P4-055: Self-rated health in patients with mild Alzheimer's disease: Baseline data from the Danish...
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antidepressives, sedatives and thyroid function drugs (most often thy- roid agonists). Acknowledgement: The study was funded by the Euro- pean Commission-Fifth Framework Programme (QLK6-CT-2002- 02455). P4-054 CEREBRAL CORTICAL ATROPHY, BRAIN INFARCTS, AND CLINICAL EXPRESSION OF ALZHEIMER PATHOLOGY: FINDINGS FROM THE NUN STUDY Suzanne L. Tyas 1 , David A. Snowdon 2 , Mark F. Desrosiers 2 , Kathryn P. Riley 2 , William R. Markesbery 2 , 1 University of Waterloo, Waterloo, ON, Canada; 2 University of Kentucky, Lexington, KY, USA. Contact e-mail: [email protected] Background: The observation that not all who meet neuropathologic criteria for Alzheimer’s disease (AD) are demented has stimulated interest in the concept of cognitive reserve. Loss of cerebral cortical tissue is hypothesized to contribute to the loss of cognitive reserve. Vascular factors may also be important in cognitive reserve. Among those who meet neuropathologic criteria for AD, atrophy and brain infarcts may distinguish between those who resist clinical expression of AD (asymptomatic AD) and those who become demented (symptomatic AD). Methods: The Nun Study is a longitudinal study of aging in 678 participants 75 years; 237 met CERAD neuropathologic criteria for AD. Cerebral cortical atrophy, brain infarcts, and neuropathologic di- agnosis of AD were determined by gross and microscopic postmortem examinations. Results: Cerebral cortical atrophy was strongly associ- ated with symptomatic AD. This association persisted after adjustment for age at death, education, and APOE-e4 in logistic regression models of the presence of any atrophy (odds ratio [OR] 6.58, 95% CI 2.92- 15.95), and showed an increasing impact of atrophy from mild (OR4.82; 95% CI 2.08-12.08) to moderate levels (OR 9.75; CI2.00-37.19). Severe levels of atrophy showed a strong, significant association (OR 111.83; 95% CI 15.07-1000), but confidence lim- its could not be accurately calculated due to the paucity of subjects with severe atrophy and asymptomatic AD (1/22 or 4.5%). Frontal (OR3.08; 95% CI 1.71-5.62), temporal (OR 5.29; 95% CI 2.71- 10.98) and parietal atrophy (OR 6.33; 95% CI 2.10-27.46) were all significantly associated with symptomatic AD; occipital atrophy was not a significant predictor, but few individuals (n 6) showed atrophy in this region. Large or lacunar brain infarcts were also significantly associated with symptomatic AD (OR 2.56; 95% CI 1.33-5.08) and remained significant in the presence of atrophy except for higher (mod- erate or severe) levels of atrophy. Conclusions: The presence of atro- phy and brain infarcts significantly reduced the ability to resist clinical expression of AD pathology. Although the impacts of these pathologies are largely independent, brain infarcts may have a reduced contribution to symptomatic AD at more severe levels of atrophy. Studies of the association and interactions of brain pathologies on clinical expression of AD pathology may provide insight into mechanisms and predictors of cognitive reserve. P4-055 SELF-RATED HEALTH IN PATIENTS WITH MILD ALZHEIMER’S DISEASE: BASELINE DATA FROM THE DANISH ALZHEIMER INTERVENTION STUDY Gunhild Waldemar 1 , Frans B. Waldorff 1,2 , Anni B. S. Nielsen 1 , Dorthe V. Buss 1 , Ane Eckermann 1 , 1 Memory Disorders Research Group, Dept. of Neurology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; 2 Research Unit and Dept. of General Practice, Institute of Public Health, Copenhagen University, Copenhagen, Denmark. Contact e-mail: gunhild.waldemar@ rh.regionh.dk Background: Self-rated health (SRH) is a complex measure which may include social, psychological, and cultural features as well as physical health. The aim of this study was to investigate predictors for SRH in patients with mild Alzheimer’s disease (AD). Methods: Baseline data from a cohort of patients with mild AD recruited for a psychosocial intervention study (Danish Alzheimer Intervention Study, DAISY) in five different regions of Denmark. The association between SRH (di- chotomised into good versus poor) was estimated in a Generalized Estimating Equation (GEE) in a three-step analysis model including covariates as well as cognitive measurements. Results: Out of 321 patients with Alzheimer’s disease 208 rated their SRH as excellent or good. Short education (OR 0.58, 0.59, 0.57, respectively), as well as the presence of additional chronic conditions beside AD (OR 0.47, 0.47, 0.45, respectively) was inversely associated with good SRH. In model two and three low quality of life was inversely associated with good SRH (OR 0.18, 0.18, respectively). In model three lower scores of Mini-Mental Status Examination (MMSE) (OR 1.00 (for MMSE 27- 30), 1,84 (for MMSE 24-26), 2.24 (for MMSE 20-23), respectively) as well as loss of insight in own deficits (OR 7.42) were significantly associated with good SRH. Conclusions: In patients with AD good or excellent SRH is associated with high education, lack of additional chronic conditions, higher scores on quality of life measures, lower scores of MMSE, and loss of insight in own deficits. Further research is needed in order to establish the validity and influence of SRH in this group of patients. P4-056 WORK-LIFE EXPERIENCE OF PSYCHOSOCIAL STRESS IN RELATION TO LATE-LIFE RISK OF DEMENTIA AND ALZHEIMER’S DISEASE Hui-Xin Wang, Maria Wahlberg, Anita Karp, Bengt Winblad, Laura Fratiglioni, Karolinska Institute, Stockholm, Sweden. Contact e- mail: [email protected] Background: A vast body of research evidence has shown that psy- chosocial job stress is a risk factor for cardiovascular diseases, but a few studies have explored its impact on occurrence of dementia and Alzheimer disease (AD). Methods: To test the hypothesis that psycho- social job stress might contribute to an increased risk of dementia and AD, a dementia free cohort of 913 community dwellers, 78 years and above, from the Kungsholmen project, Stockholm, Sweden, was fol- lowed-up for an average of 6 years (1987-1989 to 1994-1996). Demen- tia and AD were diagnosed according to the DSM-III-R. Participants’ lifetime job history was retrospectively collected from an informant. Each individual’s levels of job demands and control at the workplace were estimated for the longest occupation and for the entire occupa- tional life through a psychosocial job exposure matrix. Cox proportion- al-hazards model was used to evaluate risks of dementia and AD according to the levels of job demands, job control, and job strain. Results: Elderly people who experienced low job control were at greater risk to develop dementia and AD: adjusted Hazard Ratio (HR) of dementia was 1.85 (95% confidence interval (CI): 1.16 to 2.95) and of AD was 2.18 (1.21 to 3.91). High job demand alone was not significantly associated with an elevated dementia risk. Higher risks were found among persons with a high (high demand together with low control; HR (dementia) 1.6, 1.0 to 2.7; HR (AD)1.9, 1.0-3.5) or a passive job strain (low demand together with low control; HR (demen- tia)1.8, 1.1-3.0; HR (AD)2.1, 1.1-3.9) in comparison with people with an active job strain (high demand with high control), even after controlling for potential confounders. Vascular factors did not mediate these associations. Similar associations were found in subjects with or without ApoE 4. These associations seem stronger in people with high neuroticism score, but was not modified by support at work, and did not change when job strain was assessed for the entire working life occu- pations. Conclusions: Work life psychosocial job stress, as indicated by low job control, high or passive job strain, is associated with increased risks of dementia and AD in late life. T684 Poster Presentations P4:
Transcript of P4-055: Self-rated health in patients with mild Alzheimer's disease: Baseline data from the Danish...
antidepressives, sedatives and thyroid function drugs (most often thy-roid agonists). Acknowledgement: The study was funded by the Euro-pean Commission-Fifth Framework Programme (QLK6-CT-2002-02455).
P4-054 CEREBRAL CORTICAL ATROPHY, BRAININFARCTS, AND CLINICAL EXPRESSION OFALZHEIMER PATHOLOGY: FINDINGS FROMTHE NUN STUDY
Suzanne L. Tyas1, David A. Snowdon2, Mark F. Desrosiers2,Kathryn P. Riley2, William R. Markesbery2, 1University of Waterloo,Waterloo, ON, Canada; 2University of Kentucky, Lexington, KY, USA.Contact e-mail: [email protected]
Background: The observation that not all who meet neuropathologiccriteria for Alzheimer’s disease (AD) are demented has stimulatedinterest in the concept of cognitive reserve. Loss of cerebral corticaltissue is hypothesized to contribute to the loss of cognitive reserve.Vascular factors may also be important in cognitive reserve. Amongthose who meet neuropathologic criteria for AD, atrophy and braininfarcts may distinguish between those who resist clinical expression ofAD (asymptomatic AD) and those who become demented (symptomaticAD). Methods: The Nun Study is a longitudinal study of aging in 678participants 75� years; 237 met CERAD neuropathologic criteria forAD. Cerebral cortical atrophy, brain infarcts, and neuropathologic di-agnosis of AD were determined by gross and microscopic postmortemexaminations. Results: Cerebral cortical atrophy was strongly associ-ated with symptomatic AD. This association persisted after adjustmentfor age at death, education, and APOE-e4 in logistic regression modelsof the presence of any atrophy (odds ratio [OR]� 6.58, 95% CI� 2.92-15.95), and showed an increasing impact of atrophy from mild(OR� 4.82; 95% CI� 2.08-12.08) to moderate levels (OR� 9.75;CI� 2.00-37.19). Severe levels of atrophy showed a strong, significantassociation (OR� 111.83; 95% CI� 15.07-1000� ), but confidence lim-its could not be accurately calculated due to the paucity of subjects withsevere atrophy and asymptomatic AD (1/22 or 4.5%). Frontal(OR� 3.08; 95% CI� 1.71-5.62), temporal (OR� 5.29; 95% CI� 2.71-10.98) and parietal atrophy (OR� 6.33; 95% CI� 2.10-27.46) were allsignificantly associated with symptomatic AD; occipital atrophy wasnot a significant predictor, but few individuals (n� 6) showed atrophy inthis region. Large or lacunar brain infarcts were also significantlyassociated with symptomatic AD (OR� 2.56; 95% CI� 1.33-5.08) andremained significant in the presence of atrophy except for higher (mod-erate or severe) levels of atrophy. Conclusions: The presence of atro-phy and brain infarcts significantly reduced the ability to resist clinicalexpression of AD pathology. Although the impacts of these pathologiesare largely independent, brain infarcts may have a reduced contributionto symptomatic AD at more severe levels of atrophy. Studies of theassociation and interactions of brain pathologies on clinical expressionof AD pathology may provide insight into mechanisms and predictorsof cognitive reserve.
P4-055 SELF-RATED HEALTH IN PATIENTS WITH MILDALZHEIMER’S DISEASE: BASELINE DATA FROMTHE DANISH ALZHEIMER INTERVENTIONSTUDY
Gunhild Waldemar1, Frans B. Waldorff1,2, Anni B. S. Nielsen1,Dorthe V. Buss1, Ane Eckermann1, 1Memory Disorders ResearchGroup, Dept. of Neurology, Rigshospitalet, Copenhagen UniversityHospital, Copenhagen, Denmark; 2Research Unit and Dept. of GeneralPractice, Institute of Public Health, Copenhagen University,Copenhagen, Denmark. Contact e-mail: [email protected]
Background: Self-rated health (SRH) is a complex measure which mayinclude social, psychological, and cultural features as well as physical
health. The aim of this study was to investigate predictors for SRH inpatients with mild Alzheimer’s disease (AD). Methods: Baseline datafrom a cohort of patients with mild AD recruited for a psychosocialintervention study (Danish Alzheimer Intervention Study, DAISY) infive different regions of Denmark. The association between SRH (di-chotomised into good versus poor) was estimated in a GeneralizedEstimating Equation (GEE) in a three-step analysis model includingcovariates as well as cognitive measurements. Results: Out of 321patients with Alzheimer’s disease 208 rated their SRH as excellent orgood. Short education (OR 0.58, 0.59, 0.57, respectively), as well as thepresence of additional chronic conditions beside AD (OR 0.47, 0.47,0.45, respectively) was inversely associated with good SRH. In modeltwo and three low quality of life was inversely associated with goodSRH (OR 0.18, 0.18, respectively). In model three lower scores ofMini-Mental Status Examination (MMSE) (OR 1.00 (for MMSE 27-30), 1,84 (for MMSE 24-26), 2.24 (for MMSE 20-23), respectively) aswell as loss of insight in own deficits (OR 7.42) were significantlyassociated with good SRH. Conclusions: In patients with AD good orexcellent SRH is associated with high education, lack of additionalchronic conditions, higher scores on quality of life measures, lowerscores of MMSE, and loss of insight in own deficits. Further research isneeded in order to establish the validity and influence of SRH in thisgroup of patients.
P4-056 WORK-LIFE EXPERIENCE OF PSYCHOSOCIALSTRESS IN RELATION TO LATE-LIFE RISK OFDEMENTIA AND ALZHEIMER’S DISEASE
Hui-Xin Wang, Maria Wahlberg, Anita Karp, Bengt Winblad,Laura Fratiglioni, Karolinska Institute, Stockholm, Sweden. Contact e-mail: [email protected]
Background: A vast body of research evidence has shown that psy-chosocial job stress is a risk factor for cardiovascular diseases, but afew studies have explored its impact on occurrence of dementia andAlzheimer disease (AD). Methods: To test the hypothesis that psycho-social job stress might contribute to an increased risk of dementia andAD, a dementia free cohort of 913 community dwellers, 78 years andabove, from the Kungsholmen project, Stockholm, Sweden, was fol-lowed-up for an average of 6 years (1987-1989 to 1994-1996). Demen-tia and AD were diagnosed according to the DSM-III-R. Participants’lifetime job history was retrospectively collected from an informant.Each individual’s levels of job demands and control at the workplacewere estimated for the longest occupation and for the entire occupa-tional life through a psychosocial job exposure matrix. Cox proportion-al-hazards model was used to evaluate risks of dementia and ADaccording to the levels of job demands, job control, and job strain.Results: Elderly people who experienced low job control were atgreater risk to develop dementia and AD: adjusted Hazard Ratio (HR)of dementia was 1.85 (95% confidence interval (CI): 1.16 to 2.95) andof AD was 2.18 (1.21 to 3.91). High job demand alone was notsignificantly associated with an elevated dementia risk. Higher riskswere found among persons with a high (high demand together with lowcontrol; HR (dementia) �1.6, 1.0 to 2.7; HR (AD)�1.9, 1.0-3.5) or apassive job strain (low demand together with low control; HR (demen-tia)�1.8, 1.1-3.0; HR (AD)�2.1, 1.1-3.9) in comparison with peoplewith an active job strain (high demand with high control), even aftercontrolling for potential confounders. Vascular factors did not mediatethese associations. Similar associations were found in subjects with orwithout ApoE �4. These associations seem stronger in people with highneuroticism score, but was not modified by support at work, and did notchange when job strain was assessed for the entire working life occu-pations. Conclusions: Work life psychosocial job stress, as indicated bylow job control, high or passive job strain, is associated with increasedrisks of dementia and AD in late life.
T684 Poster Presentations P4:
