- Email: [email protected]
DUAL-TASK WALKING AS A PREDICTOR FOR LATER COGNITIVE IMPAIRMENT
Poster Presentations: Wednesday, July 19, 2017 Background: The disclosure of results from genetic (e.g., APOE) and non-genetic (e.g., amyloid or tau) biomarker testing for Alzheimer’s disease (AD) raise similar concerns regarding discrimination and stigmatization. Legal and ethical models to guide the attainment and disclosure of such AD biomarker information are needed to inform best practices in both research and clinical settings. Methods: Data on legal standards were collected and analyzed in all 50 states and the District of Columbia using empirical legal methods proposed by Tremper et al. These methods implement a four-step process of gathering, organizing, interpreting, and applying legal sources to a research question: Do current legal standards provide protections against discrimination based on genetic or non-genetic biomarker status? Additionally, Federal legislation, regulations, and case law data were collected and analyzed to evaluate whether Federal standards would provide privacy or antidiscrimination protections. Results: Data collected in all 50 states reflect privacy or anti-discrimination protections specific to individuals who learn of genetic information. An analysis of this data, state by state, consistently revealed that genetic policies designed to provide privacy or anti-discrimination protections did so by applying a definition of genetic information. Amyloid and tau biomarkers are not, by definition, genetic information and not protected by genetic information policies. An additional analysis of state and federal law found that current legal standards do not provide protections to individuals who learn their non-biomarker information, with the potential exception of “preexisting condition” protections for health insurance within the Affordable Care Act (ACA). However, a review of recent proposals to repeal the ACA would challenge these results. Conclusions: Legal and ethical issues that arise in disclosing non-genetic and genetic biomarkers must be evaluated separately. Current legal standards limit protections to individuals who learn of their genetic risk for conditions like AD. These protections do not extend to non-genetic biomarkers of disease, and this distinction should be clearly explaining to individuals who are contemplating the pursuit of biomarker testing for AD. Additionally, the potential repeal of the ACA may have dramatic consequences for disclosure of biomarker information, whether genetic or non-genetic in nature.
P4-331
ARE MEMBERS OF UNDERREPRESENTED GROUPS REALLY LESS LIKELY TO PARTICIPATE IN BIOMARKER STUDIES REQUESTING BLOOD OR CSF ? 1
2 1
Dorothy Farrar Edwards , Jennifer Dykema , Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 2University of Wisconsin Survey Center, Madison, WI, USA. Contact e-mail: [email protected] Background: Information derived from biomarkers improves detec-
tion of AD pathology years before symptoms appear. Despite known contributions of biomarkers to AD research, a major drawback is the willingness of participants to undergo a lumbar puncture (LP). Data on factors affecting participation in LP studies are limited. We examined effects of socio-demographic variables and concerns related to trust in medical research on expressed likelihood to participate in research involving blood or CSF donation. Methods: Item responses to a comprehensive survey questionnaire from a diverse sample of 410 adults (mean age¼44.7, SD¼16.7) were used in the analysis. The sample included 25.6% African Americans, 24.4% Latinos, 24.4% American Indians, 24.6% Whites. The likelihood of providing blood or CSF samples was
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rated using a 5 pt scale ranging from “Very Likely “to “Very Unlikely”. Chi Square analyses evaluated associations of ethnic/racial background, trust in medical researchers, concerns about physical pain and infection, having a family member with AD, age, and gender on likelihood of providing blood or CSF samples. Results: There was no significant association between ethnicity/race and likelihood to provide blood samples (p¼0.027), 61 % of respondents were “very or somewhat likely” to provide blood. In contrast, only 17 % of the sample was “very or somewhat likely” to provide CSF and associations between ethnicity/race and likelihood to provide CSF approached significance (p¼0.06). Concern about pain and trust (p¼0.000) in medical researchers (p¼0.000) decreased likelihood to provide CSF. Respondents more willing to provide blood were also more likely to provide CSF (p¼0.00). Younger respondents were less willing to provide CSF than older respondents (p¼0.030); Latinos expressed greater likelihood to participate in CSF studies than Whites (p¼0.017). Respondents with higher educational levels were less likely to provide CSF samples than respondents with lower education (p¼0.016). Having a family member with AD did not influence likelihood to provide blood or CSF. Conclusions: Although overall willingness to provide CSF was low, we found interesting and unexpected variations among racial/ethnic groups. Results suggest common and group specific barriers to LP studies. These issues that can inform tailored recruitment strategies designed to increase the propensity of CSF donation.
