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S20
Oral presentations / European Geriatric Medicine 6S1 (2015) S5
–
S31
Cognition and dementia
O-052
Brain amyloid deposition is associated with lower instrumental
activities of daily living performance in older adults. Results
from the MAPT study
M. Lilamand
1
, M. Cesari
2
, N. Del Campo
3
, C. Cantet
3
, M. Soto
3
,
P. Payoux
4
, P.-J. Ousset
5
, S. Andrieu
6
, B. Vellas
3
1
Bichat University Hospital, Paris, France;
2
Centre Hospitalier
Universitaire de Toulouse, Toulouse, France;
3
G´erontopole de Toulouse,
Toulouse, France;
4
Nuclear Medicine Department, Toulouse, France;
5
France;
6
Inserm 1027, Toulouse, France
Background:
Brain amyloid deposition is one of the key
pathological hallmarks underlying the cognitive changes associated
with Alzheimer’s disease (AD). Growing interest has been given to
the earliest clinical manifestations of amyloid plaques. However,
the relationship between amyloid status and activities of everyday
function remains largely unknown. In the present study, we
examined the relationship between instrumental activities of daily
living performance (using the ADL-PI score) and amyloid status in
older adults.
Methods:
Cross-sectional analyses of data from the Multidomain
Alzheimer Preventive Trial (MAPT). Volunteers underwent a
brain 18F-AV45 Positron Emission Tomography (PET) examination.
Bivariate analysis and regression models were conducted to study
the relationships between brain amyloid deposition and the total
ADL-PI score.
Results:
We included 271 participants (women=60%; age=76
±
4
years). Amyloid PET was positive (Standard Uptake Value ≥1.17)
for 103 participants (38%). The ADL-PI score was lower in amyloid
positive subjects than in their amyloid negative counterparts
(38.8 vs. 40.3, p = 0.007). This association was also confirmed in
regression models adjusted for age, gender and familial history of
AD (Odds Ratio=0.94; 95% Confidence Interval 0.89–0.99; p = 0.02).
This finding was consistent in cognitively normal individuals and in
those with mild cognitive impairment, using the clinical dementia
rating scale.
Conclusions:
This study highlighted an association between early
functional limitations and brain amyloid deposition in elderly
subjects. These symptoms could be the clinical manifestations of
amyloid plaques even in the absence of overt dementia. Further
prospective studies are warranted for examining the evolution of
ADL-PI score over the course of AD.
O-053
Role of anti-dementia drugs and multidimensional impairment
on mortality rates in frail multimorbid older patients with
dementia: results from the European MPI_AGE project
A. Pilotto
1
, R. Arboretti Giancristofaro
2
, F. Panza
3
, J. Daragjati
4
,
C. Prete
5
, M.C. Polidori
6
, A. Cella
5
, S. Maggi
7
1
Department of OrthoGeriatrics, Rehabilitation and Stabilization,
Frailty Clinic. Ospedali Galliera, Genoa, Italy;
2
Department of Technical
and Management Industrial Systems, University of Padua, Padua,
Italy;
3
Neurodegenerative Disease Unit, University of Bari, Bari, Italy;
4
Geriatrics Unit S. Antonio Hospital, Azienda ULSS 16, Padua, Italy;
5
Galliera Hospital, Genoa, Italy;
6
University of Cologne, Cologne,
Germany;
7
Italy
Background:
The role of anti-dementia drugs and multi-
dimensional impairment on mortality rates in frail multimorbid
older patients with dementia is still under debate.
Aim:
To evaluate whether anti-dementia treatments, i.e.
anticholinesterase and memantine, in older patients with dementia
is differentially effective across strata of mortality risk assessed by
the Multidimensional Prognostic Index (MPI).
Materials and Methods:
In this cohort study, 6712 community-
dwelling subjects aged 65 years and older with dementia were
assessed for mortality risk using the MPI, a validated predictive
tool for mortality calculated on information on age, sex, morbidity,
cognitive status, disability in ADL and Barthel mobility, risk of
pressure sores and social support. Participants were classified as
having MPI-1 mild, MPI-2 moderate and MPI-3 severe risk of
mortality and were followed up to nine years. Treated and untreated
cohorts were also matched by age, sex, co-morbidity, drug use and
all MPI domains.
Results:
During the follow-up period a significant difference in
mortality rates (p
<
0.0001, Log-rank test) among the three MPI
groups, MPI-1=43.7% (1812/4139 subjects), MPI-2=80.0% (1450/2193
subjects), MPI-3=85.2% (324/380 subjects). Multivariable analyses
adjusted for age, sex, co-morbidity, drug use and all MPI domains
demonstrated that higher mortality rates were associated with
lower rates of anti-dementia treatments (HR 2.65, 95% CI 2.27–3.09)
and higher multidimensional impairment (MPI-1 grade = reference;
MPI-2 HR 2.26, 95% CI 2.16–2.43; MPI-3 HR 5.37, 95% CI 4.76–6.06).
Conclusion:
The use of anti-dementia drugs and the
multidimensional impairment are significantly associated with
higher mortality in older community-dwellers subjects with
dementia.
O-054
Methodological factors in determining rates of dementia and
cognitive impairment in TIA and stroke: Applicability of short
cognitive tests
S. Pendlebury
1
, S. Klaus
2
, Z. Mehta
1
, P. Rothwell
1
1
Stroke Prevention Research Unit, Nuffield Department of Clinical
Neurosciences, Oxford, Oxford, United Kingdom;
2
Ireland
Objectives:
Cognitive assessment is recommended after stroke but
there are few data on the applicability of short cognitive tests to
the full spectrum of patients. We therefore determined rates and
causes of untestability in a population-based study of all TIA and
stroke.
Methods:
Patients with TIA or stroke prospectively recruited
(2002–2007) into the Oxford Vascular Study had
>
1 of mini-mental-
state examination (MMSE), telephone interview of cognitive status
(TICSM), Montreal cognitive assessment (MOCA), and abbreviated
mental test score (AMTS) with follow-up to 5-years.
Results:
Among 1097 consecutive assessed survivors (mean age/sd
74.8/12.1 years, 378 TIA), numbers testable with a short cognitive
test at baseline, 1, 6, 12 and 60 months were 819/1097 (75%),
760/947 (80%), 671/825 (81%), 612/762 (80%) and 381/544 (70%).
Untestability was associated with older age, greater severity of
index event and premorbid dependency. Over 90% (343/378) of TIA
patients were testable at baseline compared to only 41% (120/290)
of major stroke. Untestability was commonly caused by dysphasia
(18%) and being too unwell (13%) at baseline whereas moving out of
study area was common after 5 years (26%). Testing difficulties (eg
dysphasia, poor vision) in otherwise testable patients were more
prevalent at baseline (120/819; 15%) than thereafter: 57/760 (8%),
16/671 (2%), 7/612 (
<
1%) and 12/381 (3%) at 1, 6, 12 and 60 months.
Conclusions:
Requiring completion of a cognitive test excludes
those most at risk of cognitive impairment after TIA and stroke.
Future studies should report data on untestable patients and on
those with testing difficulties.