- Email: [email protected]
Does multilingualism reduce the risk or delay the onset of dementia?: Findings from the Nun Study
P504
Poster Presentations: P3
and follow up. Conclusions: Results provide longitudinal evidence of more rapid cognitive decline in subjects with early-onset AD.
P3-148
DOES A HISTORY OF MIGRAINES INCREASE THE RISK OF ALZHEIMER’S DISEASE OR VASCULAR DEMENTIA?
Rebecca Morton, Suzanne Tyas, University of Waterloo, Waterloo, Ontario, Canada. Background: Dementia is the most co mmon neurological disease in older adults, while headaches are the most common neurological disorder across all ages. Migraines are a common form of headache disorders that affect millions of people worldwide. Both neurological disorders—dementia and migraines—cause significant impairment for the individual, as well as substantial economic impact on society. The relationship between migraines and dementia, including Alzheimer’s disease (AD) and vascular dementia (VaD), has not yet been thoroughly explored. Methods: Analyses were based on 716 participants 65+ years from the Manitoba Study of Health and Aging in Canada. Participants screened cognitively intact at baseline, had complete data on migraine history and all covariates at baseline, and were assessed for cognitive outcomes five years later according to standard diagnostic criteria (dementia: DSM-IV; AD: NINCDS-ADRDA; VaD: NINDSAIREN). The exposure (history of migraines), confounding (age, sex, education, depression) and intervening (hypertension, diabetes, stroke, myocardial infarction and other heart conditions) variables were based on self-report, and their association with dementia, AD and VaD was assessed using multiple logistic regression models. Results: Individuals with a history of migraines were almost three times more likely (odds ratio [OR]¼2.97; 95% CI¼1.25-6.61) to develop dementia and approximately four times more likely (OR¼4.22; 95% CI: 1.59-10.42) to develop AD compared to those without a history of migraines. A history of migraines was not significantly associated with VaD either before (OR¼1.83; 95% CI: 0.39-8.52) or after (OR¼1.52; 95% CI: 0.20-7.23) adjustment for confounding and intervening variables. Conclusions: Migraines are a significant risk factor for AD. In this study, the relationship between migraines and overall dementia was apparently driven by the strong relationship between migraines and AD. Despite the vascular mechanisms involved in migraine biology, a history of migraines was not a significant risk factor for VaD. Recognition of the long-term detrimental consequences of migraines for AD has implications for the importance of migraine prevention and management as well as for our understanding of AD etiology.
P3-149
DOES MULTILINGUALISM REDUCE THE RISK OR DELAY THE ONSET OF DEMENTIA?: FINDINGS FROM THE NUN STUDY
Erica Hack1, Suzanne Tyas1, J Dubin1, Myra Fernandez1, Kathryn Riley2, University of Waterloo, Waterloo, Ontario, Canada; 2University of Kentucky, Lexington, Kentucky, United States.
1
Background: The ability to speak multiple languages has been associated with increased executive function and may thus help to resist agerelated cognitive decline. The objective of this study was to assess whether multilingualism was associated with reduced risk or delayed onset of dementia. Methods: Analyses were based on data from the Nun Study, a longitudinal study of aging in religious sisters aged 75+ years living in the United States. Dementia likelihood was assessed in 325 participants using discrete-time survival analyses; subsample analyses (n¼106) examined the influence of linguistic ability (idea density measured from autobiographical essays). Multilingualism was selfreported; dementia was diagnosed according to DSM-IV criteria. Results: Age at onset of dementia was not associated with multilingualism: monolingual participants were no more likely to develop dementia
in earlier time periods than multilinguals. When adjusted for significant covariates (baseline age and apolipoprotein E-ε4 allele [APOE-ε4] status), participants speaking 4+ languages were significantly less likely to develop dementia than monolingual participants (conditional odds ratio [OR] ¼ 0.14; 95% CI ¼ 0.01-0.66); those speaking two or three languages did not differ in dementia risk from monolinguals. An interaction of multilingualism with baseline age and ApoE-ε4 status was observed: the dementia risk in participants 85+ years with an APOEε4 allele who spoke 4+ languages was similar to that of participants <80 years without an APOE-ε4 allele who spoke one language. In models including idea density and adjusted for significant covariates (baseline age, APOE-ε4 status and education), a suggestive although nonsignificant decrease in risk was noted for participants speaking 4+ languages (conditional OR ¼ 0.53; 95% CI ¼ 0.06-4.91). Conclusions: Multilingualism did not delay onset of dementia. While a doseresponse trend of decreasing dementia risk with increasing number of languages spoken was not observed, speaking 4+ languages significantly decreased the risk of dementia compared to speaking one language; this association weakened in the idea density subsample. The presence of an APOE-ε4 allele and low idea density had a strong and consistent significant association with dementia risk and its relationship to multilingualism. The role of these variables in the relationship between multilingualism and dementia warrants further exploration.