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P4-335
DUAL-TASK WALKING AS A PREDICTOR FOR LATER COGNITIVE IMPAIRMENT
Andrea L. Rosso1, Andrea L. Metti1, Neelesh K. Nadkarni1, Kristine Yaffe2, Lenore J. Launer3, Caterina Rosano1, 1University of Pittsburgh, Pittsburgh, PA, USA; 2University of California San Francisco, San Francisco, CA, USA; 3National Institute on Aging, Bethesda, MD, USA. Contact e-mail: [email protected] Background: Early identification of those most at risk for dementia is a
growing priority. The ability to walk while performing a cognitive task (i.e. dual-task walking) is impaired in adults with mild cognitive impairment (MCI) or dementia. Poorer dual-task performance may indicate underlying neuropathology and higher risk for dementia. However, no studies have assessed the longitudinal association between poorer dual-task walking, markers of neuropathology, and risk of dementia. Methods: We analyzed longitudinal data in older adults with Modified Mini-Mental State scores 80 (n¼76; mean age¼ 78, 51% female, 33% black) who walked with and without a simultaneous visual-spatial task. Dual-task cost was calculated as change in gait speed from single-task to dual-task walking as a percentage of single-task gait speed. Participants underwent magnetic resonance imaging (MRI) in years 4 and 8 with cognitive adjudication in year 8. Grey matter volume of right and left hippocampus and annualized change in hippocampal volume were calculated from MRI. Cognitive impairment was defined as MCI or dementia at adjudication. Odds ratios (OR) and 95% confidence intervals were calculated
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Poster Presentations: Wednesday, July 19, 2017
as risk for cognitive impairment based on dual-task cost and adjusted for age, race, sex, and education. Additional adjustment by change in hippocampal volumes was conducted. Results: After 8 years, 40/76 participants were cognitively impaired (53%). Higher dual-task cost (e.g. greater decline in speed with addition of visual-spatial task) was associated with greater odds of cognitive impairment at 8 years, both before (OR per 1% increase in dual task cost¼1.08 (1.01, 1.15)) and after (OR¼1.08 (1.01, 1.16)) adjustment for demographics. Greater annualized decline in gray matter volume attenuated the association of dual task cost with cognitive impairment for both left (OR¼1.05 (0.85, 1.28)) and right (OR¼1.01 (0.94, 1.09)) hippocampus. Conclusions: In this group of high functioning older adults, greater declines in gait speed while dual-tasking predicted greater risk for cognitive impairment 8 years later. Faster hippocampal atrophy may be an important neurobiological correlate that could explain this association. Dual-task walking may serve as a stress test on central nervous system resources and could provide an early clinical indicator for increased dementia risk.
P4-336
ILLITERACY AND DYSLIPIDEMIA: RISK FACTORS FOR ALZHEIMER’S DISEASE, BUT MARKERS OF BETTER CLINICAL EVOLUTION?
