- Email: [email protected]
P4-090: A strategy for identification of dementia risk factors based on associations with specific neuropathologic lesions: The Honolulu-Asia Aging Study (HAAS) autopsy study
T694
Poster Presentations P4:
using antibodies (monoclonal IgG) specific for amyloid or the Cpn epitopes: LPS, major OMP, and purified elementary bodies. Results: Chlamydia-specific labeling was noted, in the brains of AR-39 infected mice, and was most prominent at 1 month p.i., which was prior to substantial amyloid deposition. Amyloid-specific labeling was prominent at and after 2 months p.i., but did not consistently co-localize with Chlamydia antigen. Conclusions: Our initial data suggest that Chlamydia infection, although initially established in the brains of BALB/c mice is limited with regards to co-localizing with resultant pathology, however, the infection may continue to serve as a chronic stimulus for inflammation in the brain that ultimately results in amyloid deposition. P4-088
COMMUNITY-BASED PREVALENCE OF STRUCTURAL BRAIN CHANGES IN DEMENTIA AND COGNITIVELY IMPAIRED NONDEMENTED ELDERLY FROM BRAZIL
Marcos A. Lopes1, Julio Litvoc2, Erikson F. Furtado1, Antonio C. Santos1, Ca´ssio M. C. Bottino2, 1University of Sa˜o Paulo, Ribeira˜o Preto, Brazil; 2University of Sa˜o Paulo, Sa˜o Paulo, Brazil. Contact e-mail: [email protected] Background: There are few data about structural brain changes in cognitively impaired elderly living in community from Latin America. Assessing a pattern of brain changes is essential to epidemiological investigation of dementia. Objective: The purpose of this study was to estimate the prevalence of structural brain changes in dementia and cognitively impaired nondemented elderly, in a community sample from Ribeira˜o Preto, Brazil, and its association with clinical and sociodemographic variables. Methods: A total of 1.145 randomly older people were examined with the following screening tests for dementia: Mini Mental State Examination (MMSE), Fuld Object Memory Evaluation (FOME), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and Activities for Daily Living - International Scale (ADL-IS). Screen positives were evaluated with Cambridge Examination (CAMDEX) interview and cranial computed tomography (CT). Diagnosis of dementia was made according to Diagnostic Statistical Manual of Mental Disease, Fourth Edition (DSM-IV) criteria. Results: One hundred and thirty five screen positives were evaluated, of which 101 with CT. Cognitive impairment nondementia (CIND) was found in 51 subjects and dementia in 50 (Alzheimer’s Disease: 22; Vascular Dementia 11; Alzheimer’s Disease with Cerebrovascular Disease: 9). Brain atrophy was found in 57 elderly (22 with vascular changes), vascular changes in 33 (20 with white matter lesions) and brain calcification in 21 (prevalence: 56.4%, 32.7% and 20.8%, respectively). Brain atrophy was associated with higher age (p⬍0.001), vascular changes with higher age (p:0.064), stroke (p⬍0.001) and hypertension (p: 0.014), and brain calcification with epilepsy (p:0.006) and alcohol drinking (p⬍0.05; “U” shaped relation). In comparison with CIND, vascular changes were associated with Vascular Dementia (p: 0.007; OR: 6.4; 95%CI: 1.4-27.4); brain atrophy was not associated with dementia, Alzheimer’s Disease and Vascular Dementia. Conclusions: Structural brain changes were common in a sample of impaired cognitively elderly in our country, even though in non-demented subjects. Brain atrophy detected by this method confirmed to be an unspecific change to distinguish dementia and CIND cases. Associated factors confirmed previous findings. Association between brain calcification and alcohol drinking requires further investigation. P4-089
VITAMIN E PLASMA LEVEL AND RISK OF DEMENTIA: RESULTS FROM THE KUNGSHOLMEN PROJECT
Francesca Mangialasche1,2, Laura Fratiglioni1, Patrizia Mecocci2, Bengt Winblad1, Miia Kivipelto1, 1Aging Research Center, Stockholm, Sweden; 2Institute of Gerontology and Geriatrics University of Perugia, Perugia, Italy. Contact e-mail: [email protected]