P3-150
INFLUENCE OF VASCULAR RISK FACTORS ON THE EVOLUTION OF ALZHEIMER’S DISEASE
Takashi Yamazaki1, Daiki Takano2, Mayumi Watanabe2, Ken Nagata2, 1Department of Neurology, Research Institute for Brain and Vessels, Akita, Japan; 2Research Institute for Brain and Blood, Akita, Japan. Background: Although hypertension, diabetes, dyslipidemia and congestive heart failure are now considered as vascular risk factors (VRFs) of Alzheimer’s disease (AD), it is still unclear that the VRFs may influence on the effect of treatment with acetylcholine esterase inhibitors in AD patients. We investigated the influence of VRFs on the course of cognitive decline in AD patients. Methods: The present study was based on 133 patients (44 men and 89 women) who were diagnosed as having a probable AD according to the NINCDS-ADRDA criteria. Their mean age was 76.066.1 years. All patients were on donepezil hydrochloride and underwent laboratory testings, MRI and neuropsychological evaluation including MMSE. In addition to the VRFs, use of statins, and angiotensin receptor antagonists (ARB), smoking habit and alcohol consumption were also analyzed. The evolution of cognitive function was evaluated by comparing the MMSE scores between the baseline and 2-year follow-up. According to the difference in MMSE scores, the patients were classified into 2 groups: those that showed adeterioration in MMSE score, and those whose MMSE score was unchanged or improved. The influence of VRFs was analyzed statistically in relation to the evolution in MMSE score. Results: 92 patients (non-responders) showed a deterioration in MMSE score, whereas MMSE score was stable in 41 patients (responders). The baseline MMSE score (P<0.01) and body mass index (P<0.05) negatively correlated with the clinical deterioration, and the statin use correlated positively with the stable course. Possession of VRFs did not significantly influence on the effect of donepezil hydrochloride, and this might be partly due to the treatment with statin and/ or ARB in our subjects. The baseline MMSE score positively correlated with the alcohol consumption (P<0.05). Conclusions: The present results indicate that good nutritional status in addition to the efficient management of VRFs may contribute to the stabilization of cognitive function in elderly AD patients who are on the treatment with AChEI.
Poster Presentations: P3
and follow up. Conclusions: Results provide longitudinal evidence of more rapid cognitive decline in subjects with early-onset AD.
P3-148
DOES A HISTORY OF MIGRAINES INCREASE THE RISK OF ALZHEIMER’S DISEASE OR VASCULAR DEMENTIA?
Rebecca Morton, Suzanne Tyas, University of Waterloo, Waterloo, Ontario, Canada. Background: Dementia is the most co mmon neurological disease in older adults, while headaches are the most common neurological disorder across all ages. Migraines are a common form of headache disorders that affect millions of people worldwide. Both neurological disorders—dementia and migraines—cause significant impairment for the individual, as well as substantial economic impact on society. The relationship between migraines and dementia, including Alzheimer’s disease (AD) and vascular dementia (VaD), has not yet been thoroughly explored. Methods: Analyses were based on 716 participants 65+ years from the Manitoba Study of Health and Aging in Canada. Participants screened cognitively intact at baseline, had complete data on migraine history and all covariates at baseline, and were assessed for cognitive outcomes five years later according to standard diagnostic criteria (dementia: DSM-IV; AD: NINCDS-ADRDA; VaD: NINDSAIREN). The exposure (history of migraines), confounding (age, sex, education, depression) and intervening (hypertension, diabetes, stroke, myocardial infarction and other heart conditions) variables were based on self-report, and their association with dementia, AD and VaD was assessed using multiple logistic regression models. Results: Individuals with a history of migraines were almost three times more likely (odds ratio [OR]¼2.97; 95% CI¼1.25-6.61) to develop dementia and approximately four times more likely (OR¼4.22; 95% CI: 1.59-10.42) to develop AD compared to those without a history of migraines. A history of migraines was not significantly associated with VaD either before (OR¼1.83; 95% CI: 0.39-8.52) or after (OR¼1.52; 95% CI: 0.20-7.23) adjustment for confounding and intervening variables. Conclusions: Migraines are a significant risk factor for AD. In this study, the relationship between migraines and overall dementia was apparently driven by the strong relationship between migraines and AD. Despite the vascular mechanisms involved in migraine biology, a history of migraines was not a significant risk factor for VaD. Recognition of the long-term detrimental consequences of migraines for AD has implications for the importance of migraine prevention and management as well as for our understanding of AD etiology.
