Association Between Late-Life Hypertension and Resilience to Alzheimer Dementia Among Older Adults

While midlife hypertension is known as one contributing factor for cognitive impairment and Alzheimer dementia in late-life older adults, less is known about the role of late-life hypertension in resilience to Alzheimer dementia. We examined the relationship between late-life hypertension and Alzheimer dementia resilience among older adults using the National Alzheimer’s Coordinating Center data from 2005-2020 (n=3,170). Hypertension, captured within 5 years prior to death, was defined as blood pressure (BP) ≥ 140/90 mmHg in at least two visits and/or ever treated with anti-hypertensive agents. Resilience was defined as positive Alzheimer disease (AD) pathology (CERAD score moderate or severe and BRAAK stage V or VI) from autopsy and Clinical Dementia Rating (CDR) - Sum of Boxes (SOB): 0.5-2.5 or CDR global (0-0.5) from last data point before autopsy. Student’s t-tests and Chi-square tests were conducted to compare patients with and without resilience. A multivariate logistic regression was conducted to estimate the association between late-life hypertension and resilience, adjusting for covariates of demographics and neuropathological characteristics. We had 55 resilient cases among 1,195 positive AD pathology cases. Those resilient were older (88±6.7) and had higher systolic BP (136 ± 18.2 mmHg) than non-resilient (82±7.9 years old, 130±20 mmHg. Untreated hypertension had a protective effect on resilience (adjusted OR: 3.69 (1.10-13.5, p=0.05). Patients with a systolic BP in the range of 135-145 mmHg and a diastolic BP in the range of 65-75 mmHg had the highest resilience possibility. Unlike midlife hypertension, late-life hypertension may have different effect on dementia, prompting further studies.

Late Onset Alzheimer Dementia in Patient with Genotype E3/E4: A Case Report

ackground: Alzheimer's dementia (AD) is a neurodegenerative disorder and there is progressive cognitive impairment, functional deficits and behavioral changes. This neurodegenerative disease process is classically characterized by two pathological features: amyloid- β plaque deposition and neurofibrillary tangle of tau hyperphosphorylation. The most established genetic risk factor for late-onset Alzheimer Disease is the APOE gene allele 4. We will report a case of late-onset Alzheimer's Dementia with genotype E3/E4. Case: A 70-years-old woman patient, complained by her family that she often forgets. The Mini Mental State Examination showed disturbances in orientation, attention, calculation and recall. Non-contrast Brain Magnetic resonance imaging examination revealed decrease in hippocampal volume. Patient also performed a molecular examination of the Apolipoprotein E (APOE) genotype and the genotype E3/E4 was detected Conclusion: The APOE E4 gene has a major role in the occurrence of Late-Onset Alzheimer's Dementia. Keywords: Alzheimer Dementia, Apolipoprotein E.

Abstract 1122‐000036: Demographic and Pharmacological Characteristics of Alzheimer Dementia Patients with Mild Cognitive Impairment stratified by Gender

Introduction : The role that specific clinical factors play in contributing to gender differences in Alzheimer’s patients with mild cognitive impairment (MCI) is not yet fully understood. In this study, we tested the hypothesis that pharmacological, demographic, and risk factors may contribute to gender difference in Alzheimer’s patients with MCI. Methods : Methods Data collected for 5 years was analyzed using a retrospective data analytical approach on 33,064 Alzheimer patients, including 13,569 men and 19,495 women that presented with MCI. Receiver operating characteristic (ROC) curve analysis and multivariate regression models were used to identify specific factors that contribute to gender differences in MCI patients. Results : Results Our records indicate that women that presented with MCI were more likely to be taking Buspirone (OR = 0.767, 95% CI, 0.683‐0.861, P<0.001) while men within this population were more likely to be taking Galantamine (OR = 0.559, 95% CI, 0.382‐0.818, P<0.001). ETOH use was associated with MCI in both men (OR = 0.696, 95% CI, 0.638‐0.760, P<0.001) and women with Alzheimer’s Dementia (OR = 0.484, 95% CI, 0.442‐0.529, P<0.001). Conclusions : Conclusion Our findings reveal gender differences in men and women that presented with MCI. Management strategies should consider identified factors to provide better care for Alzheimer patients with MCI.

Abstract 1122‐000029: Pharmacological and Clinical Factors Associated with Gender Difference in Alzheimer Dementia Patients

Introduction : Alzheimer dementia (AD) has been reported in both men and women. However, factors contributing to gender differences are not fully understood. We tested the hypothesis that specific pharmacological, demographic, and risk factors contribute to gender difference in AD. Methods : A retrospective analytical approach was used to analyze data from 12,632 AD patients, comprising 4,584 men and 8,048 women. Univariate and multivariate analyses determined the factors contributing to the gender difference in AD patients. Results : About 36% of AD patients were men, and 64% were women. Citalopram (OR = 1.187, 95% CI, 1.044 – 1.350, P = 0.009) was associated with men, while escitalopram (OR = 1.213, 95% CI, 1.119 – 1.315, P<0.001) was associated with women. In both men and women, increasing age (OR = 1.075, 95% CI, 1.071 – 1.079, P<0.001/OR = 1.096, 95% CI, 1.093 – 1.100, P<0.001), tobacco use (OR = 1.150, 95% CI, 1.054 – 1.254, P = 0.002/OR = 1.150, 95% CI, 1.073 – 1.233, P<0.001), and black patients (OR = 2.380, 95% CI, 2.120 – 2.674, P<0.001/OR = 1.395, 95% CI, 1.268 – 1.535, P<0.001) were associated with AD. Conclusions : Our findings reveal similarities and differences in factors associated with both men and women AD patients, suggesting the development of management strategies for the care of AD.

P.016 Hypertensive disorders in pregnancy are associated with future development of vascular dementia: A systematic review and meta-analysis

Background: We aimed to evaluate the association between hypertensive disorders in pregnancy (HDP) and future risk of cognitive impairment and dementia. Methods: Systematic searches were performed in MEDLINE and EMBASE up to April 27th, 2020. Exposure of interest included the different types of HDP. Outcomes of interest included dementia incidence, dementia subtype, and cognitive testing. Results: On qualitative review, 4/9 studies showed impaired memory, visual motor processing speed, executive function, and verbal testing in previously preeclamptic women. 2/4 studies showed impaired visual motor processing and subjective cognitive complaints in previously eclamptic women. Six cohort studies involving >2.6 million women were included in the meta-analysis. Pooled hazard ratios (aHR) with 95% confidence intervals were generally adjusted for age at delivery ethnicity, and vascular risk factors. Women with a history of gestational hypertension were more likely to develop vascular dementia (aHR 2.02 [1.45-2.83],I2:0%), but not Alzheimer disease (1.24 [0.93-1.66],single-study). Women with a history of preeclampsia were also more likely to develop vascular dementia (2.17 [1.20-3.91],I2:61.1%), but not Alzheimer dementia (1.19 [0.83-1.69],I2:69.9%). Conclusions: Whereas studies of neuropsychological testing in previously preeclamptic and eclamptic women have been heterogeneous, a history of HDP is associated with developing vascular dementia in later life.