- Email: [email protected]
IMPACT OF DIETARY PATTERNS ON COGNITIVE DECLINE AMONG DEMENTIA-FREE OLDER ADULTS: A POPULATION-BASED LONGITUDINAL STUDY
Poster Presentations: P3 WMH among Latin American populations. Methods: Seventy-seven participants above the age of 55, enrolled in The Maracaibo Aging Study, were selected for the current analysis. Baseline measures assessed neuropsychological performance, nutritional intake, hypertension, diabetes and presence of APOE ε4, while MRI (T2) was used to measure WMH (cm 3). Nutritional intake and repeat measures of tHcy concentrations (mmol/L) were acquired through laboratory analysis of overnight fasting blood samples. Participants were randomly selected within three CDR strata: unaffected (CDR ¼ 0), mild cognitive impairment [MCI] (CDR¼ 0.5) and demented (CDR > 1). Univariate analysis of continuous traits was performed using t-test and ANOVA, while multivariate analysis was conducted using multiple regression models adjusted for potential confounders. Results: The mean tHcy concentration was 15.7 (SD ¼ 6.3) ranging from 7.2 to 35.9, while the mean volume of WMHs was 46.1 (SD ¼ 36.8), ranging from 1.2 to 151.6. Among the unaffected, the mean tHcy concentration was 14.5, and 66.7% exceeded the clinical threshold for Hyperhomocysteinemia (> 11mmol/L). For those with MCI, the mean tHcy was 15.8 while 79.2% exceeded the threshold. Of those above the age of 75 and diagnosed with dementia, 90.9% exceeded the threshold. When adjusting for age, sex, education, intravenous folate and glucose, increased tHcy concentrations were associated with elevated WMHs (b ¼ 1.846; p ¼ 0.042). Conclusions: In this population with elevated tHcy,tHcy levels were positively associated with WMH, after adjusting for age, sex, education, intravenous folate and glucose. Further studies are needed to examine whether strong WMHs are associated with vascular dementia, Alzheimer’s Disease or both. P3-332
DEVELOPING STRATEGIES FOR LONGITUDINAL ASSESSMENT OF COGNITIVE FUNCTION IN THE CALIFORNIA TEACHERS STUDY
Eunjung Lee1, Lon S. Schneider1, Jung Yun Jang1, Jacqueline Lee Tilley1, Jean Kim1, Carlos Rodriguez1, Christine Juang1, Dennis Deapen1, Margaret Gatz1, Carol A. McCleary1, 1University of Southern California, Los Angeles, California, United States. Contact e-mail: [email protected] Background: The California Teachers Study (CTS) cohort, established in 1995, is a prospective cohort of 133,479 female public school employees that contains extensive exposure data over the participant’s life course, including most of the proposed risk factors of Alzheimer’s disease (AD). Developing strategies for longitudinal assessment of cognitive function is essential for the CTS to serve as a resource for large-scale etiologic research on cognitive decline. As a first step, we evaluated clock drawings in questionnaires collected from CTS participants in 2000. Methods: We randomly selected 3,000 women from w89,000 participants who returned the questionnaires in 2000 (>99% were college graduates). Trained research staff evaluated the selected clock drawings following scoring criteria that were shown to significantly discriminate between people with dementia and normal controls (Lessig et al., 2008). We obtained history of AD or senile dementia diagnoses by linkage to the 1991-2010 California hospitalization database. We used logistic regression models to examine the association between erroneous clock drawings and both age and hospital-record based dementia diagnosis. Results: The proportion of women who left the clock blank or drew an incorrect clock increased with increasing age. This proportion was also higher in women who were identified to have AD/dementia (14.8%) than other women (4.4%). Logistic regression analysis suggests that the likelihood of having blank or erroneous clocks increased by 30% per 5-year age category from 59 years to 90 years (95% CI ¼ 1.20-1.41), and that women who were identified to have AD/ dementia were 2.22 times as likely to skip or draw an incorrect clock as other women of the same age (95% confidence interval¼1.01-4.89). Conclusions: Clock drawings provide a useful indicator of baseline cognitive status in the CTS. In addition to our ongoing efforts to evaluate available cognitive data in the CTS, we are planning to test a computer-assisted assessment of multi-domain cognitive function to be conducted in all surviving CTS members as a strategy for longitudinal cognitive assessment. The CTS provides extensive high quality information on most potential environmental and lifestyle risk factors, and represents a resource for epidemiologic AD and cognitive outcomes research.