P3-149
DOES MULTILINGUALISM REDUCE THE RISK OR DELAY THE ONSET OF DEMENTIA?: FINDINGS FROM THE NUN STUDY
Erica Hack1, Suzanne Tyas1, J Dubin1, Myra Fernandez1, Kathryn Riley2, University of Waterloo, Waterloo, Ontario, Canada; 2University of Kentucky, Lexington, Kentucky, United States.
1
Background: The ability to speak multiple languages has been associated with increased executive function and may thus help to resist agerelated cognitive decline. The objective of this study was to assess whether multilingualism was associated with reduced risk or delayed onset of dementia. Methods: Analyses were based on data from the Nun Study, a longitudinal study of aging in religious sisters aged 75+ years living in the United States. Dementia likelihood was assessed in 325 participants using discrete-time survival analyses; subsample analyses (n¼106) examined the influence of linguistic ability (idea density measured from autobiographical essays). Multilingualism was selfreported; dementia was diagnosed according to DSM-IV criteria. Results: Age at onset of dementia was not associated with multilingualism: monolingual participants were no more likely to develop dementia
in earlier time periods than multilinguals. When adjusted for significant covariates (baseline age and apolipoprotein E-ε4 allele [APOE-ε4] status), participants speaking 4+ languages were significantly less likely to develop dementia than monolingual participants (conditional odds ratio [OR] ¼ 0.14; 95% CI ¼ 0.01-0.66); those speaking two or three languages did not differ in dementia risk from monolinguals. An interaction of multilingualism with baseline age and ApoE-ε4 status was observed: the dementia risk in participants 85+ years with an APOEε4 allele who spoke 4+ languages was similar to that of participants <80 years without an APOE-ε4 allele who spoke one language. In models including idea density and adjusted for significant covariates (baseline age, APOE-ε4 status and education), a suggestive although nonsignificant decrease in risk was noted for participants speaking 4+ languages (conditional OR ¼ 0.53; 95% CI ¼ 0.06-4.91). Conclusions: Multilingualism did not delay onset of dementia. While a doseresponse trend of decreasing dementia risk with increasing number of languages spoken was not observed, speaking 4+ languages significantly decreased the risk of dementia compared to speaking one language; this association weakened in the idea density subsample. The presence of an APOE-ε4 allele and low idea density had a strong and consistent significant association with dementia risk and its relationship to multilingualism. The role of these variables in the relationship between multilingualism and dementia warrants further exploration.
P3-150
INFLUENCE OF VASCULAR RISK FACTORS ON THE EVOLUTION OF ALZHEIMER’S DISEASE
Takashi Yamazaki1, Daiki Takano2, Mayumi Watanabe2, Ken Nagata2, 1Department of Neurology, Research Institute for Brain and Vessels, Akita, Japan; 2Research Institute for Brain and Blood, Akita, Japan. Background: Although hypertension, diabetes, dyslipidemia and congestive heart failure are now considered as vascular risk factors (VRFs) of Alzheimer’s disease (AD), it is still unclear that the VRFs may influence on the effect of treatment with acetylcholine esterase inhibitors in AD patients. We investigated the influence of VRFs on the course of cognitive decline in AD patients. Methods: The present study was based on 133 patients (44 men and 89 women) who were diagnosed as having a probable AD according to the NINCDS-ADRDA criteria. Their mean age was 76.066.1 years. All patients were on donepezil hydrochloride and underwent laboratory testings, MRI and neuropsychological evaluation including MMSE. In addition to the VRFs, use of statins, and angiotensin receptor antagonists (ARB), smoking habit and alcohol consumption were also analyzed. The evolution of cognitive function was evaluated by comparing the MMSE scores between the baseline and 2-year follow-up. According to the difference in MMSE scores, the patients were classified into 2 groups: those that showed adeterioration in MMSE score, and those whose MMSE score was unchanged or improved. The influence of VRFs was analyzed statistically in relation to the evolution in MMSE score. Results: 92 patients (non-responders) showed a deterioration in MMSE score, whereas MMSE score was stable in 41 patients (responders). The baseline MMSE score (P<0.01) and body mass index (P<0.05) negatively correlated with the clinical deterioration, and the statin use correlated positively with the stable course. Possession of VRFs did not significantly influence on the effect of donepezil hydrochloride, and this might be partly due to the treatment with statin and/ or ARB in our subjects. The baseline MMSE score positively correlated with the alcohol consumption (P<0.05). Conclusions: The present results indicate that good nutritional status in addition to the efficient management of VRFs may contribute to the stabilization of cognitive function in elderly AD patients who are on the treatment with AChEI.