- Email: [email protected]
Physical activity and prevalence of cognitive impairment in community-dwelling very old individuals
Poster Presentations: P3 analyses were performed in which the volume of white matter hyperintensities (WMH) was used as the dependent variable. Results: In women, brain atrophy at an average age of 75.7 was negatively associated with both minutes of walking (p¼0.02) and the mean number of grams of fish consumed (p¼0.04) at age 50. No association of walking and fish consumption with brain atrophy was evident in men. In both men and women, increased age was associated with greater brain atrophy. Neither walking nor fish consumption was associated with WMH volume. Conclusions: The findings are consistent with previous studies showing that consumption of foods containing high amounts of omega 3 fatty acids as well as increased physical exercise are associated with reduction in brain atrophy with age. The fact that this association was only evident in women may be related to the interaction of female gender with exercise (Eur J Neurosci 2001;14(12): 1992-2002) and omega 3 fatty acids (Aging Res Rev 2011;10: 124-131) in the upregulation of BDNF. P3-210
SELF-REPORTED QUALITY OF LIFE AFTER RETIREMENT AND COGNITIVE FUNCTION: DATA FROM THE NURSES’ HEALTH STUDY
Jae Kang, Francine Grodstein, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts, United States. Contact e-mail: [email protected] Background: With the rapid aging of the population, the number of years spent in retirement has also been increasing. Little is known on the relation between quality of life in retirement and its health consequences. Methods: We included a subset of 3735 Nurses’ Health Study participants (cohort of 121,700 female nurses started in 1976 followed biennially with questionnaires) who, in the 1996 follow-up questionnaire, were aged 70+ years, reported that they had fully retired at ages 60-69 years and provided a subjective assessment of whether the quality of life after retirement had stayed the same, improved or worsened as compared to before retirement. After the completion of this questionnaire, participants subsequently completed a baseline telephone cognitive battery (validated against an extensive in-person assessment) from June 1996 to May 2000, and had at least one (up to three) follow-up cognitive test(s) at 1.5 year intervals. The cognitive interview included tests of global cognition, episodic memory and executive function. The primary outcome was the global score (composites of the individual test z-scores) averaged over available repeated measures. Multiple regression analysis was used to estimate associations after controlling for various confounders (i.e., health status, education, age at retirement, depression, physical activity, alcohol intake). Results: Overall, 62% of women reported their quality of life had improved, 30% reported that it remained the same for 30%, and 8% reported that it worsened. Compared with women who reported that their quality of life stayed the same after retirement, women who reported improvement subsequently showed significantly higher mean global score (mean difference¼0.06 units, 95% CI 0.02, 0.09). This was equivalent to the difference observed between women who were about 1-2 years in age. To address potential reverse causation, we conducted secondary analyses restricted to women with higher than median baseline scores or to women who at baseline reported no recent change in their memory; findings were virtually identical. Conclusions: Among retired women, self-reported improvement in quality of life after retirement was associated subsequently with better maintenance of cognitive function over time. P3-211
IMPROVING DEMENTIA CARE IN PRIMARY CARE: IMPACT OF A TRAINING PROGRAM ON PHYSICIAN PRACTICE PATTERNS
Philip Sloane1, Christine Lathren2, David Reed1, Daniel Kaufer1, Sheryl Zimmerman3, 1University of North Carolina, Chapel Hill, North Carolina, United States; 2UNC Chapel Hill, Chapel Hill, North Carolina, United States; 3University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States. Contact e-mail: [email protected] Background: Early detection of cognitive impairment is important, as it leads to opportunities for treatment, care planning and support for family members. However, many primary care physicians are unfamiliar with re-
P633
cent evidence on time-efficient and effective dementia screening and diagnostic procedures, and as a result detection is often delayed. Methods: Primary care physicians (N¼15) and affiliated office staff (N¼11) participated in a day-long training program on dementia screening, diagnosis and management where focused case examples demonstrated the use of recommended cognitive tools including the Mini-Cog and AD-8 caregiver assessment. Physicians were encouraged to use office staff to administer and score the tools. Participants completed questionnaires regarding their dementia practices at baseline and 12 months post-training. Additionally, physicians were encouraged to make referrals to a family consultant who links caregivers to dementia community resources. Results: Physician participants were majority males (60%) practicing community-based family medicine (66%), with an average age of 52.2. In follow-up, physicians reported significant increases in use of the Mini-Cog (21% baseline vs. 80% 12 months post-training) and the AD-8 (7% vs. 60%). Regarding other dementia practice patterns, 47% responded that the training influenced whom they screened for cognitive impairment, most commonly by performing more screenings based on patient age. Many physicians (87%) also reported changes in assessment procedures, including the use of trained office staff to administer these tools. Finally, participants referred approximately 100 caregivers for connection to community resources. Conclusions: Primary care physician education can increase use of evidence-based dementia screening and diagnostic protocols and improve dementia practice patterns. Earlier detection and diagnosis may increase the quality of dementia care patients receive, including connection to care planning and support services.
