Table 3

Model results for progression to dementia in individuals with MCI at first

evaluation (n ¼ 1,476)

Rate Ratio 95% CI P

Depression 1.07 0.82 1.39 0.631

Antidepressants

SSRI 1.02 0.76 1.37 0.902

Non-selective/Other 1.29 0.92 1.80 0.137

>Race (White vs. Non-White) 1.65 1.20 2.29 0.002

Education (> H.Sch vs. < H.Sch) 1.94 1.27 2.97 0.002

Cognitive Tests

Clinical Dementia Rating 1.32 1.20 1.45 <.001

Boston Naming Test 0.97 0.95 1.00 0.018

Logical Memory 0.90 0.87 0.92 <.001

FAQ 1.24 0.99 1.55 0.066

Category Fluency 0.97 0.96 0.99 0.002

Trail Making Test - Part B 1.00 1.00 1.00 0.010

*214 individuals missing covariates: race (3), education (7), boston (50),

logical memory (66), FAQ (37), category fluency (45), trail B (113)

Poster Presentations P2S354

P2-138 COGNITIVE IMPAIRMENTANDMRI FINDINGS IN

COMMUNITY DWELLING CHINESE

Saima Hilal1, Mohammad Kamran Ikram2, YanHong Dong3, Eric Ting3,

Carol Cheung2, Anqi Qiu5, Tien Yin Wong2, Christopher Chen4,

Narayanaswamy Ramani3, 1National University Hospital, Singapore,

Singapore; 2Singapore Eye Research Institute, National University of

Singapore, Singapore, Singapore; 3National University Health System,

Singapore, Singapore; 4National University of Singapore, Singapore,

Singapore.

Background: Age-related abnormalities on magnetic resonance imag-

ing(MRI) are associatedwith cognitive impairment(CI).However, there is lim-

ited data on these associations from community-based studies in Chinese. In

this pilot study, we examined the association between the severity of CI and

MRI findings amongChinese participants in the Singapore Chinese Eye Study

(SCES).Methods:This study is part of the on-going SCES. In Phase I, all par-

ticipants aged above 60 years undergo cognitive screening using the Abbrevi-

atedMental Test (AMT) and a self-report of Progressive Forgetfulness (PFQ).

Those who fail either screen are invited to a phase II evaluation comprising

clinical, neuropsychological and laboratory testing, and brain MRI. Cognitive

function is categorised into: no cognitive impairment (NCI), cognitive impair-

ment no dementia (CIND) -mild (1-2 cognitive domains impaired), CIND-

moderate(> 2 cognitive domains impaired) and dementia, based on previously

validated criteria. On MRI, we graded the presence of stroke, lacunes, global

atrophy(GA), white matter lesions (WML) and intracranial arterial stenosi-

s(IAS) on MR Angiogram (MRA). Age- and gender-adjusted ANCOVA

models were used to assess differences between the three groups. Results:

As of 28 January 2011, 1139 participants had completed phase I. 463 failed

screening and 37 participants (age range: 62-84 years) have so far completed

phase II. Of the 20 men and 17 women,11 had NCI, 12 had CIND-mild, 11

CIND-moderate and 3 were demented. On MRI, 17 had stroke, 13 lacunes,

30 WML, 27 GA and 8 IAS. None of those with NCI had either stroke or la-

cunes and with increasing severity of CI, participants were more likely to have

abnormalities on MRI. The severity of CI was related to stroke (test-for-trend

p¼ 0.007) and lacunes (p¼ 0.025) but notwithGA(p¼ 0.5),WML(p¼ 0.12)

or IAS(p ¼ 0.77). Conclusions: In this pilot study, we find that among Chi-

nese, increased severity of cognitive impairment is associated with an in-

creased prevalence of cerebrovascular disease.

P2-139 SERUM HOMOCYSTEINE,

HOLOTRANSCOBALAMIN, FOLATE AND

COGNITION INTHEELDERLY:ALONGITUDINAL

POPULATION-BASED STUDY

Babak Hooshmand1, Ingemar Kareholt1, Alina Solomon1,

Minna Rusanen2, Jaana Leiviska3, Bengt Winblad4, Hilkka Soininen2,

Miia Kivipelto1, 1Karolinska Institutet, Stockholm, Sweden; 2University of

Eastern Finland, Kuopio, Finland; 3National Institut of Health and Welfare,

Helsinki, Finland; 4Karolinska Institutet, Huddinge, Stockholm, Sweden.

Background: The association of serum total homocysteine (tHcy), vitamin

B12, and folate with cognition in the elderly is currently controversial.

Holo-transcobalamin (holoTC) represents the biologically active fraction

of vitamin B12, but prospective studies on the impact of holoTC on cogni-

tion are limited. Aims: To investigate the relationships between serum tHcy,

holoTC, folate and cognitive function in several domains seven years later in

a longitudinal population-based study.Methods: Serum tHcy, holoTC, and

folate were measured in a dementia-free subsample of the population-based

Cardiovascular Risk Factors, Aging and Dementia (CAIDE) study in 1998.

Subjects were re-investigated 7-years later and cognitive performances were

assessed both at baseline and follow-up for global cognition, episodic mem-

ory, executive functions, semantic memory, and psychomotor speed. Anal-

yses were first restricted to 254 participants whowere non-demented in 2005

and then including subjects who developed dementia at follow-up. Multiple

linear regression analyses were used to investigate the associations of base-

line serum tHcy, holoTC, and folate concentrations with cognition.Results:

After controlling for age, sex, education, blood pressure, APOE4 allele,

stroke, smoking, body mass index, and baseline related cognitive domain;

high baseline tHcy was associated with lower scores on episodic memory,

executive functions, and semantic memory 7 years later. Increased holoTC

was related to better performance in psychomotor speed and executive func-

tions, and elevated folate concentrations were associated with higher scores

in global cognition and semantic memory. In analyses including subjects

who developed dementia at follow-up (n ¼ 20), high tHcy was additionally

associated with global cognition while holoTC was further associated with

global cognition and semantic memory.Conclusions: tHcy, holoTC, and fo-

late may be related to cognitive performance even in non-demented elderly.

The affected cognitive domains seem to suggest underlying vascular related

mechanisms as well as Alzheimer’s disease related mechanisms.

P2-140 TESTING THE FIRST-ORDER MARKOV

ASSUMPTION IN HOMOGENEOUS MARKOV

MODELING OF TRANSITION PROBABILITIES

BETWEEN COGNITIVE STATES

Thomas Koepsell1, Sarah Monsell1, 1National Alzheimer’s Coordinating

Center, Seattle, Washington, United States.

Background: Markov modeling is increasingly being used to estimate the

probability that an individual in a given cognitive state will transition to an-

other cognitive state over a certain time period. These analyses usually rely

on a first-order Markov assumption: namely, that transition probabilities are

independent of the patient’s past history, although they may depend on the

individual’s current attributes. We tested this assumption as it relates to tran-

sitions from normal cognition to mild cognitive impairment (MCI).

Methods: We studied 2,009 individuals age 65+ years who had made at

least three consecutive annual visits to an Alzheimer’s Disease Center

(ADC) in the U.S. since 2005. All underwent structured evaluations using

the Uniform Data Set each time. The three visits were termed the “previ-

ous”, “current”, and “next” visits. All individuals had normal or near-normal

cognition (not meeting criteria for MCI) on the current visit. Of these, 1,817

also had normal or near-normal cognition on the previous visit, while 192

had MCI on the previous visit. We used logistic regression to determine

whether these two groups had different probabilities of transitioning to

MCI on the next visit, before and after controlling for patient covariates

(age, gender, race, education, MMSE score, ApoE e4 genotype, and

ADC). Results: Overall, patients with MCI on the previous visit were

much more likely to transition from their current normal or near-normal

cognitive state to MCI on the next visit, compared to patients with normal

or near-normal cognition on the previous visit (OR ¼ 7.7, 95% CI ¼ 5.2 -

11.5). After controlling for all seven covariates, the association with past

MCI remained strong (OR ¼ 5.6, 95% CI ¼ 3.5 - 8.9). Conclusions: The

first-order Markov assumption failed badly in this large national cohort. Pa-

tients with a past history of MCI who subsequently reverted to normal or

near-normal cognition had a much greater chance of re-transitioning to