Background: Several studies support a role of oxidative stress (OS) in dementia and Alzheimer disease (AD). In AD there is evidence of depletion of antioxidant micronutrients, like vitamin E, which is the most powerful chain-breaking non-enzymatic antioxidant. Further, findings of increased OS in subjects with Mild Cognitive Impairment (MCI) suggest that OS is an early event in cognitive decline. However, there is still insufficient evidence regarding a causal relationship between low vitamin E level and development of dementia. In this study we aim to evaluate the association between plasma levels of different tocopherols and incidence of dementia among the oldest old persons. All tocopherols will be evaluated, and not only a-tocoferol. Each isoform possesses unique biological functions often not shared by the other family members, with ␥-tocopherol having probably stronger antioxidant properties than ␣-tocopherol. Methods: The Kungsholmen Project is a population-based longitudinal study on elderly (age 75⫹ years) in Stockholm, Sweden. For this study, a sub-sample of 232 non demented persons with a mean age of 85 years was followed-up 2 times over a 6-year period to detect incident dementia (DSM-III-R criteria). Plasma levels of tocopherols were assessed with High Performance Liquid Chromatography. The relation between plasma vitamin E at baseline and the risk of dementia was assessed with Cox regression model. Results: Mean baseline plasma level of each tocopherol isoform and total tocopherols were lower in subjects who developed dementia after a mean follow-up time of 6 years. Subjects in the lowest tertile of -, ␥- and total tocopherols had an increased risk of developing dementia compared to subjects in the medium-highest tertile (crude HR: -tocopherol 1.71, 95%CI 0.99-2.95; ␥-tocopherol 1.99, 95%CI 1.043.79; total-tocopherols: 1.92, 95% CI 1.01-3.66). For ␣-tocopherol crude HR was 1.56, 95%CI 0.91-2.69. Conclusions: Not only ␣-tocopherol, but also other vitamin E isoforms may play an important role in the development of dementia in advanced age. P4-090
A STRATEGY FOR IDENTIFICATION OF DEMENTIA RISK FACTORS BASED ON ASSOCIATIONS WITH SPECIFIC NEUROPATHOLOGIC LESIONS: THE HONOLULU-ASIA AGING STUDY (HAAS) AUTOPSY STUDY
Aaron McMurtray, Helen Petrovitch, Webster Ross, Kamal Masaki, Jane Uyehara-Lock, Lon White, Pacific Health Research Institute/University of Hawaii, Honolulu, HI, USA. Contact e-mail: [email protected] Background: Conventional efforts to identify risk factors for Alzheimer’s disease, vascular dementia, and cortical Lewy body disease are made difficult by diagnostic imprecision due to overlap of clinical features, by the frequent occurrence of brain lesions in persons without dementia, and by high rates of co-morbidity of the relevant lesions in older persons -- especially among those who became cognitively impaired prior to death. Methods: We have addressed these problems in the Honolulu-Asia Aging Study (HAAS), a population based ongoing study of brain aging in Japanese-American men, by employing standardized measures of specific neuropathologic lesions as endpoints. Data were from 425 research protocol brain autopsies on men who had been followed and examined at intervals for more than 32 years. Results: Our analyses demonstrate varied associational patterns. Some risk factors are strongly and specifically associated with a specific type of lesion (apoE 4 allele with Alzheimer lesions, p⬍.0001), some are similarly associated with different types of lesion (leukocyte counts with AD lesions [p⬍.05] and with cortical Lewy bodies [p⬍.02]), some are associated with different lesions but in opposite directions (HDL-C directly related to AD lesions [p⬍.01] but inversely associated with microvascular infarcts [p⬍.0001]), while still others have no apparent relationship with lesions but nonetheless modulate the clinical severity of impairment regardless of the underlying process (education, p⬍.001). For many factors no significant association with neuropatho-
Poster Presentations P4: logic lesions is apparent. The candidate risk factors examined include those mentioned, plus midlife BMI; midlife total cholesterol; lifetime smoking; diabetes, late life blood glucose and insulin; fibrinogen; head size; and history of head injury. Conclusions: Our findings emphasize the uncertainties involved in the interpretation of data linking risk factor exposures to clinical endpoints in late life, and the challenges implicit in assessment of interventions directed at specific pathogenic processes involved in cognitive decline and dementia in late life. P4-091
PROFILE EPIDEMIOLOGIC OF THE ADVANCED IN YEARS ATTENDS BY ALZHEIMER PROJECTAPOE: PRELIMINARY RESULTS
