- Email: [email protected]
Risk factors and predisposing genes for mild cognitive impairment in patients with type 2 diabetes mellitus
Poster Presentations P3 independently associated with CIND. An interaction was found between education and job physical demand; persons with a high level of education but a high job physical demand showed an association with CIND, both if they were employed as manual or non-manual workers (OR ¼ 4.4;95%CI ¼ 1.03-18.9, and OR ¼ 4.3;95%CI ¼ 1.6-11.7, respectively). Conclusions: Different lifetime’s socioeconomic factors are associated with CIND in late life. Early-life education seems to play the most important role. However, being in a job that is highly physically demanding might modify the effect of education, independently of occupation.
P3-016
CARDIOVASCULAR RISK AND ITS CONSEQUENCES IN THE COGNITION OF PATIENTS OF AN UNIVERSITY HOSPITAL
Luciane M. F. Restelatto, Juliana S. Varela, Amanda L. Costa, Karine Bombardelli, Elisa Rosin, Rodolfo S. Silva, Alan Palmero, Pedro Abrahim, Marcia L. Chaves, Universidade Federal do Rio Grande do Sul/Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil. Contact e-mail: [email protected] Background: The risk of dementia, depression and cognitive decline is higher in patients with pathological conditions associated with a high level of cholesterol, such as cardiovascular diseases, systemic arterial hypertension and atherosclerosis. There are evidences that ischemic lesions and vascular factors increase the risk of Alzheimer disease. This work aims to evaluate the frequency of cognitive decline and depressive symptoms in patients stratified for the risk of cardiovascular events and compare the cognitive performance of patients in the low, medium and high risk groups for ischemic events. Methods: The Framingham Score for cardiovascular risk was used to stratify 110 patients in low, medium and high cardiovascular risk. The Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15) were used for the main measures of the cognitive evaluation. The cutoff for the presence of depression was 6 on GDS. A score of 24 or less in the MMSE was considered as cognitive impairment, and in case the patient had 4 years or less of education, the cutoff point was 17. Results: The high risk group had significant lower scores on MMSE (p < 0.001) independent of education when compared to the other groups. The scores in the GDS did not vary significantly (p > 0,001) between the groups. However, patients with cardiovascular risk showed a higher prevalence of depressive symptoms (37%) than the general population. Conclusions: The present findings corroborate the differential cognitive performance of patients with high cardiovascular risk, that showed lower MMSE scores when compared with patients of the medium and low risk. Although the association of high cardiovascular risk with depressive symptoms was not statistically significant, it was noted a higher prevalence of depressive symptoms in this group of patients than in the general population.
Table 1. The frequencies of epsilon 2, epsilon 3, epsilon 4 of APOE gene in case and control groups Alleles of APOE gene
Cases
Controls
epsilon 2 epsilon 3 epsilon 4
13(10.83%) 78(65.00%) 29(24.17%)
40(16.67%) 175(72.92%) 25(10.41%)
c2 ¼ 12.646, p ¼ 0.002 Table 2. The frequencies of Alleles G and A of TNF-a gene in case and control groups Alleles of TNF-a gene
Cases
Controls
G A c2 ¼ 8.091, p ¼ 0.004
97(80.83%) 23(19.17%)
219(91.25%) 21(8.75%)
data. Depression and anxiety of subjects were assessed by Hospital Anxiety and Depression Scale. Blood samples were collected from 60 cases and 120 controls and the polymorphisms of APOE gene and promoter G/A308 of TNF-a gene were detected by PCR-RFLP. The risk factors were analyzed by logistic regression and ORs value and its 95%CIs were calculated. Results: The differences of the frequencies of alleles of APOE and TNF-a genes between case and control groups were statistical significance (Table1,2). The adjusted ORs of logistic regression analyses showed that the risk of cognitive impairment increased significantly among type 2 diabetic patients who were older (OR ¼ 5.889, 95% CI: 2.744-12.639), anxious (OR ¼ 4.205, 95% CI: 1.607-11.004), longer diabetic course (OR ¼ 3.008, 95% CI: 1.638-5.524), epsilon 4 carriers of APOE gene (OR ¼ 4.340, 95% CI: 1.589-11.854), bad glycemia control (OR ¼ 3.323, 95% CI: 1.419-7.783) and allele A carriers of TNF-a gene (OR ¼ 3.931, 95% CI:1.366-11.315), and decreased significantly among type 2 diabetic patients who had higher education level (OR ¼ 0.396, 95% CI: 0.232-0.676). No associations were found between cognitive impairment and gender, history of hypertension, family histories of hypertension and diabetes, diabetic peripheral neuropathy, diabetic retinopathy, diabetic nephropathy, smoking, drinking, depression, body mass index, serum glucose and lipids. Conclusions: The risk factors of cognitive impairment in type 2 diabetic patients were older, anxious, longer diabetic course, epsilon 4 carriers of APOE gene, bad glycemia control, allele A carriers of TNF-a gene, while higher education level was the protective factor for cognitive impairment.
