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O3‐03‐01: Predicting Alzheimer's Disease
Author(s) -
Petersen Ronald C.,
Knopman David S.,
Boeve Bradley F.,
Geda Yonas E.,
Cha Ruth,
Roberts Rosebud,
Pankratz Ver S.,
Jack Clifford R.
Publication year - 2009
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2009.05.439
Subject(s) - dementia , hazard ratio , confidence interval , proportional hazards model , medicine , alzheimer's disease , disease , cutoff , psychology , quantum mechanics , physics
were analyzed for folate and carotenoids. The association between nutritional factors and non-dementia was analyzed by logistic regression and adjusted for age, education and apoE4. Results: The risk of ASYMAD was higher among subjects with elevated folate (odds ratio 1⁄4 1.15/unit of folate, lower CL 1⁄4 1.025) and beta-carotene (odds ratio 1⁄4 1.05/unit of beta-carotene, lower CL 1⁄4 1.001) levels than in subjects who suffered from dementia. The mean concentration of folate and beta-carotene was 16.4 and 23.6 in non-demented subjects, and 12.6 and 19.1, respectively in demented subjects. Conclusion: Blood concentrations of the nutritional factors, folate and beta-carotene, were associated with non-dementia in the presence of AD pathology. Folate has several functions which may influence the clinical expression of AD. Also, folate and beta-carotene concentrations may be biomarkers for the intake of diets that are high in leafy green vegetables, and which may contribute several nutritional factors with beneficial effects in the maintenance of neural tissues. Background: Neuropsychiatric symptoms are common in Mild Cognitive Impairment (MCI). The study objectives were to 1) evaluate whether patients with MCI plus a diagnosis of Depression or Apathy had a higher risk of progressing to Alzheimer’s Disease (AD) than patients with only MCI, and 2) investigate whether neuropsychiatric symptoms in MCI predict impending AD. Methods: We followed 126 patients with amnestic and multidomain MCI consecutively admitted to the Laboratory of Neuropsychiatry, Foundation Santa Lucia in Rome, Italy. Follow-up examinations were conducted after six months after baseline, and annually for four years. At baseline, the mean age was 70.6 (SD 1⁄4 6.5) years, and 58.7% were men (n 1⁄4 34). Psychiatrists diagnosed psychiatric disorders according to the diagnostic criteria for Depression and Apathy in AD. Neuropsychiatric symptoms were assessed with the Neuropsychiatric Inventory (NPI). AD at follow-up was diagnosed according to NINCDS-ADRDA criteria. Cox proportional hazard models with 95% confidence intervals were used to assess whether the presence of a psychiatric disorder or NPI symptoms at baseline increased the risk of developing AD over four years. Results: 15 patients (16.9%) had a diagnosis of Depression at baseline, and 15 (16.9%) had Apathy. Patients with both MCI and Apathy had a fourfold risk of progressing to AD compared to patients with only MCI (HR 1⁄4 3.9; 1.2-12.7), after adjustment for age, sex, education, and baseline MMSE. There was no increased risk of AD in MCI patients with Depression (HR1⁄4 0.7; 0.2-2.1). The presence of NPI apathy symptoms were also predictive of progression to AD (HR1⁄4 3.7;1.2-11.4). There was an increased risk of developing AD in MCI patients exhibiting symptoms of disinhibition (HR 1⁄4 3.7; 1.1-12.3), aberrant motor behaviour (HR 1⁄4 3.8; 1.3-11.2), and appetite disturbances (HR1⁄4 3.6; 1.1-11.5). However, these symptoms were highly associated with Apathy, and the risks were no longer significant after adjustment for Apathy. No other NPI symptoms showed significant predictive validity for identify patients who progressed to AD. Conclusions: Apathy but not Depression at baseline can predict which patients with MCI will progress to AD. These results suggest that Apathy in MCI is a cognitive and psychiatric disturbance related to ongoing AD neurodegeneration.