given by the APC neurologist were compared to artificial-intelligence generated recommendations from AD1. Results: For each APC subject, an average of 334 data points (e.g., clinical history, labs, biometrics, cognition) were assessed compared with 1,029 data points assessed by Muses Labs for interpretation (sourced from genome, medical history – including comorbidities, medications, allergies, and vaccines – labs, and cognitive testing). The APC analyzed 58 blood biomarkers and 4 genetic risk factors, while Muses Labs processed an average of 107 blood biomarkers and w1,000 single nucleotide polymorphisms (SNPs). APC recommendations averaged 3.8 supplements/vitamins, 13.6 dietary modifications, and 8.4 lifestyle changes per subject, while AD1 averaged 16.8 supplements/ vitamins, 5.2 potential supplements/vitamins, 9.2 dietary modifications, 5.8 lifestyle changes, and 4.4 additional diagnostic tests. AD1 reports averaged 7,504.2 words per person, while APC interventions averaged 1,272.8 words, both excluding laboratory results. Conclusions: Given the complexity of emerging precision medicine interventions for AD prevention, novel and collaborative efforts using both clinical informatics and physician-based approaches may offer a more comprehensive set of potential therapeutic recommendations for those seeking to reduce risk. Using consistent software-based decision trees that utilize emerging evidence could facilitate the application of precision medicine in the clinic, expand the number of potential interventions, and make complex protocols readily accessible to a large number of physicians and patients worldwide. Further study is warranted to evaluate the longitudinal effectiveness of these augmented preventative approaches.
P2-585
BUILDING CAPACITY FOR DEMENTIA RISK REDUCTION: THE PREVENTING DEMENTIA MOOC
Maree Farrow, David D. Ward, Shannon Z. Klekociuk, James C. Vickers, University of Tasmania, Hobart, Australia. Contact e-mail: [email protected] Background: Evidence suggests that reducing population exposure to modifiable risk factors may prevent millions of dementia cases. Increased community education about this potential is needed to enable individuals, health professionals and policy makers to adopt dementia risk reduction strategies. The Preventing Dementia Massive Open Online Course (PD-MOOC) was developed by the University of Tasmania’s Wicking Centre as a public health initiative. The course aims to educate people with an interest in reducing their own risk of dementia, as well as those involved in providing services to others at risk, on the scientific basis of dementia risk reduction. Methods: The five-week PD-MOOC explores key modifiable risk factors, including those estimated to account for almost onethird of Alzheimer’s disease cases: diabetes, hypertension, obesity, physical inactivity, depression, smoking and low educational
P872
Poster Presentations: Monday, July 17, 2017
attainment. It also addresses the non-modifiable risk factors for dementia, myths about dementia risk and causes, and barriers and enablers of health-behaviour change. Information is presented using interviews with international experts, animated video material, infographics, and interactive discussion boards. Completion of the PD-MOOC was defined as a passing grade of 70% on 3 quizzes. Participants provided demographic information at enrolment and completed a feedback survey on completion. Results: The first offering of the PD-MOOC attracted 11,286 international participants (89% female; M age ¼ 49 years; 75% with post-school education; 68% Australian residents). 49% completed the MOOC and 2,149 completed the feedback survey. Most participants (>90%) agreed that the MOOC was easy to understand, provided useful information, and increased their motivation to reduce dementia risk, and that the content, quizzes and discussions helped their learning. 83% agreed the MOOC had an impact on their behaviour and lifestyle choices. Conclusions: The large enrolment and high completion rate for this first PD-MOOC highlight the scale of unmet need for quality, evidence-based and in-depth dementia risk reduction education. Participant feedback supports the appropriateness of this MOOC to increase knowledge and motivation, and its potential ability to modify dementia risk. Whether completion of the PD-MOOC is associated with prolonged engagement in activities associated with lower dementia risk will be explored in future research. P2-586
VISIT-TO-VISIT BLOOD PRESSURE VARIABILITY AND THE RISK OF DEMENTIA IN OLDER PEOPLE
Tessa van Middelaar1,2, Jan-Willem van Dalen2, Willem A. van Gool2, Bert-Jan H. van den Born2, Lonneke A. van Vught2, Eric P. Moll van Charante2, Edo Richard1,2, 1Radboud University Medical Center, Nijmegen, Netherlands; 2Academic Medical Center, Amsterdam, Netherlands. Contact e-mail: tessa. [email protected] Background: Blood pressure variability (BPV) is associated with ce-
rebrovascular damage. Whether it is associated with dementia is unclear. Our aim was to investigate whether visit-to-visit BPV is associated with incident all-cause dementia. Secondarily we studied the association with cognitive decline and cardiovascular disease (CVD). Methods: We included community-dwelling older people from the ‘Prevention of Dementia by Intensive Vascular Care’ (preDIVA) trial with three or more 2-yearly blood pressure (BP) measurements during 6-8 years follow-up. BPV was defined using coefficient of variation (CV; SD/mean 3 100) of systolic BP. Cognitive decline was assessed using the Mini-Mental State Examination (MMSE). CVD was defined as incident myocardial infarction or stroke. The association with dementia and CVD was assessed with a Cox proportional hazard regression adjusted for number of BP measurements, sociodemographic factors and cardiovascular risk factors. The association with cognition was assessed with a mixed-model analysis. Results: In 2305 participants (age, 74.262.5 year) systolic BP over all available visits was 150.1 mmHg (SD 13.6), yielding a CV of 9.0. After 6.4 year (SD 0.8) follow-up, 110 (4.8%) participants developed dementia and 140 (6.1%) incident CVD. BPV was not associated with increased risk of dementia (hazard ratio [HR] 1.02; 95% confidence interval [CI] 0.98-1.06). The highest quartile of BPV was associated with a stronger decline in MMSE (b -0.09, 95% CI -0.17 – -0.01). BPV was associated with more CVD (HR 1.07; 95% CI 1.04-1.11). Conclusions: Visit-to-visit BPV is not associated with incident all-cause dementia in older people, but is associated with cognitive decline and incident CVD.
