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Non-recognition of dementia by caregivers; frequency and correlates in the Honolulu heart program cohort
FOURTH INTERNATIONAL CONFERENCE ON ALZHEIMER’S DISEASE
positive association was found between higher sarum cholesterol level at exam 4 and higher CASI score (p=0.0001). Pack years of smoking at exam 4 was also associated with higher CASI scores (p=o.ol). Conversely, no significant associations were foundwith serum cholesterol or pack years of smoking assessed 20 years earlier at the 3rd HHP Examination. These paradoxical results are interpreted as suggesting that are more likely to continue non-demented persons smoking and have diets leading to higher cholesterol levels, as compared with cognitively impaired persons.
183
185
TEN RELATIONSHIP OF DIABETES AND QLUCOSN TOLERANCE TO COGNITIVE FUNCTION J.D. Curb, B.L. Rodriguez, L.R.
White,
problem with memory or thinking. In a logistic model containing these same variables, all but past memory were independently predictive. These findings indicate that denial of memory impairment by caregivers of mildly to moderately demented subjects is common, and that recognition is positively associated with higher education, severity of the dementia, and extent of behavioral disturbances. Failure of caregivers to recognize a problem with thinking and memory probably contributes substantially to many early or mild cases of dementia not receiving a proper medical evaluation.
H. Petrovitch,
K.H.
Masaki,
C.M.
Kuakini Medical Center, ROSS, E. Ardo. Institute on Aging and the University Honolulu, Hawaii 96917, USA.
Burchfiel,
W.
the National of Hawaii,
poorer Diabetics have been reported to have cognitive function than nondiabetics in cross sectional studies. As Dart of the Fourth examination 11991-1993) of the Honolulu Heart Program cohort of 3735 Japanese American men, cognitive function was measured by the Cognitive Assessment Screening Instrument (CASI), an instrument combining features of the Folstein MiniMental scale and the Hasagawa Scale and designed for use in cross-cultural settings. Diabetes and glucose tolerance (fasting and 2 hour post-load glucose) were also assessed. A prior assessment of glucose intolerance (nonfasting 1 hour post-load glucose) was carried out at the baseline examination in 1965-1968. After adjustment for age and education in a multiple regression model, there was no association between diabetes or glucose level 28 years previously and cognitive function at the Fourth Examination (p=O.9). However, in a similar multivariate analysis, significant negative associations were seen between cognitive function and diabetes (~10.01) as well as fasting glucose (p=O.O5) and two hour post-load glucose (~50.01) measured on the same day at the Fourth Examination, after adjustment for age, education, Apo E phenotype and hypertension. Although selective mortality may partially explain the differences seen between the cross-sectional and longitudinal data, these findings do not appear to support a long term adverse impact of disordered glucose metabolism on cognitive function. They do provide evidence for an immediate adverse effect of abnormal glucose metabolism on cognitive performance in older individuals.
NON-STEROIDAL ANTI-INFLAMMATORY DRUG USE AND ALZHEIMER’S DISEASE IN ROCHESTER, MINNESOTA. C.M. Beard, E. Kokmen, P.C. O’Brien and L.T. Kurland. Alzheimer’s Disease Center, Departments of Health Sciences Research and of Neurology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905 USA. During the conduct of the ongoing studies of dementing illness in Rochester, MN, we identified 302 new cases of Alzheimer’s disease whose onset occurred during the years 1980-1984. One age- and gender-matched control was selected from among all Rochester residents who registered for care at Mayo Clinic during the year of onset for the case. All community medical records for the cases and controls were reviewed for evidence of non-steroidal anti-inflammatory drug (NSAID) prescriptions during the year prior to and the year of onset in the case and the corresponding index years for controls. Use of aspirin and acetaminophen-containing drugs was also documented. Exposure to these preparations was considered to be substantial if the patient received a prescription or there was evidence that the patient took the drug for seven or more days. Odds ratios were estimated to compare exposure among cases and controls using the logistic regression approach for matched sets of Breslow and Day. The overall odds ratio for current and substantial exposure to any NSAID or aspirin with age in the model was 0.77 (95% CI 0.54-1.10). Limiting the analysis to current and substantial NSAID use VS. no NSAID use resulted in an odds ratio of 0.69 (95% CI 0.45-1.08). Similarly, the odds ratios for current and substantial NSAID use vs. no NSAID use were 0.85 (95% CI 0.52-1.40) and 0.34 (95% CI 0.12-0.96) for women and men, respectively. The results of this study are suggestive but not conclusive for a protective effect for NSAID use in Alzheimer’s disease.
