- Email: [email protected]
VALIDATION OF GPCOG-C IN THE CHINESE HIGHER EDUCATION POPULATION AGED OVER 80 YEARS
Poster Presentations: Tuesday, July 18, 2017 2 Universidad Aut onoma del Estado de Hidalgo, San Agustın Tlaxiaca, Mexico; 3Consejo Nacional de Ciencia y Tecnologıa, Mexico City, Mexico; 4University of Medicine, G€ottingen, Germany. Contact e-mail: [email protected]
Background: Due to natural aging and pathological events, people may experience a degree of cognitive impairment. In particular, memory, attention and processing of speed may be affected. It has been already established that the severity of such deteriorations are related to age, sex, education and the place of residency. The aim of the present work was to generate mathematical models to predict cognitive impairments in Old Adults of Mexico. The generated mathematical models could later be used to find individual indicators of cognitive impairment. Methods: The first public database was the Mexican Health & Aging Study (MHAS, 2012). MHAS has a total sample of 7,953 people that represent 5,775,031 Mexicans and it includes variables of age, education, sex and rural or urban place of residency. The Cross-Cultural Cognitive Examination (CCCE) was employed. It measures 5 psychological functions: verbal learning, verbal memory, visuospatial processing, visuospatial memory and visual scanning. Subsequently, orientation, verbal semantic fluency and numeration or subtraction were added. The second database was the NEUROPSI, a standardized test created in Mexico by Ostrosky and collaborators. As tasks proved to be similar, non-linear regression analyses were made at the following areas: mental concentration, memory, language, visuo-spatial abilities, executive functions, reading, writing and counting. To estimate the probability of having probable cognitive impairment a nonlinear model with a dichotomous dependent variable was estimated. The dependent variable was the probability of an individual obtaining a NEUROPSI score below the 10th percentile, that is, having risk of developing cognitive impairment; the independent variables were age, schooling, place of residence and sex among others. The regression to estimate was as follows: P(Y¼1 jage, school, rural, sex, x)¼ F(a1age+a2school+a3rural+a4sex+bx), where F is the logistic distribution. Results: Cognitive areas were contrasted in the equations of regression with age, education, sex and rural or urban place of residency. Conclusions: Age and to live in rural zones were related with a significant higher probability to develop cognitive impairment, while a higher level of education showed a lower incidence of suffering from cognitive impairment (see figure).
P3-517
P1175
ALZHEIMER’S DISEASE DEATH IN SUBSAHARAN AFRICA AND THE CARIBBEAN
Kristen Dodd1, Thomas O. Obisesan1, Richard F. Gillum2, 1 Howard University College of Medicine, Washington, DC, USA; 2 Howard University College of Medicine, Washington, DC, USA. Contact e-mail: [email protected] Background: Racial, gender, and geographic disparities exist in Alzheimer’s Disease and other dementias (AD), an important cause of death and disability, in high-income countries. Few published data are available on AD in sub-Saharan Africa (SSA) and the Caribbean. Methods: We examined estimated death rates with 95% uncertainty intervals (UI) from the Global Burden of Disease Study 2015 for persons aged 70 years and older in sub-Saharan Africa, high-income North America, and the Caribbean. Results: In SSA the percentage of total deaths due to AD was 2.96% (UI 2.41 – 3.6%) compared to 6.99% (UI 5.77 – 8.21%) globally. In 2015 death rates per 100,000 for AD in the Caribbean (498, UI 388 – 614) were lower than those in high-income North America (907, UI 786 – 1,022) but higher than rates in SSA (238, UI 190 – 292). Regions within SSA varied from Western SSA, which displayed the lowest rates of any region worldwide, to Central SSA. The Caribbean and all regions of SSA showed stable death rates between 1990 and 2015; whereas, high-income North America had increasing rates. Conclusions: Globally, rates of death per 100,000 for AD were lowest in SSA. Rates varied in SSA, being lowest in Western SSA. The Caribbean showed mid-range death rates that were lower than those in high-income countries of North America. Further research is needed to explore causes of these geographic variations in AD.
P3-518
VALIDATION OF GPCOG-C IN THE CHINESE HIGHER EDUCATION POPULATION AGED OVER 80 YEARS
Yong Huang, Tongji Medical College of HUST, Wuhan, China. Contact e-mail: [email protected] Background: The prevalence of dementia is higher in people aged over 80 in developing countries. To save medical resources, we usually use GPCOG-C as a screening tool. But the validation of the sensitivity and specificity in this population is still absent. Studies have shown that educational level affect the scale score, so there may be a ceiling effect. The aim of this study was to examine the validity of GPCOG-C on the high education population over 80 years old, whether there is a ceiling effect, and compare it with MMSE. Methods:
P1176
Poster Presentations: Tuesday, July 18, 2017
P3-519
PERSONALITY TRAITS AND RISK OF DEMENTIA IN BLACK AND WHITE OLDER ADULTS
Allison R. Kaup1, Alexandrea Harmell2, Kristine Yaffe3, 1San Francisco VA Medical Center/University of California San Francisco, San Francisco, CA, USA; 2San Francisco VA Medical Center, San Francisco, CA, USA; 3University of California San Francisco/San Francisco VA Medical Center, San Francisco, CA, USA. Contact e-mail: [email protected] Background: Some personality traits have been found to be associated
Using the GPCOG - C, MMSE, ADCS - ADL, Hachinski ischemia scale screening for cognitive function in Huazhong Science & Technology University community in China, with the NIA/AA diagnostic criteria for Alzheimer’s diagnosis of dementia published in 2011 as the reference. The screened crowd all met age 80 or higher, by a fixed number of year of education for 12 years. The SPSS20.0 was applied for data analysis. Results: Screening for a total of 497 people, crowd out 145 people does not meet the requirements. There are AD group 39 (11.1%), mixed AD1, 1 other types of dementia, MCI population of 235 (66.8%), dementia population 76 (21.6%). Results show that the cutoff point of the GPCOG -C patient section in the crowd is 7, with the sensitivity of 0.718 and specificity of 0.588. And it shows the sensitivity of 0.676, and the specificity of 0.715 by using the GPCOG-C two-step method, with 15 dementia patients （4.3%）not screening out. The cutoff point of MMSE in the crowd is 27, with the sensitivity of 0.615, and the specificity of 0.775. Conclusions: The accuracy of GPCOG screening for dementia was consistent with that of MMSE among the high education population over 80 years old, but GPCOG had higher diagnostic sensitivity. The results show a mild ceiling effect in the highly educated population. By contrast, the specificity of screening for dementia with the GPCOG-C two-step method was significantly higher, which is a more credible and efficient screening method.
with increased risk of dementia while others appear to be protective. As most research has been conducted among white individuals, less is known about personality traits and their association with dementia in other racial/ethnic groups. We examined the association between two personality traits – Conscientiousness and Openness to Experience – and risk of dementia in a cohort of black and white older adults. Methods: Participants were 875 black and white older adults from the Health, Aging and Body Composition study (ages 71-82, 50% female, 47% black), who completed the NEO Five-Factor Inventory: Conscientiousness and Openness to Experience personality trait scales (score range for each: 0 to 48). Participants were free of dementia at study baseline, and incident dementia over the following 8 years was determined by hospital records, prescription for dementia medication, or clinically-significant cognitive decline (1.5 SD race-specific decline on the Modified Mini-Mental State Examination). Using Cox proportional hazard models, we investigated the association between each personality trait (Conscientiousness, Openness to Experience) and risk of dementia, including whether associations differed by race. Models adjusted for demographics, education, literacy, and depressive symptoms, as well as cardiovascular factors associated with either personality trait. Results: A total of 125 participants (14%) developed dementia during study follow-up. Older adults with higher Conscientiousness were less likely to develop dementia (adjusted HR ¼ 0.95 per 1 unit on Conscientiousness scale; 95% CI: 0.92, 0.99; p ¼ .006), and this association was similar among black and white older adults (race interaction: p ¼ 0.80). There was no association between Openness to Experience and risk of dementia (adjusted HR ¼ 0.97 per 1 unit on Openness scale; 95% CI: 0.93-1.01; p ¼ .13), with no differences by race (race interaction: p ¼ 0.75). Conclusions: The personality trait of Conscientiousness is associated with reduced risk of dementia among both white and black older adults, suggesting that this trait helps protect cognitive health in aging among diverse populations. Alternatively, it is possible that low Conscientiousness may be an early symptom of the beginnings of a neurodegenerative disease process.
Table 1 Sensitivity, Specificity, and Area under the Curve (AUC) for General Practitioner Assessment of Cognition C (GPCOG-C). Patient and Informant Sections, GPCPG-C total Score, GPCOG-C “Two-Stage” Method, Mini-Mental State Examination (MMSE) Variable
GPCOG-C Patient Section
GPCOG-C Informant Section
GPCOG-C Total Score
Cut point Maximum score N* Sensitivity Specificity Positive predictive value Negative predictive value AUC Standard error of AUC
7 9 352 0.718 6 0.141 0.588 6 0.055 0.178 0.944 0.725 0.044
5 6 303 0.730 6 0.143 0.541 6 0.060 0.181 0.935 0.678 0.049
11 15 303 0.676 6 0.151 0.661 6 0.057 0.217 0.936 0.724 0.043
Two-Stage Method
MMSE
352 0.615 6 0.153 0.715 6 0.051 0.212 0.937 0.657 0.048
27 30 352 0.615 6 0.153 0.652 6 0.053 0.180 0.932 0.730 0.041
Background: Due to natural aging and pathological events, people may experience a degree of cognitive impairment. In particular, memory, attention and processing of speed may be affected. It has been already established that the severity of such deteriorations are related to age, sex, education and the place of residency. The aim of the present work was to generate mathematical models to predict cognitive impairments in Old Adults of Mexico. The generated mathematical models could later be used to find individual indicators of cognitive impairment. Methods: The first public database was the Mexican Health & Aging Study (MHAS, 2012). MHAS has a total sample of 7,953 people that represent 5,775,031 Mexicans and it includes variables of age, education, sex and rural or urban place of residency. The Cross-Cultural Cognitive Examination (CCCE) was employed. It measures 5 psychological functions: verbal learning, verbal memory, visuospatial processing, visuospatial memory and visual scanning. Subsequently, orientation, verbal semantic fluency and numeration or subtraction were added. The second database was the NEUROPSI, a standardized test created in Mexico by Ostrosky and collaborators. As tasks proved to be similar, non-linear regression analyses were made at the following areas: mental concentration, memory, language, visuo-spatial abilities, executive functions, reading, writing and counting. To estimate the probability of having probable cognitive impairment a nonlinear model with a dichotomous dependent variable was estimated. The dependent variable was the probability of an individual obtaining a NEUROPSI score below the 10th percentile, that is, having risk of developing cognitive impairment; the independent variables were age, schooling, place of residence and sex among others. The regression to estimate was as follows: P(Y¼1 jage, school, rural, sex, x)¼ F(a1age+a2school+a3rural+a4sex+bx), where F is the logistic distribution. Results: Cognitive areas were contrasted in the equations of regression with age, education, sex and rural or urban place of residency. Conclusions: Age and to live in rural zones were related with a significant higher probability to develop cognitive impairment, while a higher level of education showed a lower incidence of suffering from cognitive impairment (see figure).
P3-517
P1175
ALZHEIMER’S DISEASE DEATH IN SUBSAHARAN AFRICA AND THE CARIBBEAN
Kristen Dodd1, Thomas O. Obisesan1, Richard F. Gillum2, 1 Howard University College of Medicine, Washington, DC, USA; 2 Howard University College of Medicine, Washington, DC, USA. Contact e-mail: [email protected] Background: Racial, gender, and geographic disparities exist in Alzheimer’s Disease and other dementias (AD), an important cause of death and disability, in high-income countries. Few published data are available on AD in sub-Saharan Africa (SSA) and the Caribbean. Methods: We examined estimated death rates with 95% uncertainty intervals (UI) from the Global Burden of Disease Study 2015 for persons aged 70 years and older in sub-Saharan Africa, high-income North America, and the Caribbean. Results: In SSA the percentage of total deaths due to AD was 2.96% (UI 2.41 – 3.6%) compared to 6.99% (UI 5.77 – 8.21%) globally. In 2015 death rates per 100,000 for AD in the Caribbean (498, UI 388 – 614) were lower than those in high-income North America (907, UI 786 – 1,022) but higher than rates in SSA (238, UI 190 – 292). Regions within SSA varied from Western SSA, which displayed the lowest rates of any region worldwide, to Central SSA. The Caribbean and all regions of SSA showed stable death rates between 1990 and 2015; whereas, high-income North America had increasing rates. Conclusions: Globally, rates of death per 100,000 for AD were lowest in SSA. Rates varied in SSA, being lowest in Western SSA. The Caribbean showed mid-range death rates that were lower than those in high-income countries of North America. Further research is needed to explore causes of these geographic variations in AD.
P3-518
VALIDATION OF GPCOG-C IN THE CHINESE HIGHER EDUCATION POPULATION AGED OVER 80 YEARS
Yong Huang, Tongji Medical College of HUST, Wuhan, China. Contact e-mail: [email protected] Background: The prevalence of dementia is higher in people aged over 80 in developing countries. To save medical resources, we usually use GPCOG-C as a screening tool. But the validation of the sensitivity and specificity in this population is still absent. Studies have shown that educational level affect the scale score, so there may be a ceiling effect. The aim of this study was to examine the validity of GPCOG-C on the high education population over 80 years old, whether there is a ceiling effect, and compare it with MMSE. Methods:
P1176
Poster Presentations: Tuesday, July 18, 2017
P3-519
PERSONALITY TRAITS AND RISK OF DEMENTIA IN BLACK AND WHITE OLDER ADULTS
Allison R. Kaup1, Alexandrea Harmell2, Kristine Yaffe3, 1San Francisco VA Medical Center/University of California San Francisco, San Francisco, CA, USA; 2San Francisco VA Medical Center, San Francisco, CA, USA; 3University of California San Francisco/San Francisco VA Medical Center, San Francisco, CA, USA. Contact e-mail: [email protected] Background: Some personality traits have been found to be associated
Using the GPCOG - C, MMSE, ADCS - ADL, Hachinski ischemia scale screening for cognitive function in Huazhong Science & Technology University community in China, with the NIA/AA diagnostic criteria for Alzheimer’s diagnosis of dementia published in 2011 as the reference. The screened crowd all met age 80 or higher, by a fixed number of year of education for 12 years. The SPSS20.0 was applied for data analysis. Results: Screening for a total of 497 people, crowd out 145 people does not meet the requirements. There are AD group 39 (11.1%), mixed AD1, 1 other types of dementia, MCI population of 235 (66.8%), dementia population 76 (21.6%). Results show that the cutoff point of the GPCOG -C patient section in the crowd is 7, with the sensitivity of 0.718 and specificity of 0.588. And it shows the sensitivity of 0.676, and the specificity of 0.715 by using the GPCOG-C two-step method, with 15 dementia patients （4.3%）not screening out. The cutoff point of MMSE in the crowd is 27, with the sensitivity of 0.615, and the specificity of 0.775. Conclusions: The accuracy of GPCOG screening for dementia was consistent with that of MMSE among the high education population over 80 years old, but GPCOG had higher diagnostic sensitivity. The results show a mild ceiling effect in the highly educated population. By contrast, the specificity of screening for dementia with the GPCOG-C two-step method was significantly higher, which is a more credible and efficient screening method.
with increased risk of dementia while others appear to be protective. As most research has been conducted among white individuals, less is known about personality traits and their association with dementia in other racial/ethnic groups. We examined the association between two personality traits – Conscientiousness and Openness to Experience – and risk of dementia in a cohort of black and white older adults. Methods: Participants were 875 black and white older adults from the Health, Aging and Body Composition study (ages 71-82, 50% female, 47% black), who completed the NEO Five-Factor Inventory: Conscientiousness and Openness to Experience personality trait scales (score range for each: 0 to 48). Participants were free of dementia at study baseline, and incident dementia over the following 8 years was determined by hospital records, prescription for dementia medication, or clinically-significant cognitive decline (1.5 SD race-specific decline on the Modified Mini-Mental State Examination). Using Cox proportional hazard models, we investigated the association between each personality trait (Conscientiousness, Openness to Experience) and risk of dementia, including whether associations differed by race. Models adjusted for demographics, education, literacy, and depressive symptoms, as well as cardiovascular factors associated with either personality trait. Results: A total of 125 participants (14%) developed dementia during study follow-up. Older adults with higher Conscientiousness were less likely to develop dementia (adjusted HR ¼ 0.95 per 1 unit on Conscientiousness scale; 95% CI: 0.92, 0.99; p ¼ .006), and this association was similar among black and white older adults (race interaction: p ¼ 0.80). There was no association between Openness to Experience and risk of dementia (adjusted HR ¼ 0.97 per 1 unit on Openness scale; 95% CI: 0.93-1.01; p ¼ .13), with no differences by race (race interaction: p ¼ 0.75). Conclusions: The personality trait of Conscientiousness is associated with reduced risk of dementia among both white and black older adults, suggesting that this trait helps protect cognitive health in aging among diverse populations. Alternatively, it is possible that low Conscientiousness may be an early symptom of the beginnings of a neurodegenerative disease process.
Table 1 Sensitivity, Specificity, and Area under the Curve (AUC) for General Practitioner Assessment of Cognition C (GPCOG-C). Patient and Informant Sections, GPCPG-C total Score, GPCOG-C “Two-Stage” Method, Mini-Mental State Examination (MMSE) Variable
GPCOG-C Patient Section
GPCOG-C Informant Section
GPCOG-C Total Score
Cut point Maximum score N* Sensitivity Specificity Positive predictive value Negative predictive value AUC Standard error of AUC
7 9 352 0.718 6 0.141 0.588 6 0.055 0.178 0.944 0.725 0.044
5 6 303 0.730 6 0.143 0.541 6 0.060 0.181 0.935 0.678 0.049
11 15 303 0.676 6 0.151 0.661 6 0.057 0.217 0.936 0.724 0.043
Two-Stage Method
MMSE
352 0.615 6 0.153 0.715 6 0.051 0.212 0.937 0.657 0.048
27 30 352 0.615 6 0.153 0.652 6 0.053 0.180 0.932 0.730 0.041