FROM THE ALZHEIMER'S ASSOCIATION INTERNATIONAL CONFERENCE 2022

Also, ICU Stay May Double Risk of Dementia in Older Adults 

New insights into factors that may predict, increase or protect against the 
impact of COVID-19 and the pandemic on memory and thinking skills were revealed 
by multiple studies reported today at the Alzheimer's Association International 
Conference (R) (AAIC(R)) 2022  ( 
https://c212.net/c/link/?t=0&l=en&o=3608523-1&h=1561803295&u=https%3A%2F%2Fwww.alz.org%2Faaic&a=Alzheimer%27s+Association+International+Conference 
) in San Diego and virtually.

Logo - https://mma.prnewswire.com/media/1869584/AAIC22_purple_font_rgb_Logo.jpg 

Among the key findings reported at AAIC 2022:

    -- A group from Argentina found that persistent loss of the sense of smell 
       may be a better predictor of long-term cognitive and functional 
       impairment than severity of the initial COVID-19 disease.

    -- Hospitalization in the intensive care unit was associated with double 
       the risk of dementia in older adults, according to a study by Rush 
       Alzheimer's Disease Center in Chicago.

    -- During the pandemic, female gender, not working and lower socioeconomic 
       status were associated with more cognitive symptoms in a large study 
       population drawn from nine Latin American countries.

    -- In that same Latin American population, experiencing a positive life 
       change during the pandemic (such as more quality time with friends and 
       family or spending more time in nature) reduced the negative impact of 
       the pandemic on memory and thinking skills.

"COVID-19 has sickened and killed millions of people around the world, and for 
some, the emerging research suggests there are long-term impacts on memory and 
thinking as well," said Heather M. Snyder, Ph.D., vice president of medical and 
scientific relations at the Alzheimer's Association. "As this virus will likely 
be with us for a long time, identifying the risk and protective factors for 
cognitive symptoms can assist with the treatment and prevention of 'long COVID' 
moving forward."

Persistent loss of smell better predicts cognitive impairment than severity of 
COVID-19

Researchers in Argentina working with the Alzheimer's Association Consortium on 
Chronic Neuropsychiatric Sequelae of SARS-CoV-2 Infection ( 
https://c212.net/c/link/?t=0&l=en&o=3608523-1&h=289569650&u=https%3A%2F%2Fwww.alz.org%2Fresearch%2Ffor_researchers%2Fpartnerships%2Fsars-cov2-global-brain-study&a=Alzheimer%27s+Association+Consortium+on+Chronic+Neuropsychiatric+Sequelae+of+SARS-CoV-2+Infection 
) followed 766 adults age 55-95 exposed to COVID-19 for one year, and conducted 
a series of regular physical, cognitive and neuropsychiatric tests. Of the 
study group, 88.4% were infected and 11.6% were controls.

Clinical assessment showed functional memory impairment in two-thirds of the 
infected participants, which was severe in half of them. Another group of 
cognitive tests identified three groups with decreased performance:

    -- 11.7% showed memory-only impairment.
    -- 8.3% had impairment in attention and executive function.
    -- 11.6% displayed multidomain (including memory, learning, attention and 
       executive function) impairment.

Statistical analysis revealed that persistent loss of smell was a significant 
predictor of cognitive impairment, but severity of the initial COVID-19 disease 
was not.

"The more insight we have into what causes or at least predicts who will 
experience the significant long-term cognitive impact of COVID-19 infection, 
the better we can track it and begin to develop methods to prevent it," said 
Gabriela Gonzalez-Aleman, LCP, Ph.D., professor at Pontificia Universidad 
Catolica Argentina, Buenos Aires.

A stay in the intensive care unit may signal higher dementia risk 

Researchers from the Rush Alzheimer's Disease Center (RADC), part of Chicago's 
Rush University System for Health, used data from five diverse studies of older 
adults without known dementia (n=3,822) to observe intensive care unit (ICU) 
hospitalizations. ICU hospitalizations were previously linked to cognitive 
impairment in older patients, but few studies have examined whether they 
increase risk for dementia. 

They reviewed Medicare claims records from 1991 to 2018 (pre-pandemic), and 
checked annually for development of Alzheimer's and all type dementia using a 
standardized cognitive assessment. During an average 7.8 years follow up, 1,991 
(52%) participants experienced at least one ICU hospitalization; 1,031 (27%) 
had an ICU stay before study enrollment; and 961 (25%) had an ICU stay during 
the study period.

