- Email: [email protected]
P2-119: Transitions in cognitive status in people with vascular cognitive impairment
T406
Poster Presentations P2:
surgical intervention and we compare the impact of carotid endoarterectomy (CEA) and percutaneous transluminal angioplasty with stenting (CAS) on cognitive functions. Methods: We recruited 47 patients ⱖ65 years old: 22 underwent CEA (M:82%, F:18%; mean age:72.0⫾5.6), 25 CAS (M: 56%; F: 44%; mean age: 74.7%⫾5.7). Subjects were examined with neuropsicological tests the day before the carotid surgical intervention, and three and twelve months later. Cognitive functions, functional and affective state were evaluated at each time with: MMSE, Trail Making Test form A and form B, Babcock Story Recall Test, Rey’s Auditory Verbal Learning Test, Letter Fluency Test, Category Fluency Test, Clock Drawing Test, Copy Drawing Test, ADL, IADL, GDS. Results: No differences on cognitive functions between CAS and EAC groups were detected before and after intervention except at Trail Making Test A at T0 (CEA: 105.1⫾41.9 vs CAS: 76.5⫾26.9; p⬍0.02), at T3 (CEA: 129.0⫾70.0 vs CAS: 85.0⫾48.3; p⬍0.02) and at T12 (CEA: 128.0⫾52.8 vs CAS 77.5⫾24.0; P⬍0.01). There were no statistically significant differences both in CAS and CEA in most of the tests exploring cognitive functions and affective state after surgical intervention. In CEA group Trail Making Test B, improved significantly from T0 to T12 (T0: 238.5⫾121.0 vs T12: 186.4⫾111.0; p⬍0.05), while the Copy Drawing test worsened from T0 to T12 (T0: 12.4⫾1.8 vs T12: 11.4⫾2.7; p⬍0.01). In CAS group there was only a significant improvement in the Clock Drawing Test (Copy) from T0 to T3 (T0: 2.1⫾1.1 vs T3: 1.3⫾0.7; p⬍0.05). Conclusions: This study showed that surgical carotid intervention in subjects over 65 years is an important instrument for prevention of cerebrovascular diseases. Despite the risk of microembolization, it seems to be safe for cognitive functions. Furthermore, due to its lower invasiveness, CAS should be preferred to CEA for chirurgical treatment of carotid atherosclerosis in the elderly. P2-119
TRANSITIONS IN COGNITIVE STATUS IN PEOPLE WITH VASCULAR COGNITIVE IMPAIRMENT
Kenneth Rockwood, Samuel Searle, Arnold Mitnitski, Dalhousie University, Halifax, NS, Canada. Contact e-mail: [email protected] Background: Little is known about progression of vascular cognitive impairment. On average, cognitive function worsens over time, but some people have periods of relatively stable status and even improvement in some functions. We present a multi-state Markov model to summarize 30-month transitions in cognitive function in elderly Canadians and analyze how known risk factors influence such transitions. Methods: The Consortium to Investigate Vascular Impairment of Cognition (CIVIC) was a multi-centre (nine university affiliated dementia centers). The patients were expected to have a baseline and two follow up visits one year apart from each other. The mini-mental scale examination (MMSE) score was used in assessing cognitive status of participants (n⫽1301) of whom 134 died over the course of the 30 month period. The cognitive states were defined by the errors in MMSE after combining them appropriately (e.g., MMSE score of 30 and 29 were represented by the zero cognitive error state, and so forth). A modified Poisson model with four parameters was used to model the probabilities of transition between cognitive states (two parameters) and death (the other two parameters). The stratified analysis was conducted to analyze the influence of the risk factors (age, sex, and education level) to cognitive transitions and death. Results: The model fitted data with a very high accuracy, with the coefficient of correlation between observed and calculated transition probabilities from 0.85 to 0.94 for different strata. No significant difference between men and women were found neither in cognitive transitions nor mortality. The older sample (age ⬎74) showed had significantly worse cognitive performance in the follow-up (p⬍0.01) but no significant differences in the probability of dying. The different pattern of transitions was shown between the groups with more or less than 11 years of education. Less educated people showed higher level of cognitive decline comparing to more educated group (p⬍0.05). Conclusions: A stochastic model can be used to calculate the chances of changes in cognitive performance (including improvement and