Norberto Anizio Ferreira Frota1,2, Fabricio Oliveira Lima1,2, Vanessa Lauana Lima Silva2, Gisele Collyer Alves1, Mariana Rabelo de Brito2, Flavia Timb o Albuquerque2, Andreia Braga Mota2, Yasmin Costa e Silva2, Larissa Chagas Correa2, Lorena Cherida Alves Vidal2, Inessa Carvalho de Queiroz2, 1Hospital Geral de Fortaleza, Fortaleza, Brazil; 2Unifor, Fortaleza, Brazil. Contact e-mail: [email protected]
P4-337
STRONGER ASSOCIATION BETWEEN TYPE 2 DIABETES AND COGNITION OVER TIME
Patrick Stuchlik1, Vivian Fonseca1, Owen T. Carmichael2, Wade Gunn1, Lydia Bazzano1, 1Tulane University, New Orleans, LA, USA; 2Pennington Biomedical Research Center, Baton Rouge, LA, USA. Contact e-mail: [email protected] Background: Diabetes mellitus has been shown to be adversely associ-
ated with cognition; this association has been consistent for decades. However, it is unclear if the magnitude of this association has been affected by the rising burdens of both diabetes and cognitive impairment. Methods: Using publicly available data from the National Health and Nutrition Examination Survey (NHANES), we investigated the association between diabetes (categorized as “diabetic” when HbA1c was 6.5% or greater, “prediabetic” when HbA1c was 5.7% to 6.4%, and “non-diabetic” otherwise) and cognitive function (standardized to z-scores) at two time points. Results: Survey-weighted linear regression indicated stepwise poorer diabetes status (e.g. from “prediabetic” to “diabetic”) was associated with a decrease of 0.09 units (p<0.05) in cognitive function in NHANES III, while the same was associated with a decrease of 0.21 units (p<0.001) in NHANES 1999-2000. Multivariable survey-weighted regression, adjusted for systolic blood pressure, body mass index, age, race, sex, smoking status, and history of stroke, indicated that stepwise poorer diabetes status was associated with a decrease of 0.03 units in cognitive function in NHANES III, while the same multivariable regression in NHANES 1999-2000 was associated with 0.23 units poorer cognitive performance. Tests for equality using these estimates and their standard errors were significantly
Background: Illiteracy is a risk factor for the occurrence of dementia
and is associated with a lower cognitive reserve, but patients with a higher educational level tend to have a faster cognitive decline. Methods: One hundred and fort three patients with Alzheimer Disease an outpatient clinic of cognitive disorders in the northeastern region of Brazil were followed retrospectively. All patients were a follow-up at least 1 year. Patients who presented stability or increase in the MMSE score between the first and last visit were considered good responders. Student T test, Mann-Whitney test and Chi-square were used to compare good response and the group without good. A logistic regression analysis was performed to identify independent factors of good response. Results: The mean age of onset of symptoms was 73.4(67.2) years, with a predominance of females of 99 (69.2%). The illiteracy rate was 25.9% (37) and 63% (90) had less than 4 years of study. The mean initial MMSE was 15.3(65.6) points. The mean follow-up of the patients was 29.96 (616.2) months and the mean last MMSE was 12.79 (66.5) points. During this follow-up period, 39 patients (27.3%) had a good response to treatment. There was no difference between good and no responders according to age and follow-up time, but there was a tendency to lower initial MMSE 14.4(64.8) x 16.4(65.8) (p ¼ 0.07) and lower initial score in Pfeffer scale 16.5(68.2) x 20, 68(68) (p ¼ 0.05). There was a higher frequency of dyslipidemia 62.16 x 36.14 (p ¼ 0.01) and illiteracy 51.42% x 21.11 (p ¼ 0.02) in good responders. The presence of neuropsychiatric symptoms in follow up was more frequent in non responders (69.9% x 50%) p ¼ 0.046. In the logistic regression, only illiteracy (OR 5.23 CI 1.87-14.77) and dyslipidemia (OR 4.53 CI 1.75-11.73) had an association with good prognosis. Conclusions: Illiteracy and dyslipidemia were associated with good evolution in a group of patients with AD and low educational level.
