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[P1–486]: OCCURRENCE AND PROFILE OF COGNITIVE IMPAIRMENT IN PATIENTS WITH HEART FAILURE, CAROTID OCCLUSIVE DISEASE AND VASCULAR COGNITIVE IMPAIRMENT: THE HEART‐BRAIN CONNECTION STUDY
Author(s) -
Hooghiemstra Astrid M.,
Leeuwis Annebet E.,
Bertens Anne Suzanne,
Biessels Geert Jan,
Bots Michiel,
BrunnerLa Rocca HansPeter H.P.,
Greving Jacoba,
Kappelle Jaap,
Oostenbrugge Robert J.,
Rossum Albert,
Flier Wiesje M.
Publication year - 2017
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.2017.06.502
Subject(s) - stroop effect , dementia , cognition , audiology , memory span , cognitive impairment , medicine , verbal fluency test , cardiology , psychology , disease , neuropsychology , psychiatry , working memory
Background:As focus increases on the early treatment of patients with preclinicalAD, there is a need tounderstandhowearlymeasuresof disease progression may predict long-term patient outcomes. One measure proposed for the early detection of decline is the ADCS-PACC. We sought to evaluate the correlation between early measurements of ADCS-PACC and long-term cognition in subjects with normal cognition, but evidence of elevated amyloid. Methods:We simulated the progression of 5000 patients (mean age 1⁄4 75; 49% male) with normal cognition (mean MMSE 1⁄4 29.1; CDR 1⁄4 0) but evidence of amyloid pathology (CSF ab42< 192 pg/ml) over their remaining lifetimes using the AD Archimedes Condition-Event (ACE) simulator. The ADACE incorporates a system of disease progression equations which predict temporal evolution using data from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) and literature. The ADCSPACC was computed following Donohue et al. (JAMA Neurol, 2014) for ADNI data. Mortality was dependent on patient age, sex, and disease stage, based on published risk equations. The prognostic value of ADCS-PACC was assessed using the linear correlation between early ADCS-PACC scores and later MMSE scores. Results: The majority of patients (75%) in the simulations survived for 5 years, with a small fraction (16%) surviving 15 years. ADCS-PACC at year 1 had limited prognostic value for long-term cognition, with an r-squared ranging from 0.08 (for MMSE at 5 years) to 0.05 (for MMSE at 15 years). As patients progressed, ADCS-PACC becamemore predictive. At 2 years (mean MMSE 1⁄4 27.9, 90% survival), the r-squared values rose to 0.40 and 0.29 for MMSE at 5 years and 15 years respectively. The prognostic value ofADCS-PACC continued to improve reaching 0.56 when predicting 15 year MMSE, for ADCS-PACC at 5 years, respectively. Though MMSE is a component of ADCS-PACC, it was not the primary driver of the prognostic value of ADCS-PACC, as MMSEhas lowsensitivity in cognitivelynormal subjects. For example, MMSE at 2 years had modest correlation with MMSE at 15 years (rsquared 1⁄4 0.13). Conclusions:ADCS-PACC showed good prognostic value for long-term changes in cognition when measured during earliest stages in amyloid positive patients.