decline) and death and in estimating the effect of the risks factors and demographic conditions to these changes. P2-120
VASCULAR RISK FACTORS ARE ASSOCIATED WITH VASCULAR DEMENTIA OR CONCOMITANT CEREBROVASCULAR DISEASES BUT NOT WITH ALZHEIMER’S DISEASE: THE OSAKI-TAJIRI PROJECT (7)
Yumi Sasaki1, Mari Kasai1,2, Satoshi Yamaguchi1,3, Kyoko Akanuma1,3, Mitsue Meguro1,3, Hiroshi Ishii1,4, Kenichi Meguro1,3, 1Tohoku University Graduate School of Medicine, Sendai, Japan; 2Tohoku Medical Service Welfare Group, Hachinohe, Japan; 3The Osaki-Tajiri SKIP center, Osaki, Japan; 4Kawasaki Kokoro Hospital, Kawasaki, Japan. Contact e-mail: [email protected] Background: Hypertension, dyslipidemia, or diabetes mellitus are well known vascular risk factors for stroke or vascular dementia (VaD). However, there is a controversy as to whether the risk factors lead to Alzheimer’s disease (AD). We herein reported the relationship between vascular risk factors and dementia onset in a community. Methods: Cross-sectional study: The database of our prevalence study in 1998, which was performed in Tajiri, northern Japan, was retrospectively analyzed. The participants were non-demented older adults (the Clinical Dementia Rating; CDR 0 or CDR 0.5, n⫽465), and dementia patients (CDR1⫹, n⫽32). We defined the vascular risk factors as diabetes mellitus (DM), insulin resistance, dyslipidemia (DL), hypertension, smoking, alcohol intake, and atrial fibrillation (Af). Also, we additionally analyzed the consecutive 39 dementia outpatients in Tajiri, being consisted of 19 AD, 15 AD with cerebrovascular diseases (CVD), and 5 VaD patients. Longitudinal study: The database of our incident study in 2003 was retrospectively analyzed. We followed the non-demented participants as classifying the converters to dementia (n⫽28) and non-converters (n⫽230). For the converters, 17 participants converted to AD with or without cerebrovascular disease (NINCDSADRDA), and 5 participants converted to VaD (NINDS-AIREN). Since there were significant differences of age and sex between the converters and non-converters, we made adjustments of the factors. Results: Crosssectional study: The CDR 1⫹ group had greater number of participants with DM and Af (⫻2 test, p⬍0.05)compared with the non-dementia group. No remarkable differences were noted for other risk factors. For dementing diseases, the VaD group had more numbers of those with DM, whereas the AD with CVD group had more numbers of those with DM and DL, compared with the AD without CVD (Kruskal-Wallis, p⬍0.05). Longitudinal study: There were no significant differences on vascular risk factors between the converters to AD and the non-converters. However, the converters to VaD had greater number of DL (⫻2 test, p⬍0.05). Conclusions: We found that dementia patients had greater ratio of DM and Af. For dementing diseases, such risk factors were considered to lead to VaD or concomitant CVD, but not to ‘pure’ AD. P2-121
VASCULAR DEMENTIA AND HIGH DENSITY LIPOPROTEIN C IN ELDERLY PATEINTS
Veer Bahadur Singh, Devraja R, K.K. Verma, Rajesh Bisnoi, Vijay K. Tundwal, S.P. Medical College, Bikaner, India. Contact e-mail: [email protected] Background: Some alterations of the lipoprotein profile have been associated with cerebrovascular disease. Recently, it has been suggested that cerebrovascular disease might play a role in the pathogenesis of vascular dementia (VD). Nevertheless, the possible association of dyslipidemias with Vascular Dementia is still a debatable issue. Methods: We investigated the lipid profile in 100 older patients with vascular dementia. The patients were compared with 54 community dwelling non-demented older controls. Results: After adjustment for functional status, blood sedimentation rate, and serum albumin levels, no differences in lipid profile emerged between the two groups, with the exception of HDL-C that was