P3-333
P751 RISK FACTORS FOR COGNITIVE CHANGE IN PATIENTS WITH DEMENTIA DUE TO ~ PAULO, ALZHEIMER’S DISEASE FROM SAO BRAZIL
Fabricio Ferreira de Oliveira1, Paulo Henrique Ferreira Bertolucci1, Elizabeth Suchi Chen1, Marilia Arruda Cardoso Smith1, 1Federal University of S~ao Paulo-UNIFESP, S~ao Paulo, Sao Paulo, Brazil. Contact e-mail: [email protected] Background: Low schooling, high cardiovascular risk and APOE4+ haplotypes are risk factors for dementia due to Alzheimer’s disease (AD). We aimed to determine the impacts of gender, education, age of dementia onset, coronary heart disease risk and APOE haplotypes over the rate of progression of AD in a sample of patients with low mean schooling from S~ao Paulo, Brazil. Methods: Patients with late-onset AD according to National Institute on Aging - Alzheimer’s Association criteria were assessed for gender, schooling, cardiovascular risk factors, APOE haplotypes and time since dementia onset to reach Clinical Dementia Rating (CDR) scores >1.0, and Mini-Mental State Examination (MMSE) scores of 20 and 15. Framingham risk scores and 10-year coronary heart disease risk were estimated for all patients. Genotyping was undertaken with TaqManÒ Real-Time PCR technology. Mann-Whitney test and linear regressions were employed for statistical analysis, significance at r<0.05. Results: A total of 175 consecutive patients were included; 122 (69.7%) were female and 53 (30.3%) were male, and 162 (92.6%) used cholinesterase inhibitors. Mean schooling was 3.8763.5 years (range 0-15). Mean age of AD onset was 73.466.4 years-old, earlier for carriers of the APOE -ε4/ε4 haplotype (r¼0.027). Concerning cardiovascular risk factors, 33 patients were obese (18.9%), 137 had arterial hypertension (78.3%), 129 had hypercholesterolemia (73.7%), 46 had diabetes mellitus (26.3%), 43 had history of alcohol use (24.6%) and 63 had smoking history (36.0%). Mean Framingham risk scores were 19.6862.6 for females (range 11-25) and 15.0461.1 for males (range 13-17), uncorrelated with cognitive decline. Mean 10-year coronary heart disease risk was 14.3%67.4% (range 1%-30%), higher for males (20.6%64.8%) than for females (11.6%66.7%), with no overall impact over cognitive decline. Age of AD onset was negatively correlated with time to CDR>1.0 (b¼-0.125;r<0.001), to MMSE¼20 (b¼0.091;r¼0.003) and to MMSE¼15 (b¼-0.116;r¼0.006). Schooling was correlated with time to MMSE¼20 (b¼0.162;r¼0.003) in all patients, and to MMSE¼15 in females (b¼0.219;r¼0.034) and carriers of APOE4+ haplotypes of both genders (b¼0.180;r¼0.049). Conclusions: Cognitive decline is faster for patients with later onset of AD, whereas the protective effect of education is stronger in the earlier dementia stages, particularly for females and APOE4+ carriers. P3-334
IMPACT OF DIETARY PATTERNS ON COGNITIVE DECLINE AMONG DEMENTIA-FREE OLDER ADULTS: A POPULATION-BASED LONGITUDINAL STUDY
Behnaz Shakersain1, Laura Fratiglioni2, Giola Santoni3, Susanna Larsson4, Gerd Faxen-Irving5, Weili Xu1, 1Aging Research Center, Karolinska Institutet, Stockholm, Sweden; 2ARC- Karolinska Institutet, Stockholm, Sweden; 3ARC, Karolinska Institutet, Stockholm, Sweden; 4Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 5Karolinska University Hospital, Huddinge, Stockholm, Sweden. Contact e-mail: [email protected] Background: The effect of dietary patterns on cognitive decline remains unclear. We aimed to verify the hypothesis that dietary patterns are associated with global cognitive changes among older dementia-free adults over time. Methods: Within the population-based Swedish National study on Aging and Care-Kungsholmen, 2142 dementia-free participants aged ¼60 years were identified at baseline and followed-up for 6 years. Global cognitive functioning (Mini Mental State Examination, MMSE) was assessed at baseline and follow-ups. Data on dietary intake were collected through a validated semi-quantitative food frequency questionnaire (98 items) at baseline. Based on principle component factor analysis, two