The researchers found that, in analyses adjusted for age, sex, education and 
race, experiencing ICU hospitalization was associated with 63% higher risk of 
Alzheimer's dementia and 71% higher risk of all type dementia. In models 
further adjusted for other health factors such as vascular risk factors and 
disease, other chronic medical conditions, and functional disabilities, the 
association was even stronger: ICU hospitalization was associated with 110% 
greater risk of Alzheimer's and 120% greater risk of all type dementia.

"We found that ICU hospitalization was associated with double the risk of 
dementia in community-based older adults," said Bryan D. James, Ph.D., 
epidemiologist at RADC. "These findings could be significant given the high 
rate of ICU hospitalization in older persons, and especially due to the 
tremendous upsurge in ICU hospitalizations during the COVID-19 pandemic. 
Understanding the link between ICU hospitalization and the development of 
dementia is of utmost importance now more than ever."

"More research is necessary to replicate these findings and elucidate the 
factors that may increase dementia risk. For example, is it the critical 
illness that sends someone to the hospital or potentially modifiable procedures 
during the hospitalization that drives dementia risk?" James added.

One positive life change during the pandemic may buffer against cognitive 
symptoms

Investigators from countries across Central and South America and the United 
States examined whether sociodemographic factors and changes in life associated 
with the pandemic were related to experiencing cognitive symptoms, including 
problems with memory, attention and other thinking skills, during the early 
phases of the pandemic.

In the study reported at AAIC, 2,382 Spanish-speaking adults age 55-95 (average 
65.3 years, 62.3% female) from nine countries in Latin America completed an 
online or telephone survey, had electronic cognitive testing, and filled out an 
inventory assessing the positive and negative impacts of the pandemic between 
May and December 2020. Of the total study population, 145 (6.09%) experienced 
COVID-19 symptoms.

Participants were from: Uruguay (1,423, 59.7%), Mexico (311, 13.1%), Peru (153, 
6.4%), Chile (152, 6.4%), Dominican Republic (117, 4.9%), Argentina (106, 
4.5%), Colombia (50, 2.1%), Ecuador (39, 1.6%), Puerto Rico (19, 0.8%) and 
Other (12, 0.5%)

Key findings:

    -- Female gender, not currently working and lower socioeconomic status were 
       all independently    associated with more cognitive symptoms during the 
       early part of the pandemic.
    -- Negative life changes during the pandemic, such as economic difficulties 
       and limited social activities, were significantly associated with more 
       cognitive symptoms. However, this association was weaker among study 
       participants who reported at least one positive life change during the 
       pandemic, including spending more time with friends and family or more 
       time outside in nature.

"Identifying risk and protective factors for cognitive symptoms during the 
pandemic is an important step towards the development of prevention efforts," 
said Maria Marquine, Ph.D., associate professor in the Departments of Medicine 
and Psychiatry, and director of disparities research in the Division of 
Geriatrics, Gerontology and Palliative Care at the University of California, 
San Diego. "The experience of positive life changes during the pandemic might 
buffer the detrimental impact of negative life changes on cognitive symptoms."

"This study is an example of how investigators from diverse countries in Latin 
America and the United States, many of whom had never worked together before 
and had limited resources, came together under difficult circumstances but with 
a shared goal to advance scientific understanding about Alzheimer's, and the 
important contributions that such multicultural partnerships can yield," 
Marquine added.

About the Alzheimer's Association International Conference(R) (AAIC(R))
The Alzheimer's Association International Conference (AAIC) is the world's 
largest gathering of researchers from around the world focused on Alzheimer's 
and other dementias. As a part of the Alzheimer's Association's research 
program, AAIC serves as a catalyst for generating new knowledge about dementia 
and fostering a vital, collegial research community.
AAIC 2022 home page: www.alz.org/aaic/
AAIC 2022 newsroom: www.alz.org/aaic/pressroom.asp
AAIC 2022 hashtag: #AAIC22

About the Alzheimer's Association(R)
The Alzheimer's Association is a worldwide voluntary health organization 
dedicated to Alzheimer's care, support and research. Our mission is to lead the 
way to end Alzheimer's and all other dementia — by accelerating global 
research, driving risk reduction and early detection, and maximizing quality 
care and support. Our vision is a world without Alzheimer's and all other 
dementia(R). Visit alz.org ( 
https://c212.net/c/link/?t=0&l=en&o=3608523-1&h=2360337763&u=https%3A%2F%2Fwww.alz.org%2F&a=alz.org) 
or call 800.272.3900.
    -- Gabriela Gonzalez-Aleman, LCP, Ph.D., et al.Olfactory dysfunction but 
       not COVID-19 severity predicts severity of cognitive sequelae following 
       SARS-CoV-2 infection in Amerindian older adults. (Funders: Fundación de 
       Lucha contra los Trastornos Neurológicos y Psiquiátricos en Minorías 
       (FULTRA); Alzheimer's Association)
    -- Bryan James, Ph.D., et al. ICU hospitalization and incident dementia in 
       community-based cohorts of older adults. (Funder: National Institute on 
       Aging)
    -- Maria Marquine, Ph.D., et al. Cognitive symptoms among middle- and 
       older-age adults in Latin America during the coronavirus disease 2019 
       (COVID-19) pandemic: Risk and protective factors. (Funders: 
       Massachusetts General Hospital Executive Committee on Research, 
       Philanthropic Gift to the University of California, San Diego Division 
       of Geriatrics, Plan Ibirapita Uruguay (Inclusion Digital de Personas 
       Mayores)).

*** AAIC 2022 news releases may contain updated data that does not match what 
is reported in the following abstracts. 

Proposal ID: 66868
Title: Olfactory dysfunction but not COVID-19 severity predicts severity of 
cognitive sequelae following SARS-CoV-2 infection in Amerindian older adults
Background: COVID-19 has affected more than 380 million people. Infections may 
result in long term sequelae, including neuropsychiatric symptoms. In older 
adults COVID-19 sequelae resemble early Alzheimer's disease, and may share risk 
factors and blood biomarkers with it. The Alzheimer's Association Consortium on 
Chronic Neuropsychiatric Sequelae of SARS-CoV-2 infection (CNS SC2) established 
harmonized definitions, ascertainment and assessment methodologies to evaluate 
and longitudinally follow up cohorts of older adults with exposure to COVID-19. 
We present one year data in a prospective cohort from Argentina.
Method: Participants (n=766) are older adults (> or = 60 years) recruited from 
the provincial health registry containing all SARS-CoV-2 testing data. We 
randomly invite older adults stratified by PCR COVID-19 testing status 
regardless of symptom severity, between 3 and 6 months after recovery. 
Assessment includes interview with the Schedules for Clinical Assessment in 
Neuropsychiatry (SCAN) and Clinical Dementia Rating scale (CDR); neurocognitive 
assessment; emotional reactivity scale; and neurological assessment including 
semiquantitative olfactory function test, motor function, coordination and gait.
Result: We assessed 88.4% infected participants and 11.6 % controls. Education 
is 10.36 +/- 5.6 years and age is 66.9 +/- 6.14 years. Level of care during 
COVID-19 is described in Figure 1. Normalized cognitive Z-scores categorize the 
cohort in 3 groups with decreased performance compared to normal cognition: 
memory only impairment (Single-domain,11.7%); impairment in attention+executive 
function without memory impairment (Two-domain, 8.3%); and multiple domain 
impairment (Multiple domain,11.6%). Logistic regression showed that severity of 
anosmia, but not clinical status, significantly predicts cognitive impairment. 
No controls had olfactory dysfunction. Cognitive impairment is defined as 
Z-scores below (- 2) (Table 1). Clinical assessment with SCAN revealed 
functional memory impairment in two thirds of infected patients (CDR > or = 1), 
which was severe in half of them. Phone-based follow up at 1 year revealed high 
adherence (4 participants declined). Five were deceased at follow up. Rates of 
re-infection (between 10 and 23%) were not affected by the vaccination schedule 
(Table 2).
Conclusion: The longitudinal cohort had very high adherence. Persistent 
cognitive and functional impairment after SARS-CoV-2 infection is predicted by 
persistent anosmia but not by the severity of the initial COVID-19 disease.

Presenting Author
Gabriela Gonzalez-Aleman, LCP, Ph.D. (gabigoa@gmail.com) 
Pontificia Universidad Catolica Argentina, Buenos Aires

