- Email: [email protected]
HEART RATE VARIABILITY AND COGNITIVE FUNCTION IN MIDDLE-AGE ADULTS: THE CARDIA STUDY
Poster Presentations: Sunday, July 16, 2017 P1-569
MIDLIFE PULMONARY FUNCTION AND RISK OF DEMENTIA LATER IN LIFE
Paola Gilsanz1,2, Jason Flatt3, Charles P. Quesenberry, Jr,2, Rachel A. Whitmer1,2, 1University of California, San Francisco, San Francisco, CA, USA; 2Kaiser Permanente Division of Research, Oakland, CA, USA; 3UCSF School of Medicine, San Francisco, CA, USA. Contact e-mail: [email protected] Background: Poor pulmonary function is associated with worse cognition and greater brain atrophy in midlife and increased risk of dementia-associated mortality. However, it is unclear if there is a longitudinal association between pulmonary function in midlife and dementia, and if so, whether the association is spurious due to mutual risk factors such as hypertension, vascular disease, and smoking. Methods: We evaluated 10,067 members of Kaiser Permanente Northern California ages 40-45 between 1964-1973 who remained members as of 1/1/96. Midlife pulmonary function was assessed by forced expiratory volume in one second (FEV1) during clinical exams between 1964-1973 and ranked into quintiles. Height, weight, race, education, and smoking (current, past, or never) were also collected between 1964-1973. Electronic health records from 1/1/1996-10/1/2015 were used to identify cases of dementia (ICD-9 codes 331.0, 290.4x, 290.0, 290.1x, 290.2x, 290.3, 294.2x, and 294.8), stroke, heart failure, and diabetes. Cox proportional hazard models (age as time scale) evaluated the association between the lowest quintile of midlife pulmonary function and dementia risk adjusted for sociodemographics and vascular risk factors across the lifecourse. Participants were censored at dementia diagnosis, death, gap in health plan membership, or end of study. Results: The cohort was 55% female and 73% White. The lowest quintile of FEV1 values ranged between 0.2-2 liters and 30% were diagnosed with dementia over 20 years of follow-up. Compared to members in the highest quintile of FEV1, members in the lowest quintile of FEV1 were 20% more likely to develop dementia (adjusted Hazards Ratio (aHR)¼1.20; 95% Confidence Interval:1.02-1.40) adjusting for height and sociodemographics. This relationship persisted after further adjustment for BMI and hypertension at midlife (aHR¼1.18; 95% CI:1.01-1.38) but was slightly attenuated after controlling for midlife smoking (aHR¼1.17; 95% CI:0.99-1.37). Members in the lowest quintile of FEV1 had almost 30% greater dementia risk (aHR¼1.29; 95% CI:1.10-1.51) adjusting for height, sex, race, education, smoking, midlife risk factors (BMI, hypertension, smoking) and late life medical conditions (diabetes, heart failure, stroke). Conclusions: Low levels of midlife pulmonary function were associated with risk of dementia independent of hypertension and smoking. Further research is needed to identify the relevant pathogenic mechanisms.