P752
Poster Presentations: P3
dietary patterns emerged: 1) western-like pattern including potatoes, highfat spreads and dairy products, refined grains, meat, sweets and cookies, beer and spirits; and 2) prudent-like pattern including fruits, vegetables, legumes, cereals, whole grains, rice/pasta, low-fat dairy products, fish, poultry and tea. Data were analyzed using the multilevel Mixed-effects linear regression with adjustment for potential confounders. Results: At baseline, western-like and prudent-like dietary patterns were significantly associated with age, sex, education, physical activity, and supplement intakes. The mean MMSE score was 29.260.8 at baseline and 27.962.7 at 6year follow-up. In multi-adjusted Mixed-effects model, higher adherence to western-like dietary pattern was significantly associated with global cognitive decline (b: -0.06; 95% CI: -0.09, -0.03, p¼<.001), but higher adherence to prudent-like dietary pattern was inversely related to cognitive decline (b: 0.05; 95% CI: 0.02, 0.08, p¼.001). The coefficients were adjusted for total energy intake, demographics, physical activity, smoking, anthropometrics, chronic conditions, APOE4 allele, and vitamin or mineral supplement intakes. Conclusions: Western-like dietary pattern is associated with an increased risk of cognitive decline, whereas prudentlike dietary pattern seems to play a protective role in cognitive aging among dementia-free older adults. P3-335
COGNITIVE RESERVE AND COGNITIVE FUNCTION: A META-ANALYSIS
Carol Opdebeeck1, Anthony Martyr2, Linda Clare1, 1Bangor University, Bangor, United Kingdom; 2Bangor University, Bangor, Wales, United Kingdom. Contact e-mail: [email protected] Background: Cognitive reserve is thought to delay the onset of dementia and the progress of cognitive decline in later life. As cognitive reserve cannot be directly measured, it is commonly indexed by those experiences and activities thought to increase it. However, the associations between proxy measures of cognitive reserve and cognitive function vary across studies and within different cognitive domains. This meta-analysis aimed to synthesise the existing research to assess the relationships between cognitive reserve and cognitive function in cognitively healthy people aged over 50. Methods: Cognitive reserve was considered in terms of the three most common proxy measures, namely educational level, occupational complexity, and engagement in cognitively-stimulating activities, and measures which combine these three domains. Thirty studies with a total of 52,694 participants were included in the random-effects meta-analysis. Of these, 21 used a measure of education, nine used a measure of occupational complexity, 10 used a measure of participation in cognitively-stimulating leisure activities, and one used a combination of the three proxies. Results: In this random effects meta-analysis all three proxies had a modest positive association with cognitive function; occupational complexity showed the most variation across different cognitive domains. Heterogeneity ranged from moderate to high which indicates that the included studies differed substantially in their variance, supporting the use of a random effects meta-analysis. Conclusions: This meta-analysis and other recent findings support the view that the commonly used proxies of cognitive reserve share an underlying process but that each additionally provides a unique contribution to an individual’s cognitive reserve. A further understanding of this relationship would aid in establishing which lifestyle changes could help delay cognitive decline and the onset of dementia. P3-336
