Mariateresa Garrì

Prevalence of dementia in the oldest old: The Monzino 80-plus population based study

Epidemiological studies commonly include too few of the oldest old to provide accurate prevalence rates of dementia in older age groups. Estimates of the number of those affected, necessary for healthcare planning, are thus flawed. The objective is to estimate the prevalence of dementia and levels of dementia severity in a very large population of oldest old and to investigate the relation between age and dementia prevalence in the extreme ages.

A Population-based study of dementia in the oldest old: the Monzino 80-plus Study

BackgroundDespite being the fastest growing and the most cognitively impaired age group, the oldest olds are under-represented in clinical research. The purpose of this study was to describe the design, methods, and baseline characteristics of the survey population and investigate possible differences in demographic, cognitive, functional, and behavioral characteristics between oldest old with and without any performance on cognitive tests and between oldest old alive and those deceased prior to the interview.MethodsThe Monzino 80-plus Study is a prospective door-to-door population-based survey among 80 years or older residents in the municipalities in the province of Varese, Italy. Dementia cases were identified with a one-phase design. Trained psychologists interviewed both the subject and a proxy informant. The interview included a comprehensive standardized questionnaire together with an array of rating scales and a multidomain cognitive battery to assess cognitive and functional ability, behavioral disturbances and mood.ResultsInformation was available for 2,139 of the 2,428 registered individuals aged 80 years or older. Main baseline characteristics of the population are reported and discussed. In comparison with those living, elderly persons who had died before the first visit were older, had twice the rate of institutionalization, poorer cognitive performance and competence, and significantly greater instrumental and basic functional disability. The percentage of elderly persons, alive at baseline, without Mini-Mental State Examination rose rather evenly with age. Moreover, they had significantly worse cognitive competence and functional ability, and reported higher prevalences of depressive symptoms and problem behaviors than those with Mini-Mental State Examination.ConclusionsProspective investigation of a large population of oldest old can contribute significantly to understanding the relations between age, cognitive decline, and dementia occurrence. Use of informant-based instruments in surveys in the oldest old is crucial in assessing everyday functioning and changes, especially in participants with no cognitive test performance available. Failure to include information on deceased elderly would underestimate, increasingly with age, the prevalence of cognitive and functional disability in the elderly population.

HEADACHES AND DEMENTIA IN THE OLDEST-OLD: THE MONZINO 80-PLUS POPULATION-BASED STUDY

Background:We aimed to describe the multiplicity of chronic diseases in Alzheimer disease (AD) in a nested case-control study. Methods: We used a random sample of 1 million individuals from the year 2000 registration data in Taiwan National Health Insurance program to describe the comorbid pattern among patients with dementia during 2001-2011. Incident dementia was identified by International Classification of Diseases, Ninth Revision, first ever coded after 2001. Incident AD was further restricted to those treated with cholinesterase inhibitors or memantine of approved reimbursement. We selected 14 comorbid medical diseases with reference to the list of multiple chronic conditions developed by the US Department of Health and Human Services. Incident dementia and AD cases were ageand sex-matched to a set of control subjects (1: 2 ratio). We described the frequency and pattern of comorbidity in AD and validated in a smaller sample from a regional hospital by in-person interview and medical records review. We employed conditional logistic regression to estimate the associations between chronic diseases and AD. Results:A total of 16,381 incident dementia cases were identified during 2001-2011 with mean age at 76.1 years (SD1⁄410.5) and female preponderance (52%). About 8% of these dementia cases were deemed AD with approved AD drug reimbursement. The most common 5 comorbidities in AD were hypertension (54%), osteoarthritis (38%), depression (32%), diabetes mellitus (27%) and cerebrovascular diseases (24%); and they were also more often associated with AD cases than their matched controls after adjusting for age and sex (respective odds ratios: 1.36, 1.44, 3.23, 1.51, 2.26, p < 0.001). The number of comorbidity was 3-fold greater (p < 0.001) in the AD group (median: 3; range: 0-8) than the control group (median: 1; range: 0-10). Conclusions:Multimorbidity in AD is very common. Cerebrovascular risks are associated with AD even among those relatively “pure” cases deemed eligible for AD drug reimbursement, supporting that the co-existence is a typical feature of AD at old age and integrated medical care is much needed.

History of labial herpes and dementia among the oldest-old: The monzino 80-plus study