P3-212
PHYSICAL ACTIVITY AND PREVALENCE OF COGNITIVE IMPAIRMENT IN COMMUNITYDWELLING VERY OLD INDIVIDUALS
Claire Chevallier-Collins1, Achille E. Tchalla2, Laubarie Cecile2, Nicolas Signol2, No€elle Cardinaud2, Marion Charenton2, Anne G. E. Collins3, Thierry Dantoine2, 1University Hospital Center of Limoges, Limoges, France; 2University Hospital Center of Limoges, Limoges, France; 3Brown University, Providence, Rhode Island, United States. Contact e-mail: [email protected] Background: Many cohort studies have examined the association between physical activity and cognitive impairment among older people. However, to our knowledge, no epidemiological cross-sectional study has examined the association between physical activity according to the WHO recommendations and cognitive impairment, in a population -based study on very old persons 75 years or older. Methods: We investigated whether physical activity according to the World Health Organization (WHO) was associated with a lower prevalence of cognitive impairment in the GEROPASS population-based study conducted in France from 2011. A total of 205 community-dwelling elderly (age 75 or older) underwent a Comprehensive Geriatric Assessment, including medical examination, memory tests, autonomy and frailty assessment, and provided blood samples. Cognitive impairment was assessed using MMS-E (Mini-Mental State Examination). Norms of MMS-E were individually adjusted for socio-cultural level. Moderate Intensity Physical activity was assessed using self-report of physical activity within the past two weeks. Participants were considered active if they spent at least 600kCal per week of physical activity, and if the physical exercise was of moderate-to-high intensity. Potential confounding factors were considered, including age, gender, cardiovascular risk factors, history of depression or cardiovascular disease, vitamin deficiencies, renal failure and obstructive sleep apnea. Results: Mean age of the sample was 83.4 years old (SD ¼ 5.2). We found a main effect of physical activity (>600kCal/ week) on cognitive impairment measured through adjusted MMS-E, indicating a higher chance of impairment for less active subjects (N ¼ 205, odds ratio 0.34, p ¼ 0.01). This finding remained significant after adjustment for potential confounding factors (p ¼ 0.04). Conclusions: Physical activity according to the WHO recommendations was associated with a decreased prevalence of cognitive impairment in the population of very old persons, which will raise promising public health strategies if these results are confirmed by further prospective studies.
SELF-REPORTED QUALITY OF LIFE AFTER RETIREMENT AND COGNITIVE FUNCTION: DATA FROM THE NURSES’ HEALTH STUDY
Jae Kang, Francine Grodstein, Brigham and Women’s Hospital/Harvard Medical School, Boston, Massachusetts, United States. Contact e-mail: [email protected] Background: With the rapid aging of the population, the number of years spent in retirement has also been increasing. Little is known on the relation between quality of life in retirement and its health consequences. Methods: We included a subset of 3735 Nurses’ Health Study participants (cohort of 121,700 female nurses started in 1976 followed biennially with questionnaires) who, in the 1996 follow-up questionnaire, were aged 70+ years, reported that they had fully retired at ages 60-69 years and provided a subjective assessment of whether the quality of life after retirement had stayed the same, improved or worsened as compared to before retirement. After the completion of this questionnaire, participants subsequently completed a baseline telephone cognitive battery (validated against an extensive in-person assessment) from June 1996 to May 2000, and had at least one (up to three) follow-up cognitive test(s) at 1.5 year intervals. The cognitive interview included tests of global cognition, episodic memory and executive function. The primary outcome was the global score (composites of the individual test z-scores) averaged over available repeated measures. Multiple regression analysis was used to estimate associations after controlling for various confounders (i.e., health status, education, age at retirement, depression, physical activity, alcohol intake). Results: Overall, 62% of women reported their quality of life had improved, 30% reported that it remained the same for 30%, and 8% reported that it worsened. Compared with women who reported that their quality of life stayed the same after retirement, women who reported improvement subsequently showed significantly higher mean global score (mean difference¼0.06 units, 95% CI 0.02, 0.09). This was equivalent to the difference observed between women who were about 1-2 years in age. To address potential reverse causation, we conducted secondary analyses restricted to women with higher than median baseline scores or to women who at baseline reported no recent change in their memory; findings were virtually identical. Conclusions: Among retired women, self-reported improvement in quality of life after retirement was associated subsequently with better maintenance of cognitive function over time. P3-211