P1-570
INEQUALITIES IN RECEIPT OF MENTAL AND PHYSICAL HEALTH CARE IN PEOPLE WITH DEMENTIA IN THE U.K.: ROLE OF SOCIOECONOMIC STATUS, GENDER AND ETHNICITY
Claudia Cooper1, Irene Petersen1, Tra My Pham1, Jill Manthorpe2, Rosalind Raine1, Rebecca Lodwick1, Kate Walters1, Steve Iliffe3, 1 University College London, London, United Kingdom; 2King’s College London, London, United Kingdom; 3University College London, London, United Kingdom. Contact e-mail: [email protected] Background: UK Dementia Strategies prioritise fair access to mental
and physical healthcare. We investigate whether there are inequal-
P513
ities by deprivation, gender or ethnicity in healthcare received by people with dementia, and compared healthcare received by people with and without dementia. Methods: We investigated primary care records of 68, 061 community dwelling dementia patients and 259,337 people without dementia (2002-13). We tested hypotheses that people with dementia from more deprived areas, and who are women receive more psychotropic medication, fewer surgery consultations, are less likely to receive annual blood pressure, weight monitoring and an annual review, compared with those from less deprived areas and men. Results: Only half of people with dementia received a documented annual review. Deprivation was not associated with healthcare received. Compared to men with dementia, women with dementia had lower rates of surgery consultations (adjusted IRR 0.90, 95% CI 0.90-0.91), of annual blood pressure monitoring (adjusted IRR 0.96, 95% CI 0.95-0.97) and of annual weight monitoring (adjusted IRR 0.91, 95% CI 0.90-0.93). Men with dementia were less likely to be taking psychotropic medication than women with dementia. People with dementia had fewer surgery consultations and were less likely to have their weight and blood pressure monitored at least annually, compared to the non-dementia group. We will present new findings regarding the relationship of ethnic group to receiving a dementia diagnosis and healthcare received. Conclusions: People with dementia, in particular women, appear to receive less primary health care, but take more psychotropic medication that may negatively impact their physical health. Reducing these inequalities and improving access of people with dementia to preventative healthcare could improve the health of people with dementia.
P1-571
HEART RATE VARIABILITY AND COGNITIVE FUNCTION IN MIDDLE-AGE ADULTS: THE CARDIA STUDY
Adina Zeki Al Hazzouri1, Tali Elfassy1, Mercedes Carnethon2, Donald Lloyd-Jones3, Kristine Yaffe4, 1University of Miami, Miami, FL, USA; 2Northwestern University Feinberg School of Medicine, Chicago, IL, USA; 3Northwestern University, Chicago, IL, USA; 4University of California San Francisco/ San Francisco VA Medical Center, San Francisco, CA, USA. Contact e-mail: axz122@ miami.edu Background: Lower heart rate variability (HRV), a marker of car-
diac autonomic dysfunction, has been associated with major risk factors of cognitive impairment. Yet the direct association of HRV with cognitive function remains relatively unexplored, particularly early in the life course. Methods: We used data from the Coronary Artery Risk Development in Young Adults to examine whether measures of HRV are associated with cognitive function in middle-age. In 2005 (our study baseline), two measures of HRV, standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive differences (RMSSD), were calculated using 10-second 12-lead electrocardiogram. Lower SDNN (2.6ms to 17.4ms) and lower RMSSD (2.2ms to 17.8ms) were defined as the lowest quartiles. Five years later, in 2010, three cognitive tests were administered including a test of verbal memory (Rey Auditory-Verbal Learning Test, RAVLT, range 0-15), processing speed (Digit Symbol Substitution Test, DSST, range 0-133), and executive function (Stroop interference). Results: 2,118 participants (57.7% female, 42.2% black) with a mean baseline age of 45.3 years were included in this analysis. In demographic-adjusted models, compared to participants with the upper three quarters of SDNN,
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Poster Presentations: Sunday, July 16, 2017
participants with lower SDNN scored 1.76 points worse on DSST (p¼0.01) and 1.14 points worse on Stroop (p¼0.02). After adjusting for behavioral and cardiovascular risk factors, lower SDNN remained significantly associated with worse stroop (p¼0.01) but not with DSST. There was no association between RMSSD and cognitive function. Conclusions: Our findings suggest that lower SDDN is associated with worse executive function among middle-aged adults, above and beyond cardiovascular risk factors. P1-572
LONG-TERM EFFECTS OF PREDIABETES AND DIABETES ON COGNITIVE TRAJECTORIES IN A POPULATIONBASED COHORT
