MAINTAINING COGNITIVE IMPAIRMENT PATIENTS IN A MILDER DISEASE STAGE RESULTS IN LESS HEALTHCARE RESOURCE UTILIZATION

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Poster Presentations: Tuesday, July 26, 2016

Germany; 5Institute of Social Medicine, Occupational Health and Public Health (ISAP), Faculty of Medicine, University of Leipzig, Leipzig, Germany; 6LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany. Contact e-mail: francisca.then@ medizin.uni-leipzig.de Background: Previous studies have shown that individuals with poor

social relationships have an increased risk for dementia. Dementia risk, however, can also be positively influenced by lifestyle factors such as high mental demands at work (in particular as the work environment affects a very long lifetime period). Thus, our objective was to investigate whether the cognitive functioning of socially isolated individuals may profit from high mental work demands. Methods: Analyses were based on n¼10,000 participants (aged 40-80 years) of the population-based German LIFE-Adult-Study. All participants underwent medical examinations and filled out standardized questionnaires. Cognitive functioning was assessed via the Verbal Fluency Test (VFT) and the Trail-Making Test (TMT). Social relationships were assessed via the Lubben Social Network Scale (LSNS-6). Results: The difference in cognitive functioning between high and low mental work demand conditions was larger in socially isolated individuals (VFT: 2.7 words, TMT-B: 26 seconds) compared to socially well integrated individuals (VFT: 2.1 words, TMT-B: 9 seconds). Multivariate regression analyses – adjusted for age, gender, and education – indicated that both mental work demands as well as social relationships are significantly associated with the level of cognitive functioning (p<0.001). Results also suggest interaction effects indicating a stronger impact of mental work demands on cognitive functioning in socially isolated individuals than in well integrated individuals. Conclusions: The findings imply that individuals with poor social relationships may particularly benefit from high mental work demands regarding their risk for dementia. The level of mental demands at work could therefore be an important target for tailored preventative approaches. P3-378

PATIENTS WITH ALZHEIMER’S DISEASE SUFFERED REDUCED QUALITY OF LIFE RELATIVE TO THE GENERAL POPULATION: RESULTS FROM A RECENT MULTINATIONAL CROSS-SECTIONAL SURVEY

Xiaohan Hu1,2, Eddie Jones3, Robert Wood3, Christopher M. Black1, Baishali M. Ambegaonkar1, Rezaul Karim Khandker1, 1Merck&Co., Inc., Kenilworth, NJ, USA; 2Temple University, Philadelphia, PA, USA; 3Adelphi Real World, Macclesfield, United Kingdom. Contact e-mail: xiaohan.hu@ merck.com Background: Alzheimer’s disease (AD) could reduce patients’ qual-

ity of life (QoL) substantially, however, how this impact compares to the general population is less well understood. This analysis aimed to quantify the impact of AD on patients’ QoL relative to a similar population without AD. Methods: Data were taken from two sources; 2013 Adelphi Real World Dementia Disease Specific Programme (DSP) and 2012 Health Survey for England (HSE). The former is a cross-sectional survey of physicians, and patients over 50 years old with cognitive impairment (CI) in France, Germany, Italy, Spain, UK and US, while the latter is a general population sample of adults and children, representative of the whole English population at both national and regional level. Inverse probability weighted regression adjustment (IPWRA) was used to assess difference in EuroQoL-5D (EQ-5D-3L) between the AD sample of DSP and general public HSE sample, while controlling for following data points common to both sources; age, sex, body mass index, employment status and conditions suffered. Statistical significance

was assessed via calculation of Abadie-Imbens standard error. Results: A total of 10,333 subjects (median age 43.0, 54.3% female)

and 4,013 AD patients (median age 79.0, 57.6% female) were collected in HSE and DSP. After IPWRA, other than mental disorders, all covariates had an absolute standardized mean difference (SMD) <10%. The presence of mental disorders remained imbalanced, however the corresponding absolute SMD vastly reduced from 103% to 37%. EQ-5D-3L was significantly lower in AD sample compared to HSE sample after IPWRA (0.65 vs 0.73, p<0.001), and the mean difference exceeded the minimally important difference of 0.0741. It should be noted that AD patients who completed EQ-5D-3L had a better cognitive function compared to entire AD sample (mean MMSE score: 19.5 vs 16.6). Therefore the difference in QoL between AD sample as a whole and general public would be expected to be even larger. Conclusions: The detrimental impact of AD on patients’ QoL is still significant compared to general population without AD despite currently available therapies. These results suggest that early and effective interventions are in need to control this condition and to potentially improve patients’ QoL. P3-379

