- Email: [email protected]
COHORT STUDIES HAVE A ROLE TO PLAY IN DEMENTIA RESEARCH
Oral Sessions: O2-11: Epidemiology: New Approaches in Collecting and Analyzing Data
308 participants (8.5%) became demented between fourth and fifth study round. Trajectories of decline in BADL, IADL, and MMSE were significantly stronger in persons who developed dementia. Among dementia subtypes, trajectories of decline were stronger in IADL and MMSE for Alzheimer’s disease, in BADL and IADL for vascular dementia, and in BADL, IADL, and MMSE for Parkinson’s disease dementia. For participants developing dementia, decline in BADL was linear, while decline in IADL and MMSE followed a quadratic relation (Figure). When excluding data from the fifth study round, only difference in trajectory of IADLdecline between incident demented and dementia-free participants became non-significant. Conclusions: Our findings demonstrate that not only cognitive but also daily functioning starts to decline already early in the process towards dementia. However, interestingly, trajectories of decline in cognitive and daily functioning do differ strongly among different subtypes of dementia.
P189
are a variety of more detailed measures used to assess cognitive function. The number of cohorts able to look at some forms of dementia is small. Many cohorts include blood samples and collection of imaging data is becoming more feasible in studies of people living in the community. Conclusions: There is considerable scope to exploit existing cohorts but it would be useful to harmonise measures to a greater extent to facilitate analysis using multiple cohorts. To maximise use of existing data and fill in the gaps researchers should build on the coordination and collaboration that is promoted by the JPND among others.
O2-11-04
USE OF AUTOMATED PHARMACY DATA TO EXAMINE CUMULATIVE MEDICATION EXPOSURES AND DEMENTIA: THE ADULT CHANGES IN THOUGHT STUDY (ACT)
Shelly L. Gray1, Sascha Dublin2, Melissa Anderson2, Onchee Yu2, Rod Walker2, Rebecca A. Hubbard2, Paul K. Crane1, Eric Berg Larson2, 1 University of Washington, Seattle, Washington, United States; 2Group Health Research Institute, Seattle, Washington, United States. Contact e-mail: [email protected]
Figure. Trajectories of decline in BADL, IADL, and MMSE before diagnosis of dementia. Higher BADL and IADL reflect worse daily functioning. Black dots represent the reference of persons remaining dementia-free. White dots represents persons who were incident demented at the fifth study round (last dot), with error bars for the 95% confidence intervals of effect sizes. O2-11-03
Background: Automated pharmacy data facilitate s detailed investigations of associations between long-term medication use and dementia outcomes. Several medication classes have been associated with increased risk for acute cognitive deficits and dementia. We used extensive pharmacy data to determine whether high cumulative exposure to anticholinergic medications, benzodiazepines and opioids was associated with greater dementia risk. Methods: Analyses included 3,434 ACT study participants with 10 years of Group Health enrollment prior to study entry to ensure sufficient exposure data. Medication exposures were defined from automated pharmacy data. We defined cumulative exposure as the total standardized daily dose of each medication class dispensed in the past 10 years (see Table footnotes). We excluded the most recent 1 year to exclude use related to prodromal symptoms. Outcomes were DSM-IV all-cause dementia and NINCDSADRDA possible or probable Alzheimer’s disease (AD). Cox regression models were used with cumulative exposures as time-varying variables. We assessed medication exposure categorically as well as continuously using cubic splines. All models adjusted for demographic and behavioral
COHORT STUDIES HAVE A ROLE TO PLAY IN DEMENTIA RESEARCH
Elizabeth Breeze1, Nicola Jean Hart1, Dag Aarsland2, Catherine Moody3, Carol Brayne4, 1Alzheimer’s Society, London, United Kingdom; 2Karolinska Institutet, Stavanger, Norway; 3UK Medical Research Council on behalf of JPND, London, United Kingdom; 4University of Cambridge, Cambridge, United Kingdom. Contact e-mail: [email protected] Background: To reduce the burden of dementias on societies we need to know about modifiable risk factors, pathways to progression, and more about the services people receive and how well they function in the community. Much of this information can be researched by means of observational (i.e. non-experimental) longitudinal studies. Methods: Longitudinal studies of the general population in Europe were identified that could contribute to dementia research; the scoping project assessed gaps in information available and methodological problems in using information to answer research questions. Results: The details of 158 cohort studies were examined as part of scoping exercises for the Alzheimer’s Society and EU Joint Programme Neurodegenerative Disease (JPND) research initiative. Between them they covered a wide range of ages and included a wealth of information on lifestyles and health and socioeconomic factors. The cohorts covered people born throughout the 20 th century and some new birth cohorts that are in planning or progress. There was no gender predominance. Gaps identified included low geographical coverage of eastern Europe, insufficient ethnic variation, and not many studies enabling inter-generational research. The MMSE is the most common instrument used in the studies whereas there
Figure 1. Hazard ratios (HR) for the association of all-cause dementia with 10 year cumulative exposure to anticholinergic medicaitons using cubic splines (green). The black bars indicate the HR of the model using categorical exposure (no use, 1-90 TSD, 91-365 TSD, 365-1095 TSD, >1095 TSD)
308 participants (8.5%) became demented between fourth and fifth study round. Trajectories of decline in BADL, IADL, and MMSE were significantly stronger in persons who developed dementia. Among dementia subtypes, trajectories of decline were stronger in IADL and MMSE for Alzheimer’s disease, in BADL and IADL for vascular dementia, and in BADL, IADL, and MMSE for Parkinson’s disease dementia. For participants developing dementia, decline in BADL was linear, while decline in IADL and MMSE followed a quadratic relation (Figure). When excluding data from the fifth study round, only difference in trajectory of IADLdecline between incident demented and dementia-free participants became non-significant. Conclusions: Our findings demonstrate that not only cognitive but also daily functioning starts to decline already early in the process towards dementia. However, interestingly, trajectories of decline in cognitive and daily functioning do differ strongly among different subtypes of dementia.