Poster Presentations P2:
surgical intervention and we compare the impact of carotid endoarterectomy (CEA) and percutaneous transluminal angioplasty with stenting (CAS) on cognitive functions. Methods: We recruited 47 patients ⱖ65 years old: 22 underwent CEA (M:82%, F:18%; mean age:72.0⫾5.6), 25 CAS (M: 56%; F: 44%; mean age: 74.7%⫾5.7). Subjects were examined with neuropsicological tests the day before the carotid surgical intervention, and three and twelve months later. Cognitive functions, functional and affective state were evaluated at each time with: MMSE, Trail Making Test form A and form B, Babcock Story Recall Test, Rey’s Auditory Verbal Learning Test, Letter Fluency Test, Category Fluency Test, Clock Drawing Test, Copy Drawing Test, ADL, IADL, GDS. Results: No differences on cognitive functions between CAS and EAC groups were detected before and after intervention except at Trail Making Test A at T0 (CEA: 105.1⫾41.9 vs CAS: 76.5⫾26.9; p⬍0.02), at T3 (CEA: 129.0⫾70.0 vs CAS: 85.0⫾48.3; p⬍0.02) and at T12 (CEA: 128.0⫾52.8 vs CAS 77.5⫾24.0; P⬍0.01). There were no statistically significant differences both in CAS and CEA in most of the tests exploring cognitive functions and affective state after surgical intervention. In CEA group Trail Making Test B, improved significantly from T0 to T12 (T0: 238.5⫾121.0 vs T12: 186.4⫾111.0; p⬍0.05), while the Copy Drawing test worsened from T0 to T12 (T0: 12.4⫾1.8 vs T12: 11.4⫾2.7; p⬍0.01). In CAS group there was only a significant improvement in the Clock Drawing Test (Copy) from T0 to T3 (T0: 2.1⫾1.1 vs T3: 1.3⫾0.7; p⬍0.05). Conclusions: This study showed that surgical carotid intervention in subjects over 65 years is an important instrument for prevention of cerebrovascular diseases. Despite the risk of microembolization, it seems to be safe for cognitive functions. Furthermore, due to its lower invasiveness, CAS should be preferred to CEA for chirurgical treatment of carotid atherosclerosis in the elderly. P2-119
TRANSITIONS IN COGNITIVE STATUS IN PEOPLE WITH VASCULAR COGNITIVE IMPAIRMENT
Kenneth Rockwood, Samuel Searle, Arnold Mitnitski, Dalhousie University, Halifax, NS, Canada. Contact e-mail: [email protected] Background: Little is known about progression of vascular cognitive impairment. On average, cognitive function worsens over time, but some people have periods of relatively stable status and even improvement in some functions. We present a multi-state Markov model to summarize 30-month transitions in cognitive function in elderly Canadians and analyze how known risk factors influence such transitions. Methods: The Consortium to Investigate Vascular Impairment of Cognition (CIVIC) was a multi-centre (nine university affiliated dementia centers). The patients were expected to have a baseline and two follow up visits one year apart from each other. The mini-mental scale examination (MMSE) score was used in assessing cognitive status of participants (n⫽1301) of whom 134 died over the course of the 30 month period. The cognitive states were defined by the errors in MMSE after combining them appropriately (e.g., MMSE score of 30 and 29 were represented by the zero cognitive error state, and so forth). A modified Poisson model with four parameters was used to model the probabilities of transition between cognitive states (two parameters) and death (the other two parameters). The stratified analysis was conducted to analyze the influence of the risk factors (age, sex, and education level) to cognitive transitions and death. Results: The model fitted data with a very high accuracy, with the coefficient of correlation between observed and calculated transition probabilities from 0.85 to 0.94 for different strata. No significant difference between men and women were found neither in cognitive transitions nor mortality. The older sample (age ⬎74) showed had significantly worse cognitive performance in the follow-up (p⬍0.01) but no significant differences in the probability of dying. The different pattern of transitions was shown between the groups with more or less than 11 years of education. Less educated people showed higher level of cognitive decline comparing to more educated group (p⬍0.05). Conclusions: A stochastic model can be used to calculate the chances of changes in cognitive performance (including improvement and