Elza Maria Moreira, Anielle Jacomini, Bianca Borsatto Galera, Bruna Grassiela Cordeiro, Camilla Magalha˜es de Oliveira Amaral, UNIC - Universidade de Cuiaba´, Cuiaba´, Brazil. Contact e-mail: [email protected] Background: The process of old age around the world brought the increase of new cases of the brain degeneration disease, between them, the most common Alzheimer disease (AD). Talking about the genetics disease, studies showed a possible connection between the allele E 4 located in the chromosome 19 and AD. Although there are several epidemiologic studies in Brazil, in some parts of this country, as west center, these studies are insufficient. Methods: Based on this the authors have been studying the epidemiologic profile of the patient seen by Alzheimer Project APO-E, with the finishing line expound the allele and genotypic prevalence of gene APO-E, relating them with the disease associated to the aged. Those patients were chosen without a regular selection, both sexes with fifty years old above, in the Hospital Geral Universita´rio de Cuiaba´-MT, on the period between February and October/ 2007. All of them passed by a pattern interview to collect some data as: age, sex, level of education, race, origin, type of residence, among others, over and above clinical and lab evaluation, cognitive evaluation with some specific tests as Mini-mental state examination (MMSE), verbal fluency, Katz, Pfeiffer, Yesavage and molecular evaluation through PCR (Polymerase Chain Reaction) to identify the gene APO-E. Results: The average of the patients age are respectively 63,02 and 66,12 years old. The previous epidemiology results show that the majority of the patients are from capital Cuiaba´, mullato and black, have elementary school, have familiar gain around 1.200 reais and have at least one chronicle disease. Conclusions: Because this study report only preliminary results, there isn’t a molecular study in this part of the search yet. These results are analyzed in order to plan next activities in specialized health service, to support the old population in the state. P4-092
PREVALENCE OF DEMENTIA IN KOREAN ELDERLY: RESULTS FROM THE KOREAN LONGITUDINAL STUDY OF HEALTH AND AGING (KLoSHA)
Joon Hyuk Park1, Yoon Seok Huh1, Jung Jae Lee1, Ji Woon Jeong1, Jin Yeong Choe1, Hyun Ah Roh1, Seok Bum Lee1, Jin Hyeong Jhoo2, Ki Woong Kim1, 1Seoul National University Bundang Hospital, Seongnam, Republic of Korea; 2Kangwon National University Bundang Hospital, Kangwondo, Republic of Korea. Contact e-mail: [email protected] Background: The study goal was to estimate the prevalence of dementia among community-dwelling elderly aged 65 years and over in Korea. This study was a part of Longitudinal Study on Health and Aging (KLoSHA) which had been designed as a population-based prospective cohort study of the health, aging and common geriatric diseases in Korean elderly. Methods: A simple random sample (N⫽1118) was drawn from the roster of 61,730 persons aged 65 years or older. All the standardized clinical interviews, neurological and physical examinations were conduced by clinical research nurses and geriatric physicians with advanced training in neurology, psychiatry and dementia research according to the protocol of the Korean Version of the CERAD clinical assessment battery (CERAD-K).
T695
Alzheimer’s disease (AD) was diagnosed according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (NINCDSADRDA) criteria, and vascular dementia (VD) was diagnosed according to the National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l’Enseignement en Neurosciences (NINDS-AIREN) criteria. Results: Among the 1,118 samples, 714 subjects agreed to participate and completed the present study and the response rate was 63.9%. The prevalence rate of dementia was 5.2% (95% CI⫽3.66.8%), increasing from 2.0% in elderly aged 65-69 years old to 22.2% in elderly aged 80 years or older. The crude prevalence of AD and VD were 3.5% (95% CI⫽2.2-4.8%) and 1.0% (95% CI⫽0.3-1.7%). Age - and education-standardized prevalence estimates for AD, VD and overall dementia in Korean elders aged 65 years or older were 4.5% (95% CI⫽3.06.0%), 0.9% (95% CI⫽0.2-1.6%), and 6.4% (95% CI⫽4.6-8.2%). After adjusting for age, gender and education using logistic regression analysis, aging and female gender were significant risk factors for AD and dementia overall. Conclusions: The prevalence rate of dementia in this study was 6.4%, which is lower than those in other western countries but similar to or somewhat higher than those reported in other Asian countries (4.7% to 8.5% in Japan, 1.8% to 4.6% in China). Increasing age and female gender were associated with a higher prevalence of the dementia overall as well as AD. P4-093
CEREBRAL ATHEROSCLEROTIC AND HYPOPERFUSION RISK PROFILES FOR DEMENTIA AND ALZHEIMER’S DISEASE IN THE KUNGSHOLMEN PROJECT
Chengxuan Qiu, Weili Xu, Bengt Winblad, Laura Fratiglioni, Karolinska Institutet, Stockholm, Sweden. Contact e-mail: [email protected] Background: Several vascular risk factors are shown to be individually involved in the development of dementia including Alzheimer disease. We sought to develop differential vascular risk profiles for dementia and Alzheimer disease in older people. Methods: A standard follow-up procedure was applied three times to a community-based dementia-free cohort of 1270 individuals aged ⱖ75 years during a 9-year period to detect dementia and Alzheimer cases following the DSM-III-R criteria. Vascular risk profiles were scored by counting number of high systolic pressure, diabetes or pre-diabetes, and stroke for atherosclerotic profile, and low diastolic pressure, low pulse pressure, and heart failure for brain hypoperfusion profile. Data were analyzed with Cox proportional-hazards models adjusting for major potential confounders. Results: During the total of 6406 person-years of follow-up (mean per person, 5.1 years; maximum, 10.5 years), 428 subjects developed dementia, including 328 with Alzheimer disease. The risk of dementia and Alzheimer disease was significantly associated with increasing scores of atherosclerotic and hypoperfusion risk profiles in a does-response manner; the atherosclerotic score ⱖ2 or hypoperfusion score ⱖ 2 was associated with an approximately two-fold increased risk for dementia and Alzheimer disease. There was no evidence of statistical interaction of any vascular risk profiles with antihypertensive drug use and APOE genotype on the risk of dementia. Conclusions: A heavier burden of cerebral atherosclerotic- and hypoperfusion-related vascular factors in later life increases the risk of dementia and Alzheimer disease. P4-094
HOMOCYSTEINE AND THE RISK OF DEVELOPING DEMENTIA: A PROSPECTIVE STUDY
Pierluigi Quadri1, Mauro Tettamanti2, Enrica Zanda1, Rita Pezzati1, Stefano Panzeri1, Alessandro Levorato1, Claudia Fragiacomo1, Ugo Lucca2, 1Ospedali Regionali of Mendrisio and Lugano, Mendrisio, Switzerland; 2Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy. Contact e-mail: [email protected]
Poster Presentations P4:
using antibodies (monoclonal IgG) specific for amyloid or the Cpn epitopes: LPS, major OMP, and purified elementary bodies. Results: Chlamydia-specific labeling was noted, in the brains of AR-39 infected mice, and was most prominent at 1 month p.i., which was prior to substantial amyloid deposition. Amyloid-specific labeling was prominent at and after 2 months p.i., but did not consistently co-localize with Chlamydia antigen. Conclusions: Our initial data suggest that Chlamydia infection, although initially established in the brains of BALB/c mice is limited with regards to co-localizing with resultant pathology, however, the infection may continue to serve as a chronic stimulus for inflammation in the brain that ultimately results in amyloid deposition. P4-088
COMMUNITY-BASED PREVALENCE OF STRUCTURAL BRAIN CHANGES IN DEMENTIA AND COGNITIVELY IMPAIRED NONDEMENTED ELDERLY FROM BRAZIL
Marcos A. Lopes1, Julio Litvoc2, Erikson F. Furtado1, Antonio C. Santos1, Ca´ssio M. C. Bottino2, 1University of Sa˜o Paulo, Ribeira˜o Preto, Brazil; 2University of Sa˜o Paulo, Sa˜o Paulo, Brazil. Contact e-mail: [email protected] Background: There are few data about structural brain changes in cognitively impaired elderly living in community from Latin America. Assessing a pattern of brain changes is essential to epidemiological investigation of dementia. Objective: The purpose of this study was to estimate the prevalence of structural brain changes in dementia and cognitively impaired nondemented elderly, in a community sample from Ribeira˜o Preto, Brazil, and its association with clinical and sociodemographic variables. Methods: A total of 1.145 randomly older people were examined with the following screening tests for dementia: Mini Mental State Examination (MMSE), Fuld Object Memory Evaluation (FOME), Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE), and Activities for Daily Living - International Scale (ADL-IS). Screen positives were evaluated with Cambridge Examination (CAMDEX) interview and cranial computed tomography (CT). Diagnosis of dementia was made according to Diagnostic Statistical Manual of Mental Disease, Fourth Edition (DSM-IV) criteria. Results: One hundred and thirty five screen positives were evaluated, of which 101 with CT. Cognitive impairment nondementia (CIND) was found in 51 subjects and dementia in 50 (Alzheimer’s Disease: 22; Vascular Dementia 11; Alzheimer’s Disease with Cerebrovascular Disease: 9). Brain atrophy was found in 57 elderly (22 with vascular changes), vascular changes in 33 (20 with white matter lesions) and brain calcification in 21 (prevalence: 56.4%, 32.7% and 20.8%, respectively). Brain