George Razay

A community-based exercise programme to improve functional ability in people with Alzheimer's disease: A randomized controlled trial

RATIONALE Dementia is a common neurodegenerative condition in older age associated with functional decline across multiple domains. This decline impacts not only on the person with dementia, but also on their informal carers and health and aged care systems. With the number of people with dementia rapidly increasing and few effective treatments, there is now a critical need for interventions to improve functional ability in those with the condition. AIMS AND OBJECTIVE This study assesses the effectiveness of a community-based home exercise programme in improving cognitive and physical function and independence in activities of daily living (ADL) in people with Alzheimers disease, the most common form of dementia. METHODS In a 4-month randomized controlled trial, 40 community-dwelling patients diagnosed with Alzheimers disease and their informal carers were randomly allocated to either the treatment (exercise plus usual treatment) or control (usual treatment) group. The exercise programme consisted of daily exercises and walking under the supervision of their carer. Patients were assessed at baseline and 4-months follow-up by a blinded assessor on primary outcome measures of cognitive and physical function and ADL using standardized assessment scales. RESULTS Sixteen men and 24 women diagnosed with Alzheimers disease participated in the study. They had a mean age of 74.1 years (range 51-89) and a mean Mini Mental State Examination score of 22.0 (range 10-28), indicating mild to moderate dementia. At 4-months follow-up, patients who exercised, compared with controls, had improved cognition (increased Mini Mental State Examination scores by 2.6 points, p < 0.001), better mobility (2.9 seconds faster on Timed Up and Go, p = 0.004) and increased Instrumental Activities of Daily Living scores by 1.6 (p = 0.007). CONCLUSION This study suggests that participation in a community-based exercise programme can improve cognitive and physical function and independence in ADL in people with Alzheimers disease.

Obesity, abdominal obesity and Alzheimer disease.

Background/Aims: Obesity has a strong association with vascular and metabolic diseases, which have been linked with Alzheimer disease (AD). While recent studies have reported an association between mid-life obesity and dementia, the role of later-life obesity is less clear. This study investigated the relation between AD, obesity and abdominal obesity at later-life in a case-control study. Methods: Participants were 50 consecutive patients with probable AD from memory disorders clinics in Launceston, Australia, and Bristol, England, and 75 cognitively normal controls. Height and weight [from which body mass index (BMI) was calculated] and hip and waist circumferences (from which waist-hip ratio was calculated) were measured. Participants were classified according to their BMI as: underweight (BMI <20.0 kg/m2); normal weight (BMI 20.0–24.9 kg/m2); overweight (BMI 25–29.9 kg/m2), or obese (BMI ≧30 kg/m2). They were classified as abdominally obese if their waist-hip ratio was >0.9 (men) or >0.8 (women). Results: AD was associated with obesity [OR 9.5, 95% CI 2.4–37.3, p = 0.001], underweight (OR 5.4, CI 0.9–33.7, p = 0.07) and abdominal obesity (OR 2.5, CI 1.1–5.7, p = 0.027) using logistic regression analyses adjusted for age, sex and location. The inclusion of metabolic risk factors in the model increased the ORs for obesity (OR 12.6, CI 2.8–56.5, p = 0.001) and underweight (OR 7.9, CI 1.0–66.3, p = 0.056). Conclusion: AD may be associated with obesity, underweight and abdominal obesity at later life. Larger prospective studies are required to investigate this further.

Blood Pressure, Dementia and Alzheimer’s Disease: The OPTIMA Longitudinal Study

Background/Aims: Studies on the relation between blood pressure (BP), dementia and Alzheimer’s disease (AD) have yielded inconsistent results, showing an association with high or low BP, or no association with BP. The study was designed to look at the longitudinal effect of BP on cognitive function. Methods: Participants were part of the OPTIMA longitudinal study of patients with dementia and agematched cognitively healthy controls. The Cambridge Cognitive Examination (CAMCOG) and BP were measured. We tested the dependence of CAMCOG scores on BP using generalised linear mixed models. Results: A total of 235 were cognitively healthy controls, 42 had mild cognitive impairment (MCI), 141 had AD, and 59 had other dementia syndrome (ODS). In AD patients, the rate of decline of CAMCOG scores showed an inverted U-shaped (non-linear) dependence on diastolic BP. High (110 mm Hg) and low (60 mm Hg) levels of diastolic BP were related to faster cognitive decline over 5 years of follow-up (z = –2.51, p = 0.012). CAMCOG scores also showed an inverted U-shaped dependence on pulse pressure (z = –2.29, p = 0.022). Conclusion: High and low BP levels are related to faster cognitive decline in AD patients. This could have implications for the prevention and treatment of AD.

P4-048: Pulse pressure, dementia and Alzheimer's disease: The Oxford Project to Investigate Memory and Ageing (OPTIMA) Longitudinal Study

went telephonic cognitive assessment by the Modified Telephone Interview for Cognitive Status. Subjects identified as possibly demented were interviewed face-to-face. Tendency for rumination in familial and work setting ranged between “1” always forget, “2” tend to forget, “3‘tend to ruminate, “4” usually ruminate. Results: Of 1,892 subject assessed for dementia (mean age 82 at assessment), 309 were diagnosed as demented, 175 as suffering from cognitive impairment not sufficient for the diagnosis of dementia and 1,408 had no cognitive impairment. The prevalence rates of dementia (and odds ratios relative to those with least tendency for rumination, adjusted for age, area of birth, and socioeconomic status) were 21% for group “1‘, with the lowest rumination score, 18%, 14% and 14% for groups “2‘, “3” and “4” in groups of rumination in familial settings respectively and 24%, 19%, 15% and 15% for groups “1” through “4” respectively of tendency for rumination in work settings. In both settings, estimated OR for dementia decreased by 0.19 0.20 for each rise in rumination score. Conclusions: Examining psychologicalcognitive style when confronting distress might shed light into personality characteristics that increase the risk for dementia. Mechanisms underlying these associations remain elusive.

P4-097: Previous and concurrent blood pressure and cognitive function in dementia and Alzheimer's disease: The Oxford Project to Investigate Memory and Ageing (OPTIMA) Longitudinal Study

George Razay, Jonathon Williams, Elizabeth King, A. David Smith, Gordon Wilcock, Dept of Medicine, Launceston General Hospital, University of Tasmania, Launceston, Australia; OPTIMA, Radcliffe Infirmary, Oxford, United Kingdom; Dept of Physiology, Anatomy & Genetics, University of Oxford, Oxford, United Kingdom; Nuffield Dept of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom. Contact e-mail: george.razay@dhhs.tas.gov.au

P4-134: Ventriculo-peritoneal shunting for normal pressure hydrocephalus: A prospective study

uation of memory, attention, language, praxias, orientation and executive function; neuropsychiatric exam; functional evaluation using Pfeffer’s scale of daily living activities and neuroimaging evaluation (cranial computerized tomography CT and/or magnetic resonance imaging MRI). Conclusions: All of the patients presented with cognitive and behavioral alterations, but in different degrees, dependent upon the following variables: intensity of the structural abnormalities in neuroimage exams; latency until the beginning of specific treatment with aciclovir, and others. Memory deficit pattern found in herpetic encephalitis resembles that observed in Korsakoff syndrome and in Alzheimer’s disease. Behavioral symptoms were compatible with Kluver-Bucy syndrome and resembled that observed in frontotemporal dementia. Neuroimaging exams showed asymmetric mesial temporal pathology in most of the cases with extension to the orbitofrontal areas in some cases.