Background:Labial herpes is an infection caused by the herpes simplex virus type 1 (HSV1). Once infected, this virus can reside in latent form lifelong in the peripheral nervous system. Since the viral DNA has been found in a high proportion of elderly brains, it has been suggested that HSV1 enters the brain in older age as a consequence of the weakening of the immune system with age. Evidence has been reported linking HSV1 to Alzheimer’s disease. Objective of the present study was to investigate the association of history of labial herpes with dementia among the oldest old in a populationbased study of 80-years and older residents in Varese province, Italy (Monzino 80-plus Study). Methods: At first visit, subjects and/or carers, mainly a family member, were interviewed using a standardized questionnaire to assess the presence of a history of labial herpes infection / cold sores. Diagnosis of dementia was made according to DSM-IV criteria. Results:Data on history of herpes labialis was available for 2,105 subjects (72.4% women). Mean age of the population was 90.2 years (SD 6.1). A positive history of labial herpes was reported by 566 oldest old (26.9%). Frequency of herpes labialis infection was lower among subjects with dementia at first visit (17.8%) than among those without (32.2%): OR: 0.46, 95% CI: 0.37-0.57, p < 0.0001 (univariate logistic model). This difference remained significant when corrected for age, sex, and education (p < 0.0001) and also when the multivariable model was further adjusted for other clinical conditions (diabetes, hypertension, heart failure, atrial fibrillation, myocardial infarction, stroke, and chronic obstructive pulmonary disease): adjusted OR: 0.60, 95% CI: 0.46-0.76, p < 0.0001. Conclusions: In the present population-based study, in the very old a history of herpes labialis infection was associated with a lower risk of dementia at initial visit.

Head trauma and risk of dementia in the oldest-old: The Monzino 80-plus study

Background: The risks, prevention and epidemiology of Alzheimer’s disease continue to remain uncertain despite extensive research. A few modifiable risk and preventive factors, such as low education, obesity, smoking, physical inactivity, and certain hormone therapies, have been reported from epidemiological studies. However, many studies have been limited by methodological quality and relatively small sample sizes, typically involving up to a few hundred Alzheimer’s disease cases and a few thousand participants. Studies from large-scale population-based cohorts with extensive exposure assessment and sufficiently long followup are critically needed. We describe the California Teachers Study cohort, established in 1995 primarily for breast cancer research, as a developing resource for large-scale etiologic Alzheimer’s disease research. Methods: The California Teachers Study consists of 133,479 women who have provided extensive exposure data over their life course including most putative risk factors for Alzheimer’s disease. Four waves of questionnaires have been sent since 1995. In the year 2000, we included neuropsychological test items that focused on visuospatial and language function. Results: Active and retired California public school professionals provided information on environmental and lifestyle factors that may be important for Alzheimer’s disease risk, including obesity, physical and social activity, medical history, medications, hormone use, diet, and demographic factors. In 2000-2001, w78,000 participants completeda clock drawing, cube drawing, and picture description task. Of these, w35,000 were 70 years or older in 2010. Assessment of Alzheimer’s disease in the cohort can be done by database linkage to California statewide hos pitalization data, which includes diagnoses after hospitalization, emergency department visits, and outpatient surgery. Conclusions:Large cohorts are needed in order to pursue risk and prevention research in Alzheimer’s disease, as recommended by the 2010 NIH State-ofthe-Science expert consensus conference. The California Teachers Study provides extensive high quality information on mostpotential environmental and lifestyle risk and protective factors, and represents a robust cohort for epidemiologic research, as a resource to conduct timely analyses using accrued cases, and for prospective outcomes research in Alzheimer’s disease.

APOE genotype and the risk of dementia in the oldest-old: The Monzino 80-plus study

Background: The risks, prevention and epidemiology of Alzheimer’s disease continue to remain uncertain despite extensive research. A few modifiable risk and preventive factors, such as low education, obesity, smoking, physical inactivity, and certain hormone therapies, have been reported from epidemiological studies. However, many studies have been limited by methodological quality and relatively small sample sizes, typically involving up to a few hundred Alzheimer’s disease cases and a few thousand participants. Studies from large-scale population-based cohorts with extensive exposure assessment and sufficiently long followup are critically needed. We describe the California Teachers Study cohort, established in 1995 primarily for breast cancer research, as a developing resource for large-scale etiologic Alzheimer’s disease research. Methods: The California Teachers Study consists of 133,479 women who have provided extensive exposure data over their life course including most putative risk factors for Alzheimer’s disease. Four waves of questionnaires have been sent since 1995. In the year 2000, we included neuropsychological test items that focused on visuospatial and language function. Results: Active and retired California public school professionals provided information on environmental and lifestyle factors that may be important for Alzheimer’s disease risk, including obesity, physical and social activity, medical history, medications, hormone use, diet, and demographic factors. In 2000-2001, w78,000 participants completeda clock drawing, cube drawing, and picture description task. Of these, w35,000 were 70 years or older in 2010. Assessment of Alzheimer’s disease in the cohort can be done by database linkage to California statewide hos pitalization data, which includes diagnoses after hospitalization, emergency department visits, and outpatient surgery. Conclusions:Large cohorts are needed in order to pursue risk and prevention research in Alzheimer’s disease, as recommended by the 2010 NIH State-ofthe-Science expert consensus conference. The California Teachers Study provides extensive high quality information on mostpotential environmental and lifestyle risk and protective factors, and represents a robust cohort for epidemiologic research, as a resource to conduct timely analyses using accrued cases, and for prospective outcomes research in Alzheimer’s disease.

Does dementia affect the economic status of the oldest old? Results from the Monzino 80-plus Study

ures in the SNAC-K population of the same age group were 15.1%, 9.8%, and 17.3%. The overall mortality rates (per 100 person-years) of patients with dementia were 26.2% (95% CI 23.0-29.4) in the KP population, and 21.3% (95% CI 18.5-24.1) in the SNAC-K population (P>0.05). Conclusions: There is no convincing evidence suggesting that the prevalence and case-fatality rates of dementia have been changed over the 15-year period in central Stockholm, Sweden. This implies that on an average the incidence of dementia is relatively stable.