MAINTAINING COGNITIVE IMPAIRMENT PATIENTS IN A MILDER DISEASE STAGE RESULTS IN LESS HEALTHCARE RESOURCE UTILIZATION

Xiaohan Hu1,2, Eddie Jones3, Robert Wood3, Christopher M. Black1, Rezaul Karim Khandker1, Baishali M. Ambegaonkar1, 1Merck&Co., Inc., Kenilworth, NJ, USA; 2Temple University, Philadelphia, PA, USA; 3Adelphi Real World, Macclesfield, United Kingdom. Contact e-mail: xiaohan.hu@ merck.com Background: Patients suffering from advanced stages of Alz-

heimer’s disease (AD) could incur high costs because of gradual loss of the basic life functions and the supervision required. This analysis aimed to compare the healthcare resource utilization (HCRU) of patients in different stages of cognitive impairment (CI). Methods: Data were taken from the 2013 Adelphi Real World Dementia Disease Specific Programme, a cross-sectional survey of physicians, and patients over 50 years old with CI in France, Germany, Italy, Spain, the UK and the US. Physicians completed patient record forms containing patient demographics, clinical characteristics and HCRU. Patients were classified into four CI subgroups based on their current mini–mental state examination score and diagnostic labels; prodromal (24-30), mild (18-23), moderate (10-17) and severe (<10). The latter three groups had a diagnostic label of AD, early onset AD or mixed dementia, while the first group could not have one of these labels but had a mild CI (MCI), amnestic MCI, pre-dementia AD or prodromal AD label. Propensity score matching, controlling for patient demographics and clinical characteristics, was used to assess differences in HCRU between prodromal/mild patients and moderate/severe patients. Statistical significance was assessed via the calculation of the Abadie-Imbens standard error. Results: A total of 3592 patients (median age 78.0, 55.5% female) were collected, of which 1959 were prodromal/mild patients and 1633 moderate/severe. Each moderate/severe patient was matched 1:1 to a prodromal/mild patient with replacement. After matching, all covariates had an absolute standardised mean difference <10%. The mean differences in specialist consultations (4.5 moderate/severe versus 3.8 prodromal/ mild), number of hospitalizations (0.4 vs 0.3) and number of inpatient days (3.7 vs 1.5) in the last 12 months were all statistically significant (p<0.05). Moderate/severe patients also required significantly more professional caregiver hours per week (36.7 vs 20.8,

Poster Presentations: Tuesday, July 26, 2016

p<0.001) and a significantly higher proportion of these patients were institutionalized (21.4 vs 8.8, p<0.001). Conclusions: Later stage CI patients incur more HCRU than prodromal/mild patients, consequently imposing a heavier burden on healthcare system. Therefore, therapies that could delay cognitive decline can have the potential for important clinical benefits and substantial cost savings for healthcare systems in countries with rapidly aging populations. P3-380

ADDRESSING THE CHALLENGE OF WORKFORCE CAPACITY IN DEMENTIA RESEARCH

James Pickett1, Sonja Marjanovic2, 1Alzheimer’s Society (UK), London, United Kingdom; 2RAND Europe, Cambridge UK, United Kingdom. Contact e-mail: [email protected] Background: Dementia currently affects 850,000 people in the UK, devastates families and costs the UK economy an estimated £26 billion a year. After decades of underfunding, investment in dementia research in increasing, but there are still too few researchers working on the condition. A small research workforce may limit the progress that can be made in all fields of investigation, including aetiology, treatment development, care and public health. Alzheimer’s Society commissioned RAND Europe to conduct an independent review of the UK dementia research landscape with a particular emphasis on the current research capacity challenges and policy strategies to address them. Methods: RAND Europe’s review used three methods: (i) a bibliometric analysis of UK dementia research; (ii) a tracing exercise of dementia PhDs from the British Library to estimate retention of researchers in the field; (iii) in-depth interviews to investigate workforce strengths and gaps in more depth. These three streams of work were combined to develop a set of ten policy recommendations for building capacity within the UK dementia research workforce. Results: Bibliometric analysis identified the UK as second in the world in terms of the number of dementia research publications produced. There is a shortage of people completing PhDs in dementia, with five times fewer theses completed compared to those in cancer fields. There is also a lack of security and career progression for early career researchers, with at least 70% of recent PhDs leaving the field within 4 years. In biomedical dementia research, there is a particular lack of opportunities for those at the mid-career stage, whereas in clinical and care professions, the opportunity gap is mostly at the early career stage where people will enter into research for the first time. Conclusions: Significantly more academic, clinical and care researchers must be brought into the dementia to find new, innovative ways for our health and social care systems to support the increasing number of people living with dementia. This work has developed ten policy recommendations to inform future strategies aimed at building a large and diverse dementia research community in the UK. Reference: Marjanovic et al. (2015) RAND Europe report P3-381