atrophy was associated with higher age (p⬍0.001), vascular changes with higher age (p:0.064), stroke (p⬍0.001) and hypertension (p: 0.014), and brain calcification with epilepsy (p:0.006) and alcohol drinking (p⬍0.05; “U” shaped relation). In comparison with CIND, vascular changes were associated with Vascular Dementia (p: 0.007; OR: 6.4; 95%CI: 1.4-27.4); brain atrophy was not associated with dementia, Alzheimer’s Disease and Vascular Dementia. Conclusions: Structural brain changes were common in a sample of impaired cognitively elderly in our country, even though in non-demented subjects. Brain atrophy detected by this method confirmed to be an unspecific change to distinguish dementia and CIND cases. Associated factors confirmed previous findings. Association between brain calcification and alcohol drinking requires further investigation. P4-089
VITAMIN E PLASMA LEVEL AND RISK OF DEMENTIA: RESULTS FROM THE KUNGSHOLMEN PROJECT
Francesca Mangialasche1,2, Laura Fratiglioni1, Patrizia Mecocci2, Bengt Winblad1, Miia Kivipelto1, 1Aging Research Center, Stockholm, Sweden; 2Institute of Gerontology and Geriatrics University of Perugia, Perugia, Italy. Contact e-mail: [email protected]
Background: Several studies support a role of oxidative stress (OS) in dementia and Alzheimer disease (AD). In AD there is evidence of depletion of antioxidant micronutrients, like vitamin E, which is the most powerful chain-breaking non-enzymatic antioxidant. Further, findings of increased OS in subjects with Mild Cognitive Impairment (MCI) suggest that OS is an early event in cognitive decline. However, there is still insufficient evidence regarding a causal relationship between low vitamin E level and development of dementia. In this study we aim to evaluate the association between plasma levels of different tocopherols and incidence of dementia among the oldest old persons. All tocopherols will be evaluated, and not only a-tocoferol. Each isoform possesses unique biological functions often not shared by the other family members, with ␥-tocopherol having probably stronger antioxidant properties than ␣-tocopherol. Methods: The Kungsholmen Project is a population-based longitudinal study on elderly (age 75⫹ years) in Stockholm, Sweden. For this study, a sub-sample of 232 non demented persons with a mean age of 85 years was followed-up 2 times over a 6-year period to detect incident dementia (DSM-III-R criteria). Plasma levels of tocopherols were assessed with High Performance Liquid Chromatography. The relation between plasma vitamin E at baseline and the risk of dementia was assessed with Cox regression model. Results: Mean baseline plasma level of each tocopherol isoform and total tocopherols were lower in subjects who developed dementia after a mean follow-up time of 6 years. Subjects in the lowest tertile of -, ␥- and total tocopherols had an increased risk of developing dementia compared to subjects in the medium-highest tertile (crude HR: -tocopherol 1.71, 95%CI 0.99-2.95; ␥-tocopherol 1.99, 95%CI 1.043.79; total-tocopherols: 1.92, 95% CI 1.01-3.66). For ␣-tocopherol crude HR was 1.56, 95%CI 0.91-2.69. Conclusions: Not only ␣-tocopherol, but also other vitamin E isoforms may play an important role in the development of dementia in advanced age. P4-090
A STRATEGY FOR IDENTIFICATION OF DEMENTIA RISK FACTORS BASED ON ASSOCIATIONS WITH SPECIFIC NEUROPATHOLOGIC LESIONS: THE HONOLULU-ASIA AGING STUDY (HAAS) AUTOPSY STUDY
Aaron McMurtray, Helen Petrovitch, Webster Ross, Kamal Masaki, Jane Uyehara-Lock, Lon White, Pacific Health Research Institute/University of Hawaii, Honolulu, HI, USA. Contact e-mail: [email protected] Background: Conventional efforts to identify risk factors for Alzheimer’s disease, vascular dementia, and cortical Lewy body disease are made difficult by diagnostic imprecision due to overlap of clinical features, by the frequent occurrence of brain lesions in persons without dementia, and by high rates of co-morbidity of the relevant lesions in older persons -- especially among those who became cognitively impaired prior to death. Methods: We have addressed these problems in the Honolulu-Asia Aging Study (HAAS), a population based ongoing study of brain aging in Japanese-American men, by employing standardized measures of specific neuropathologic lesions as endpoints. Data were from 425 research protocol brain autopsies on men who had been followed and examined at intervals for more than 32 years. Results: Our analyses demonstrate varied associational patterns. Some risk factors are strongly and specifically associated with a specific type of lesion (apoE 4 allele with Alzheimer lesions, p⬍.0001), some are similarly associated with different types of lesion (leukocyte counts with AD lesions [p⬍.05] and with cortical Lewy bodies [p⬍.02]), some are associated with different lesions but in opposite directions (HDL-C directly related to AD lesions [p⬍.01] but inversely associated with microvascular infarcts [p⬍.0001]), while still others have no apparent relationship with lesions but nonetheless modulate the clinical severity of impairment regardless of the underlying process (education, p⬍.001). For many factors no significant association with neuropatho-