Anna Marseglia1, Anna K. Dahl Aslan2,3, Laura Fratiglioni3,4, Giola Santoni5, Nancy L. Pedersen3,6, Weili Xu3,7, 1Aging Research Center, Karolinska Institutet, Stockholm, Sweden; 2Jonkoping University, Jonkoping, Sweden; 3Karolinska Institutet, Stockholm, Sweden; 4Stockholm Gerontology Research Center, Stockholm, Sweden; 5Karolinska Institute, Stockholm, Sweden; 6University of Southern California, Los Angeles, CA, USA; 7Tianjin Medical University, Tianjin, China. Contact e-mail: anna. [email protected] Background: Although diabetes has been linked to dementia risk,
the cognitive trajectories in older adults with diabetes remain unclear. We aimed to investigate the effect of prediabetes and diabetes on cognitive trajectories among cognitively intact older adults in a long-term follow-up study. Methods: Within the Swedish Adoption/ Twin Study of Aging, 793 cognitively intact older adults aged 50 were identified at baseline and followed for up to 23 years. Cognitive domains (verbal, spatial/fluid, memory, perceptual speed) were assessed at baseline and up to seven follow-ups. Prediabetes was defined according to blood glucose levels in diabetes-free participants. Diabetes was ascertained based on self-report, hypoglycemic medication use and blood glucose levels. Data were analyzed with linear mixed-effect models adjusting for potential confounders. Results: At baseline, 68 participants (8.6%) had prediabetes and 45 (5.7%) had diabetes among all participants. Compared to diabetes-free individuals, people with diabetes had lower performance in spatial/fluid abilities (b -2.63; 95% CI -5.36, 0.05; p ¼ 0.058), and an accelerated linear decline over time in verbal abilities (b -0.15; 95% CI -0.29, -0.01; p ¼ 0.041). Prediabetes was associated with an accelerated decline in processing speed (b -0.01; 95% CI -0.02, -0.004; p ¼ 0.041), but with a better maintenance of memory (b 0.23; 95% CI 0.05, 0.42; p ¼ 0.013) over the follow-up. Conclusions: Prediabetes may accelerate processing speed decline, and diabetes is associated with the verbal ability decline, suggesting that diabetes and even prediabetes affect especially the cognitive domains of fluid intelligence at the early stages of cognitive impairment. P1-573
SERUM INSULIN AND THE RISK OF DEMENTIA AND COGNITIVE DECLINE: A LONGITUDINAL POPULATION-BASED STUDY
Babak Hooshmand1,2, Shireen Sindi1, Tuomo H€anninen3, Jaan Leiviska4, Hilkka Soininen5,6,7, Miia Kivipelto1,5,8,9,10, 1Karolinska Institutet, Stockholm, Sweden; 2Ulm University Hospital, Ulm, Germany; 3 Department of Neurology, Kuopio University Hospital, Kuopio, Finland; 4 National Institute for Health and Welfare (THL), Helsinki, Finland; 5 University of Eastern Finland, Kuopio, Finland; 6Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland; 7Institute of Clinical Medicine, Kuopio, Finland; 8Kuopio University Hospital, Kuopio, Finland; 9 National Institute for Health and Welfare, Helsinki, Finland; 10Karolinska Institutet-Stockholm University, Stockholm, Sweden. Contact e-mail: Babak. [email protected]
Background: Diabetes mellitus has been linked to an increased risk of dementia and Alzheimer’s disease (AD), but it is not clear if this is due to the direct effect of insulin. Our aim was to examine the association of serum insulin with the risk of incident dementia, Alzheimer disease, and cognitive decline over 7-years in a sample of Finnish community-dwelling elderly. Methods: A dementia-free sample of 304 subjects aged 65-79 years derived from the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study was followed up for 7 years to detect incident dementia and AD. Global cognition, episodic memory, executive functioning, verbal expression, and psychomotor speed were assessed both at baseline and at follow-up. The association of serum insulin with incident dementia and cognitive decline was analyzed with multiple logistic regression and linear risk models, respectively. Results: The odds ratios (ORs) (95% confidence interval (CI)) for each increase of 1 mU/L serum insulin were 1.11 (1.01 - 1.23) for incident dementia and 1.10 (0.99 - 1.22) for incident AD after adjusting for several potential confounders including age, sex, education, follow-up time, systolic blood pressure, diastolic blood pressure, Body mass index, history of stroke, smoking status, history of diabetes, and APOEε4 status. In addition, elevated serum insulin values at baseline were related to faster decline in global cognition over 7 years: b coefficient (SE) were -0.045 (0.02); P ¼ 0.05. No associations were found for specific cognitive domains. Conclusions: Higher concentrations of insulin are related to an increased risk of dementia and cognitive decline over 7 years. P1-574
DIETARY INFLAMMATORY INDEX, INFLAMMATION AND COGNITIVE DECLINE IN OLDER ADULTS: THE HEALTH ABC STUDY
