- Email: [email protected]
Progress of the australian imaging, biomarkers, and lifestyle (AIBL) cohort with 72 months of assessment: Attrition, disease progression, and mortality
Poster Presentations: P2 P2-260
DIABETES IS ASSOCIATED WITH WORSE EXECUTIVE FUNCTION IN BOTH EASTERN AND WESTERN POPULATIONS: SHANGHAI AGING STUDY AND MAYO CLINIC STUDY OF AGING
Qianhua Zhao, Huashan Hospital, Fudan University, Shanghai, China. Contact e-mail: [email protected] Background: It remains unknown whether the association between
diabetes mellitus (DM) and cognitive function differs in Eastern and Western populations. This study aimed to elucidate whether DM is associated with worse cognitive performance in both populations. Methods: The Shanghai Aging Study (SAS) and the Mayo Clinic Study of Aging (MCSA) are two population-based studies with similar design and methodology in Shanghai, China and Rochester, MN USA. Non-demented participants underwent cognitive testing, and DM was assessed from the medical record. Separate analyses were performed in SAS and MCSA regarding the association between DM and cognitive performance. Results: A total of 3348 Chinese participants in the SAS and 3734 American subjects in the MCSA were included. Compared with MCSA subjects, SAS participants were younger, less educated, and had lower frequency of vascular disease, APOE ε4 carriers and obesity. Participants with DM (compared to non-DM participants) performed significantly worse on all the cognitive domains in both the SAS and MCSA. After adjustment for age, sex and education, and vascular covariates, DM was associated with worse performance in executive function (b¼ -0.15, p ¼ 0.001 for SAS, and b¼ -0.10, p ¼ 0.008 for MCSA) in the total sample and in the cognitively normal sub-sample. Furthermore, DM was associated with poor performance in visuospatial skills, language, and memory in the SAS, but not in the MCSA. Conclusions: Diabetes is associated with cognitive dysfunction, in particular exerts a negative impact on executive function regardless of race, age and prevalence of vascular risk factors.
P2-261
IMPACT OF SUSTAINED ECONOMIC HARDSHIP ON COGNITIVE FUNCTIONING
Adina Zeki Al Hazzouri1, Tali Elfassy1, Stephen Sidney2, David R. Jacobs, Jr.3, Kristine Yaffe4, 1University of Miami, Miami, FL, USA; 2Kaiser Permanente of Northern California, Oakland, CA, USA; 3University of Minnesota, Minneapolis, MN, USA; 4University of California, San Francisco, San Francisco, CA, USA. Contact e-mail: [email protected] Background: The association of low income and poor health is well
established. Yet most previous studies have examined income at only one time and very few examined cognitive health. Methods: We used income data collected in 1990, 1992, 1995, 2000, 2005, and 2010 from a prospective cohort of young to middle-aged adult participants in the Coronary Artery Risk Development In Young Adults Study (N¼3383), to examine the cumulative effect of economic hardship on cognitive health. Using U.S. Census information and family size, we defined economic hardship as a household income of less than 200 percent of the federal poverty level for the relevant year. To define cumulative economic hardship we then calculated the percent times between 1900 and 2010 that subjects were in poverty and classified participants as experiencing economic hardship: never, less than a third, more than a third, or all-times. In 2010, participants underwent a cognitive battery consisting of the Rey Auditory-Verbal Learning Test of verbal memory, the Digit Symbol Substitution Test of processing speed, and the Stroop test of executive function. For ease of interpretation, we transformed all cognitive test scores into standardized z scores,
P591
with positive values indicating better performance and negative values indicating worse performance. Results: After adjustment for age, sex, race, marital status, smoking, BMI, diastolic and systolic blood pressure, fasting blood glucose, total cholesterol, depressive symptoms and education, there were significant graded associations between sustained economic hardship and all three measures of cognitive functioning. As compared to subjects without any economic hardship, those with economic hardship ‘more than a third’ of times and those with ‘all-time’ hardship were significantly more likely to perform worse on verbal memory (standardized difference of -0.1; 95%CI¼-0.20, -0.00; and -0.2; 95%CI¼-0.33, -0.06 respectively), processing speed (standardized difference of -0.31; 95%CI¼-0.4, -0.22; and -0.65; 95%CI¼-0.77, -0.52 respectively), and executive function (standardized difference of -0.14; 95%CI¼-0.24, -0.04; and -0.37; 95%CI¼-0.51, -0.23 respectively). Similar results were observed when examining the associations between sustained self-reported financial hardship over 25 years and poor cognitive function. Conclusions: Sustained economic hardship over 20 years was associated with worse cognitive function among middle-aged adults.