P189
are a variety of more detailed measures used to assess cognitive function. The number of cohorts able to look at some forms of dementia is small. Many cohorts include blood samples and collection of imaging data is becoming more feasible in studies of people living in the community. Conclusions: There is considerable scope to exploit existing cohorts but it would be useful to harmonise measures to a greater extent to facilitate analysis using multiple cohorts. To maximise use of existing data and fill in the gaps researchers should build on the coordination and collaboration that is promoted by the JPND among others.
O2-11-04
USE OF AUTOMATED PHARMACY DATA TO EXAMINE CUMULATIVE MEDICATION EXPOSURES AND DEMENTIA: THE ADULT CHANGES IN THOUGHT STUDY (ACT)
Shelly L. Gray1, Sascha Dublin2, Melissa Anderson2, Onchee Yu2, Rod Walker2, Rebecca A. Hubbard2, Paul K. Crane1, Eric Berg Larson2, 1 University of Washington, Seattle, Washington, United States; 2Group Health Research Institute, Seattle, Washington, United States. Contact e-mail: [email protected]
Figure. Trajectories of decline in BADL, IADL, and MMSE before diagnosis of dementia. Higher BADL and IADL reflect worse daily functioning. Black dots represent the reference of persons remaining dementia-free. White dots represents persons who were incident demented at the fifth study round (last dot), with error bars for the 95% confidence intervals of effect sizes. O2-11-03
Background: Automated pharmacy data facilitate s detailed investigations of associations between long-term medication use and dementia outcomes. Several medication classes have been associated with increased risk for acute cognitive deficits and dementia. We used extensive pharmacy data to determine whether high cumulative exposure to anticholinergic medications, benzodiazepines and opioids was associated with greater dementia risk. Methods: Analyses included 3,434 ACT study participants with 10 years of Group Health enrollment prior to study entry to ensure sufficient exposure data. Medication exposures were defined from automated pharmacy data. We defined cumulative exposure as the total standardized daily dose of each medication class dispensed in the past 10 years (see Table footnotes). We excluded the most recent 1 year to exclude use related to prodromal symptoms. Outcomes were DSM-IV all-cause dementia and NINCDSADRDA possible or probable Alzheimer’s disease (AD). Cox regression models were used with cumulative exposures as time-varying variables. We assessed medication exposure categorically as well as continuously using cubic splines. All models adjusted for demographic and behavioral
COHORT STUDIES HAVE A ROLE TO PLAY IN DEMENTIA RESEARCH
Elizabeth Breeze1, Nicola Jean Hart1, Dag Aarsland2, Catherine Moody3, Carol Brayne4, 1Alzheimer’s Society, London, United Kingdom; 2Karolinska Institutet, Stavanger, Norway; 3UK Medical Research Council on behalf of JPND, London, United Kingdom; 4University of Cambridge, Cambridge, United Kingdom. Contact e-mail: [email protected] Background: To reduce the burden of dementias on societies we need to know about modifiable risk factors, pathways to progression, and more about the services people receive and how well they function in the community. Much of this information can be researched by means of observational (i.e. non-experimental) longitudinal studies. Methods: Longitudinal studies of the general population in Europe were identified that could contribute to dementia research; the scoping project assessed gaps in information available and methodological problems in using information to answer research questions. Results: The details of 158 cohort studies were examined as part of scoping exercises for the Alzheimer’s Society and EU Joint Programme Neurodegenerative Disease (JPND) research initiative. Between them they covered a wide range of ages and included a wealth of information on lifestyles and health and socioeconomic factors. The cohorts covered people born throughout the 20 th century and some new birth cohorts that are in planning or progress. There was no gender predominance. Gaps identified included low geographical coverage of eastern Europe, insufficient ethnic variation, and not many studies enabling inter-generational research. The MMSE is the most common instrument used in the studies whereas there
Figure 1. Hazard ratios (HR) for the association of all-cause dementia with 10 year cumulative exposure to anticholinergic medicaitons using cubic splines (green). The black bars indicate the HR of the model using categorical exposure (no use, 1-90 TSD, 91-365 TSD, 365-1095 TSD, >1095 TSD)