Claire T. McEvoy1, Nitin Shivappa2, James R. Hebert3, Feng Xia4, Eric Vittinghoff1, Kristine Yaffe4,5, 1University of California, San Francisco, San Francisco, CA, USA; 2University of South Carolina, Columbia, SC, USA; 3University of South Carolina, Columbia, SC, USA; 4 San Francisco VA Medical Center, San Francisco, CA, USA; 5University of California San Francisco / San Francisco VA Medical Center, San Francisco, CA, USA. Contact e-mail: [email protected] Background: Inflammation is implicated in the pathogenesis of
Alzheimer’s disease and progression of age-related neurodegeneration. Diet is known to modulate systemic inflammation. For example, fruit and vegetables have anti-inflammatory effects and saturated fat has pro-inflammatory effects. Few studies to date have investigated inflammatory dietary factors in relation to cognitive decline. The dietary Inflammatory Index (DIITM) is an empirically derived score that reflects inflammatory potential of the diet. We examined associations between DII scores, inflammatory biomarkers and longitudinal cognitive decline in the HealthABC Study. Methods: Baseline energy-adjusted DII (E-DII) scores were computed from food frequency questionnaire data on 2,429 nondemented adults, aged 74 6 2.8 (range 69.3 to 80.9) years. Higher E-DII scores indicated greater pro-inflammatory dietary potential. Inflammatory biomarkers (CRP and IL-6) also were measured at baseline. Cognitive decline was assessed using repeated Modified Mini Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST) scores over a 9-year follow-up period. Linear mixed models were used to examine the association between EDII and trajectory of cognitive decline. Results: Mean E-DII was -2.39 61.70 (range -5.49 to +2.90). In multivariable models, participants in the highest E-DII tertile (more pro-inflammatory diet) had significantly increased mean CRP levels compared to the middle and
MIDLIFE PULMONARY FUNCTION AND RISK OF DEMENTIA LATER IN LIFE
Paola Gilsanz1,2, Jason Flatt3, Charles P. Quesenberry, Jr,2, Rachel A. Whitmer1,2, 1University of California, San Francisco, San Francisco, CA, USA; 2Kaiser Permanente Division of Research, Oakland, CA, USA; 3UCSF School of Medicine, San Francisco, CA, USA. Contact e-mail: [email protected] Background: Poor pulmonary function is associated with worse cognition and greater brain atrophy in midlife and increased risk of dementia-associated mortality. However, it is unclear if there is a longitudinal association between pulmonary function in midlife and dementia, and if so, whether the association is spurious due to mutual risk factors such as hypertension, vascular disease, and smoking. Methods: We evaluated 10,067 members of Kaiser Permanente Northern California ages 40-45 between 1964-1973 who remained members as of 1/1/96. Midlife pulmonary function was assessed by forced expiratory volume in one second (FEV1) during clinical exams between 1964-1973 and ranked into quintiles. Height, weight, race, education, and smoking (current, past, or never) were also collected between 1964-1973. Electronic health records from 1/1/1996-10/1/2015 were used to identify cases of dementia (ICD-9 codes 331.0, 290.4x, 290.0, 290.1x, 290.2x, 290.3, 294.2x, and 294.8), stroke, heart failure, and diabetes. Cox proportional hazard models (age as time scale) evaluated the association between the lowest quintile of midlife pulmonary function and dementia risk adjusted for sociodemographics and vascular risk factors across the lifecourse. Participants were censored at dementia diagnosis, death, gap in health plan membership, or end of study. Results: The cohort was 55% female and 73% White. The lowest quintile of FEV1 values ranged between 0.2-2 liters and 30% were diagnosed with dementia over 20 years of follow-up. Compared to members in the highest quintile of FEV1, members in the lowest quintile of FEV1 were 20% more likely to develop dementia (adjusted Hazards Ratio (aHR)¼1.20; 95% Confidence Interval:1.02-1.40) adjusting for height and sociodemographics. This relationship persisted after further adjustment for BMI and hypertension at midlife (aHR¼1.18; 95% CI:1.01-1.38) but was slightly attenuated after controlling for midlife smoking (aHR¼1.17; 95% CI:0.99-1.37). Members in the lowest quintile of FEV1 had almost 30% greater dementia risk (aHR¼1.29; 95% CI:1.10-1.51) adjusting for height, sex, race, education, smoking, midlife risk factors (BMI, hypertension, smoking) and late life medical conditions (diabetes, heart failure, stroke). Conclusions: Low levels of midlife pulmonary function were associated with risk of dementia independent of hypertension and smoking. Further research is needed to identify the relevant pathogenic mechanisms.