186 184 FREQUNNCY NON-RECOSNITION OF DNNNNTIA BY CAREGIVERS; AND CORRNLATNS IN TNN HONOLULU NNART PROGRAN CONORT. G.W. Ross, L.R. White, C. Trockman, H. Petrovitch, K.H. Honolulu Veterans Masaki, D. Chiu, C. Murdaugh. (347 N. Kuakini Affairs; NIA; Honolulu Heart Program HI.); NINR. Street, Honolulu, Little is known about how often cognitive impairment due to dementia goes unrecognized, although anecdotal Our subjects were reports suggest it may be common. a longitudinally studied cohort of elderly from evaluations in Japanese men undergoing cognitive conjunction with the Honolulu Heart Program fourth Among 155 subjects meeting the DSMIIIR examination. 17% had caregivers who denied criteria for dementia, having noticed any problem with thinking or memory. This undoubtedly underestimates the phenomenon because since the DSMIIIR of a definitional circularity, difficulties with memory require that criteria interview of a family ascertained by (ordinarily informant) be of sufficient severity to interfere with Of an additional social or occupational functioning. criteria but meeting DSMIIIR 45 subjects not nonetheless judged very mildly to moderatly demented, In a 52% had caresivers who denied memory imnairment. stepwise analysis of variance using ail 200 demented subjects, the BEHAVE-AD score, the clinical dementia rating scale score (an overall indicator of dementia most severity), subject education, and pastmemorywere strongly correlated with caregiver recognition of a
ALZHEIMER’S DISEASE AND HISTORY OF BLOOD TRANSFUSION. E.S. O’Meara, W.A. Kukull, J.D. Bowen, W.C. McCormick, L. Ten, M. Pfanschmidt, J.D. Thompson, E.B. Larson. Department of Epidemiology SC-36, University of Washington, Seattle WA 98195 USA Some dementias, such as Creutzfeldt-Jakob disease, may result from transmissible agents. To assess the possibility of a bloodbome transmissible agent in Alzheimer’s disease, we compared the history of blood transfusions among newly recognized Probable Alzheimer’s disease (AD) cases [n=278] and randomly selected controls [r-r=3001 frequency matched for age and sex. All subjects were enrollees in the same prepaid health plan. Cases received a standardized diagnostic evaluation; control subjects were interviewed and tested to insure that they were cognitively intact. History of transfusion was obtained from proxy respondents for both cases and controls. Only transfusions which occurred more than 1 year prior to symptom onset (for cases) or to a similar “reference year” (for controls) were counted. Transfusion during the risk period was more frequent among controls than cases: 15.8% of cases and 21.7% of controls received transfusion (odds ratio = 0.79, 95% Cl: 0.50 - 1.25). Logistic regression showed that age, sex and education were neither confounders nor effect modtfiers of the association (adjusted odds ratio = 0.81, 95% Cl: 0.51 - 1.29). To examine the temporal relationship between transfusion and disease, we evaluated subjects with transfusions occurring 5 10 years and >I0 years before AD onset. Logistic regression adjusting for age, sex and education showed little difference between time periods (OR=0.66, 95% Cl:
positive association was found between higher sarum cholesterol level at exam 4 and higher CASI score (p=0.0001). Pack years of smoking at exam 4 was also associated with higher CASI scores (p=o.ol). Conversely, no significant associations were foundwith serum cholesterol or pack years of smoking assessed 20 years earlier at the 3rd HHP Examination. These paradoxical results are interpreted as suggesting that are more likely to continue non-demented persons smoking and have diets leading to higher cholesterol levels, as compared with cognitively impaired persons.
183
185
TEN RELATIONSHIP OF DIABETES AND QLUCOSN TOLERANCE TO COGNITIVE FUNCTION J.D. Curb, B.L. Rodriguez, L.R.
White,
problem with memory or thinking. In a logistic model containing these same variables, all but past memory were independently predictive. These findings indicate that denial of memory impairment by caregivers of mildly to moderately demented subjects is common, and that recognition is positively associated with higher education, severity of the dementia, and extent of behavioral disturbances. Failure of caregivers to recognize a problem with thinking and memory probably contributes substantially to many early or mild cases of dementia not receiving a proper medical evaluation.
H. Petrovitch,
K.H.
Masaki,
C.M.
Kuakini Medical Center, ROSS, E. Ardo. Institute on Aging and the University Honolulu, Hawaii 96917, USA.
Burchfiel,
W.
the National of Hawaii,
poorer Diabetics have been reported to have cognitive function than nondiabetics in cross sectional studies. As Dart of the Fourth examination 11991-1993) of the Honolulu Heart Program cohort of 3735 Japanese American men, cognitive function was measured by the Cognitive Assessment Screening Instrument (CASI), an instrument combining features of the Folstein MiniMental scale and the Hasagawa Scale and designed for use in cross-cultural settings. Diabetes and glucose tolerance (fasting and 2 hour post-load glucose) were also assessed. A prior assessment of glucose intolerance (nonfasting 1 hour post-load glucose) was carried out at the baseline examination in 1965-1968. After adjustment for age and education in a multiple regression model, there was no association between diabetes or glucose level 28 years previously and cognitive function at the Fourth Examination (p=O.9). However, in a similar multivariate analysis, significant negative associations were seen between cognitive function and diabetes (~10.01) as well as fasting glucose (p=O.O5) and two hour post-load glucose (~50.01) measured on the same day at the Fourth Examination, after adjustment for age, education, Apo E phenotype and hypertension. Although selective mortality may partially explain the differences seen between the cross-sectional and longitudinal data, these findings do not appear to support a long term adverse impact of disordered glucose metabolism on cognitive function. They do provide evidence for an immediate adverse effect of abnormal glucose metabolism on cognitive performance in older individuals.