P2-262
PROGRESS OF THE AUSTRALIAN IMAGING, BIOMARKERS, AND LIFESTYLE (AIBL) COHORT WITH 72 MONTHS OF ASSESSMENT: ATTRITION, DISEASE PROGRESSION, AND MORTALITY
Joanne S. Robertson1, Paul Maruff1,2, Lance Macaulay3, Ralph N. Martins4, Colin L. Masters1, Stephanie R. Rainey-Smith4, Christopher Fowler1, Simon M. Laws5, Adrian Kamer1, Christopher C. Rowe6, Victor L. Villemagne1,6, Kathryn A. Ellis7,8, David Ames7,8 The AIBL Research Group, 1The Florey Institute of Neuroscience and Mental Health, Parkville, Australia; 2Cogstate Ltd, Melbourne, Australia; 3CSIRO, Melbourne, Australia; 4Sir James McCusker Alzheimer’s Disease Research Unit (Hollywood Private Hospital), Perth, Australia; 5Edith Cowan University, Perth, Australia; 6 Austin Health, Melbourne, Australia; 7The University of Melbourne, Melbourne, Australia; 8National Ageing Research Institute, Melbourne, Australia. Contact e-mail: [email protected] Background: The AIBL study of ageing is an experimental prospec-
tive study of 1112 elderly Australians at risk of, or clinically diagnosed with, Alzheimer’s disease (AD). The AIBL cohort has now completed the fifth assessment, 72 months after enrolment. Here we report rates of attrition, disease progression and mortality for this assessment. Methods: The inclusion/exclusion criteria and assessment protocol for the AIBL cohort has been described in detail elsewhere (Ellis et al., 2009). Briefly, participants undergo an array of blood tests, clinical and cognitive evaluation and brain imaging (in a subgroup) every 18 months. At the completion of assessment, all data is integrated and reviewed by an expert panel of psychiatrists, neurologists and neuropsychologists where a consensus clinical classification is made. At baseline, 768 (69.06%) participants were classified as cognitively normal (CN); 133 (11.96%) as meeting clinical criteria for Mild Cognitive Impairment (MCI) and 211 (18.97%) for AD. Results: 598 participants (53.78% of the initial cohort) were re-assessed at 72 months. 119 (10.70%) had deceased and 395 (35.52%) failed to return (FTR). 484 participants (80.94%) were classified as CN; 49 (8.19%) as MCI; 59 (9.87%) as AD and 7 (1.17%) as having non-AD cognitive impairment or dementia. Of the baseline CN group, 26.30% FTR, 11.20% progressed to MCI or AD and 2.47% died. Of the baseline MCI group, 51.88% FTR, 15.79%
P592
Poster Presentations: P2
progressed to AD and 16.54% died. Of the baseline AD group, 49.29% FTR and 35.55% died. Survival analyses indicated clinical groups were equivalent in rate of attrition due to death or FTR, and in rates of mortality with FTR controlled. With mortality and FTR controlled, rate of progression to AD was greater in the MCI group than the rate of progression to MCI or AD in the CN group (p<0.01). Conclusions: The AIBL study has successfully followed over 50% of its initial cohort across 6 years. While group membership at baseline does not predict death or FTR, rates of disease progression are higher in the MCI than CN group. The AIBL study remains as a unique cohort that still contains sufficient sample size for investigation of risk factors for AD.
P2-263
STATE AND TRAIT-DEPENDENT ASSOCIATIONS OF VITAMIN D WITH BRAIN FUNCTION AND STRUCTURE DURING AGING
Alexandra M. Kueider1, Madhav Thambisetty1, Palchamy Elango1, Christos Davatzikos2, Erus Guray2, Yang An1, Toshiko Tanaka1, Melissa Kitner-Triolo1, Luigi Ferrucci1, 1National Institute on Aging, Baltimore, MD, USA; 2University of Pennsylvania, Philadelphia, PA, USA. Contact e-mail: [email protected] Background: Although observational studies have shown Vitamin-D deficiency is associated with increased risk of all-cause dementia, Alzheimer’s disease and age-associated cognitive decline, these results may be influenced by confounding and reverse causation. Examining the relationship between genetic variants regulating vitamin-D levels and brain function/structure may overcome some of these limitations. Methods: Data from non-demented participants in the Baltimore Longitudinal Study of Aging (BLSA), were used in the current analyses (n¼848, mean follow-up interval 10.4 years). Serum concentrations of 25-hydroxyvitamin D [25(OH)D] and single nucleotide polymorphisms (SNPs) in the group-specific component (GC) (rs17467825, rs2282679, rs2298850, rs3755967) gene were examined for associations with cognitive performance using linear mixed models. A composite score of the 4 GC SNPs was created. In data from the BLSA neuroimaging substudy (BLSANI, n¼120, mean follow-up interval 7.8 years), we tested whether GC SNPs influenced changes in brain volumes during aging. Results: As reported previously, GC SNPs were associated with serum concentration of [25(OH)D]. The minor allele of each GC SNP was associated with a 3.68 nmol/L (95% CI -4.72, -2.65) reduction in serum 25(OH)D. Lower serum [25(OH)D] concentration was associated with poorer performance on the clock drawing to command task at baseline (b¼0.02, p¼.007). At baseline, the composite GC SNP minor alleles were associated with poorer performance on the clock drawing (3:25 (b¼-0.74, p¼.01), Boston naming (BNT, b¼0.50, p¼.01), Wide Range Achievement Test word reading subcomponent (WRAT; b¼-0.44, p¼.04) and Rey-Osterrieth Complex Figure-total copy (b¼-0.85, p¼.02) tests. In longitudinal analyses, minor alleles of GC SNPs were associated with attenuated declines on clock drawing, BNT, WRAT and Rey copy tests. Composite GC SNPs were associated with significantly faster rates of decline in volumes of total gray matter, middle occipital and middle frontal gyri, as well as the cuneus. GCs SNPs were marginally associated with faster declines in occipital gray matter. Conclusions: Vitamin-D exerts both state and trait-dependent effects on brain function and structure during aging. The widespread associations between vitamin-D regulatory SNPs and cognition as well as longitudinal
rates of brain atrophy, suggests a mechanistic basis for the relationship between vitamin-D and mental health outcomes during aging.
P2-264
STIGMATIZING ATTITUDES OF RELATIVES AGAINST PEOPLE SUFFERING FROM DEMENTIA IN URBAN AND RURAL AREAS OF THE REPUBLIC OF CONGO: AN EPIDEMCA-FU RESULT
Gilles Tixier Charnel Kehoua1,2, Catherine-Marie Dubreuil1,2, Bebene Ndamba Bandzouzi1,2,3, Ma€elenn Guerchet1,2,4, Pascal Mbelesso1,2,5, Jean-Franc¸ois Dartigues6, Pierre-Marie Preux1,2,7, 1 INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; 2Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; 3Department of Neurology, University Hospital of Brazzaville, Brazzaville, Congo; 4King’s College London, Centre for Global Mental Health, Institute of Psychiatry, Health Service and Population Research Department, London, United Kingdom; 5Dept. of Neurology, Amitie Hospital, Bangui, Central African Republic; 6Bordeaux University, Bordeaux, France; 7University Hospital, CEBIMER, Limoges, France. Contact e-mail: [email protected] Background: Dementia is a global public health problem. Its association with socio-cultural representations in sub-Saharan Africa is a challenge. The main objective of the study was to describe the stigmatizing attitudes faced by elderly demented (ED) in urban area (Brazzaville) and rural area (Gamboma) in the Republic of Congo. Methods: Two methods were used to conduct this study in urban and rural areas. The first used Explanatory Model Interview Catalogue “EMIC” and the second, unstructured interviews of participant observation and life stories of participants (ethnological approach). Results: Sixty-two participants were included in this study of which 31 ED and 31 relatives. No equivalent to the biomedical concept of “dementia” was found in the local languages. The disease remains unknown but the dementia phenomenon is perceived and is not medicalized. 54.8% of ED were stigmatized by relatives. The stigma of ED was associated with: the refusal to marry or to have a child who marries a family member of an ED; marital problems (in the couple of ED and the relatives), behavioral disorders of ED and accusations of witchcraft. The stigma originated from social representations of the dementia phenomenon seen by relatives. Some symptoms and psychological and behavioral signs of the insanities were stigmatizing for the relatives: ambulation and running away; delirious and hallucinatory syndrome; food, sexual, sphincters or sleep-wake rhythm disorders. The integration of ED within the family and in the entourage was conditioned by their ability to contribute to the expenses. Their involvement in the activities of daily living was an attenuation factor of stigma. Older age (80-95 years), female gender, independent churches, traditional juridictions, low and instable incomes were implicated in the process of stigmatization of the relatives and entourage against ED. Conclusions: In Congo, the disease is a social fact, and belongs to the culture. Its treatment must take into account socio-cultural aspects.
P2-265
THE EFFECTS OF SOCIOECONOMIC INEQUALITIES ON INCIDENCE OF COGNITIVE IMPAIRMENT AMONG COMMUNITY-DWELLING ELDERLY IN SEOUL
Geon Ha Kim1, Hye Ah Lee1, Hye Sook Park1, Dong Young Lee2, KyoungGyu Choi1, Jee Hyang Jeong1, 1Ewha Womans University Mokdong Hospital, Seoul, South Korea; 2Seoul Metropolitan Center for Dementia, Seoul, South Korea. Contact e-mail: [email protected]
DIABETES IS ASSOCIATED WITH WORSE EXECUTIVE FUNCTION IN BOTH EASTERN AND WESTERN POPULATIONS: SHANGHAI AGING STUDY AND MAYO CLINIC STUDY OF AGING
Qianhua Zhao, Huashan Hospital, Fudan University, Shanghai, China. Contact e-mail: [email protected] Background: It remains unknown whether the association between
diabetes mellitus (DM) and cognitive function differs in Eastern and Western populations. This study aimed to elucidate whether DM is associated with worse cognitive performance in both populations. Methods: The Shanghai Aging Study (SAS) and the Mayo Clinic Study of Aging (MCSA) are two population-based studies with similar design and methodology in Shanghai, China and Rochester, MN USA. Non-demented participants underwent cognitive testing, and DM was assessed from the medical record. Separate analyses were performed in SAS and MCSA regarding the association between DM and cognitive performance. Results: A total of 3348 Chinese participants in the SAS and 3734 American subjects in the MCSA were included. Compared with MCSA subjects, SAS participants were younger, less educated, and had lower frequency of vascular disease, APOE ε4 carriers and obesity. Participants with DM (compared to non-DM participants) performed significantly worse on all the cognitive domains in both the SAS and MCSA. After adjustment for age, sex and education, and vascular covariates, DM was associated with worse performance in executive function (b¼ -0.15, p ¼ 0.001 for SAS, and b¼ -0.10, p ¼ 0.008 for MCSA) in the total sample and in the cognitively normal sub-sample. Furthermore, DM was associated with poor performance in visuospatial skills, language, and memory in the SAS, but not in the MCSA. Conclusions: Diabetes is associated with cognitive dysfunction, in particular exerts a negative impact on executive function regardless of race, age and prevalence of vascular risk factors.
P2-261
IMPACT OF SUSTAINED ECONOMIC HARDSHIP ON COGNITIVE FUNCTIONING
Adina Zeki Al Hazzouri1, Tali Elfassy1, Stephen Sidney2, David R. Jacobs, Jr.3, Kristine Yaffe4, 1University of Miami, Miami, FL, USA; 2Kaiser Permanente of Northern California, Oakland, CA, USA; 3University of Minnesota, Minneapolis, MN, USA; 4University of California, San Francisco, San Francisco, CA, USA. Contact e-mail: [email protected] Background: The association of low income and poor health is well
established. Yet most previous studies have examined income at only one time and very few examined cognitive health. Methods: We used income data collected in 1990, 1992, 1995, 2000, 2005, and 2010 from a prospective cohort of young to middle-aged adult participants in the Coronary Artery Risk Development In Young Adults Study (N¼3383), to examine the cumulative effect of economic hardship on cognitive health. Using U.S. Census information and family size, we defined economic hardship as a household income of less than 200 percent of the federal poverty level for the relevant year. To define cumulative economic hardship we then calculated the percent times between 1900 and 2010 that subjects were in poverty and classified participants as experiencing economic hardship: never, less than a third, more than a third, or all-times. In 2010, participants underwent a cognitive battery consisting of the Rey Auditory-Verbal Learning Test of verbal memory, the Digit Symbol Substitution Test of processing speed, and the Stroop test of executive function. For ease of interpretation, we transformed all cognitive test scores into standardized z scores,
P591
with positive values indicating better performance and negative values indicating worse performance. Results: After adjustment for age, sex, race, marital status, smoking, BMI, diastolic and systolic blood pressure, fasting blood glucose, total cholesterol, depressive symptoms and education, there were significant graded associations between sustained economic hardship and all three measures of cognitive functioning. As compared to subjects without any economic hardship, those with economic hardship ‘more than a third’ of times and those with ‘all-time’ hardship were significantly more likely to perform worse on verbal memory (standardized difference of -0.1; 95%CI¼-0.20, -0.00; and -0.2; 95%CI¼-0.33, -0.06 respectively), processing speed (standardized difference of -0.31; 95%CI¼-0.4, -0.22; and -0.65; 95%CI¼-0.77, -0.52 respectively), and executive function (standardized difference of -0.14; 95%CI¼-0.24, -0.04; and -0.37; 95%CI¼-0.51, -0.23 respectively). Similar results were observed when examining the associations between sustained self-reported financial hardship over 25 years and poor cognitive function. Conclusions: Sustained economic hardship over 20 years was associated with worse cognitive function among middle-aged adults.
P2-262
PROGRESS OF THE AUSTRALIAN IMAGING, BIOMARKERS, AND LIFESTYLE (AIBL) COHORT WITH 72 MONTHS OF ASSESSMENT: ATTRITION, DISEASE PROGRESSION, AND MORTALITY
Joanne S. Robertson1, Paul Maruff1,2, Lance Macaulay3, Ralph N. Martins4, Colin L. Masters1, Stephanie R. Rainey-Smith4, Christopher Fowler1, Simon M. Laws5, Adrian Kamer1, Christopher C. Rowe6, Victor L. Villemagne1,6, Kathryn A. Ellis7,8, David Ames7,8 The AIBL Research Group, 1The Florey Institute of Neuroscience and Mental Health, Parkville, Australia; 2Cogstate Ltd, Melbourne, Australia; 3CSIRO, Melbourne, Australia; 4Sir James McCusker Alzheimer’s Disease Research Unit (Hollywood Private Hospital), Perth, Australia; 5Edith Cowan University, Perth, Australia; 6 Austin Health, Melbourne, Australia; 7The University of Melbourne, Melbourne, Australia; 8National Ageing Research Institute, Melbourne, Australia. Contact e-mail: [email protected] Background: The AIBL study of ageing is an experimental prospec-
tive study of 1112 elderly Australians at risk of, or clinically diagnosed with, Alzheimer’s disease (AD). The AIBL cohort has now completed the fifth assessment, 72 months after enrolment. Here we report rates of attrition, disease progression and mortality for this assessment. Methods: The inclusion/exclusion criteria and assessment protocol for the AIBL cohort has been described in detail elsewhere (Ellis et al., 2009). Briefly, participants undergo an array of blood tests, clinical and cognitive evaluation and brain imaging (in a subgroup) every 18 months. At the completion of assessment, all data is integrated and reviewed by an expert panel of psychiatrists, neurologists and neuropsychologists where a consensus clinical classification is made. At baseline, 768 (69.06%) participants were classified as cognitively normal (CN); 133 (11.96%) as meeting clinical criteria for Mild Cognitive Impairment (MCI) and 211 (18.97%) for AD. Results: 598 participants (53.78% of the initial cohort) were re-assessed at 72 months. 119 (10.70%) had deceased and 395 (35.52%) failed to return (FTR). 484 participants (80.94%) were classified as CN; 49 (8.19%) as MCI; 59 (9.87%) as AD and 7 (1.17%) as having non-AD cognitive impairment or dementia. Of the baseline CN group, 26.30% FTR, 11.20% progressed to MCI or AD and 2.47% died. Of the baseline MCI group, 51.88% FTR, 15.79%
P592
Poster Presentations: P2
progressed to AD and 16.54% died. Of the baseline AD group, 49.29% FTR and 35.55% died. Survival analyses indicated clinical groups were equivalent in rate of attrition due to death or FTR, and in rates of mortality with FTR controlled. With mortality and FTR controlled, rate of progression to AD was greater in the MCI group than the rate of progression to MCI or AD in the CN group (p<0.01). Conclusions: The AIBL study has successfully followed over 50% of its initial cohort across 6 years. While group membership at baseline does not predict death or FTR, rates of disease progression are higher in the MCI than CN group. The AIBL study remains as a unique cohort that still contains sufficient sample size for investigation of risk factors for AD.
P2-263
STATE AND TRAIT-DEPENDENT ASSOCIATIONS OF VITAMIN D WITH BRAIN FUNCTION AND STRUCTURE DURING AGING
Alexandra M. Kueider1, Madhav Thambisetty1, Palchamy Elango1, Christos Davatzikos2, Erus Guray2, Yang An1, Toshiko Tanaka1, Melissa Kitner-Triolo1, Luigi Ferrucci1, 1National Institute on Aging, Baltimore, MD, USA; 2University of Pennsylvania, Philadelphia, PA, USA. Contact e-mail: [email protected] Background: Although observational studies have shown Vitamin-D deficiency is associated with increased risk of all-cause dementia, Alzheimer’s disease and age-associated cognitive decline, these results may be influenced by confounding and reverse causation. Examining the relationship between genetic variants regulating vitamin-D levels and brain function/structure may overcome some of these limitations. Methods: Data from non-demented participants in the Baltimore Longitudinal Study of Aging (BLSA), were used in the current analyses (n¼848, mean follow-up interval 10.4 years). Serum concentrations of 25-hydroxyvitamin D [25(OH)D] and single nucleotide polymorphisms (SNPs) in the group-specific component (GC) (rs17467825, rs2282679, rs2298850, rs3755967) gene were examined for associations with cognitive performance using linear mixed models. A composite score of the 4 GC SNPs was created. In data from the BLSA neuroimaging substudy (BLSANI, n¼120, mean follow-up interval 7.8 years), we tested whether GC SNPs influenced changes in brain volumes during aging. Results: As reported previously, GC SNPs were associated with serum concentration of [25(OH)D]. The minor allele of each GC SNP was associated with a 3.68 nmol/L (95% CI -4.72, -2.65) reduction in serum 25(OH)D. Lower serum [25(OH)D] concentration was associated with poorer performance on the clock drawing to command task at baseline (b¼0.02, p¼.007). At baseline, the composite GC SNP minor alleles were associated with poorer performance on the clock drawing (3:25 (b¼-0.74, p¼.01), Boston naming (BNT, b¼0.50, p¼.01), Wide Range Achievement Test word reading subcomponent (WRAT; b¼-0.44, p¼.04) and Rey-Osterrieth Complex Figure-total copy (b¼-0.85, p¼.02) tests. In longitudinal analyses, minor alleles of GC SNPs were associated with attenuated declines on clock drawing, BNT, WRAT and Rey copy tests. Composite GC SNPs were associated with significantly faster rates of decline in volumes of total gray matter, middle occipital and middle frontal gyri, as well as the cuneus. GCs SNPs were marginally associated with faster declines in occipital gray matter. Conclusions: Vitamin-D exerts both state and trait-dependent effects on brain function and structure during aging. The widespread associations between vitamin-D regulatory SNPs and cognition as well as longitudinal
rates of brain atrophy, suggests a mechanistic basis for the relationship between vitamin-D and mental health outcomes during aging.