Proposal ID: 61678
Title: Cognitive symptoms among middle- and older-age adults in Latin America 
during the coronavirus disease 2019 (COVID-19) pandemic: Risk and protective 
factors
Background: The COVID-19 pandemic has impacted daily life worldwide, with 
possible negative consequences for cognitive health. Self-reported cognitive 
symptoms are linked to the development of Alzheimer's disease and related 
dementias (ADRDs). Identifying risk and protective factors for cognitive 
symptoms during the pandemic is an important step towards the development of 
ADRD prevention efforts. We aimed to examine correlates of cognitive symptoms 
among middle- and older-age adults in Latin America before the availability of 
vaccines to prevent COVID-19, including sociodemographic factors and changes in 
life.
Method: Spanish-speaking adults ages 55-95 (N=2,382, Table 1) living in Latin 
America completed an online survey between May and December 2020. Cognitive 
symptoms were assessed via the 12-item Everyday Cognition (ECog) questionnaire. 
Negative (e.g., economic difficulties, limited social activities) and positive 
(e.g., more quality time with close others, increased time in nature/outside) 
life changes associated with the pandemic were measured via a subset of items 
from the Epidemic-Pandemic Impacts Inventory. Sociodemographic factors included 
age, years of education, gender, occupation and socioeconomic status (SES). 
Covariates included time since March 2020 (estimated onset of the pandemic in 
Latin America), country of survey completion, and having experienced COVID-19 
symptoms. Multivariable linear regression models were ran on ECog total scores 
including covariates and sociodemographic factors (Model 1), and then adding 
terms for negative and positive life changes and their interaction (Model 2).
Results: Model 1 showed female gender (p=.04), not currently working (p=.02) 
and lower SES (p<.001) were independently associated with more cognitive 
symptoms. Model 2 showed a significant interaction between negative and 
positive life changes (p<.001), indicating that negative life changes were 
significantly associated with more cognitive symptoms, but this association was 
weaker among participants who reported at least one positive life change during 
the pandemic (Figure 1).
Conclusion: Cognitive symptoms might be more common among certain segments of 
the Latin American population, including women, and those who are not working 
and have low SES. The experience of positive life changes during the pandemic 
might buffer the detrimental impact of negative life changes on cognitive 
symptoms. These risk and protective factors might be considered in ADRD 
prevention efforts.

Presenting Author
Maria Marquine, PhD mmarquine@health.ucsd.edu
University of California San Diego, La Jolla, California

Proposal ID: 67719
Title: ICU hospitalization and incident dementia in community-based cohorts of 
older adults
Background: Critical illness and intensive care unit (ICU) hospitalization in 
older patients have been shown to increase risk of long-term cognitive 
impairment. However, most data come from patients recruited from the ICU 
without controls or information on pre-ICU cognition. We are not aware of a 
community-based sample that allows examination of how ICU hospitalization 
changes risk for dementia.
Method: We used data from 5 diverse epidemiologic cohorts at the Rush 
Alzheimer's Disease Center (RADC) linked to Medicare claims data from 1991 to 
2018 to observe ICU hospitalizations (both prior to RADC enrollment and during 
RADC follow-up) in older adults enrolled without known dementia. Incident 
Alzheimer's and all type dementia was assessed using standardized annual 
cognitive assessment. The association of ICU hospitalization with incident 
dementia was tested in a time-varying Cox model allowing hazard rate to change 
at time of ICU hospitalization during follow-up. All models were adjusted for 
age, sex, education, and race. Fully adjusted models also included terms for 
baseline measures of hypertension, diabetes, BMI, vascular risk factors, 
vascular disease burden, other chronic medical conditions, functional 
disabilities, depression, and physical activity.
Result: Participants (n=3,822; mean age=77.3, SD=7.5) were followed for an 
average of 7.8 years (SD=5.5) from study enrollment. ICU hospitalization was 
experienced by 1,992 (52.1%) of participants; 1031 (27.0%) before RADC 
enrollment, and 961 (25.1%) during follow-up. In models adjusted for 
demographics, ICU hospitalization was associated with an increased risk of 
Alzheimer's (HR=1.63, 95% CI = 1.41, 1.88) and all type dementia (HR=1.71, 95% 
CI = 1.48, 1.97). In fully adjusted models, the association was stronger with 
ICU associated with double the risk of Alzheimer's (HR=2.10, 95% CI = 1.66, 
2.65) and all type dementia (HR=2.20, 95% CI = 1.75, 2.77).
Conclusion: We found that ICU hospitalization was associated with double the 
risk of dementia in community-based older adults compared to those who did not 
experience ICU hospitalization using standardized annual cognitive assessment. 
These findings could be significant given the high rate of ICU hospitalization 
in older persons, and rising ICU hospitalizations more recently during the 
COVID-19 pandemic.

Presenting Author
Bryan James, PhD Bryan_James@rush.edu
Rush Alzheimer's Disease Center, Chicago, Illinois
 
SOURCE  Alzheimer’s Association

CONTACT: Alzheimer's Association Media Line, 312.335.4078, media@alz.org; AAIC 
2022 Press Office, aaicmedia@alz.org