- Email: [email protected]
Changes in cognition in relation to frailty in older Canadians
Poster Presentations P3 2 University of South Florida, Tampa, FL, USA. Contact e-mail: arnold. [email protected]
Background: On average, cognition declines with age, but more rapidly in some groups than in others. In individuals, cognition can even improve, although this is often viewed simply as diagnostic unreliability. Widely used models focus on a small number of outcomes, (e.g. worse /not worse, dead / alive). By contrast, multistate transition models allow simultaneous consideration of many outcomes - including mortality. Methods: We analyzed two, four, six and eight-year cognitive changes and mortality with a novel multistate model. Its performance is illustrated with standard risk factors in a cohort of Japanese Americans living in King County, The Kame Project (n¼1985). Cognitive states were defined by errors in the Cognitive Abilities Screening Instrument score. Successive cognitive states - from high cognition/low errors to impaired cognition/high errors - errors were grouped by 2’s, an analytically detectable interval. Transition probabilities were modeled using the Poisson model with the Poisson mean and mortality both dependent on the cognitive state, and covariates: age, sex, and APOE genotype. Results: After two years, the probability of improvement was 29.3% (95% CI¼27%-31.6%); the probability of remaining stable was 22.3% (20.1%24.4%); that of getting worse was 39.1% (36.6%-41.5%). The probability of death was 8.8% (7.4%-10.2%). After 8 years, the chance of dying was 24.4% (22.3%-26.5%), whereas the chance of cognitive worsening, stability and improvement did not change as much: 24.7% (22.5%-26.8%), 17.7% (15.8%-19.6%), and 33.2% (30.8%-35.5%) respectively. In multivariable analyses, age, sex and education were independently associated with cognitive changes, improvements were more likely among younger, more educated people and in women. Conclusions: A multistate transition model can estimate the impact of common covariates on the individual probabilities of cognitive improvement, stability decline and death. Especially with public health initiatives aimed at preventing dementia, such an approach can reveal novel patterns of change in response to interventions. P3-161
CHANGES IN COGNITION IN RELATION TO FRAILTY IN OLDER CANADIANS
Arnold B. Mitnitski, Nader Fallah, Kenneth Rockwood, Dalhousie University, Halifax, NS, Canada. Contact e-mail: [email protected] Background: With age, on average, people show decline in both cognition and in fitness, appreciated as increasing frailty. While frailty is recognized as a risk for dementia, it is less clear how the accumulation of general health deficits relates to the accumulation of cognitive deficits, although each has been identified separately as arising from structurally similar stochastic processes. Methods: Here, we analyzed how five-year changes in cognition (defined as the errors 0n the Modified Mini-Mental State Examination) are related to general health status (defined by the Frailty Index) in older Canadians (n ¼ 8,403). Cognitive change was analyzed using a novel multistate transition (stochastic) model the output of which was well fit (R-square >0.85) by a modified Poisson distribution. Results: In multivariable analyses, both age and frailty were independently associated with cognitive changes and the risk of death. Risk estimates varied by sex. Women had both a higher chance of staying alive (29% died, 95%CI¼27%-31%) and of showing improvement or stabilization (34%, 95%CI¼32%-36%), whereas fewer men survived (34% died, 95%CI¼32%-36%) and fewer showed stabilization or improvement (30%, 95%CI¼28%-32%). Frail people less often showed cognitive improvement or stabilization (20%, 95% CI¼18%-22%) compared to non-frail people, of whom 39% (95%¼37%-41%) did not deteriorate. Similarly, frail people were more likely to die (48%, 95%CI¼46%-50%) versus 20% (95% CI¼18%-22%) of non-frail people. By contrast, there was no difference in mortality by education level, but a greater chance of cognitive stabilization/ improvement for people with higher education. Among more educated people 35% improved or remained stable (95% CI¼33%-37%) than did less educated people (29%, 95%CI¼27%-31%). The overall probability of dying amongst higher educated people was 28% (95%CI¼26%-30%) versus 36% (95%CI¼34%-38%) in people with lower levels of education. Conclusions: Cognitive changes generally correlate with general health status. Men and women each show deleterious effects from frailty, but the profiles of relative risk expression differ between them.