decline) and death and in estimating the effect of the risks factors and demographic conditions to these changes. P2-120
VASCULAR RISK FACTORS ARE ASSOCIATED WITH VASCULAR DEMENTIA OR CONCOMITANT CEREBROVASCULAR DISEASES BUT NOT WITH ALZHEIMER’S DISEASE: THE OSAKI-TAJIRI PROJECT (7)
Yumi Sasaki1, Mari Kasai1,2, Satoshi Yamaguchi1,3, Kyoko Akanuma1,3, Mitsue Meguro1,3, Hiroshi Ishii1,4, Kenichi Meguro1,3, 1Tohoku University Graduate School of Medicine, Sendai, Japan; 2Tohoku Medical Service Welfare Group, Hachinohe, Japan; 3The Osaki-Tajiri SKIP center, Osaki, Japan; 4Kawasaki Kokoro Hospital, Kawasaki, Japan. Contact e-mail: [email protected] Background: Hypertension, dyslipidemia, or diabetes mellitus are well known vascular risk factors for stroke or vascular dementia (VaD). However, there is a controversy as to whether the risk factors lead to Alzheimer’s disease (AD). We herein reported the relationship between vascular risk factors and dementia onset in a community. Methods: Cross-sectional study: The database of our prevalence study in 1998, which was performed in Tajiri, northern Japan, was retrospectively analyzed. The participants were non-demented older adults (the Clinical Dementia Rating; CDR 0 or CDR 0.5, n⫽465), and dementia patients (CDR1⫹, n⫽32). We defined the vascular risk factors as diabetes mellitus (DM), insulin resistance, dyslipidemia (DL), hypertension, smoking, alcohol intake, and atrial fibrillation (Af). Also, we additionally analyzed the consecutive 39 dementia outpatients in Tajiri, being consisted of 19 AD, 15 AD with cerebrovascular diseases (CVD), and 5 VaD patients. Longitudinal study: The database of our incident study in 2003 was retrospectively analyzed. We followed the non-demented participants as classifying the converters to dementia (n⫽28) and non-converters (n⫽230). For the converters, 17 participants converted to AD with or without cerebrovascular disease (NINCDSADRDA), and 5 participants converted to VaD (NINDS-AIREN). Since there were significant differences of age and sex between the converters and non-converters, we made adjustments of the factors. Results: Crosssectional study: The CDR 1⫹ group had greater number of participants with DM and Af (⫻2 test, p⬍0.05)compared with the non-dementia group. No remarkable differences were noted for other risk factors. For dementing diseases, the VaD group had more numbers of those with DM, whereas the AD with CVD group had more numbers of those with DM and DL, compared with the AD without CVD (Kruskal-Wallis, p⬍0.05). Longitudinal study: There were no significant differences on vascular risk factors between the converters to AD and the non-converters. However, the converters to VaD had greater number of DL (⫻2 test, p⬍0.05). Conclusions: We found that dementia patients had greater ratio of DM and Af. For dementing diseases, such risk factors were considered to lead to VaD or concomitant CVD, but not to ‘pure’ AD. P2-121
VASCULAR DEMENTIA AND HIGH DENSITY LIPOPROTEIN C IN ELDERLY PATEINTS
Veer Bahadur Singh, Devraja R, K.K. Verma, Rajesh Bisnoi, Vijay K. Tundwal, S.P. Medical College, Bikaner, India. Contact e-mail: [email protected] Background: Some alterations of the lipoprotein profile have been associated with cerebrovascular disease. Recently, it has been suggested that cerebrovascular disease might play a role in the pathogenesis of vascular dementia (VD). Nevertheless, the possible association of dyslipidemias with Vascular Dementia is still a debatable issue. Methods: We investigated the lipid profile in 100 older patients with vascular dementia. The patients were compared with 54 community dwelling non-demented older controls. Results: After adjustment for functional status, blood sedimentation rate, and serum albumin levels, no differences in lipid profile emerged between the two groups, with the exception of HDL-C that was