P2-587
FACTORS ASSOCIATED WITH POOR PERFORMANCE OF MINI-MENTAL STATE EXAMINATION IN COMMUNITYDWELLING ELDERY KOREANS
Young Hun Yun1, Eun Jung Lee2, 1Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of South Korea; 2KimLee Clinic, Bucheon, Republic of South Korea. Contact e-mail: [email protected] Background: This study aimed to determine the associated factors with the cognitive function of elderly Korean population. Methods:
Data was collected in a single urban district-dwelling 13,275 Koreans over 60 years old from November 2013 to December 2016. Korean version of the Mini-mental State Exam (K-MMSE) was administrated to all subjects. We collected demographic variables from subjects and caregivers by questionnaire including age, sex, height, weight, level of education, past medical histories and habitual histories. The levels of cognition were divided into ‘normal’, ‘intermediate’, and ‘poor’ cognitive performance groups based on their K-MMSE scores adjusted. Multinomial logistic regression was used for the assessment of correlation between risk factors and the cognition levels. Results: Prevalence of intermediate group was estimated to be 9.1% and that of poor group was 14.3%. The subjects with older age (OR 1.06, 95% CI 1.05-1.07), stroke (OR 1.24, 95% CI 1.03-1.56) and smoking (OR 1.35, 95% CI 1.06-1.65) had higher risk for intermediate group while increased years of schooling was protective (OR 0.92, 95% CI 0.91-0.93). The risk for poor group was increased with older age (OR 1.09, 95% CI 1.08-1.1), stroke (OR 1.62, 95% CI (1.39-1.9), smoking (OR 1.20, 95% CI 1.03-1.42), diabetes mellitus (OR 1.23, 95% CI 1.09-1.35), alcohol drinking (OR 1.26, 95% CI 1.07-1.45) and underweight (OR 1.43, 95% CI 1.13-1.77). However, the subjects with female (OR 0.66, 95% CI 0.59-0.75), high educational attainment (OR 0.88, 95% CI 0.88-0.91) and Dyslipidemia (OR 0.73, 95% CI 0.69-0.85) had decreased risk for poor group. Vascular risk factors were not differently affected between both sexes. Among three age groups, the association between poor cognitive performance and previous stroke was higher in sixties than other age groups (OR 2.31, 95% CI 1.71-3.18). Conclusions: The associated factors with poor cognitive performance were older age, previous stroke, smoking, diabetes mellitus, alcohol drinking and underweight in community-dwelling elderly Koreans. The vascular risk factors for cognitive decline were not varied according to sex or age groups. This study could warrant a further prospective cohort to establish the risk factors for cognitive decline and dementia in Korean population.
P2-588
CASE STUDY OF A WELL-KNOWN SWEDISH VISUAL ARTIST SUFFERING FROM ALZHEIMER’S DISEASE
Axel Holmbom Larsen1, Lennart Minthon2, Elisabet Londos2, 1 Clinical Memory Research Unit, Malm€o, Sweden; 2Clinical Memory Research Unit, Dept of Clinical Sciences, Malm€o, Lund University, Malm€o, Sweden. Contact e-mail: axel.holmbom. [email protected] Background: Visual artistic creativity is an outcome of complex inter-
actions between large numbers of structures within the brain, such as cooperation within the occipital and temporal cortex as well as the ventral and dorsal visual stream and areas responsible for motor function and execution. Utilizing these complex interactions is necessary in order to produce art, create representative art and