P3-018 P3-017
RISK FACTORS AND PREDISPOSING GENES FOR MILD COGNITIVE IMPAIRMENT IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Xiuying Qi1, Xianhai Meng1, Yun Xie1, Dan Qian1, Yuying Zhou2, Xia Zhao1, Fangfang Shen1, 1Tianjin Medical University, Tianjin, China; 2 Tianjin Huanhu Hospital, Tianjin, China. Contact e-mail: qixiuying@tijmu. edu.cn Background: The study was carried out in order to explore risk factors and predisposing genes for mild cognitive impairment in patients with type 2 diabetes, and provide scientific basis for preventing Alzheimer’s disease. Methods: A hospital-based case-control study was conducted in Tianjin, China from May, 2008 to March, 2009. The subjects included 248 type 2 diabetic patients, in which 60 patients with mild cognitive impairment were confirmed by using Mini-mental State Examination scale and clock drawing test and constituted case group and 188 patients without cognitive impairment constituted control group. The information of subjects was collected by using self-made questionnaire, which including demographic data, disease history, disease family history, behavior pattern, clinical data, laboratory
S453
INFLUENCE OF TRANSFERRIN SATURATION ON DEMENTIA: IS THERE A CUT OFF VALUE?
Servet Ariogul, Burcu B. Yavuz, Mustafa Cankurtaran, Ibrahim C. Haznedaroglu, Meltem Halil, Zekeriya Ulger, Bulent Altun, Hacettepe University Faculty of Medicine, Ankara, Turkey. Contact e-mail: [email protected] Background: Iron has an important role in oxygen transport, storage and in enzymatic reactions. The hypothesis that deficiency of iron may lead to cognitive decline has been tested by us previously. This study aimed to examine the association between iron status and dementia. Another aim was to determine if the standard cut off value of transferrin saturation for iron deficiency is also accurate for dementia. Methods: Within 2009 consecutive patients admitted to Geriatric Medicine outpatient clinic 622 who fulfilled the inclusion criteria were enrolled in the study. Comprehensive geriatric assessment, cognitive assessment and laboratory analysis including blood count, iron, total iron binding capacity, ferritin, and transferrin saturation were performed. ROC curve analysis was performed to determine a cut off value for transferrin saturation that has an influence on dementia. Results: Mean age of the study group was 72.5 6 6.5 and 439
P3-016
CARDIOVASCULAR RISK AND ITS CONSEQUENCES IN THE COGNITION OF PATIENTS OF AN UNIVERSITY HOSPITAL
Luciane M. F. Restelatto, Juliana S. Varela, Amanda L. Costa, Karine Bombardelli, Elisa Rosin, Rodolfo S. Silva, Alan Palmero, Pedro Abrahim, Marcia L. Chaves, Universidade Federal do Rio Grande do Sul/Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil. Contact e-mail: [email protected] Background: The risk of dementia, depression and cognitive decline is higher in patients with pathological conditions associated with a high level of cholesterol, such as cardiovascular diseases, systemic arterial hypertension and atherosclerosis. There are evidences that ischemic lesions and vascular factors increase the risk of Alzheimer disease. This work aims to evaluate the frequency of cognitive decline and depressive symptoms in patients stratified for the risk of cardiovascular events and compare the cognitive performance of patients in the low, medium and high risk groups for ischemic events. Methods: The Framingham Score for cardiovascular risk was used to stratify 110 patients in low, medium and high cardiovascular risk. The Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15) were used for the main measures of the cognitive evaluation. The cutoff for the presence of depression was 6 on GDS. A score of 24 or less in the MMSE was considered as cognitive impairment, and in case the patient had 4 years or less of education, the cutoff point was 17. Results: The high risk group had significant lower scores on MMSE (p < 0.001) independent of education when compared to the other groups. The scores in the GDS did not vary significantly (p > 0,001) between the groups. However, patients with cardiovascular risk showed a higher prevalence of depressive symptoms (37%) than the general population. Conclusions: The present findings corroborate the differential cognitive performance of patients with high cardiovascular risk, that showed lower MMSE scores when compared with patients of the medium and low risk. Although the association of high cardiovascular risk with depressive symptoms was not statistically significant, it was noted a higher prevalence of depressive symptoms in this group of patients than in the general population.
Table 1. The frequencies of epsilon 2, epsilon 3, epsilon 4 of APOE gene in case and control groups Alleles of APOE gene
Cases
Controls
epsilon 2 epsilon 3 epsilon 4
13(10.83%) 78(65.00%) 29(24.17%)
40(16.67%) 175(72.92%) 25(10.41%)
c2 ¼ 12.646, p ¼ 0.002 Table 2. The frequencies of Alleles G and A of TNF-a gene in case and control groups Alleles of TNF-a gene
Cases
Controls
G A c2 ¼ 8.091, p ¼ 0.004
97(80.83%) 23(19.17%)
219(91.25%) 21(8.75%)
data. Depression and anxiety of subjects were assessed by Hospital Anxiety and Depression Scale. Blood samples were collected from 60 cases and 120 controls and the polymorphisms of APOE gene and promoter G/A308 of TNF-a gene were detected by PCR-RFLP. The risk factors were analyzed by logistic regression and ORs value and its 95%CIs were calculated. Results: The differences of the frequencies of alleles of APOE and TNF-a genes between case and control groups were statistical significance (Table1,2). The adjusted ORs of logistic regression analyses showed that the risk of cognitive impairment increased significantly among type 2 diabetic patients who were older (OR ¼ 5.889, 95% CI: 2.744-12.639), anxious (OR ¼ 4.205, 95% CI: 1.607-11.004), longer diabetic course (OR ¼ 3.008, 95% CI: 1.638-5.524), epsilon 4 carriers of APOE gene (OR ¼ 4.340, 95% CI: 1.589-11.854), bad glycemia control (OR ¼ 3.323, 95% CI: 1.419-7.783) and allele A carriers of TNF-a gene (OR ¼ 3.931, 95% CI:1.366-11.315), and decreased significantly among type 2 diabetic patients who had higher education level (OR ¼ 0.396, 95% CI: 0.232-0.676). No associations were found between cognitive impairment and gender, history of hypertension, family histories of hypertension and diabetes, diabetic peripheral neuropathy, diabetic retinopathy, diabetic nephropathy, smoking, drinking, depression, body mass index, serum glucose and lipids. Conclusions: The risk factors of cognitive impairment in type 2 diabetic patients were older, anxious, longer diabetic course, epsilon 4 carriers of APOE gene, bad glycemia control, allele A carriers of TNF-a gene, while higher education level was the protective factor for cognitive impairment.
P3-018 P3-017
RISK FACTORS AND PREDISPOSING GENES FOR MILD COGNITIVE IMPAIRMENT IN PATIENTS WITH TYPE 2 DIABETES MELLITUS
Xiuying Qi1, Xianhai Meng1, Yun Xie1, Dan Qian1, Yuying Zhou2, Xia Zhao1, Fangfang Shen1, 1Tianjin Medical University, Tianjin, China; 2 Tianjin Huanhu Hospital, Tianjin, China. Contact e-mail: qixiuying@tijmu. edu.cn Background: The study was carried out in order to explore risk factors and predisposing genes for mild cognitive impairment in patients with type 2 diabetes, and provide scientific basis for preventing Alzheimer’s disease. Methods: A hospital-based case-control study was conducted in Tianjin, China from May, 2008 to March, 2009. The subjects included 248 type 2 diabetic patients, in which 60 patients with mild cognitive impairment were confirmed by using Mini-mental State Examination scale and clock drawing test and constituted case group and 188 patients without cognitive impairment constituted control group. The information of subjects was collected by using self-made questionnaire, which including demographic data, disease history, disease family history, behavior pattern, clinical data, laboratory
S453
INFLUENCE OF TRANSFERRIN SATURATION ON DEMENTIA: IS THERE A CUT OFF VALUE?
Servet Ariogul, Burcu B. Yavuz, Mustafa Cankurtaran, Ibrahim C. Haznedaroglu, Meltem Halil, Zekeriya Ulger, Bulent Altun, Hacettepe University Faculty of Medicine, Ankara, Turkey. Contact e-mail: [email protected] Background: Iron has an important role in oxygen transport, storage and in enzymatic reactions. The hypothesis that deficiency of iron may lead to cognitive decline has been tested by us previously. This study aimed to examine the association between iron status and dementia. Another aim was to determine if the standard cut off value of transferrin saturation for iron deficiency is also accurate for dementia. Methods: Within 2009 consecutive patients admitted to Geriatric Medicine outpatient clinic 622 who fulfilled the inclusion criteria were enrolled in the study. Comprehensive geriatric assessment, cognitive assessment and laboratory analysis including blood count, iron, total iron binding capacity, ferritin, and transferrin saturation were performed. ROC curve analysis was performed to determine a cut off value for transferrin saturation that has an influence on dementia. Results: Mean age of the study group was 72.5 6 6.5 and 439