Walking in late middle age and prevalence of dementia in centenarians in the monzino 80-plus study

the 3MS (adjusted odds ratio (AOR) 1⁄4 2.37, 95% confidence interval (CI) 1.16, 4.87). This association remained significant after further adjustment for degree of hypoxia (defined as the % of sleep time with SpO2 < 90%). Women with greater night time wakefulness had more than twice the odds of impaired verbal fluency (vegetable naming) (AOR 1⁄4 2.17, 95% CI 1.10, 4.28). There was a trend toward an association between elevated night time wakefulness and brief delayed recall (verbal memory) (AOR 1⁄4 1.83, 95% CI 0.94, 3.54). We observed no association between total sleep time and cognitive outcomes after accounting for greater night time wakefulness and potential confounders. Conclusions: Among very old women, sleep fragmentation, as manifested by greater night time wakefulness, is independently associated with impaired performance on tests of general cognitive function and verbal fluency, after accounting for sleep duration. Exploratory analyses suggest that the association between fragmented sleep and general cognitive function is independent of hypoxemia.

Hypertension, antihypertensive treatments and dementia in the oldest old: The Monzino 80-plus Study

Background: Inconsistent results have been reported on the increased risk of dementia associated with hypertension and on the possible protective effect of antihypertensive treatments against dementia. Studies in the oldestold, the age segment of the population the most affected by dementing disorders, are scant. Objective: To cross-sectionally and longitudinally investigate the association of hypertension and antihypertensive treatment with prevalence and incidence of dementia in a population-based study of all 80 years or older residents in eight municipalities of Varese province, Italy (Monzino 80-plus Study).Methods: Information on history of hypertension and current antihypertensive treatment, for whatever indication, was obtainedwith a standardized questionnaire from both the subject and a primary informant, usually a family member. Diagnosis of dementia was based on DSM-IV criteria. Results: At first visit, hypertension was present in 56.6% of the initial population (n 1⁄4 1,842; women: 74.5%; mean age 88.46 4.7 years; mean education: 5.16 2.5 years). Prevalence of dementia was not significantly different between individuals with (32.4%) and without (35.2%) hypertension (p 1⁄4 0.2075), or between individuals taking (32.1%) and not taking (36.1%) an antihypertensive treatment (p 1⁄4 0.0776). Non-demented subjects at first visit with at least one follow-up available were 1,004. Percentage of individuals who developed dementia in the following 5.5 years was not significantly different between individuals with (47.2%) and without (47.7%) hypertension (p 1⁄4 0.6425), or between individuals taking (43.7%) and not taking (54.4%) an antihypertensive drug (p 1⁄4 0.1596). Exploring the effect of different antihypertensive subclasses, angiotensin II antagonists (p 1⁄4 0.0466) and beta-blockers (p 1⁄4 0.0038) were significantly associated with a lower incidence of dementia. After adjustment for age, sex, education, BMI, diabetes, stroke, number of drugs taken, and depression, the association remained significant only for beta-blockers (HR: 0.47, 95%CI: 0.21-0.92, p 1⁄4 0.0256). Conclusions: The present population-based study showed no significant relationship between hypertension or current antihypertensive drug use and the risk of developing dementia in the oldest-old. The differential effect of the various antihypertensive subclasses on dementia incidence suggest a possible mechanism of action other than blood pressure lowering for some of them. Further studies should explore the possible benefit associated with the use of beta-blockers or angiotensin II antagonists in the very old. P2-145 RISK FACTORS FOR SEVERE DEMENTIA FROM A POPULATION-BASED SAMPLE OF INCIDENT ALZHEIMER’S DISEASE: THE CACHE COUNTY DEMENTIA PROGRESSION STUDY. Peter Rabins, Sarah Schwartz, JoAnn Tschanz, Chris Corcoran, Betty Black, Elizabeth Fauth, Michelle Mielke, Constantine Lyketsos, 1 Johns Hopkins University, Baltimore, Maryland, United States; 2 Utah State University, Logan, Utah, United States; Johns Hopkins Medicine, Baltimore, Maryland, United States.

Friendship and incidence of dementia: The monzino 80-plus study

(70.6%) were women. MMSE scores were moderately and significantly correlated with transferrin saturation (r 1⁄4 0.32, p < 0.001). Transferrin saturation was significantly lower in the patients with dementia (25.7 (12.8-44.3) vs. 29.1 (3.7-49.8); p 1⁄4 0.040). ROC analysis revealed that the cut off 19.19 for transferrin saturation has an effect on dementia (sensitivity 40.7%, specificity 84.5%). Conclusions: The results of this study revealed that iron status may be related to cognitive dysfunction and dementia before reaching the severity to cause anemia. Different cut off values of transferrin saturation, varying from 15 to 18, have been given in the literature for iron deficiency. This study shows that 19.19 can be an appropriate cut off value.