European Geriatric Medicine - Supplement 1 - Volume 7 - October 2016

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O-039
Blood pressure circadian rhythm and prognosis of older subjects
with cognitive impairment
N. Nesti 1, C. Lorenzi1, E. Mossello1, E. Giuliani 1, M. Bulgaresi1, V. Caleri 2,
M. Pieraccioli 1, E. Tonon2, M.C. Cavallini1, D. Simoni1, C. Baroncini1,
M. Di Bari 1, C.A. Biagini2, N. Marchionni1, A. Ungar1. 1Research Unit of
Medicine of Ageing, Department of Experimental and Clinical Medicine,
University of Florence and Azienda Ospedaliero Universitaria Careggi,
Florence; 2Division of Geriatric Medicine, Azienda Unità Sanitaria Locale
3, Pistoia, Italy
Introduction: The loss of physiological blood pressure (BP) drop
during nighttime (BP dipping) is associated with cardiovascular
mortality. Few data exists about prognostic meaning of BP dipping in
cognitively impaired older subjects. Aim of this study is to evaluate the
prognostic effect of BP values and dipping pattern in older subjects
with dementia or Mild Cognitive Impairment (MCI) referred to two
memory clinics.
Methods: All subjects underwent ambulatory blood pressure mon-
itoring (ABPM).
According to the rate of decline of systolic BP during nighttime
compared with daytime, circadian rhythm was defined as dipping (D,
− 10% or less), non dipping (ND, between − 9% and 0), or reverse
dipping (RD, >0).
Results: We included 185 patients (mean age 79, mean MMSE score
22,7, 72% with high BP). After a median follow-up time of 3 years,
survival was significantly shorter in subjects with RD (n = 49) in
comparisonwith ND (n = 79) (p = 0.002) and D (n = 57) (p = 0.021). The
association between RD and mortality risk increased with decreasing
levels of daytime systolic BP. In a multivariable Cox regression model,
mortality risk was independently associated both with daytime
SBP>144 mmHg (OR 3.04; 95%CI 1.26, 7.36) and with RD (=R 3.11;
95%CI 1.33, 7.28). Among 124 survivors, MMSE score change did not
differ significantly according to dipping status.
Key conclusions: In cognitively impaired older subjects high BP and
inversion of physiological nighttime dipping were both associated
with mortality risk. The prognostic effect of RD was stronger in those
with lower daytime BP. These results might partly be explained by
autonomic failure.
O-040
Comparison of cognitive functioning in spousal dementia
caregivers with two demographically matched control groups:
results from the DeStress study
M. O’Sullivan, M.M. Pertl, S. Brennan, I.H. Robertson, B.A. Lawlor.
Neuro-Enhancement for Independent Lives (NEIL), Trinity College
Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
Objectives: Recent population studies indicate that informal caregiv-
ing is associated with better health and cognition, supporting the
healthy caregiver hypothesis. However, caring for a spouse with
dementia is recognised as a chronic stressor, which may negatively
impact cognition. Evidence supporting the stress-cognition link in
caregivers includes self-selecting reference groups, which may
outperform groups selected by other methods.
Methods: We compared cognitive function in 253 spousal dementia
caregivers with two demographically matched non-caregiving control
groups drawn from (1) a recent Irish population study and (2) a self-
selecting sample. Comparable cognitive measures in all groups
included global cognitive functioning, processing speed, reaction
time and verbal fluency. Analysis of covariance was employed to
control for demographics, medications and dementia risk factors such
as obesity, smoking and physical inactivity.
Results: Caregivers outperformed control groups on processing speed
(p < .001 and .02 respectively) and reaction time (p < .001 and .04);
these differences were present despite more prevalent depressive
symptoms, stress, hypertension, and emotional problems in caregivers
(all p ’s < .001). However, caregivers performed more poorly on verbal
fluency compared with the population control group (p < 0.01). When
depression was entered as a covariate in the analyses only the
association with verbal fluency was no longer significant.
Conclusion: Our results support the healthy caregiver hypothesis for
domain specific cognitive outcomes. However, spousal dementia
caregivers display a decrement in executive function associated with
greater depression.
O-041
Increased mortality and hospital readmission risk in patients with
dementia and a history of cardiovascular disease: results from a
nationwide registry linkage study
I.E. van de Vorst, I. Vaartjes, M.L. Bots, H.L. Koek. University Medical
Center, Utrecht
Introduction: To evaluate the impact of cardiovascular disease (CVD)
on mortality and risk of hospital readmission in patients with
dementia.
Methods: A prospective hospital-based cohort of 59,194 patients
with dementia (admitted to a hospital or visiting a dayclinic) was
constructed from 2000 through 2010. Patients (38.7% men, mean age
81.4 years (SD 7.0)), were divided in those with and those without a
history of CVD (total CVD; coronary heart disease (CHD), heart failure
(HF), stroke, atrial fibrillation (AF) or other CVD). Absolute mortality
risks (ARs) were investigated and median survival times were
calculated using Kaplan-Meier curves. Hazard ratios (HRs) for
mortality and readmission (adjusted for age, sex, comorbidity) were
investigated using Cox analyses.
Results: Three-year ARs were higher (45.1% versus 36.8%) and median
survival times were shorter (40.5 months, 95%CI 39.0–42.0 versus 50.0
months, 95%CI 48.7–51.3, p < 0.001) among patients visiting a day-
clinic with a history of CVD than in those without. Differences were
less pronounced for inpatients. Among dayclinic patients, a history of
CVD (HR for total CVD 1.25, 95%CI 1.19– 1.32, HF 1.97, 95%CI 1.63–2.39,
stroke 1.39, 95%CI 1.16–1.66, AF 1.19, 95%CI 1.02–1.39, and other CVD
1.14, 95%CI 1.04–1.25) increased three-year mortality risk. There were
no differences in mortality for inpatients with/without a history of
CVD. Risk for readmission was further increased in the presence of
CVD in both patients groups.
Conclusion: Mortality and readmission risks are significantly higher
in hospitalized dementia patients with a history of CVD than in those
without. This was most pronounced in dayclinic patients.
O-042
Delirium as a non-traumatic brain injury: older patients with
delirium have similar biomarker profiles to patients with isolated
traumatic brain injury
T.A. Jackson1, B. Shears1, J.M. Lord1, A. Belli1, J. Hazeldine1. 1Institute of
Inflammation and Ageing, University of Birmingham, UK
Introduction: Delirium is an acute, severe neuropsychiatric syndrome
associated with poor outcomes. Delirium is associated with a central
inflammatory response, usually due to a precipitating peripheral
inflammatory insult. However the pathophysiology remains poorly
understood. Traumatic brain injury (TBI) is also common, associated
with poor outcome. It mirrors delirium as it is associated with a
peripheral inflammatory response secondary to a precipitating central
inflammatory insult. As such investigating peripheral serum biomar-
kers of neuronal injury in both conditions may provide insights into
their pathophysiology.
Methods: Peripheral serum biomarkers of neuronal injury (S100β,
neurone specific enolase [NSE], eotaxin and glial fibrillary acidic
protein [GFAP]) were analysed by ELISA and multiplex. These were
then compared in patients with delirium and isolated TBI, and healthy
controls. Relationships between these biomarkers with delirium
outcome and motoric subtype were also explored.
Results: Delirium (n = 62, age = 85.6 ± 0.8 yrs) and TBI (n = 8, age =
37.1 ± 3.41 yrs) were associated with significantly higher serum S100β,
NSE and GFAP compared with controls (all p < 0.05). There was no
Oral presentations / European Geriatric Medicine 7S1 (2016) S1–S27 S12