P1-570
INEQUALITIES IN RECEIPT OF MENTAL AND PHYSICAL HEALTH CARE IN PEOPLE WITH DEMENTIA IN THE U.K.: ROLE OF SOCIOECONOMIC STATUS, GENDER AND ETHNICITY
Claudia Cooper1, Irene Petersen1, Tra My Pham1, Jill Manthorpe2, Rosalind Raine1, Rebecca Lodwick1, Kate Walters1, Steve Iliffe3, 1 University College London, London, United Kingdom; 2King’s College London, London, United Kingdom; 3University College London, London, United Kingdom. Contact e-mail: [email protected] Background: UK Dementia Strategies prioritise fair access to mental
and physical healthcare. We investigate whether there are inequal-
P513
ities by deprivation, gender or ethnicity in healthcare received by people with dementia, and compared healthcare received by people with and without dementia. Methods: We investigated primary care records of 68, 061 community dwelling dementia patients and 259,337 people without dementia (2002-13). We tested hypotheses that people with dementia from more deprived areas, and who are women receive more psychotropic medication, fewer surgery consultations, are less likely to receive annual blood pressure, weight monitoring and an annual review, compared with those from less deprived areas and men. Results: Only half of people with dementia received a documented annual review. Deprivation was not associated with healthcare received. Compared to men with dementia, women with dementia had lower rates of surgery consultations (adjusted IRR 0.90, 95% CI 0.90-0.91), of annual blood pressure monitoring (adjusted IRR 0.96, 95% CI 0.95-0.97) and of annual weight monitoring (adjusted IRR 0.91, 95% CI 0.90-0.93). Men with dementia were less likely to be taking psychotropic medication than women with dementia. People with dementia had fewer surgery consultations and were less likely to have their weight and blood pressure monitored at least annually, compared to the non-dementia group. We will present new findings regarding the relationship of ethnic group to receiving a dementia diagnosis and healthcare received. Conclusions: People with dementia, in particular women, appear to receive less primary health care, but take more psychotropic medication that may negatively impact their physical health. Reducing these inequalities and improving access of people with dementia to preventative healthcare could improve the health of people with dementia.