NUTRIENT PATTERNS AND COGNITION AMONG TWO POPULATIONS SHARING COMMON ANCESTRAL ORIGIN: RESULTS FROM THE 3C (FRANCE) AND NUAGE (QUEBEC) STUDIES
Benjamin Alles1, Cecilia Samieri2, Pierre-Hugues Carmichael3, MartheAline Jutand2, Bryna Shatenstein4, Pierrette Gaudreau5, Helene Payette6, Danielle Laurin7, Pascale Barberger-Gateau8, 1Laval University, Quebec, Quebec, Canada; 2INSERM U897, Bordeaux, France; 3Centre d’Excellence sur le Vieillissement de Quebec, Quebec, Quebec, Canada; 4Institut Universitaire de Geriatrie de Montreal, Montreal, Quebec, Canada; 5 University of Montreal and CHUM Research Center, Montreal, Quebec, Canada; 6Centre de Recherche sur le Vieillissement-Centre de Sante et des
Services Sociaux, Sherbrooke, Quebec, Canada; 7H^opital du Saint-Sacrement, Quebec, Quebec, Canada; 8INSERM, U897, University Bordeaux Segalen, Bordeaux, France. Contact e-mail: benjamin.alles@ isped.u-bordeaux2.fr Background: Nutrient or dietary patterns that capture the complexity of food intake have been associated with better cognitive function in older persons. To date, no study has compared the link between a posteriori derived nutrient patterns and cognitive function in two different populations with common ancestral origin, but exposed to different environments. The aim of this study was to identify nutrient patterns and to assess their relationship with cognitive function and its decline among two older populations in France and Quebec, Canada. Methods: Participants from the Three-City cohort study (3C, France, n¼1,388) and Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge, Quebec, Canada, n¼1,454) had repeated measures of global cognitive function measured by the Mini Mental State Examination (MMSE) over up to five years. Their dietary intake was assessed at baseline by a 24-hour recall. Nutrient patterns were obtained through factor-analysis using principal component analysis (FAPCA). Longitudinal analyses using linear mixed models were performed separately in each cohort to evaluate the association between nutrient patterns and cognition. Results: In 3C, the mean age was 75.7 y (standard deviation, SD¼4.8) with 62.8% percent of women; in NuAge, it was 74.3 y (SD¼4.2) with 52.1% of women. Three nutrient patterns were identified in each study: a healthy diet and a western diet, both relatively similar in the two cohorts, and a traditional diet specific to dietary habits of each country. In 3C, a greater healthy nutrient pattern score was associated with better cognitive function at baseline (decreasing number MMSE errors with higher healthy pattern scores at baseline, p<0.005), while a greater western nutrient pattern score was associated with worse cognitive function (increasing number MMSE errors with higher western pattern score, p<0.05). In NuAge, no association was observed between nutrient patterns and cognitive impairment. In both studies, no association between any of the nutrient patterns scores and cognitive decline was reported. Conclusions: These results suggest that nutrition may influence the level of global cognitive function. Longer follow-up is required to reveal the dynamics between diet and cognitive decline in both studies.
P3-337
NETWORK VISUALIZATION TO DISCERN PATTERNS OF RELATIONSHIPS BETWEEN SYMPTOMS IN DEMENTIA
Arnold Mitnitski1, Kenneth Rockwood1, Matthew Richard1, 1DGI Clinical, Halifax, Nova Scotia, Canada. Contact e-mail: amitnitski@ dgiclinical.com Background: The multidimensional characterization of complex diseases such as dementia usually demands a large number of cases in order to obtain reliable inferences. Even so, the number of participants in many studies, including clinical trials, is small in comparison to dementia complexity. Here we suggest an approach based on network visualization, combined with resampling, to discern the patterns of relationships among multiple dementia symptoms. Methods: The data came from on online symptom tracking tool on the SymptomGuide (SG) website,. Four hundred randomly selected patients were classified evenly into two groups, corresponding to mild and moderate-to- severe dementia, respectively. Of the 60 symptoms, the 25 symptoms with prevalence >10% were selected. For all pairs of symptoms relative risks (RR) of c-occurrence and their pointwise mutual information (PMI) were calculated. The null hypothesis (RR¼1 or equivalently PMI¼0) was assessed using bootstrap samples of 100 000 with replacement to calculate the RR and PMI between symptoms. Results: The number of connections between mild and moderate/severe groups declined significantly (from 906 5 to 5663, p<0.001). The mild group showed 32 positive (synergetic) connections, compared to 16 in moderate/severe group. The number of negative connections (antagonistic) also decreased, from 58 in the mild group to 40 connections in moderate/severe group. For example, in mild dementia, decreased interest/ initiative had 4 synergetic and 9 antagonistic relationships with other
DEVELOPING STRATEGIES FOR LONGITUDINAL ASSESSMENT OF COGNITIVE FUNCTION IN THE CALIFORNIA TEACHERS STUDY
Eunjung Lee1, Lon S. Schneider1, Jung Yun Jang1, Jacqueline Lee Tilley1, Jean Kim1, Carlos Rodriguez1, Christine Juang1, Dennis Deapen1, Margaret Gatz1, Carol A. McCleary1, 1University of Southern California, Los Angeles, California, United States. Contact e-mail: [email protected] Background: The California Teachers Study (CTS) cohort, established in 1995, is a prospective cohort of 133,479 female public school employees that contains extensive exposure data over the participant’s life course, including most of the proposed risk factors of Alzheimer’s disease (AD). Developing strategies for longitudinal assessment of cognitive function is essential for the CTS to serve as a resource for large-scale etiologic research on cognitive decline. As a first step, we evaluated clock drawings in questionnaires collected from CTS participants in 2000. Methods: We randomly selected 3,000 women from w89,000 participants who returned the questionnaires in 2000 (>99% were college graduates). Trained research staff evaluated the selected clock drawings following scoring criteria that were shown to significantly discriminate between people with dementia and normal controls (Lessig et al., 2008). We obtained history of AD or senile dementia diagnoses by linkage to the 1991-2010 California hospitalization database. We used logistic regression models to examine the association between erroneous clock drawings and both age and hospital-record based dementia diagnosis. Results: The proportion of women who left the clock blank or drew an incorrect clock increased with increasing age. This proportion was also higher in women who were identified to have AD/dementia (14.8%) than other women (4.4%). Logistic regression analysis suggests that the likelihood of having blank or erroneous clocks increased by 30% per 5-year age category from 59 years to 90 years (95% CI ¼ 1.20-1.41), and that women who were identified to have AD/ dementia were 2.22 times as likely to skip or draw an incorrect clock as other women of the same age (95% confidence interval¼1.01-4.89). Conclusions: Clock drawings provide a useful indicator of baseline cognitive status in the CTS. In addition to our ongoing efforts to evaluate available cognitive data in the CTS, we are planning to test a computer-assisted assessment of multi-domain cognitive function to be conducted in all surviving CTS members as a strategy for longitudinal cognitive assessment. The CTS provides extensive high quality information on most potential environmental and lifestyle risk factors, and represents a resource for epidemiologic AD and cognitive outcomes research.
P3-333
P751 RISK FACTORS FOR COGNITIVE CHANGE IN PATIENTS WITH DEMENTIA DUE TO ~ PAULO, ALZHEIMER’S DISEASE FROM SAO BRAZIL
Fabricio Ferreira de Oliveira1, Paulo Henrique Ferreira Bertolucci1, Elizabeth Suchi Chen1, Marilia Arruda Cardoso Smith1, 1Federal University of S~ao Paulo-UNIFESP, S~ao Paulo, Sao Paulo, Brazil. Contact e-mail: [email protected] Background: Low schooling, high cardiovascular risk and APOE4+ haplotypes are risk factors for dementia due to Alzheimer’s disease (AD). We aimed to determine the impacts of gender, education, age of dementia onset, coronary heart disease risk and APOE haplotypes over the rate of progression of AD in a sample of patients with low mean schooling from S~ao Paulo, Brazil. Methods: Patients with late-onset AD according to National Institute on Aging - Alzheimer’s Association criteria were assessed for gender, schooling, cardiovascular risk factors, APOE haplotypes and time since dementia onset to reach Clinical Dementia Rating (CDR) scores >1.0, and Mini-Mental State Examination (MMSE) scores of 20 and 15. Framingham risk scores and 10-year coronary heart disease risk were estimated for all patients. Genotyping was undertaken with TaqManÒ Real-Time PCR technology. Mann-Whitney test and linear regressions were employed for statistical analysis, significance at r<0.05. Results: A total of 175 consecutive patients were included; 122 (69.7%) were female and 53 (30.3%) were male, and 162 (92.6%) used cholinesterase inhibitors. Mean schooling was 3.8763.5 years (range 0-15). Mean age of AD onset was 73.466.4 years-old, earlier for carriers of the APOE -ε4/ε4 haplotype (r¼0.027). Concerning cardiovascular risk factors, 33 patients were obese (18.9%), 137 had arterial hypertension (78.3%), 129 had hypercholesterolemia (73.7%), 46 had diabetes mellitus (26.3%), 43 had history of alcohol use (24.6%) and 63 had smoking history (36.0%). Mean Framingham risk scores were 19.6862.6 for females (range 11-25) and 15.0461.1 for males (range 13-17), uncorrelated with cognitive decline. Mean 10-year coronary heart disease risk was 14.3%67.4% (range 1%-30%), higher for males (20.6%64.8%) than for females (11.6%66.7%), with no overall impact over cognitive decline. Age of AD onset was negatively correlated with time to CDR>1.0 (b¼-0.125;r<0.001), to MMSE¼20 (b¼0.091;r¼0.003) and to MMSE¼15 (b¼-0.116;r¼0.006). Schooling was correlated with time to MMSE¼20 (b¼0.162;r¼0.003) in all patients, and to MMSE¼15 in females (b¼0.219;r¼0.034) and carriers of APOE4+ haplotypes of both genders (b¼0.180;r¼0.049). Conclusions: Cognitive decline is faster for patients with later onset of AD, whereas the protective effect of education is stronger in the earlier dementia stages, particularly for females and APOE4+ carriers. P3-334
IMPACT OF DIETARY PATTERNS ON COGNITIVE DECLINE AMONG DEMENTIA-FREE OLDER ADULTS: A POPULATION-BASED LONGITUDINAL STUDY
Behnaz Shakersain1, Laura Fratiglioni2, Giola Santoni3, Susanna Larsson4, Gerd Faxen-Irving5, Weili Xu1, 1Aging Research Center, Karolinska Institutet, Stockholm, Sweden; 2ARC- Karolinska Institutet, Stockholm, Sweden; 3ARC, Karolinska Institutet, Stockholm, Sweden; 4Division of Nutritional Epidemiology, National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; 5Karolinska University Hospital, Huddinge, Stockholm, Sweden. Contact e-mail: [email protected] Background: The effect of dietary patterns on cognitive decline remains unclear. We aimed to verify the hypothesis that dietary patterns are associated with global cognitive changes among older dementia-free adults over time. Methods: Within the population-based Swedish National study on Aging and Care-Kungsholmen, 2142 dementia-free participants aged ¼60 years were identified at baseline and followed-up for 6 years. Global cognitive functioning (Mini Mental State Examination, MMSE) was assessed at baseline and follow-ups. Data on dietary intake were collected through a validated semi-quantitative food frequency questionnaire (98 items) at baseline. Based on principle component factor analysis, two
P752
Poster Presentations: P3
dietary patterns emerged: 1) western-like pattern including potatoes, highfat spreads and dairy products, refined grains, meat, sweets and cookies, beer and spirits; and 2) prudent-like pattern including fruits, vegetables, legumes, cereals, whole grains, rice/pasta, low-fat dairy products, fish, poultry and tea. Data were analyzed using the multilevel Mixed-effects linear regression with adjustment for potential confounders. Results: At baseline, western-like and prudent-like dietary patterns were significantly associated with age, sex, education, physical activity, and supplement intakes. The mean MMSE score was 29.260.8 at baseline and 27.962.7 at 6year follow-up. In multi-adjusted Mixed-effects model, higher adherence to western-like dietary pattern was significantly associated with global cognitive decline (b: -0.06; 95% CI: -0.09, -0.03, p¼<.001), but higher adherence to prudent-like dietary pattern was inversely related to cognitive decline (b: 0.05; 95% CI: 0.02, 0.08, p¼.001). The coefficients were adjusted for total energy intake, demographics, physical activity, smoking, anthropometrics, chronic conditions, APOE4 allele, and vitamin or mineral supplement intakes. Conclusions: Western-like dietary pattern is associated with an increased risk of cognitive decline, whereas prudentlike dietary pattern seems to play a protective role in cognitive aging among dementia-free older adults. P3-335
COGNITIVE RESERVE AND COGNITIVE FUNCTION: A META-ANALYSIS
Carol Opdebeeck1, Anthony Martyr2, Linda Clare1, 1Bangor University, Bangor, United Kingdom; 2Bangor University, Bangor, Wales, United Kingdom. Contact e-mail: [email protected] Background: Cognitive reserve is thought to delay the onset of dementia and the progress of cognitive decline in later life. As cognitive reserve cannot be directly measured, it is commonly indexed by those experiences and activities thought to increase it. However, the associations between proxy measures of cognitive reserve and cognitive function vary across studies and within different cognitive domains. This meta-analysis aimed to synthesise the existing research to assess the relationships between cognitive reserve and cognitive function in cognitively healthy people aged over 50. Methods: Cognitive reserve was considered in terms of the three most common proxy measures, namely educational level, occupational complexity, and engagement in cognitively-stimulating activities, and measures which combine these three domains. Thirty studies with a total of 52,694 participants were included in the random-effects meta-analysis. Of these, 21 used a measure of education, nine used a measure of occupational complexity, 10 used a measure of participation in cognitively-stimulating leisure activities, and one used a combination of the three proxies. Results: In this random effects meta-analysis all three proxies had a modest positive association with cognitive function; occupational complexity showed the most variation across different cognitive domains. Heterogeneity ranged from moderate to high which indicates that the included studies differed substantially in their variance, supporting the use of a random effects meta-analysis. Conclusions: This meta-analysis and other recent findings support the view that the commonly used proxies of cognitive reserve share an underlying process but that each additionally provides a unique contribution to an individual’s cognitive reserve. A further understanding of this relationship would aid in establishing which lifestyle changes could help delay cognitive decline and the onset of dementia. P3-336
NUTRIENT PATTERNS AND COGNITION AMONG TWO POPULATIONS SHARING COMMON ANCESTRAL ORIGIN: RESULTS FROM THE 3C (FRANCE) AND NUAGE (QUEBEC) STUDIES
Benjamin Alles1, Cecilia Samieri2, Pierre-Hugues Carmichael3, MartheAline Jutand2, Bryna Shatenstein4, Pierrette Gaudreau5, Helene Payette6, Danielle Laurin7, Pascale Barberger-Gateau8, 1Laval University, Quebec, Quebec, Canada; 2INSERM U897, Bordeaux, France; 3Centre d’Excellence sur le Vieillissement de Quebec, Quebec, Quebec, Canada; 4Institut Universitaire de Geriatrie de Montreal, Montreal, Quebec, Canada; 5 University of Montreal and CHUM Research Center, Montreal, Quebec, Canada; 6Centre de Recherche sur le Vieillissement-Centre de Sante et des
