Poster Presentations: Monday, July 17, 2017
CONVERSION FROM MILD COGNITIVE IMPAIRMENT TO DEMENTIA: A BRAZILIAN STUDY
Karolina G. Cesar1, Sonia Maria Dozzi Brucki2, Ricardo Nitrini3, 1University of S~ao Paulo, Sao Paulo, Brazil; 2 Medical School of University of S~ao Paulo, S~ao Paulo, Brazil; 3 University of S~ao Paulo Medical School, S~ao Paulo, Brazil. Contact e-mail: [email protected]
Background: Dementia is one of the major health issues due to the
entire sample was 70.37613.35 years, and included greater proportion of women (71.08%) than men. Mean MMSE scores increased with years of education regardless of age group, but decreased with increasing age, while the 12 years of education group had performed poorest. For the initial unadjusted estimates, Whites had the highest mean MMSE score (AAs¼27.1663.43; Whites¼27.6263.12; Hispanics¼25.4064.72; Asians¼26.8563.01; Others¼26.9862.70), With adjustments for age and education, racerelated differences in MMSE score became attenuated (AAs¼26.2663.13; Whites¼26.1763.32; Hispanics¼24.7364.49; Asians¼25.6162.87; Others¼26.0162.80), except for Hispanics whose MMSE score remained relatively lower. Conclusions: Our data underscores the importance of increased attention to age and education adjusted MMSE norms in AAs. While it is possible that our observations in other racial groups may be influenced by sample size, validation these findings in other cohorts, may improve the efficiency of the tool, and therefore, its clinical and research use in diverse populations.
rapidly growing elderly population. Studies on the evolution of mild cognitive impairment (MCI) or cognitive impairment no dementia (CIND) are scarce in developing countries. The aim of this study was to evaluate the rate of conversion from CIND and MCI to dementia and the predictors of this conversion. Methods: This was an ongoing epidemiological study with the elderly (aged 60 years) living in the municipality of Tremembe, Brazil, where CIND was diagnosed in 135 among 630 individuals assessed [19.5% (95% CI: 16.6 - 22.8)]. Patients with CIND were invited to be reexamined in their homes, approximately 3.5 years after the first assessment. The diagnosis was done through consensus meeting with data of history, educational level, neurological evaluations, scores of neuropsychological tests (Brief Cognitive Screening Battery (BCSB), Mini-Mental State Examination (MMSE), verbal fluency test (semantic and phonemic) and clock drawing test), score of Pfeffer Functional Activities Questionnaire (FAQ) and of Cornell scale for depression, in comparison with the first phase scores. Results: Reevaluation was performed in 75 individuals (20 patients had died, 18 did not accepted a new evaluation, 10 were not reached and 12 only answered to the FAQ by phone). Nineteen individuals converted to dementia (rate of conversion¼ 7.2/year). Complaints of cognitive decline by the individual and/or informant were reported at the prevalence study by 66 individuals (MCI group), whereas in 9 there was no cognitive complaint (CIND group). Among the 66 individuals of the MCI group, 18 converted to dementia (conversion rate ¼ 7.8%/year) whereas 9 (3.9%/year) were normal at reevaluation (p¼0.4). The predictors for conversion to dementia in the MCI group in univariate analysis were higher age (p¼0.015), lower
Poster Presentations: Monday, July 17, 2017
scores in the MMSE (p¼0.036), in delayed recall of BCSB (p¼0.048) and higher scores in the FAQ (p¼0.014). Low education was not predictive of conversion to dementia (p¼0.367). Conclusions: The conversion rate of CIND and MCI to dementia were in lower range when compared to international studies mostly performed in developed countries. Educational level was not a predictor of conversion to dementia. P2-529
MILD COGNITIVE IMPAIRMENT IS, IN CONTRAST TO DEMENTIA, ASSOCIATED WITH AN INCREASED RISK OF CANCER
Kimberly Dieudonnee van der Willik1,2, T. Rikje Ruiter1, M. Kamran Ikram1, Bruno Stricker1, Sanne B. Schagen2, M. Arfan Ikram3, 1Erasmus Medical Center, Rotterdam, Netherlands; 2Netherlands Cancer Institute, Amsterdam, Netherlands; 3Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands. Contact e-mail: [email protected]
erasmusmc.nl Background: Dementia and cancer are major public health concerns. Previous studies showed an inverse relation between dementia and cancer. However, it is uncertain whether this observation is based on biological mechanisms or if it is due to epidemiological limitations. Mild cognitive impairment (MCI) represents the earliest clinical features of dementia. We investigated the relation between MCI and cancer in addition to the association between dementia and cancer to better understand the nature of this finding. Methods: We assessed the relation between incident dementia and cancer in 13,207 participants of the prospective population-based Rotterdam Study. The association between MCI and cancer was studied in 5,181 persons of this cohort. Only solid and hematological cancer types were included. Cox proportional hazard models were used, adjusting for important confounding factors including age, sex, body mass index, education level, smoking status, and alcohol use. In addition, we excluded the first two and five years of follow-up time to limit the effect of reversed causality. Results: In total 1,404 patients were diagnosed with dementia of whom 63 developed cancer. Dementia was associated with a decreased risk of cancer (hazard ratio (HR) 0$53; 95% CI 0$41-0$68). Seventy seven out of 501 persons with MCI were diagnosed with cancer. Persons with MCI had an increased risk of cancer (HR 1$21; 95% CI 0$95-1$53). The risk of cancer was increased after exclusion of the first two and five years of follow-up time (HR 1$28; 95% CI 0$97-1$68 and HR 1$75; 95% CI 1$21-2$53). The risk of cancer in persons with MCI was significantly higher compared to the risk in dementia patients (P <0.001). Conclusions: In this population-based cohort, MCI is associated with an increased risk of cancer. Our results imply that the previous found decreased risk of cancer in patients with dementia is the result of methodological limitations.
DEMENTIA AMONG COMMUNITYDWELLING, OFF-RESERVE INDIGENOUS POPULATIONS IN ONTARIO
Laura A. Warren1, Alexandra Martiniuk2, David Henry1, Amy R. Borenstein3, Nancy Kreiger1, Jennifer Walker4, 1 University of Toronto, Toronto, ON, Canada; 2George Institute, Sydney, Australia; 3University of South Florida, Tampa, FL, USA; 4Centre for Rural and Northern Health Research, Laurentian University, Sudbury, ON, Canada. Contact e-mail: [email protected]
com Background: There is evidence to suggest the burden of dementia may be greater in Indigenous populations than it is in non-Indigenous populations. The objective of this study is to characterize the epidemiology of dementia diagnoses and care in off-reserve, community-dwelling, Ontario Indigenous populations using data from the Canadian Community Health Survey (CCHS) and provincial health insurance claims datasets housed at the Institute of Clinical and Evaluative Sciences (ICES). Methods: We have established a Community Advisory Board (CAB) comprised of five members from a variety of research backgrounds, Indigenous communities and lived experiences to provide leadership, support and direction to all stages of our research. Indigenous and non-Indigenous populations will be identified using the CCHS. We will use a definition of dementia (including Alzheimer’s disease) developed and previously validated by ICES. All analyses will be conducted using SAS 9.3. Differences in prevalence estimates and patterns of care and service usage for Indigenous and non-Indigenous participants will be compared using Chi-square tests for frequencies and t-tests for means. Risk factors for dementia will be identified using PROC GENMOD to build a multivariate logistic model for both Indigenous and non-Indigenous participants. Results: Participant characteristics will be reported as frequencies and proportions for Indigenous and non-Indigenous respondents by sex. Age-specific dementia prevalence estimates will also be reported for each group. Odds ratios will be reported from the final multivariate model for Indigenous and non-Indigenous participants. Differences in frequencies of drug prescirption types (e.g. Donepezil, Galantamine, Memantine, Rivastigmine, Tacrine), hospital admissions, specialist care, home care, and physician visits will be will be identified using Chi-square tests between Indigenous and non-Indigenous participants. Conclusions: This study will be the first of its kind in Ontario. By characterizing the epidemiology of dementia cases and care in community-dwelling, off-reserve, Indigenous populations we hope to identify risk factors, identify patterns of care for dementia health services, and increase awareness of dementia among Indigenous populations in Ontario.