High use of dietary supplements is associated with a decreased risk of cognitive impairment: A cohort study from KLOSCAD

Poster Presentations: P4 literature, in contrast to the increasing prescription of these routes. Our aim was to evaluate mortality and survival of demented elderly with advanced dementia with dysphagia and to compare these outcomes between patients on oral or enteral routes of nutrition. Hospital admissions, incidence of pneumonia and caregiver overload were also compared. Methods: A prospective observational cohort wit 64 patients (32 with oral and 32 with enteral route) was estimated to evaluate mortality and survival by the method of KaplanMeier. Patients with advanced dementia define as FAST 7A or worse were included. Patients with dementia of other etiologies, ALS, tracheotomies and cancer were excluded. Follow up was performed by telephone for a minimum of 6 months. The scale by Zarit et al was employed to evaluate caregiver overload. Results: 67 patients were recruited, 36 in the oral route arm, 55,2% with probable Alzheimer’s dementia, 85.1% classified as FAST 7C or above. Mean age was 84.79, the majority of patients were females (85.1%), widowers (56.7%) and with low level of education (2.9 years, average). Both groups were similar with respect to all sociodemographic and clinical variables, with the exception of place of recruitment (hospital or outpatient) and number of pressure ulcers. Mortality after 3 months was 11,1% among patients in the oral route group and 41,9% in the alternative route group (p¼0,004), increasing to 27,8% and 58,1%, respectively, at 6 months (p¼0.012). The Kaplan-Meier survival analysis showed increased survival in oral route patients (p¼0,004), which persisted after censoring of crossover (p ¼ 0.01) and group migration after crossover (p <0.001). More aspiration pneumonia diagnosis were observed among patients in the alternative route group (p¼0.006), but there were no differences in hospital admissions between groups (p¼0.365). No differences between groups were observed in caregiver overload at recruitment and at follow up. Conclusions: The use of alternative feeding routes resulted in increased mortality in demented elderly and more hospital admissions were observed in this group. Frequency of pneumonia and caregiver overload were similar in both groups. P4-269

HIGH USE OF DIETARY SUPPLEMENTS IS ASSOCIATED WITH A DECREASED RISK OF COGNITIVE IMPAIRMENT: A COHORT STUDY FROM KLOSCAD

Yoonseop So1, Ji Won Han2, Tae Hui Kim3, Ki Woong Kim1, 1Seoul National University Bundang Hospital, Systems Biomedical Informatics National Core Research Center, Center for the Korean Longitudinal Study on Cognitive Aging and Dementia, Seongnam-si, Gyeonggi-do, South Korea; 2Seoul National University Bundang Hospital, Systems Biomedical Informatics National Core Research Center, Center for the Korean Longitudinal Study on Cognitive Aging and Dementia, Seongnam-si, Gyeonggi-do, South Korea; 3Bundang Seoul National University Hospital, Systems Biomedical Informatics National Core Research Center, Center for the Korean Longitudinal Study on Cognitive Aging and Dementia, Seongnam-si, Gyeonggi-do, South Korea. Contact e-mail: sonamuhanalm@ nate.com Background: This study examined the association of supplements with cognitive impairment in older adults. Methods: The Korean Longitudinal Study on Cognitive Aging and Dementia (KLOSCAD) is a population-based prospective elderly cohort study on cognitive aging and dementia that was launched in 2009. A simple random sample (N ¼ 13,749) was drawn from Koreans aged 60 years or older. Finally 7083 participants (age ¼ 70.34 6 6.93 years old, education ¼ 8.01 6 5.29 years, female ¼ 57.4%) were eligible for the current analysis (response rate ¼ 51.5%). Participants had Clinical and Neuropsychological evaluations for dementia. Participants were divided two groups which were normal group and cognitive impairment group. Cognitive impairment group was CIND and all-cause dementia included AD and other types of possible or probable dementia. Supplements which we surveyed are Ginkgo, Ginseng, Multi-Vitamin, Omega-3(DHA, EPA), Green tea. Odds ratios of association between supplements intake and cognitive impairment group were calculated in logistic regression models controlling for confounding variables. Results: Ginseng, Multi-Vitamin, Omega-3, was significantly difference between normal group and cognitive impairment group (p¼0.007, p<0.001, p¼0.002 respectively). But Ginkgo, Green tea was not significantly (p¼0.685, p¼0.532 respectively) different between normal group and cogni-