P1-571
HEART RATE VARIABILITY AND COGNITIVE FUNCTION IN MIDDLE-AGE ADULTS: THE CARDIA STUDY
Adina Zeki Al Hazzouri1, Tali Elfassy1, Mercedes Carnethon2, Donald Lloyd-Jones3, Kristine Yaffe4, 1University of Miami, Miami, FL, USA; 2Northwestern University Feinberg School of Medicine, Chicago, IL, USA; 3Northwestern University, Chicago, IL, USA; 4University of California San Francisco/ San Francisco VA Medical Center, San Francisco, CA, USA. Contact e-mail: axz122@ miami.edu Background: Lower heart rate variability (HRV), a marker of car-
diac autonomic dysfunction, has been associated with major risk factors of cognitive impairment. Yet the direct association of HRV with cognitive function remains relatively unexplored, particularly early in the life course. Methods: We used data from the Coronary Artery Risk Development in Young Adults to examine whether measures of HRV are associated with cognitive function in middle-age. In 2005 (our study baseline), two measures of HRV, standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive differences (RMSSD), were calculated using 10-second 12-lead electrocardiogram. Lower SDNN (2.6ms to 17.4ms) and lower RMSSD (2.2ms to 17.8ms) were defined as the lowest quartiles. Five years later, in 2010, three cognitive tests were administered including a test of verbal memory (Rey Auditory-Verbal Learning Test, RAVLT, range 0-15), processing speed (Digit Symbol Substitution Test, DSST, range 0-133), and executive function (Stroop interference). Results: 2,118 participants (57.7% female, 42.2% black) with a mean baseline age of 45.3 years were included in this analysis. In demographic-adjusted models, compared to participants with the upper three quarters of SDNN,
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Poster Presentations: Sunday, July 16, 2017
participants with lower SDNN scored 1.76 points worse on DSST (p¼0.01) and 1.14 points worse on Stroop (p¼0.02). After adjusting for behavioral and cardiovascular risk factors, lower SDNN remained significantly associated with worse stroop (p¼0.01) but not with DSST. There was no association between RMSSD and cognitive function. Conclusions: Our findings suggest that lower SDDN is associated with worse executive function among middle-aged adults, above and beyond cardiovascular risk factors. P1-572
LONG-TERM EFFECTS OF PREDIABETES AND DIABETES ON COGNITIVE TRAJECTORIES IN A POPULATIONBASED COHORT
Anna Marseglia1, Anna K. Dahl Aslan2,3, Laura Fratiglioni3,4, Giola Santoni5, Nancy L. Pedersen3,6, Weili Xu3,7, 1Aging Research Center, Karolinska Institutet, Stockholm, Sweden; 2Jonkoping University, Jonkoping, Sweden; 3Karolinska Institutet, Stockholm, Sweden; 4Stockholm Gerontology Research Center, Stockholm, Sweden; 5Karolinska Institute, Stockholm, Sweden; 6University of Southern California, Los Angeles, CA, USA; 7Tianjin Medical University, Tianjin, China. Contact e-mail: anna. [email protected] Background: Although diabetes has been linked to dementia risk,
the cognitive trajectories in older adults with diabetes remain unclear. We aimed to investigate the effect of prediabetes and diabetes on cognitive trajectories among cognitively intact older adults in a long-term follow-up study. Methods: Within the Swedish Adoption/ Twin Study of Aging, 793 cognitively intact older adults aged 50 were identified at baseline and followed for up to 23 years. Cognitive domains (verbal, spatial/fluid, memory, perceptual speed) were assessed at baseline and up to seven follow-ups. Prediabetes was defined according to blood glucose levels in diabetes-free participants. Diabetes was ascertained based on self-report, hypoglycemic medication use and blood glucose levels. Data were analyzed with linear mixed-effect models adjusting for potential confounders. Results: At baseline, 68 participants (8.6%) had prediabetes and 45 (5.7%) had diabetes among all participants. Compared to diabetes-free individuals, people with diabetes had lower performance in spatial/fluid abilities (b -2.63; 95% CI -5.36, 0.05; p ¼ 0.058), and an accelerated linear decline over time in verbal abilities (b -0.15; 95% CI -0.29, -0.01; p ¼ 0.041). Prediabetes was associated with an accelerated decline in processing speed (b -0.01; 95% CI -0.02, -0.004; p ¼ 0.041), but with a better maintenance of memory (b 0.23; 95% CI 0.05, 0.42; p ¼ 0.013) over the follow-up. Conclusions: Prediabetes may accelerate processing speed decline, and diabetes is associated with the verbal ability decline, suggesting that diabetes and even prediabetes affect especially the cognitive domains of fluid intelligence at the early stages of cognitive impairment. P1-573