P3-162
P391 PLASMA F2-ISOPROSTANE LEVEL DOES NOT PREDICT COGNITIVE FUNCTION IN NONDEMENTED ELDERLY: FINDINGS FROM THE HEALTH ABC STUDY
Alexandra J. Fiocco1, Karla Lindquist1, Alka Kanaya1, Tamara B. Harris2, Lew Kuller3, Caterina Rosano4, Suzanne Satterfield5, Eleanor M. Simonsick6, Kristine Yaffe1, 1University of California San Francisco, San Francisco, CA, USA; 2National Institute on Aging, Bethesda, MD, USA; 3University of Pittsburgh, Pittsburgh, PA, USA; 4Graduate School of Public Health, Pittsburgh, PA, USA; 5University of Tennessee Health Science Center, Memphis, TN, USA; 6National Institute on Aging, Baltimore, MD, USA. Contact e-mail: [email protected] Background: Oxidative stress may play an important role in the development of Alzheimer’s disease (AD). Recently, F2-isoprostanes (F2-IsoP) have gained attention as a reliable oxidation biomarker of aging. Several case-control studies suggest that patients with AD patients exhibit higher F2-IsoPs compared to healthy controls in cerebral spinal fluid (CSF). However, there are no epidemiological studies that have assessed the relationship between plasma F2-IsoP levels and longitudinal cognitive function in nondemented elders. Methods: We studied a biracial cohort of 726 non-demented elders between the ages of 70 and 79 years at baseline and followed them for 8 years. Baseline plasma F2-IsoP levels were measured in unthawed plasma samples by gas chromatography-mass spectrometry. Participants were grouped according to F2-IsoP tertile. Cognitive function was measured using the Digit Symbol Substitution test (DSST) at years 1, 5, and 8 and the Modified Mini-Mental State Exam (3MS) at years 1, 3, and 8. The association between F2-IsoP and cognitive function was analyzed using repeated measures random effects models, adjusting for age, race, gender, education, BMI and hypertension. Odds ratios were calculated (low F2-IsoP tertile as reference) to assess the association between F2-IsoP tertile and cognitive impairment (1 sd decline on the 3MS). Results: There was no significant association between F2-IsoP tertile and cognitive function, as measured by the DSST and 3MS, at baseline or on repeated measure 7-year change (ps>0.05). Further, no association was found between F2-IsoP tertile and risk of cognitive impairment over years: Mid- F2-IsoP OR¼0.93 (95% CI 0.57, 1.53), High-F2-IsoP OR¼0.96 (95% CI 0.57, 1.63) with low tertile as reference group. Conclusions: This was the first epidemiological study to assess the relationship between plasma F2-IsoP and cognitive decline in a diverse cohort of non-demented elders. Our findings do not support the use of F2IsoP plasma levels as a biomarker for cognitive aging. P3-163
PREVALENCE OF COGNITIVE IMPAIRMENT AND DEMENTIA IN A COHORT OF OLDEST OLD IN ` STUDY BRAZIL: THE PIETA
Paulo Caramelli1, Antonio L. Teixeira1, Maira T. Barbosa1, Ana Paula Santos1, Marcelo Pellizzaro1, Henrique C. Guimara˜es1, Roge´rio G. Beato1, B. Machado Joa˜o Carlos1, Hellen Marra1, Etelvina L. Santos1, Patrı´cia P. A. Fialho1, Thais H. Machado1, Viviane A. Carvalho1, Anne M. Koenig1, Mariana A. Almeida1, Simone R. Fonseca1, Cerise F. A. Coutinho1, Elisa Franc¸a1, Natali F. Dezontini1, Clarissa V. Moreira1, Debora P. Maia1, Mauro Q. Cunningham1, Emı´lia Sakurai2, 1Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil; 2School of Mathematics and Statistics, Federal University of Minas Gerais, Belo Horizonte, Brazil. Contact e-mail: [email protected] Background: Few data are available on the prevalence of cognitive impairment among the oldest-old population of developing countries. The goal of this study was to determine the prevalence of cognitive impairment no dementia (CIND) and dementia in a cohort of Brazilian oldest-old individuals and the associated sociodemographic and clinical variables. Methods: The study was conducted in the rural and urban areas of the city of Caete´, Minas Gerais state, Brazil. The city has 1,155 subjects aged 75 years or more (oldest-old) according to the 2007 Brazilian census. We aimed to evaluate at least 50% of these individuals. The selected random sample was submitted to a general personal and health questionnaire, the Mini-Mental State Examination, the Pfeffer Functional Activities Questionnaire, a brief cognitive
Background: On average, cognition declines with age, but more rapidly in some groups than in others. In individuals, cognition can even improve, although this is often viewed simply as diagnostic unreliability. Widely used models focus on a small number of outcomes, (e.g. worse /not worse, dead / alive). By contrast, multistate transition models allow simultaneous consideration of many outcomes - including mortality. Methods: We analyzed two, four, six and eight-year cognitive changes and mortality with a novel multistate model. Its performance is illustrated with standard risk factors in a cohort of Japanese Americans living in King County, The Kame Project (n¼1985). Cognitive states were defined by errors in the Cognitive Abilities Screening Instrument score. Successive cognitive states - from high cognition/low errors to impaired cognition/high errors - errors were grouped by 2’s, an analytically detectable interval. Transition probabilities were modeled using the Poisson model with the Poisson mean and mortality both dependent on the cognitive state, and covariates: age, sex, and APOE genotype. Results: After two years, the probability of improvement was 29.3% (95% CI¼27%-31.6%); the probability of remaining stable was 22.3% (20.1%24.4%); that of getting worse was 39.1% (36.6%-41.5%). The probability of death was 8.8% (7.4%-10.2%). After 8 years, the chance of dying was 24.4% (22.3%-26.5%), whereas the chance of cognitive worsening, stability and improvement did not change as much: 24.7% (22.5%-26.8%), 17.7% (15.8%-19.6%), and 33.2% (30.8%-35.5%) respectively. In multivariable analyses, age, sex and education were independently associated with cognitive changes, improvements were more likely among younger, more educated people and in women. Conclusions: A multistate transition model can estimate the impact of common covariates on the individual probabilities of cognitive improvement, stability decline and death. Especially with public health initiatives aimed at preventing dementia, such an approach can reveal novel patterns of change in response to interventions. P3-161
CHANGES IN COGNITION IN RELATION TO FRAILTY IN OLDER CANADIANS
Arnold B. Mitnitski, Nader Fallah, Kenneth Rockwood, Dalhousie University, Halifax, NS, Canada. Contact e-mail: [email protected] Background: With age, on average, people show decline in both cognition and in fitness, appreciated as increasing frailty. While frailty is recognized as a risk for dementia, it is less clear how the accumulation of general health deficits relates to the accumulation of cognitive deficits, although each has been identified separately as arising from structurally similar stochastic processes. Methods: Here, we analyzed how five-year changes in cognition (defined as the errors 0n the Modified Mini-Mental State Examination) are related to general health status (defined by the Frailty Index) in older Canadians (n ¼ 8,403). Cognitive change was analyzed using a novel multistate transition (stochastic) model the output of which was well fit (R-square >0.85) by a modified Poisson distribution. Results: In multivariable analyses, both age and frailty were independently associated with cognitive changes and the risk of death. Risk estimates varied by sex. Women had both a higher chance of staying alive (29% died, 95%CI¼27%-31%) and of showing improvement or stabilization (34%, 95%CI¼32%-36%), whereas fewer men survived (34% died, 95%CI¼32%-36%) and fewer showed stabilization or improvement (30%, 95%CI¼28%-32%). Frail people less often showed cognitive improvement or stabilization (20%, 95% CI¼18%-22%) compared to non-frail people, of whom 39% (95%¼37%-41%) did not deteriorate. Similarly, frail people were more likely to die (48%, 95%CI¼46%-50%) versus 20% (95% CI¼18%-22%) of non-frail people. By contrast, there was no difference in mortality by education level, but a greater chance of cognitive stabilization/ improvement for people with higher education. Among more educated people 35% improved or remained stable (95% CI¼33%-37%) than did less educated people (29%, 95%CI¼27%-31%). The overall probability of dying amongst higher educated people was 28% (95%CI¼26%-30%) versus 36% (95%CI¼34%-38%) in people with lower levels of education. Conclusions: Cognitive changes generally correlate with general health status. Men and women each show deleterious effects from frailty, but the profiles of relative risk expression differ between them.
