JC2011-08 Vascular Risk Factors Promote MCI to Alzheimer Dz - Dr Wang

Vascular Risk Factors Promote Conversion from Mild Cognitive Impairment to Alzheimer disease: 

Vascular Risk Factors Promote Conversion from Mild Cognitive Impairment to Alzheimer disease Jackson Wang, PGY-3

Clinical Vignette : 

Clinical Vignette A 75 y.o woman with PMH HTN, DM presents to your K6 clinic with increasing forgetfulness for the past few months. She has been noticing difficulty remembering certain important appointments and dates. She had difficulty recalling what she had for dinner last night and also recent scores of her favorite baseball game. Patient lives independently and is able to perform all her IADL and ADL. On exam, she scored normal on GDS, no neurological deficit except some decreased proprioception in the lower extremities. She did well on MMSE except for short term recall. What is your diagnosis?

MCI vs. Dementia : 

MCI vs. Dementia Similarities and Differences? Age Usually affects population 65 years or older Functional status and executive function Course of progression around 10% per year 8 th leading cause of death in US ( cannot be prevented? ) Financial burden

QUOTE: 

QUOTE “Only effective treatment -- or prevention -- can reduce health care costs by preventing millions of boomers from living an average of 10 years with dementia and tripling costs from up to $200 billion to as much as $600 billion a year.” Dr. George Bartzokis is a professor of psychiatry at the UCLA Semel Institute for Neuroscience and Human Behavior and a member of the UCLA Brain Research Institute and the UCLA Laboratory of Neuro Imaging

Goals for the Study : 

Goals for the Study Primary Endpoint Investigate the effect of VRF and their treatment on the conversion of MCI to AD

Methods and Design : 

Methods and Design Observation study conducted between Jan 2004 to Dec 2009 involving 10 local communities within the city of Chongqing, China Inclusion/exclusion criteria

Slide 8: 

26841 eligible 18683 screened 837 with MCI enrolled 638 completed, 352 in MCI vs. 268 in AD 3496 N/A, 4302 declined 17846 excluded NOVRF VRF NO TX FEW TX ALL TX

Slide 10: 

MMSE/AD= I + (B)VRF(T)+ C

Function of Time x VRF: 

Function of Time x VRF MMSE TIME VRF NO VRF

Discussion: 

Discussion P rimary endpoint reached VRF associated with increased risk of incident for AD Treatment group showed reduced risk Mechanisms Unclear Possible CV related? Metabolism of B-amyloid ?

Uncertainties : 

Uncertainties Confounders? Age and Time Power of the study Treatment targets? Severity of VRF? Long term f/u ? Unexplained pathophysiology (increase in VRF increased risk of MCI, therefore affecting AD, or MCI ->AD or perhaps lower the threshold)?

Questions for the Audience : 

Questions for the Audience What are some possible confounders in this observational study? Assuming these results are valid, what do you interpret them to mean, and will that change the way you practice?

THANK YOU : 

THANK YOU Special thanks to Dr. Acharya, Dr. Desai, and Dr. Nelson, Ingeborg and Hong.