NON-STEROIDAL ANTI-INFLAMMATORY DRUG USE AND ALZHEIMER’S DISEASE IN ROCHESTER, MINNESOTA. C.M. Beard, E. Kokmen, P.C. O’Brien and L.T. Kurland. Alzheimer’s Disease Center, Departments of Health Sciences Research and of Neurology, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905 USA. During the conduct of the ongoing studies of dementing illness in Rochester, MN, we identified 302 new cases of Alzheimer’s disease whose onset occurred during the years 1980-1984. One age- and gender-matched control was selected from among all Rochester residents who registered for care at Mayo Clinic during the year of onset for the case. All community medical records for the cases and controls were reviewed for evidence of non-steroidal anti-inflammatory drug (NSAID) prescriptions during the year prior to and the year of onset in the case and the corresponding index years for controls. Use of aspirin and acetaminophen-containing drugs was also documented. Exposure to these preparations was considered to be substantial if the patient received a prescription or there was evidence that the patient took the drug for seven or more days. Odds ratios were estimated to compare exposure among cases and controls using the logistic regression approach for matched sets of Breslow and Day. The overall odds ratio for current and substantial exposure to any NSAID or aspirin with age in the model was 0.77 (95% CI 0.54-1.10). Limiting the analysis to current and substantial NSAID use VS. no NSAID use resulted in an odds ratio of 0.69 (95% CI 0.45-1.08). Similarly, the odds ratios for current and substantial NSAID use vs. no NSAID use were 0.85 (95% CI 0.52-1.40) and 0.34 (95% CI 0.12-0.96) for women and men, respectively. The results of this study are suggestive but not conclusive for a protective effect for NSAID use in Alzheimer’s disease.
186 184 FREQUNNCY NON-RECOSNITION OF DNNNNTIA BY CAREGIVERS; AND CORRNLATNS IN TNN HONOLULU NNART PROGRAN CONORT. G.W. Ross, L.R. White, C. Trockman, H. Petrovitch, K.H. Honolulu Veterans Masaki, D. Chiu, C. Murdaugh. (347 N. Kuakini Affairs; NIA; Honolulu Heart Program HI.); NINR. Street, Honolulu, Little is known about how often cognitive impairment due to dementia goes unrecognized, although anecdotal Our subjects were reports suggest it may be common. a longitudinally studied cohort of elderly from evaluations in Japanese men undergoing cognitive conjunction with the Honolulu Heart Program fourth Among 155 subjects meeting the DSMIIIR examination. 17% had caregivers who denied criteria for dementia, having noticed any problem with thinking or memory. This undoubtedly underestimates the phenomenon because since the DSMIIIR of a definitional circularity, difficulties with memory require that criteria interview of a family ascertained by (ordinarily informant) be of sufficient severity to interfere with Of an additional social or occupational functioning. criteria but meeting DSMIIIR 45 subjects not nonetheless judged very mildly to moderatly demented, In a 52% had caresivers who denied memory imnairment. stepwise analysis of variance using ail 200 demented subjects, the BEHAVE-AD score, the clinical dementia rating scale score (an overall indicator of dementia most severity), subject education, and pastmemorywere strongly correlated with caregiver recognition of a
ALZHEIMER’S DISEASE AND HISTORY OF BLOOD TRANSFUSION. E.S. O’Meara, W.A. Kukull, J.D. Bowen, W.C. McCormick, L. Ten, M. Pfanschmidt, J.D. Thompson, E.B. Larson. Department of Epidemiology SC-36, University of Washington, Seattle WA 98195 USA Some dementias, such as Creutzfeldt-Jakob disease, may result from transmissible agents. To assess the possibility of a bloodbome transmissible agent in Alzheimer’s disease, we compared the history of blood transfusions among newly recognized Probable Alzheimer’s disease (AD) cases [n=278] and randomly selected controls [r-r=3001 frequency matched for age and sex. All subjects were enrollees in the same prepaid health plan. Cases received a standardized diagnostic evaluation; control subjects were interviewed and tested to insure that they were cognitively intact. History of transfusion was obtained from proxy respondents for both cases and controls. Only transfusions which occurred more than 1 year prior to symptom onset (for cases) or to a similar “reference year” (for controls) were counted. Transfusion during the risk period was more frequent among controls than cases: 15.8% of cases and 21.7% of controls received transfusion (odds ratio = 0.79, 95% Cl: 0.50 - 1.25). Logistic regression showed that age, sex and education were neither confounders nor effect modtfiers of the association (adjusted odds ratio = 0.81, 95% Cl: 0.51 - 1.29). To examine the temporal relationship between transfusion and disease, we evaluated subjects with transfusions occurring 5 10 years and >I0 years before AD onset. Logistic regression adjusting for age, sex and education showed little difference between time periods (OR=0.66, 95% Cl: