Jianzhao Shen

Cholesterol, APOE genotype, and Alzheimer disease: An epidemiologic study of Nigerian Yoruba

Objective: To examine the relationship between cholesterol and other lipids, APOE genotype, and risk of Alzheimer disease (AD) in a population-based study of elderly Yoruba living in Ibadan, Nigeria. Methods: Blood samples and clinical data were collected from Yoruba study participants aged 70 years and older (N = 1,075) as part of the Indianapolis-Ibadan Dementia Project, a longitudinal epidemiologic study of AD. Cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglyceride levels were measured in fasting blood samples. DNA was extracted and APOE was genotyped. Diagnoses of AD were made by consensus using National Institute of Neurologic Disorders/Stroke-Alzheimers Disease and Related Disorders Association criteria. Results: Logistic regression models showed interaction after adjusting for age and gender between APOE-ε4 genotype and biomarkers in the risk of AD cholesterol*genotype (p = 0.022), LDL*genotype (p= 0.018), and triglyceride*genotype (p = 0.036). Increasing levels of cholesterol and LDL were associated with increased risk of AD in individuals without the APOE-ε4 allele, but not in those with APOE-ε4. There was no significant association between levels of triglycerides and AD risk in those without APOE-ε4. Conclusions: There was a significant interaction between cholesterol, APOE-ε4, and the risk of Alzheimer disease (AD) in the Yoruba, a population that has lower cholesterol levels and lower incidence rates of AD compared to African Americans. APOE status needs to be considered when assessing the relationship between lipid levels and AD risk in population studies.

Outcomes of newly referred neurology outpatients with depression and pain

Background: Although depression and pain are common in neurology outpatients, patient factors influencing chronicity are poorly understood. The authors sought to determine the predictors of persistent depression and pain symptoms at 3 and 12 months after an initial outpatient neurology clinic visit. Methods: Consecutive new patients (n = 483) at three clinics completed the Patient Health Questionnaire nine-item depression scale and the Brief Pain Inventory at baseline and at 3- and 12-month follow-up. Multivariate analysis was used to model 3- and 12-month depression and pain severity. Results: The prevalence of depression and pain at baseline/3/12 months was depression 33%/28%/27% and pain 66%/61%/62%. Independent predictors of depression severity at follow-up were more severe depression and pain at baseline and less improvement in pain (model r2 = 0.53 to 0.56). Independent predictors of pain intensity at follow-up were more severe pain and depression at baseline and less improvement in depression (model r2 = 0.44 to 0.46). Health care utilization and impairments in health status were greatest in patients with coexisting depression and pain and least in those with neither depression nor pain. Conclusions: Depression and pain symptoms in neurology outpatients often persist for at least 12 months and have long-term negative effects on patients’ health status. Pain is more likely to persist in patients with depression, and depression is more likely to persist in those with coexistent pain.

Prevalence rates for dementia and Alzheimer's disease in African Americans: 1992 versus 2001.

This study compares age‐specific and overall prevalence rates for dementia and Alzheimers disease (AD) in two nonoverlapping, population‐based cohorts of elderly African Americans in Indianapolis in 2001 and 1992.

Selenium level is associated with apoE ε4 in rural elderly Chinese

OBJECTIVE Se is an essential trace element in human nutrition associated with antioxidant activity. Previous studies on predictors of toenail Se or serum Se have mostly concentrated on demographic factors such as age and gender. The present paper examines the association between apoE genotype and Se levels in nail samples in a rural elderly Chinese cohort. DESIGN Two thousand Chinese aged 65 years and over from four counties in China were enrolled in a cohort to study the association of Se with cognitive decline. Nail samples were collected from each participant and analysed for Se levels. Dietary Se intake was estimated from an FFQ using Se contents measured in food items collected from each village. Blood samples on filter cards were collected and analysed for apoE genotype. Mixed-effect models were constructed with nail Se level as the dependent variable and each village as the random effect, which controlled for the potential confounding effect from correlation in Se measures obtained from participants residing in the same village. RESULTS In this elderly Chinese cohort, carriers of the apoE epsilon4 allele had significantly lower Se levels measured in nail samples than non-carriers after adjusting for other significant covariates and controlling for estimated dietary Se intake. There was no significant difference between the two genotypes on estimated Se dietary intake (P = 0.6451). CONCLUSIONS Future studies are needed to examine the mechanism underlying the association between the apoE epsilon4 allele and Se levels, including the role of oxidative stress and that of reduced lipid metabolism in the apoE epsilon4 carriers.