Poster Presentations P4: logic lesions is apparent. The candidate risk factors examined include those mentioned, plus midlife BMI; midlife total cholesterol; lifetime smoking; diabetes, late life blood glucose and insulin; fibrinogen; head size; and history of head injury. Conclusions: Our findings emphasize the uncertainties involved in the interpretation of data linking risk factor exposures to clinical endpoints in late life, and the challenges implicit in assessment of interventions directed at specific pathogenic processes involved in cognitive decline and dementia in late life. P4-091
PROFILE EPIDEMIOLOGIC OF THE ADVANCED IN YEARS ATTENDS BY ALZHEIMER PROJECTAPOE: PRELIMINARY RESULTS
Elza Maria Moreira, Anielle Jacomini, Bianca Borsatto Galera, Bruna Grassiela Cordeiro, Camilla Magalha˜es de Oliveira Amaral, UNIC - Universidade de Cuiaba´, Cuiaba´, Brazil. Contact e-mail: [email protected] Background: The process of old age around the world brought the increase of new cases of the brain degeneration disease, between them, the most common Alzheimer disease (AD). Talking about the genetics disease, studies showed a possible connection between the allele E 4 located in the chromosome 19 and AD. Although there are several epidemiologic studies in Brazil, in some parts of this country, as west center, these studies are insufficient. Methods: Based on this the authors have been studying the epidemiologic profile of the patient seen by Alzheimer Project APO-E, with the finishing line expound the allele and genotypic prevalence of gene APO-E, relating them with the disease associated to the aged. Those patients were chosen without a regular selection, both sexes with fifty years old above, in the Hospital Geral Universita´rio de Cuiaba´-MT, on the period between February and October/ 2007. All of them passed by a pattern interview to collect some data as: age, sex, level of education, race, origin, type of residence, among others, over and above clinical and lab evaluation, cognitive evaluation with some specific tests as Mini-mental state examination (MMSE), verbal fluency, Katz, Pfeiffer, Yesavage and molecular evaluation through PCR (Polymerase Chain Reaction) to identify the gene APO-E. Results: The average of the patients age are respectively 63,02 and 66,12 years old. The previous epidemiology results show that the majority of the patients are from capital Cuiaba´, mullato and black, have elementary school, have familiar gain around 1.200 reais and have at least one chronicle disease. Conclusions: Because this study report only preliminary results, there isn’t a molecular study in this part of the search yet. These results are analyzed in order to plan next activities in specialized health service, to support the old population in the state. P4-092
PREVALENCE OF DEMENTIA IN KOREAN ELDERLY: RESULTS FROM THE KOREAN LONGITUDINAL STUDY OF HEALTH AND AGING (KLoSHA)
Joon Hyuk Park1, Yoon Seok Huh1, Jung Jae Lee1, Ji Woon Jeong1, Jin Yeong Choe1, Hyun Ah Roh1, Seok Bum Lee1, Jin Hyeong Jhoo2, Ki Woong Kim1, 1Seoul National University Bundang Hospital, Seongnam, Republic of Korea; 2Kangwon National University Bundang Hospital, Kangwondo, Republic of Korea. Contact e-mail: [email protected] Background: The study goal was to estimate the prevalence of dementia among community-dwelling elderly aged 65 years and over in Korea. This study was a part of Longitudinal Study on Health and Aging (KLoSHA) which had been designed as a population-based prospective cohort study of the health, aging and common geriatric diseases in Korean elderly. Methods: A simple random sample (N⫽1118) was drawn from the roster of 61,730 persons aged 65 years or older. All the standardized clinical interviews, neurological and physical examinations were conduced by clinical research nurses and geriatric physicians with advanced training in neurology, psychiatry and dementia research according to the protocol of the Korean Version of the CERAD clinical assessment battery (CERAD-K).
