Risk factors for cognitive and functional change in one year in patients with Alzheimer's disease dementia from São Paulo, Brazil

Abstract Midlife cerebrovascular risk, low cognitive reserve and APOE4 + haplotypes are risk factors for Alzheimer's disease dementia (AD). We prospectively searched for factors that might be associated with yearly changes in caregiver burden, cognition, basic and instrumental functionality in...

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Bibliographic Details
Published in:	Journal of the neurological sciences 2015-12, Vol.359 (1), p.127-132
Main Authors:	de Oliveira, Fabricio Ferreira, Pivi, Glaucia Akiko Kamikado, Chen, Elizabeth Suchi, Smith, Marilia Cardoso, Bertolucci, Paulo Henrique Ferreira
Format:	Article
Language:	eng
Subjects:	Activities of daily living Activities of Daily Living - psychology Aged Aged, 80 and over Alzheimer disease Alzheimer Disease - complications Alzheimer Disease - genetics Antipsychotic Agents - adverse effects Apolipoproteins E - genetics Body Mass Index Brazil Cognition Cognition Disorders - etiology Cohort Studies Dementia Educational Status Female Genotype Humans Male Motor Activity - physiology Neurology Neuropsychological Tests Outcome Assessment (Health Care) Psychiatric Status Rating Scales Risk Factors
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Summary:	Abstract Midlife cerebrovascular risk, low cognitive reserve and APOE4 + haplotypes are risk factors for Alzheimer's disease dementia (AD). We prospectively searched for factors that might be associated with yearly changes in caregiver burden, cognition, basic and instrumental functionality in 193 consecutive outpatients with late-onset AD, namely gender, APOE haplotypes, schooling, age at AD onset, marital status, depression, cerebrovascular risk factors, serum TSH levels, cognitive and physical activities, and treatment with cholinesterase inhibitors or anti-psychotics, while also investigating associations between APOE haplotypes and patient participation in cognitive or physical activities. Higher education led to greater declines in instrumental functionality, whereas increases in body mass index were associated with rises in basic functionality and cognitive test scores. Established cerebrovascular risk factors had no independent effects over cognitive or functional change, but their combinations led to cognitive improvement, possibly related to enhanced cerebral perfusion in late life. Cholinesterase inhibitors improved caregiver burden. Enhanced instrumental functionality and steeper cognitive decline by the use of anti-psychotics might be attributed to improved behavioural symptoms and neuropsychiatric side effects, respectively. Each copy of APOE -ε4 (β = − 0.102) led to cumulative decreased participation in physical activities (ρ = 0.015). These results might impact public health policies and the interpretation of clinical trials for AD.
ISSN:	0022-510X 1878-5883