Services Sociaux, Sherbrooke, Quebec, Canada; 7H^opital du Saint-Sacrement, Quebec, Quebec, Canada; 8INSERM, U897, University Bordeaux Segalen, Bordeaux, France. Contact e-mail: benjamin.alles@ isped.u-bordeaux2.fr Background: Nutrient or dietary patterns that capture the complexity of food intake have been associated with better cognitive function in older persons. To date, no study has compared the link between a posteriori derived nutrient patterns and cognitive function in two different populations with common ancestral origin, but exposed to different environments. The aim of this study was to identify nutrient patterns and to assess their relationship with cognitive function and its decline among two older populations in France and Quebec, Canada. Methods: Participants from the Three-City cohort study (3C, France, n¼1,388) and Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge, Quebec, Canada, n¼1,454) had repeated measures of global cognitive function measured by the Mini Mental State Examination (MMSE) over up to five years. Their dietary intake was assessed at baseline by a 24-hour recall. Nutrient patterns were obtained through factor-analysis using principal component analysis (FAPCA). Longitudinal analyses using linear mixed models were performed separately in each cohort to evaluate the association between nutrient patterns and cognition. Results: In 3C, the mean age was 75.7 y (standard deviation, SD¼4.8) with 62.8% percent of women; in NuAge, it was 74.3 y (SD¼4.2) with 52.1% of women. Three nutrient patterns were identified in each study: a healthy diet and a western diet, both relatively similar in the two cohorts, and a traditional diet specific to dietary habits of each country. In 3C, a greater healthy nutrient pattern score was associated with better cognitive function at baseline (decreasing number MMSE errors with higher healthy pattern scores at baseline, p<0.005), while a greater western nutrient pattern score was associated with worse cognitive function (increasing number MMSE errors with higher western pattern score, p<0.05). In NuAge, no association was observed between nutrient patterns and cognitive impairment. In both studies, no association between any of the nutrient patterns scores and cognitive decline was reported. Conclusions: These results suggest that nutrition may influence the level of global cognitive function. Longer follow-up is required to reveal the dynamics between diet and cognitive decline in both studies.
P3-337
NETWORK VISUALIZATION TO DISCERN PATTERNS OF RELATIONSHIPS BETWEEN SYMPTOMS IN DEMENTIA
Arnold Mitnitski1, Kenneth Rockwood1, Matthew Richard1, 1DGI Clinical, Halifax, Nova Scotia, Canada. Contact e-mail: amitnitski@ dgiclinical.com Background: The multidimensional characterization of complex diseases such as dementia usually demands a large number of cases in order to obtain reliable inferences. Even so, the number of participants in many studies, including clinical trials, is small in comparison to dementia complexity. Here we suggest an approach based on network visualization, combined with resampling, to discern the patterns of relationships among multiple dementia symptoms. Methods: The data came from on online symptom tracking tool on the SymptomGuide (SG) website,. Four hundred randomly selected patients were classified evenly into two groups, corresponding to mild and moderate-to- severe dementia, respectively. Of the 60 symptoms, the 25 symptoms with prevalence >10% were selected. For all pairs of symptoms relative risks (RR) of c-occurrence and their pointwise mutual information (PMI) were calculated. The null hypothesis (RR¼1 or equivalently PMI¼0) was assessed using bootstrap samples of 100 000 with replacement to calculate the RR and PMI between symptoms. Results: The number of connections between mild and moderate/severe groups declined significantly (from 906 5 to 5663, p<0.001). The mild group showed 32 positive (synergetic) connections, compared to 16 in moderate/severe group. The number of negative connections (antagonistic) also decreased, from 58 in the mild group to 40 connections in moderate/severe group. For example, in mild dementia, decreased interest/ initiative had 4 synergetic and 9 antagonistic relationships with other