THIRD INTERNATIONAL CONFERENCE ON ALZHEIMER’S DISEASE Sl17

allows to take into account the grouping of the subjects in the parishes and to adjust on individual factors. Age, sex, educational level and occupation were entered as explanatory variables.

Results : Among the 3318 subjects included in the analyses, 785 (24%) presented a cognitive impairment. The median of the

aluminum concentration in drinking water was 5 Kg witha range of 0.5 pg to 1800 pg. The effect of aluminum on the risk of cognitive impairment was not significant.

Conclusion : In the range of our aluminum concentrations, the chronic exposure to aluminum seems to have no effect on the risk of cognitive impairment. The analyses with all the data are in progress.

460 HYPERTENSION AND NEUROPSYCHOMGICAL PERFORMANCE IN THE ELDERLY, J. Kuusisto, K. Koivisto*, L. Mykkdnen, M. Laakso, E-L Helkala*, T. Hlnninen*, K. PyGrtila and P. Riekkinen* . Depts of Medicine and Neurology*, Kuopio University Hospital, Kuopio, Finland. Hypertension is known to be associated with increased risk for vascular dementia. However, population-based studies indicating that cognitive function is disturbed in hypertensive subjects are lacking. Therefore, cognitive function was examined in a random sample of 978 elderly subjects of Kuopio town, eastern Finland. From 772 non-diabetic subjects altogether 396 were hypertensive (systolic blood pressure 160 mmHg or over, diastolic blood pressure 95 mmHg or over, or anti-hypertensive medication) and 376 were normotensive. The following neuropsychological screening tests were used to measure cognitive function: the Mini-Mental State Examination Test(MMSE), Heaton Visual Reproduction Test (HVRT), Trail Making Test (TNT), Buschke Selective Reminding Test (BSR) and Verbal Fluency Test (VFT). The hypertensive group scored more poorly in most screening tests, especially in the Trail Making Test, which evaluates ability to solve problems, and Verbal Fluency Test, which assesses long-time semantic memory. This difference in neuropsychological performance between hypertensive and normotensive groups remained significant even after adjustment for age, sex and education. Within hypertensive group, subjects with high insulin scored more poorly than did non-

fasting

hyperinsulinaemic hypertensive subjects, especially in the Verbal Fluency Test and Trail Making Test. Thus, hypertension is associated with the impairment in problem-solving and verbal functions. Furthermore, hyperinsulinaemia seems to identify a subgroup of hypertensive subjects who have particularly poor performance in neuropsychological screening tests.

461 EPIDEMIOLOGICAL ISSUES IN THE STUDY OF AGE AND MEMORY, F. Cavarzeran and F. Grigoletto, Department of Biostatistics and Epidemiology, Fidia, Abano Terme (PD), Italy

The study design of Progetto Memoria is structured as a cross sectional stratified random sample of normal, healthy adults age 20-79. Data collection has been accomplished through a series of successive steps, from selection of the subjects through the Local Registries of all the residents, to their recruitment with the help of family physicians, until completion of the study measures. Epidemiological methods included the analyses of the reliability of measures, sample size and composition, precision estimates and attrition as well as the use of specific data management and quality control techniques. Representativeness of the sample was obtained by a proportional random sampling that permitted selection of a sample whose age and sex distribution closely resembled that of the general Italian population. Statistical processing

problems encountered during data analyses were approached by statistical models and methods of different complexity, from univariate analysis of variance to multivariate analysis of covariance

462 AGE ASSOCIATED MEMORY IMPAIRMENT: PREVALENCE IN A LIVING AT HOME POPULATION, E. Meini, E. Ferrario, G. Cappa, L. Carat- to, F. Fabris. Institute of Gerontology; University of Turin, c.so Bramante 88, 10126 Torino, Italy. 263 subjects, aged seventy and over, (39 men and 224 women; mean age 71.9 + 2.4), were studied with the Crook and co- workers protocol of clinical and neuropsychological research for the identification of patients affected by AAMI (1). They were all living at home and had no severe sight and/or hearing impairment. All subjects were attending the gymna- stics COurSeS organized by the Turin municipality. 33 (12.5% of the sample) were recognized as affected by AAMI. A rela- tion was found between AAMI and schooling. The entire popu- lation (AAMI end not) will be followed for next five years.

(1) Crook T., Bartus R.T., Ferris S.H., Whitehouse P., Cohen G.D., Gershon S. Age-associated memory impairment. Proposed diagnostic criteria and measures of clinical change: report of a National Institute of Mental Health work group. Dev. Neuropsychol. 1986; 2:261-76.

463 THE SELECTIVE EFFECT OF SURVIVAL UPON COGNITIVE FUNCTION OF INSTITUTIONALIZED VERY OLD MEN. T Perls, WL Ooi, J Morris, L Lipsitz. Hebrew Rehabilitation Center for Aged and Division on Aging, Harvard Medical School, Boston, MA.

Few previous studies of the prevalence of cognitive dysfunction in older persons stratified by gender or examined the oldest old. Since cognitive dysfunction and related disorders (eg. stroke) are associated with increased mortalitv. persons surviving to very advanced age may be a selected cohort who have escaped the development of neurodegenerative disease. Cognitive status was examined as a function of age by analyzing a representative national sample of older men and women in 250 nursing homes (n = 1905). Using a validated cognitive performance score, cognitive function was found to improve cross-sectionally in men Ip< ,051 from age 65-89 to 90-99, but for women there was a trend towards more impaired cognitive function. For those aged 90-99 yrs. men performed better than women 162% vs. 40% ‘good cognition”, respectively, P= .004l. Six month mortality rates for those with “poor cognition” were hiQhar in men than in women, especially for those aQed 80-89 yrs 143% vs. 20%. p< ,051. Thus older, cognitively impaired men may be less likely to survive into advanced age than their female counterparts.

To determine whether the results in a nursing home INH) population were influenced by selection bias, a representative sample of older persons from Massachusetts In = 1910). was also analyzed (6% were in NH and 94% in the community). CoQnitive status was assessed as “impaired’ if subjects had one or more errors on 3 orientation questions and had a problem with decision making. Cognitive function was better for men than for women age 85 and above(p = ,041. For those 90-99 years old, proportionately fewer men were cognitively impaired than women (28.6% vs. 40.4%. p=.O6), as in the NH group. Survivors Iage 85-99. p c .OOl) had bener cognitive function than non- survivors. Mortality in men (age 85-99 Yrsl with “impaired” CoQnition was higher than for similarly aQed and impaired women (48.0% vs 31 .l%, p= .lO).

Ordinal logistic regression was used to determine predictors of cognitive decline over a 6 month period in the NH cohort. For women these predictors were: advanced age and residence in NH for > 60 days; and for men: stroke (p<.O51. Thus, development of stroke in older men may predispose to cognitive dwfunction and premature mortality, thereby selecting for more cognitively intact men among the oldest old.

464 Validation of a questionnaire to detect dementia cases in families Panisset M (1). Feteanu D (2). Berr C (3). (1) INSERM U324, Paris, (2) HBpital Paul Brousse, Villejuif, (3) INSERM Neuroepidemiology, Villejuif, FRANCE

The only way to evaluate the risk of Familial Alzheimer’s Disease (AD) is through information obtained from