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P1‐587: ESTIMATING THE COSTS OF INFORMAL CARE FOR ALZHEIMER'S AND RELATED DEMENTIAS IN THE US
Author(s) -
Allorant Adrien,
Dieleman Joseph L.
Publication year - 2019
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.2019.06.1192
Subject(s) - dementia , activities of daily living , gerontology , medicine , caregiver burden , health care , disease , psychiatry , economics , economic growth , pathology
Background: Visit-to-visit blood pressure variability (BPV) has been associated with lower hippocampal volume, cerebral microbleeds, cortical infarcts and white matter hyper-intensities. Given this relationship to structural brain changes, BPV is a likely mechanism for impaired cognitive function and dementia. However, the few studies examining such associations were mainly conducted in patients at high risk of cardiovascular events, only based on few BPV indicators and reported conflicting results. Methods:We studied 3,319 non-institutionalized older patients participating in the S.AGES cohort. The follow-up period was 3 years with a clinical visit every 6 months. Several indicators were used to investigate BPV: standard deviation (SD), coefficient of variation (CV), variation independent of mean (VIM), residual standard deviation (RSD), average real variability (ARV), successive variation (SV). Systolic (SBPV), diastolic (DBPV) and mean arterial pressure variability (MAPV) were considered. Cognition was assessed using the Mini-Mental State Examination and incident dementia using the Diagnostic and Statistical Manual of Mental Disorders. Linear mixed models and Cox proportional hazards models were used, respectively to assess the impact of BPV on cognitive function over time and incident dementia. Results:Among the 3319 subjects (mean age, 78 years; 57% female; university level, 20%), 93 (2.8%) developed dementia. Higher SBPV was significantly associated with poorer cognitive performances (1-sd increase of CV: b 6 SE 1⁄4 -0.12 6 0.06, p 1⁄4 0.03) after adjustment for demographics, baseline systolic blood pressure, antihypertensive drugs, coronary artery disease, chronic heart failure, atrial fibrillation, stroke, dyslipidemia, smoking. Similar results were observed for DBPV and MAPV (p<0.001). All BPV indicators reported similar trends. After adjustment, higher SBPV was also associated with greater risk of dementia (1-sd increase of CV: HR 1⁄4 1.23, 95% CI [1.011.50], p 1⁄4 0.04). Similar results were observed for DBPV (1-sd increase of CV: HR 1⁄4 1.28, p 1⁄4 0.01) and MAPV (1-sd increase of CV: HR 1⁄4 1.35, p 1⁄4 0<0.01). Conclusions:Higher SBPV, DBPV and MAPV were associated with poorer cognitive performances and increased risk of dementia, independently of baseline blood pressure levels. Controlling blood pressure instability could possibly be a strategy in preserving cognitive function among older adults. P1-586 THE LIFETIME COST OF DEMENTIA IN THE UNITED STATES: RESULTS FROM A DEMENTIA MICROSIMULATION POLICY MODEL