NHANES 1999-2000
NHANES III White (%) Black (%) Female (%) Current Smoker (%) History of Stroke (%) SBP BMI
75.7 11.2 52.3 28.1 2.0 117.9 (20.9) 25.3 (6.9)
65.7 11.8 51.1 20.8 2.5 117.0 (22.6) 25.2 (8.7)
Values are expressed as median (interquartile range) unless otherwise specified NHANES III
White (%) Black (%) Female (%) Smoker (%) Stroke (%) SBP BMI
NHANES 1999-2000
Non (81.5)
Pre (13.7)
Diab (4.9)
Non (83.7)
Pre (10.8)
Diab (5.6)
77.8
65.5
68.7
68.7
66.5
59.2
9.4
19.9
17.9
10.2
14.9
16.0
53.1
48.1
50.5
51.6
53.0
48.1
27.7
33.0
20.9
21.1
20.8
15.9
1.3
4.0
7.2
1.6
5.8
7.2
115.9 127.1 133.3 116.3 130.9 130.7 (18.8) (25.4) (22.4) (20.0) (30.0) (25.2) 24.8 27.4 29.5 25.7 30.2 30.5 (6.4) (7.1) (8.6) (7.2) (8.6) (9.4)
Values are expressed as median (interquartile range) unless otherwise specified
P4-331
ARE MEMBERS OF UNDERREPRESENTED GROUPS REALLY LESS LIKELY TO PARTICIPATE IN BIOMARKER STUDIES REQUESTING BLOOD OR CSF ? 1
2 1
Dorothy Farrar Edwards , Jennifer Dykema , Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; 2University of Wisconsin Survey Center, Madison, WI, USA. Contact e-mail: [email protected] Background: Information derived from biomarkers improves detec-
tion of AD pathology years before symptoms appear. Despite known contributions of biomarkers to AD research, a major drawback is the willingness of participants to undergo a lumbar puncture (LP). Data on factors affecting participation in LP studies are limited. We examined effects of socio-demographic variables and concerns related to trust in medical research on expressed likelihood to participate in research involving blood or CSF donation. Methods: Item responses to a comprehensive survey questionnaire from a diverse sample of 410 adults (mean age¼44.7, SD¼16.7) were used in the analysis. The sample included 25.6% African Americans, 24.4% Latinos, 24.4% American Indians, 24.6% Whites. The likelihood of providing blood or CSF samples was
P1417
rated using a 5 pt scale ranging from “Very Likely “to “Very Unlikely”. Chi Square analyses evaluated associations of ethnic/racial background, trust in medical researchers, concerns about physical pain and infection, having a family member with AD, age, and gender on likelihood of providing blood or CSF samples. Results: There was no significant association between ethnicity/race and likelihood to provide blood samples (p¼0.027), 61 % of respondents were “very or somewhat likely” to provide blood. In contrast, only 17 % of the sample was “very or somewhat likely” to provide CSF and associations between ethnicity/race and likelihood to provide CSF approached significance (p¼0.06). Concern about pain and trust (p¼0.000) in medical researchers (p¼0.000) decreased likelihood to provide CSF. Respondents more willing to provide blood were also more likely to provide CSF (p¼0.00). Younger respondents were less willing to provide CSF than older respondents (p¼0.030); Latinos expressed greater likelihood to participate in CSF studies than Whites (p¼0.017). Respondents with higher educational levels were less likely to provide CSF samples than respondents with lower education (p¼0.016). Having a family member with AD did not influence likelihood to provide blood or CSF. Conclusions: Although overall willingness to provide CSF was low, we found interesting and unexpected variations among racial/ethnic groups. Results suggest common and group specific barriers to LP studies. These issues that can inform tailored recruitment strategies designed to increase the propensity of CSF donation.
