The West Point Senior Care Study UPDATE 18 MAY 11

The West Point Senior Care Study UPDATE 18 MAY 11

Introduction Paula A Corrigan, MD MPH Col USAF MC CFS Program Director General Preventive Medicine Residency USAFSAM, Brooks City-Base TX Principle Investigator West Point Senior Care Study Toni Randall, BA Psychology Executive Assistant West Point Senior Care Study

Presentation Overview West Point Study Background West Point Senior Care Study Background Alzheimer s/dementia Background Proposal for Alzheimer s/dementia Data Collection

The West Point Study Initiated to investigate whether the military can identify those who are at high risk of cardiovascular disease (CVD) by looking at risk factors BP, Cholesterol, Exercise, Smoking Funding came through in 1952 and USMA Class of 1956 selected to participate in the study Cohort of 474 upon graduation in 1956 387 members of the cohort (81%) underwent a final detailed cardiac evaluation at Brooks in 1992

Results 46 had been identified as having CVD by that time: 5 sudden cardiac deaths 14 heart attacks 12 angina 15 asymptomatic but identified on studies 12% incidence of CVD (less than US population at same age 17%) Risk of CVD did relate to risk factors, with smoking and cholesterol having the highest correlation

West Point Senior Care Study The goals of the original study had been met and the study was stopped in 1992 The West Point Senior Care Study was initiated in 2001 New cohort added spouses to the mix 306 of the original WPS cohort (65%) 170 additional spouses New data collection Health surveys every two years All voluntary Determine activity and functionality of cohort as they age

West Point Senior Care Study Surveys sent 2002, 2004, 2006, 2008 Data organized and analyzed No significant trends identified Nothing worthy of publishing so far Strengths of study: Great support from cohort with average 77% participation rate for questionnaires

West Point Senior Care Study Future direction Class members voiced interest in participating in Alzheimer s research Literature search begun to identify if there was a way to collect meaningful data from the group about Alzheimer s and dementia Proposal drafted concerning adding this to ongoing study

Alzheimer s Disease and Dementia Dementia is caused by various diseases that result in damaged brain cells and their connections Alzheimer s disease Vascular dementia Dementia with Lewy bodies Parkinson s disease Frontotemporal dementia CJD Normal pressure hydrocephalus Mixed dementia Dementia causes memory loss and other decline in cognitive function

Alzheimer s Statistics An estimated 5.4 million Americans have AD 13% of Americans over age 65 have AD (5.2 million) Nearly 50% of those over age 85 have AD 2/3 of those with AD are women Women live longer than men so are more likely to develop AD or dementia in their lifetime At any given age, women are not more likely than men to develop AD With the aging population, by 2030 those over age 65 with AD is estimated to increase by 50% to 7.7 million AD is the 6 th leading cause of death, and the 5 th leading cause for those age 65 or older

Risk Factors for Alzheimer s and Dementia Advancing age (over age 65) Family history Educational level Vascular disease Head trauma Cardiovascular risk factors Some studies have correlated mid-life chol levels with risk Apolipoprotein E (APOE)- e4 gene Provides blueprint for protein that carries cholesterol in bloodstream Those with one or two APOE-e4 genes are at higher risk to develop Alzheimer s Mild cognitive impairment

Mild Cognitive Impairment Mild cognitive impairment (MCI) as determined on screening tests Some individuals with MCI will develop dementia, some will not Of those with MCI, up to 15% per year will progress to dementia One tool for screening for MCI is the AD8 questionnaire developed by Washington Univ. Alzheimer s Disease Research Center 8 questions, scored by spouse or other informant Can determine who have further assessment for dementia

Preventing Alzheimer s and Dementia New research focused on going back in time to determine when and how the brain deteriorates Current treatment not very effective at treating the disease as the brain is already damaged If we can determine risk factors, particularly those that are modifiable, it could help us to slow down the disease West Point Class of 1956 has a wealth of data concerning modifiable risk factors collected over many years, especially cholesterol, which has been linked to AD Proposal is to now collect more dementia related information as part of the Senior Care Study, including MCI screen, and try to correlate to earlier data

New Proposal Send out usual surveys Fall 2011 Add the AD8 questionnaire to be answered by a spouse or family member of Class of 1956 members Obtain current cholesterol data, if possible Follow data on which Class members develop Alzheimer s or dementia and correlate with MCI and cholesterol data to see if connection exists If class agrees, new protocol must be approved by 711 HPW Institutional Review Board (IRB) this summer

West Point Senior Care Study Administration USAFSAM has moved from Brooks City-Base to Wright Patterson AFB Study continues to be funded and located at WPAFB Col Kelly West new Principle Investigator (PI) Ms Toni Randall to continue as Assistant Records have moved to WPAFB Hard copy and electronic data are always maintained in a secure manner and no personal information is seen by other than PI and assistant

Conclusion The West Point Study represents one of the longest running studies on cardiac risk factors in the USA We are grateful to the class of 1956 for their dedication and support of this effort We hope to be able to collect meaningful data related to the risk of Alzheimer s and dementia with the goal of publication in a scientific journal

Questions?