COMPARISION OF PROFESSIONAL GUIDELINES REGARDING THE USE OF GENETIC AND PATHOLOGICAL BIOMARKERS

Rosa Gonzalez1, Jalayne J. Arias2, 1Cleveland Clinic, Cleveland, OH, USA; 2 University of California San Francisco, San Francisco, CA, USA. Contact e-mail: [email protected] Background: Professional guidelines include recommendations and

standards to integrate the use of Alzheimer’s disease biomarkers (genetic and pathological) in clinical practice and research.

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Guidelines establish standards for clinicians and researchers when addressing ethical questions, including whether to offer testing and how to disclose results. Guidelines addressing ethical questions regarding genetic testing have a more substantial history than recently discovered pathological markers. It has been suggested that existing genetic marker guidelines can also apply to pathological markers. However, the blanket adoption comes with risks of missing nuances between biomarkers which hold ethical, legal, or policy relevance. Methods: Using PubMed, researchers applied search terms including combinations of Alzheimer’s, biomarkers, genetics, ethics, and searches using individual markers (i.e., amyloid, APOE) to find professional guidelines for the use of genetic and pathological biomarkers. Researchers analyzed professional guidelines to compare recommendations between genetic and pathological biomarkers. Results: Guidelines of genetic markers differ depending on factors such as: clinical vs. research use, symptomatic vs. asymptomatic status, and dominant vs. susceptibility genetic marker. The ACMG has published guidelines for clinical genetic testing that emphasize extensive pre and post genetic counseling in all patients regardless of any of the previous listed factors. Because of the uncertainty of genetic results in research, the National Human Genome Research Institute (NHGRI) generally discourages researchers from disclosing results to research participant. Pathological marker guidelines are under ongoing development due to the uncertainty of clinical value. Under the NIA-AA criteria amyloid biomarker testing is restricted to research. Similarly, the Amyloid Imaging Task Force limited PET-amyloid imaging to symptomatic patients with atypical presentation of Alzheimer’s disease. (AUC) Finally, in 2013 the Centers for Medicaid and Medicare restricted payment coverage for amyloid imaging to narrow circumstances, which do not include asymptomatic patients. Conclusions: Professional guidelines for pathological markers and genetic markers share similar structures when differentiating between symptomatic versus asymptomatic individuals. However, key differences between pathological markers and genetic markers challenge the complete adoption of genetic guidelines for pathological biomarkers. P3-382

GLOBAL DEMENTIA POLICY OVERVIEW

Marc Wortmann, Alzheimer’s Disease International, London, United Kingdom. Contact e-mail: [email protected] Background: The Global prevalence of Alzheimer’s disease and other dementias has been estimated at 46.8 million in 2015 and the cost of the disease was calculated at $818 billion, according to the World Alzheimer Report 2015. This is a significant increase compared to the number in the previous review in 2010. This makes dementia one of the most important health challenges of the 21st century. Methods: A number of policy initiatives have been taken at the global level since 2012. This includes a joint report, “Dementia: A Global Health Priority” by the World Health Organization (WHO) and Alzheimer’s Disease International (ADI); a G8 Summit in London in December 2013, follow by legacy events in the UK, Canada, Japan and USA and the Global Action Against Dementia collaboration of G7 countries and other stakeholders including the creation of the World Dementia Council in 2014; a Ministerial Conference on Dementia at WHO in March 2015; some other meetings and initiatives. Results: More than 20 countries now developed a national Alzheimer or dementia strategy. A number of governments have increased funding for research, including the USA, UK, Canada, Japan and Netherlands. The WHO region for the