P2-264
STIGMATIZING ATTITUDES OF RELATIVES AGAINST PEOPLE SUFFERING FROM DEMENTIA IN URBAN AND RURAL AREAS OF THE REPUBLIC OF CONGO: AN EPIDEMCA-FU RESULT
Gilles Tixier Charnel Kehoua1,2, Catherine-Marie Dubreuil1,2, Bebene Ndamba Bandzouzi1,2,3, Ma€elenn Guerchet1,2,4, Pascal Mbelesso1,2,5, Jean-Franc¸ois Dartigues6, Pierre-Marie Preux1,2,7, 1 INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; 2Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; 3Department of Neurology, University Hospital of Brazzaville, Brazzaville, Congo; 4King’s College London, Centre for Global Mental Health, Institute of Psychiatry, Health Service and Population Research Department, London, United Kingdom; 5Dept. of Neurology, Amitie Hospital, Bangui, Central African Republic; 6Bordeaux University, Bordeaux, France; 7University Hospital, CEBIMER, Limoges, France. Contact e-mail: [email protected] Background: Dementia is a global public health problem. Its association with socio-cultural representations in sub-Saharan Africa is a challenge. The main objective of the study was to describe the stigmatizing attitudes faced by elderly demented (ED) in urban area (Brazzaville) and rural area (Gamboma) in the Republic of Congo. Methods: Two methods were used to conduct this study in urban and rural areas. The first used Explanatory Model Interview Catalogue “EMIC” and the second, unstructured interviews of participant observation and life stories of participants (ethnological approach). Results: Sixty-two participants were included in this study of which 31 ED and 31 relatives. No equivalent to the biomedical concept of “dementia” was found in the local languages. The disease remains unknown but the dementia phenomenon is perceived and is not medicalized. 54.8% of ED were stigmatized by relatives. The stigma of ED was associated with: the refusal to marry or to have a child who marries a family member of an ED; marital problems (in the couple of ED and the relatives), behavioral disorders of ED and accusations of witchcraft. The stigma originated from social representations of the dementia phenomenon seen by relatives. Some symptoms and psychological and behavioral signs of the insanities were stigmatizing for the relatives: ambulation and running away; delirious and hallucinatory syndrome; food, sexual, sphincters or sleep-wake rhythm disorders. The integration of ED within the family and in the entourage was conditioned by their ability to contribute to the expenses. Their involvement in the activities of daily living was an attenuation factor of stigma. Older age (80-95 years), female gender, independent churches, traditional juridictions, low and instable incomes were implicated in the process of stigmatization of the relatives and entourage against ED. Conclusions: In Congo, the disease is a social fact, and belongs to the culture. Its treatment must take into account socio-cultural aspects.
P2-265
THE EFFECTS OF SOCIOECONOMIC INEQUALITIES ON INCIDENCE OF COGNITIVE IMPAIRMENT AMONG COMMUNITY-DWELLING ELDERLY IN SEOUL
Geon Ha Kim1, Hye Ah Lee1, Hye Sook Park1, Dong Young Lee2, KyoungGyu Choi1, Jee Hyang Jeong1, 1Ewha Womans University Mokdong Hospital, Seoul, South Korea; 2Seoul Metropolitan Center for Dementia, Seoul, South Korea. Contact e-mail: [email protected]