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tive impairment group. Multi-Vitamin in upper-middle quartile (50thw75th percentile, OR¼0.56, p¼0.001) and the upper quartile (75thw100th percentile, OR¼0.64, p¼0.010) was significantly associated with a decreased risk of cognitive impairment after controlling for age, gender, education, smoking, alcohol intake, exercise (Metabolic Equivalent Task), head trauma, Cumulative Illness Rting Scale, Modified Hachinski Ischemic Score, Geriatric Depression Scale-Korean Version. But the other supplements was not significantly associated with decreased the risk of cognitive impairment after controlling for confounding variables. Conclusions: More normal group than cognitive impairment group took supplements. Multi-Vitamin was significantly associated with decreased risk of cognitive impairment in elderly Koreans. P4-270

OMEGA-3 FISH OIL WITH PURIFIED EICOSAPENTANENOIC ACID STIMULATES CEREBRAL PERFUSION

Harold Pretorius1, Hanno Schumacher1, Thomas Quistorf1, Nichole Richards1, Elizabeth Budke1, 1Blue Ash Nuclear Medicine, Cincinnati, Ohio, United States. Contact e-mail: [email protected] Background: Omega-3 fish oil stimulates cerebral perfusion by a prostaglandin-dependant mechanism as shown by animal studies. We reported at the International Conference on Alzheimer’s Disease in Madrid, Spain, 2006 that acid ethyl esters of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) or Lovaza, stimulated cerebral perfusion. Owing to possibly more favorable effects of purified EPA (Vascepa) on serum lipids, not only decreasing serum triglycerides but also increasing serum high-density lipoprotein and decreasing low density lipoprotein (LDL) vs. Lovaza which increases LDL, it is likely that Vascepa will be used increasingly. Methods: Brain SPECT used70 MBq Tc-99m-HMPAO and a Siemens ECAM with an ultra-high resolution (5.9 mm) collimator for basal and 8 grams oral EPA-stimulated images obtained after 45 minutes. To verify the cortical metabolic index (CMi) from SPECT, a Siemens ECAT Exact 47 with 5 mm resolution and 20 MBq F18 fludeoxyglucose (FDG). We verified a cerebral flow reserve index (FRi), the difference of a cortical perfusion index (CPi) and CMi, as a measure of cerebral perfusion in humans by comparing multiple known perfusion stimulants, including 0.8 mg sublingual nitroglycerin, 500 mg IVacetazolamide, 50 grams oral coconut oil and 10 grams oral Lovaza, all of which produce FRi (10+-2)% in near normal subjects. Results: A 57-year-old diabetic woman with minor memory complaints had CMI 59.0% by SPECT andFRi (8.4+2.1)% when imaged fasting and normoglycemic. The regionally differential stimulant effects of purified EPA were shown in a 69-year-old traumatic brain-injured (TBI) man with mild cognitive impairment, whose CMi was (65.2+-2.2)%by FDG PET and (70.7+-3.5)% by SPECT. His post EPA FRi of - (6.8+-2.7)% correlated with decreased blilateral parieto-occipital and bilateral mesial temporal perfusion tracer deficits which is not unusual in TBI patients and similar to metabolic deficits in Alzheimer’s disease. Similar results were obtained with 10 grams oral Lovaza after 3 hours or 50 grams oral coconut oil after 60 to 90 minutes. Conclusions: Purified EPA omega3 fish oil has favorable effects on serum lipids and also remarkable effects on cerebral perfusion with potential for significance in both diagnosis and therapeutics of cognitive impairment. P4-271

NUTRITION INTERVENTION IN SENIOR RESIDENCES: BRAIN-HEALTHY WHOLE FOODS

Nancy Emerson Lombardo1, 1Boston University School of Medicine, Acton, Massachusetts, United States. Contact e-mail: [email protected] Background: Studies suggest that diets can either reduce risk and slow cognitive decline, or hasten brain decline. Many particularly potent anti-oxidant nutrients such as spices, herbs, certain vegetables and fruits have been shown to have protective effects in animal models of AD. Some spices have similar effects as cholinesterase inhibitors approved for AD. Both cinnamon and grape seed extract can inhibit oligomerization of A-beta in animal models. Studies of established comprehensive diets such as the Mediterranean Diet or the DASH anti-hypertensive diet, can do more than single foods or nutrients in protecting the brain. A combination of nutritional supplements designed by this author reversed mitochondrial dysfunction in several important brain regions in triple-transgenic AD mice. Other