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P4‐157: NEURAL CORRELATES OF EARLY LIFE STRESS IN A POPULATION AT HIGHER RISK FOR DEMENTIA: A PILOT STUDY IN OLDER ABORIGINAL AUSTRALIANS
Author(s) -
Radford Kylie,
Perdereau Jade,
Delbaere Kim,
Draper Brian,
Piguet Olivier,
Rae Caroline,
Lavrencic Louise,
Broe G A Tony
Publication year - 2018
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.2018.06.2562
Subject(s) - ctq tree , confounding , amygdala , hippocampus , context (archaeology) , dementia , medicine , hippocampal formation , psychology , poison control , biology , injury prevention , disease , paleontology , environmental health , domestic violence
Background: Illiteracy, midlife cerebrovascular risk and copies of APOE-ε4 are risk factors for Alzheimer’s dementia (AD). This study aimed to explore the impacts of risk factors for progression of AD in S~ao Paulo, Brazil. Methods:Outpatients with late-onset AD were assessed for APOE haplotypes (rs7412&rs429358 genotyped by TaqMan Real-Time PCR technology) and the following potential baseline predictors: gender, schooling, age at dementia onset, lifetime urban living and sanitary conditions, occupational complexity, cognitive and physical activities, cerebrovascular risk factors (obesity, lifetime alcohol use and smoking, length of arterial hypertension, diabetes mellitus and a dyslipidemic profile), pacemaker use, creatinine clearance, body mass index, waist circumference, head traumas with unconsciousness, treated systemic bacterial infections, amount of surgical procedures under general anesthesia and family history of AD. Participants were followed from October/2010 to May/2017 for time since dementia onset to reach Clinical Dementia Rating (CDR) >1.0, and Mini-Mental State Examination (MMSE) scores 20&15. Significant independent variables were included in multiple regressions. Results:Of 227 patients (154 women, 119 APOE-ε4 carriers), 173 reached CDR>1.0 in 3.8862.6 years, 202 reached MMSE1⁄420 in 3.2262.6 years, and 132 reachedMMSE1⁄415 in 4.6362.9 years. AD onset at 73.6066.4 years-old (earlier for APOE-ε4/ε4 carriers, p<0.001) was the only variable associated with all endpoints in multiple correlations: for each year later dementia onset, CDR>1.0 was reached 0.122 year earlier (p<0.001), MMSE1⁄420 0.094 year earlier (p1⁄40.001), and MMSE1⁄415 0.107 year earlier (p1⁄40.005). Lifetime physical inactivity was associated with MMSE1⁄420 reached 0.763 year earlier (p1⁄40.042), whereas MMSE1⁄415 was reached 1.851 year later for patients with obesity (p1⁄40.012), and 1.200 year later for patients with family history of AD (p1⁄40.019). For APOE-ε4 carriers, schooling significantly delayed cognitive decline, whereas lifetime sanitary conditions and waist circumference trended towards later cognitive decline. For APOE-ε4 non-carriers, length of arterial hypertension trended towards earlier cognitive and functional decline. Conclusions: Patients with later AD onset had faster cognitive and functional decline. Obesity and family history of AD delayed cognitive decline, while physical inactivity accelerated early cognitive decline, and schooling delayed cognitive decline only for APOE-ε4 carriers. These outcomes represent interactions between effects of brain reserve and cerebral perfusion over neurodegeneration. (FAPESP grant #2015/10109-5.)