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DUAL-TASK WALKING AS A PREDICTOR FOR LATER COGNITIVE IMPAIRMENT
Andrea L. Rosso1, Andrea L. Metti1, Neelesh K. Nadkarni1, Kristine Yaffe2, Lenore J. Launer3, Caterina Rosano1, 1University of Pittsburgh, Pittsburgh, PA, USA; 2University of California San Francisco, San Francisco, CA, USA; 3National Institute on Aging, Bethesda, MD, USA. Contact e-mail: [email protected] Background: Early identification of those most at risk for dementia is a
growing priority. The ability to walk while performing a cognitive task (i.e. dual-task walking) is impaired in adults with mild cognitive impairment (MCI) or dementia. Poorer dual-task performance may indicate underlying neuropathology and higher risk for dementia. However, no studies have assessed the longitudinal association between poorer dual-task walking, markers of neuropathology, and risk of dementia. Methods: We analyzed longitudinal data in older adults with Modified Mini-Mental State scores 80 (n¼76; mean age¼ 78, 51% female, 33% black) who walked with and without a simultaneous visual-spatial task. Dual-task cost was calculated as change in gait speed from single-task to dual-task walking as a percentage of single-task gait speed. Participants underwent magnetic resonance imaging (MRI) in years 4 and 8 with cognitive adjudication in year 8. Grey matter volume of right and left hippocampus and annualized change in hippocampal volume were calculated from MRI. Cognitive impairment was defined as MCI or dementia at adjudication. Odds ratios (OR) and 95% confidence intervals were calculated
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Poster Presentations: Wednesday, July 19, 2017
as risk for cognitive impairment based on dual-task cost and adjusted for age, race, sex, and education. Additional adjustment by change in hippocampal volumes was conducted. Results: After 8 years, 40/76 participants were cognitively impaired (53%). Higher dual-task cost (e.g. greater decline in speed with addition of visual-spatial task) was associated with greater odds of cognitive impairment at 8 years, both before (OR per 1% increase in dual task cost¼1.08 (1.01, 1.15)) and after (OR¼1.08 (1.01, 1.16)) adjustment for demographics. Greater annualized decline in gray matter volume attenuated the association of dual task cost with cognitive impairment for both left (OR¼1.05 (0.85, 1.28)) and right (OR¼1.01 (0.94, 1.09)) hippocampus. Conclusions: In this group of high functioning older adults, greater declines in gait speed while dual-tasking predicted greater risk for cognitive impairment 8 years later. Faster hippocampal atrophy may be an important neurobiological correlate that could explain this association. Dual-task walking may serve as a stress test on central nervous system resources and could provide an early clinical indicator for increased dementia risk.
P4-336
ILLITERACY AND DYSLIPIDEMIA: RISK FACTORS FOR ALZHEIMER’S DISEASE, BUT MARKERS OF BETTER CLINICAL EVOLUTION?
Norberto Anizio Ferreira Frota1,2, Fabricio Oliveira Lima1,2, Vanessa Lauana Lima Silva2, Gisele Collyer Alves1, Mariana Rabelo de Brito2, Flavia Timb o Albuquerque2, Andreia Braga Mota2, Yasmin Costa e Silva2, Larissa Chagas Correa2, Lorena Cherida Alves Vidal2, Inessa Carvalho de Queiroz2, 1Hospital Geral de Fortaleza, Fortaleza, Brazil; 2Unifor, Fortaleza, Brazil. Contact e-mail: [email protected]
P4-337
STRONGER ASSOCIATION BETWEEN TYPE 2 DIABETES AND COGNITION OVER TIME
Patrick Stuchlik1, Vivian Fonseca1, Owen T. Carmichael2, Wade Gunn1, Lydia Bazzano1, 1Tulane University, New Orleans, LA, USA; 2Pennington Biomedical Research Center, Baton Rouge, LA, USA. Contact e-mail: [email protected] Background: Diabetes mellitus has been shown to be adversely associ-
ated with cognition; this association has been consistent for decades. However, it is unclear if the magnitude of this association has been affected by the rising burdens of both diabetes and cognitive impairment. Methods: Using publicly available data from the National Health and Nutrition Examination Survey (NHANES), we investigated the association between diabetes (categorized as “diabetic” when HbA1c was 6.5% or greater, “prediabetic” when HbA1c was 5.7% to 6.4%, and “non-diabetic” otherwise) and cognitive function (standardized to z-scores) at two time points. Results: Survey-weighted linear regression indicated stepwise poorer diabetes status (e.g. from “prediabetic” to “diabetic”) was associated with a decrease of 0.09 units (p<0.05) in cognitive function in NHANES III, while the same was associated with a decrease of 0.21 units (p<0.001) in NHANES 1999-2000. Multivariable survey-weighted regression, adjusted for systolic blood pressure, body mass index, age, race, sex, smoking status, and history of stroke, indicated that stepwise poorer diabetes status was associated with a decrease of 0.03 units in cognitive function in NHANES III, while the same multivariable regression in NHANES 1999-2000 was associated with 0.23 units poorer cognitive performance. Tests for equality using these estimates and their standard errors were significantly
Background: Illiteracy is a risk factor for the occurrence of dementia
and is associated with a lower cognitive reserve, but patients with a higher educational level tend to have a faster cognitive decline. Methods: One hundred and fort three patients with Alzheimer Disease an outpatient clinic of cognitive disorders in the northeastern region of Brazil were followed retrospectively. All patients were a follow-up at least 1 year. Patients who presented stability or increase in the MMSE score between the first and last visit were considered good responders. Student T test, Mann-Whitney test and Chi-square were used to compare good response and the group without good. A logistic regression analysis was performed to identify independent factors of good response. Results: The mean age of onset of symptoms was 73.4(67.2) years, with a predominance of females of 99 (69.2%). The illiteracy rate was 25.9% (37) and 63% (90) had less than 4 years of study. The mean initial MMSE was 15.3(65.6) points. The mean follow-up of the patients was 29.96 (616.2) months and the mean last MMSE was 12.79 (66.5) points. During this follow-up period, 39 patients (27.3%) had a good response to treatment. There was no difference between good and no responders according to age and follow-up time, but there was a tendency to lower initial MMSE 14.4(64.8) x 16.4(65.8) (p ¼ 0.07) and lower initial score in Pfeffer scale 16.5(68.2) x 20, 68(68) (p ¼ 0.05). There was a higher frequency of dyslipidemia 62.16 x 36.14 (p ¼ 0.01) and illiteracy 51.42% x 21.11 (p ¼ 0.02) in good responders. The presence of neuropsychiatric symptoms in follow up was more frequent in non responders (69.9% x 50%) p ¼ 0.046. In the logistic regression, only illiteracy (OR 5.23 CI 1.87-14.77) and dyslipidemia (OR 4.53 CI 1.75-11.73) had an association with good prognosis. Conclusions: Illiteracy and dyslipidemia were associated with good evolution in a group of patients with AD and low educational level.
NHANES 1999-2000
NHANES III White (%) Black (%) Female (%) Current Smoker (%) History of Stroke (%) SBP BMI
75.7 11.2 52.3 28.1 2.0 117.9 (20.9) 25.3 (6.9)
65.7 11.8 51.1 20.8 2.5 117.0 (22.6) 25.2 (8.7)
Values are expressed as median (interquartile range) unless otherwise specified NHANES III
White (%) Black (%) Female (%) Smoker (%) Stroke (%) SBP BMI
NHANES 1999-2000
Non (81.5)
Pre (13.7)
Diab (4.9)
Non (83.7)
Pre (10.8)
Diab (5.6)
77.8
65.5
68.7
68.7
66.5
59.2
9.4
19.9
17.9
10.2
14.9
16.0
53.1
48.1
50.5
51.6
53.0
48.1
27.7
33.0
20.9
21.1
20.8
15.9
1.3
4.0
7.2
1.6
5.8
7.2
115.9 127.1 133.3 116.3 130.9 130.7 (18.8) (25.4) (22.4) (20.0) (30.0) (25.2) 24.8 27.4 29.5 25.7 30.2 30.5 (6.4) (7.1) (8.6) (7.2) (8.6) (9.4)
Values are expressed as median (interquartile range) unless otherwise specified