IMPROVING DEMENTIA CARE IN PRIMARY CARE: IMPACT OF A TRAINING PROGRAM ON PHYSICIAN PRACTICE PATTERNS
Philip Sloane1, Christine Lathren2, David Reed1, Daniel Kaufer1, Sheryl Zimmerman3, 1University of North Carolina, Chapel Hill, North Carolina, United States; 2UNC Chapel Hill, Chapel Hill, North Carolina, United States; 3University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States. Contact e-mail: [email protected] Background: Early detection of cognitive impairment is important, as it leads to opportunities for treatment, care planning and support for family members. However, many primary care physicians are unfamiliar with re-
P633
cent evidence on time-efficient and effective dementia screening and diagnostic procedures, and as a result detection is often delayed. Methods: Primary care physicians (N¼15) and affiliated office staff (N¼11) participated in a day-long training program on dementia screening, diagnosis and management where focused case examples demonstrated the use of recommended cognitive tools including the Mini-Cog and AD-8 caregiver assessment. Physicians were encouraged to use office staff to administer and score the tools. Participants completed questionnaires regarding their dementia practices at baseline and 12 months post-training. Additionally, physicians were encouraged to make referrals to a family consultant who links caregivers to dementia community resources. Results: Physician participants were majority males (60%) practicing community-based family medicine (66%), with an average age of 52.2. In follow-up, physicians reported significant increases in use of the Mini-Cog (21% baseline vs. 80% 12 months post-training) and the AD-8 (7% vs. 60%). Regarding other dementia practice patterns, 47% responded that the training influenced whom they screened for cognitive impairment, most commonly by performing more screenings based on patient age. Many physicians (87%) also reported changes in assessment procedures, including the use of trained office staff to administer these tools. Finally, participants referred approximately 100 caregivers for connection to community resources. Conclusions: Primary care physician education can increase use of evidence-based dementia screening and diagnostic protocols and improve dementia practice patterns. Earlier detection and diagnosis may increase the quality of dementia care patients receive, including connection to care planning and support services.
P3-212
PHYSICAL ACTIVITY AND PREVALENCE OF COGNITIVE IMPAIRMENT IN COMMUNITYDWELLING VERY OLD INDIVIDUALS
Claire Chevallier-Collins1, Achille E. Tchalla2, Laubarie Cecile2, Nicolas Signol2, No€elle Cardinaud2, Marion Charenton2, Anne G. E. Collins3, Thierry Dantoine2, 1University Hospital Center of Limoges, Limoges, France; 2University Hospital Center of Limoges, Limoges, France; 3Brown University, Providence, Rhode Island, United States. Contact e-mail: [email protected] Background: Many cohort studies have examined the association between physical activity and cognitive impairment among older people. However, to our knowledge, no epidemiological cross-sectional study has examined the association between physical activity according to the WHO recommendations and cognitive impairment, in a population -based study on very old persons 75 years or older. Methods: We investigated whether physical activity according to the World Health Organization (WHO) was associated with a lower prevalence of cognitive impairment in the GEROPASS population-based study conducted in France from 2011. A total of 205 community-dwelling elderly (age 75 or older) underwent a Comprehensive Geriatric Assessment, including medical examination, memory tests, autonomy and frailty assessment, and provided blood samples. Cognitive impairment was assessed using MMS-E (Mini-Mental State Examination). Norms of MMS-E were individually adjusted for socio-cultural level. Moderate Intensity Physical activity was assessed using self-report of physical activity within the past two weeks. Participants were considered active if they spent at least 600kCal per week of physical activity, and if the physical exercise was of moderate-to-high intensity. Potential confounding factors were considered, including age, gender, cardiovascular risk factors, history of depression or cardiovascular disease, vitamin deficiencies, renal failure and obstructive sleep apnea. Results: Mean age of the sample was 83.4 years old (SD ¼ 5.2). We found a main effect of physical activity (>600kCal/ week) on cognitive impairment measured through adjusted MMS-E, indicating a higher chance of impairment for less active subjects (N ¼ 205, odds ratio 0.34, p ¼ 0.01). This finding remained significant after adjustment for potential confounding factors (p ¼ 0.04). Conclusions: Physical activity according to the WHO recommendations was associated with a decreased prevalence of cognitive impairment in the population of very old persons, which will raise promising public health strategies if these results are confirmed by further prospective studies.