P3-162
P391 PLASMA F2-ISOPROSTANE LEVEL DOES NOT PREDICT COGNITIVE FUNCTION IN NONDEMENTED ELDERLY: FINDINGS FROM THE HEALTH ABC STUDY
Alexandra J. Fiocco1, Karla Lindquist1, Alka Kanaya1, Tamara B. Harris2, Lew Kuller3, Caterina Rosano4, Suzanne Satterfield5, Eleanor M. Simonsick6, Kristine Yaffe1, 1University of California San Francisco, San Francisco, CA, USA; 2National Institute on Aging, Bethesda, MD, USA; 3University of Pittsburgh, Pittsburgh, PA, USA; 4Graduate School of Public Health, Pittsburgh, PA, USA; 5University of Tennessee Health Science Center, Memphis, TN, USA; 6National Institute on Aging, Baltimore, MD, USA. Contact e-mail: [email protected] Background: Oxidative stress may play an important role in the development of Alzheimer’s disease (AD). Recently, F2-isoprostanes (F2-IsoP) have gained attention as a reliable oxidation biomarker of aging. Several case-control studies suggest that patients with AD patients exhibit higher F2-IsoPs compared to healthy controls in cerebral spinal fluid (CSF). However, there are no epidemiological studies that have assessed the relationship between plasma F2-IsoP levels and longitudinal cognitive function in nondemented elders. Methods: We studied a biracial cohort of 726 non-demented elders between the ages of 70 and 79 years at baseline and followed them for 8 years. Baseline plasma F2-IsoP levels were measured in unthawed plasma samples by gas chromatography-mass spectrometry. Participants were grouped according to F2-IsoP tertile. Cognitive function was measured using the Digit Symbol Substitution test (DSST) at years 1, 5, and 8 and the Modified Mini-Mental State Exam (3MS) at years 1, 3, and 8. The association between F2-IsoP and cognitive function was analyzed using repeated measures random effects models, adjusting for age, race, gender, education, BMI and hypertension. Odds ratios were calculated (low F2-IsoP tertile as reference) to assess the association between F2-IsoP tertile and cognitive impairment (1 sd decline on the 3MS). Results: There was no significant association between F2-IsoP tertile and cognitive function, as measured by the DSST and 3MS, at baseline or on repeated measure 7-year change (ps>0.05). Further, no association was found between F2-IsoP tertile and risk of cognitive impairment over years: Mid- F2-IsoP OR¼0.93 (95% CI 0.57, 1.53), High-F2-IsoP OR¼0.96 (95% CI 0.57, 1.63) with low tertile as reference group. Conclusions: This was the first epidemiological study to assess the relationship between plasma F2-IsoP and cognitive decline in a diverse cohort of non-demented elders. Our findings do not support the use of F2IsoP plasma levels as a biomarker for cognitive aging. P3-163
PREVALENCE OF COGNITIVE IMPAIRMENT AND DEMENTIA IN A COHORT OF OLDEST OLD IN ` STUDY BRAZIL: THE PIETA
Paulo Caramelli1, Antonio L. Teixeira1, Maira T. Barbosa1, Ana Paula Santos1, Marcelo Pellizzaro1, Henrique C. Guimara˜es1, Roge´rio G. Beato1, B. Machado Joa˜o Carlos1, Hellen Marra1, Etelvina L. Santos1, Patrı´cia P. A. Fialho1, Thais H. Machado1, Viviane A. Carvalho1, Anne M. Koenig1, Mariana A. Almeida1, Simone R. Fonseca1, Cerise F. A. Coutinho1, Elisa Franc¸a1, Natali F. Dezontini1, Clarissa V. Moreira1, Debora P. Maia1, Mauro Q. Cunningham1, Emı´lia Sakurai2, 1Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil; 2School of Mathematics and Statistics, Federal University of Minas Gerais, Belo Horizonte, Brazil. Contact e-mail: [email protected] Background: Few data are available on the prevalence of cognitive impairment among the oldest-old population of developing countries. The goal of this study was to determine the prevalence of cognitive impairment no dementia (CIND) and dementia in a cohort of Brazilian oldest-old individuals and the associated sociodemographic and clinical variables. Methods: The study was conducted in the rural and urban areas of the city of Caete´, Minas Gerais state, Brazil. The city has 1,155 subjects aged 75 years or more (oldest-old) according to the 2007 Brazilian census. We aimed to evaluate at least 50% of these individuals. The selected random sample was submitted to a general personal and health questionnaire, the Mini-Mental State Examination, the Pfeffer Functional Activities Questionnaire, a brief cognitive