T695
Alzheimer’s disease (AD) was diagnosed according to the National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association (NINCDSADRDA) criteria, and vascular dementia (VD) was diagnosed according to the National Institute of Neurological Disorders and Stroke-Association Internationale pour la Recherche et l’Enseignement en Neurosciences (NINDS-AIREN) criteria. Results: Among the 1,118 samples, 714 subjects agreed to participate and completed the present study and the response rate was 63.9%. The prevalence rate of dementia was 5.2% (95% CI⫽3.66.8%), increasing from 2.0% in elderly aged 65-69 years old to 22.2% in elderly aged 80 years or older. The crude prevalence of AD and VD were 3.5% (95% CI⫽2.2-4.8%) and 1.0% (95% CI⫽0.3-1.7%). Age - and education-standardized prevalence estimates for AD, VD and overall dementia in Korean elders aged 65 years or older were 4.5% (95% CI⫽3.06.0%), 0.9% (95% CI⫽0.2-1.6%), and 6.4% (95% CI⫽4.6-8.2%). After adjusting for age, gender and education using logistic regression analysis, aging and female gender were significant risk factors for AD and dementia overall. Conclusions: The prevalence rate of dementia in this study was 6.4%, which is lower than those in other western countries but similar to or somewhat higher than those reported in other Asian countries (4.7% to 8.5% in Japan, 1.8% to 4.6% in China). Increasing age and female gender were associated with a higher prevalence of the dementia overall as well as AD. P4-093
CEREBRAL ATHEROSCLEROTIC AND HYPOPERFUSION RISK PROFILES FOR DEMENTIA AND ALZHEIMER’S DISEASE IN THE KUNGSHOLMEN PROJECT
Chengxuan Qiu, Weili Xu, Bengt Winblad, Laura Fratiglioni, Karolinska Institutet, Stockholm, Sweden. Contact e-mail: [email protected] Background: Several vascular risk factors are shown to be individually involved in the development of dementia including Alzheimer disease. We sought to develop differential vascular risk profiles for dementia and Alzheimer disease in older people. Methods: A standard follow-up procedure was applied three times to a community-based dementia-free cohort of 1270 individuals aged ⱖ75 years during a 9-year period to detect dementia and Alzheimer cases following the DSM-III-R criteria. Vascular risk profiles were scored by counting number of high systolic pressure, diabetes or pre-diabetes, and stroke for atherosclerotic profile, and low diastolic pressure, low pulse pressure, and heart failure for brain hypoperfusion profile. Data were analyzed with Cox proportional-hazards models adjusting for major potential confounders. Results: During the total of 6406 person-years of follow-up (mean per person, 5.1 years; maximum, 10.5 years), 428 subjects developed dementia, including 328 with Alzheimer disease. The risk of dementia and Alzheimer disease was significantly associated with increasing scores of atherosclerotic and hypoperfusion risk profiles in a does-response manner; the atherosclerotic score ⱖ2 or hypoperfusion score ⱖ 2 was associated with an approximately two-fold increased risk for dementia and Alzheimer disease. There was no evidence of statistical interaction of any vascular risk profiles with antihypertensive drug use and APOE genotype on the risk of dementia. Conclusions: A heavier burden of cerebral atherosclerotic- and hypoperfusion-related vascular factors in later life increases the risk of dementia and Alzheimer disease. P4-094
HOMOCYSTEINE AND THE RISK OF DEVELOPING DEMENTIA: A PROSPECTIVE STUDY
Pierluigi Quadri1, Mauro Tettamanti2, Enrica Zanda1, Rita Pezzati1, Stefano Panzeri1, Alessandro Levorato1, Claudia Fragiacomo1, Ugo Lucca2, 1Ospedali Regionali of Mendrisio and Lugano, Mendrisio, Switzerland; 2Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy. Contact e-mail: [email protected]