SERUM INSULIN AND THE RISK OF DEMENTIA AND COGNITIVE DECLINE: A LONGITUDINAL POPULATION-BASED STUDY
Babak Hooshmand1,2, Shireen Sindi1, Tuomo H€anninen3, Jaan Leiviska4, Hilkka Soininen5,6,7, Miia Kivipelto1,5,8,9,10, 1Karolinska Institutet, Stockholm, Sweden; 2Ulm University Hospital, Ulm, Germany; 3 Department of Neurology, Kuopio University Hospital, Kuopio, Finland; 4 National Institute for Health and Welfare (THL), Helsinki, Finland; 5 University of Eastern Finland, Kuopio, Finland; 6Neurocenter, Neurology, Kuopio University Hospital, Kuopio, Finland; 7Institute of Clinical Medicine, Kuopio, Finland; 8Kuopio University Hospital, Kuopio, Finland; 9 National Institute for Health and Welfare, Helsinki, Finland; 10Karolinska Institutet-Stockholm University, Stockholm, Sweden. Contact e-mail: Babak. [email protected]
Background: Diabetes mellitus has been linked to an increased risk of dementia and Alzheimer’s disease (AD), but it is not clear if this is due to the direct effect of insulin. Our aim was to examine the association of serum insulin with the risk of incident dementia, Alzheimer disease, and cognitive decline over 7-years in a sample of Finnish community-dwelling elderly. Methods: A dementia-free sample of 304 subjects aged 65-79 years derived from the Cardiovascular Risk Factors, Aging, and Dementia (CAIDE) study was followed up for 7 years to detect incident dementia and AD. Global cognition, episodic memory, executive functioning, verbal expression, and psychomotor speed were assessed both at baseline and at follow-up. The association of serum insulin with incident dementia and cognitive decline was analyzed with multiple logistic regression and linear risk models, respectively. Results: The odds ratios (ORs) (95% confidence interval (CI)) for each increase of 1 mU/L serum insulin were 1.11 (1.01 - 1.23) for incident dementia and 1.10 (0.99 - 1.22) for incident AD after adjusting for several potential confounders including age, sex, education, follow-up time, systolic blood pressure, diastolic blood pressure, Body mass index, history of stroke, smoking status, history of diabetes, and APOEε4 status. In addition, elevated serum insulin values at baseline were related to faster decline in global cognition over 7 years: b coefficient (SE) were -0.045 (0.02); P ¼ 0.05. No associations were found for specific cognitive domains. Conclusions: Higher concentrations of insulin are related to an increased risk of dementia and cognitive decline over 7 years. P1-574
DIETARY INFLAMMATORY INDEX, INFLAMMATION AND COGNITIVE DECLINE IN OLDER ADULTS: THE HEALTH ABC STUDY
Claire T. McEvoy1, Nitin Shivappa2, James R. Hebert3, Feng Xia4, Eric Vittinghoff1, Kristine Yaffe4,5, 1University of California, San Francisco, San Francisco, CA, USA; 2University of South Carolina, Columbia, SC, USA; 3University of South Carolina, Columbia, SC, USA; 4 San Francisco VA Medical Center, San Francisco, CA, USA; 5University of California San Francisco / San Francisco VA Medical Center, San Francisco, CA, USA. Contact e-mail: [email protected] Background: Inflammation is implicated in the pathogenesis of
Alzheimer’s disease and progression of age-related neurodegeneration. Diet is known to modulate systemic inflammation. For example, fruit and vegetables have anti-inflammatory effects and saturated fat has pro-inflammatory effects. Few studies to date have investigated inflammatory dietary factors in relation to cognitive decline. The dietary Inflammatory Index (DIITM) is an empirically derived score that reflects inflammatory potential of the diet. We examined associations between DII scores, inflammatory biomarkers and longitudinal cognitive decline in the HealthABC Study. Methods: Baseline energy-adjusted DII (E-DII) scores were computed from food frequency questionnaire data on 2,429 nondemented adults, aged 74 6 2.8 (range 69.3 to 80.9) years. Higher E-DII scores indicated greater pro-inflammatory dietary potential. Inflammatory biomarkers (CRP and IL-6) also were measured at baseline. Cognitive decline was assessed using repeated Modified Mini Mental State Examination (3MS) and Digit Symbol Substitution Test (DSST) scores over a 9-year follow-up period. Linear mixed models were used to examine the association between EDII and trajectory of cognitive decline. Results: Mean E-DII was -2.39 61.70 (range -5.49 to +2.90). In multivariable models, participants in the highest E-DII tertile (more pro-inflammatory diet) had significantly increased mean CRP levels compared to the middle and