O4-05-06: Prevalence rates for demenita and Alzheimer's disease in elderly African Americans in Indianapolis: 1992 vs 2001

Latino 1.3; 95% CI 0.9-1.7). Conclusions: African American adults aged 65 and above were more likely to experience cognitive decline compared to White older adults after accounting for demographics, socioeconomics, comorbidity, and their baseline cognitive function. There was no difference between Latino older adults and Whites in rates of cognitive decline. Future research to identify ways to reduce cognitive decline, particularly for racially-diverse groups, are needed.

P4-385: Statin use protects against cognitive decline in African-American elderly

treatment and reasons for discontinuation in 125 patients (66 females) who were treated in our outpatient clinic between 2000 2004. From among 66 patients who had started treatment on donepezil, 30 discontinued (45%), 21due to apparent lack of efficacy, two due to side effects and seven due to other reasons. The mean duration of treatment was 35.7 20.3 months, median 34. The results of MMSE examinations at onset of the treatment were mean 20 4.3, median 22, and at discontinuation 13 4.9, median 11. 59 patients were started on rivastigmine, of whom 33 discontinued (56%), 14 due to apparent lack of efficacy, 11 due to side effects and eight due to other reasons. The mean duration of treatment was 27.7 18.8 months, median 26. The results of MMSE examination at onset of the treatment were mean 21 3.5, median 23, and at discontinuation 17 4.7, median 16. A two-tailed T-test for differences of duration of treatment between the 2 groups favored donepezil (p 0.041). Conclusions: Patients seem to be maintained longer on donepezil than on rivastigmine. Apparent lack of efficacy was the main reason for discontinuation of both. The efficacy of both treatments seems similar.

P3-124: Selenium and cognitive function in rural elderly Chinese

derly subjects, 906 households were eligible and 682 subjects participated. Subjective memory complaints were assessed by subjective memory complaint questionnaire (SMCQ), which consists of 14 items reflecting general memory function and everyday memory function. Variables associated with SMC including cognitive function, depressive symptoms, hearing impairment and daytime sleepiness were evaluated by trained research nurses using Geriatric Health Assessment Package (GHAP). Bivariate associations between SMCQ and clinical variables were investigated using simple linear regression analysis. To determine which variables were independently associated with SMCQ and its two subscales, stepwise multiple linear regression analysis was performed for each scale. Results: The following were associated with SMC in simple linear regression analysis: cognitive function, depressive symptoms, visual and hearing impairment, excessive daytime sleepiness, activities of daily living function, history of urinary incontinence, fall and pain (p 0.05). In stepwise multiple linear regression analysis, excessive daytime sleepiness and hearing impairment were independently and consistently associated with SMC after controlling for objective cognitive function and depressive function. Moreover, these noncognitive variables were stronger predictors of SMC than objective cognitive function. Conclusions: Among elderly subjects in the general population, noncognitive variables including daytime sleepiness and hearing impairment were associated with SMC independent of depression and objective cognitive function. Moreover, association of SMC with daytime sleepiness and hearing impairment was stronger than that of cognitive function. Our results suggested that SMC are not a simple reflection of objective cognitive function. Thus, clinicians should carefully evaluate the multiple noncognitive domains when elderly subjects report memory complaints.