2. Federal University of São Paulo Escola Paulista de Medicina
Caregiver awareness of diagnosis and treatment of cerebrovascular risk factors in patients with dementia due to Alzheimer’s disease at an university hospital in São Paulo, Brazil
Fabricio Ferreira de Oliveira MD MSc
Paulo Henrique Ferreira Bertolucci MD MSc PhD
Elizabeth Suchi Chen MSc PhD
Marilia de Arruda Cardoso Smith MSc PhD

3. Disclosures of Interest:
F. F. Oliveira:
Grant/Research Support from CAPES – Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
Consultant of Gerson Lehrman Group
P. H. F. Bertolucci:
Professor of Federal University of São Paulo – UNIFESP
E. S. Chen:
Grant/Research Support from FAPESP – The State of São Paulo Research Foundation
M. A. C. Smith:
Full Professor of Federal University of São Paulo – UNIFESP

4. Introduction
AChEis and Memantine have modest effects over cognition and daily function in Alzheimer’s disease1
Importance of seeking control of modifiable risk factors
More than a third of worldwide cases of Alzheimer’s disease are attributable to cerebrovascular risk factors2
1. Ballard C, Gauthier S, Corbett A, Brayne C, Aarsland D, Jones E.
Alzheimer’s disease.
Lancet 377: , 2011.
2. Barnes DE & Yaffe K.
The projected effect of risk factor reduction on Alzheimer’s disease prevalence.
Lancet Neurol 10: , 2011.

5. Aim
To estimate the importance of caregivers’ roles in patients’ adherence to control of cerebrovascular risk

6. Methods 132 consecutive patients (88 female + 44 male)
Cognitive screening
Evaluation for cerebrovascular risk factors:
Systemic Hypertension
Hypercholesterolemia
Diabetes mellitus
Obesity (BMI >=30kg/m2)
Family history of vascular events
Drinking >10 litres of alcoholic beverages per year
Currently or previously smoking

7. Methods
Caregivers were inquired on awareness of the need to control cerebrovascular risk factors for prevention of vascular events and neurodegenerative diseases such as Alzheimer’s disease
Caregivers were inquired if patients were encouraged to follow any specific diets, to have a regular physical activity, or to accept pharmacological treatment
Fisher’s exact test
Significance: ρ<0.05

8. Results CDR: 1.0: 50 patients (37.9%) 2.0: 57 patients (43.2%)
No influence over awareness of the need to control cerebrovascular risk (ρ=0.999)
No influence over adherence to dietary therapy (ρ=0.477)
No influence over adherence to physical therapy (ρ=0.468)

9. Results Cerebrovascular risk factors:
Systemic hypertension: n=114 (86.4%)
Hypercholesterolemia: n=93 (70.4%)
Diabetes mellitus: n=36 (27.3%)
Obesity: n=20 (15.2%)
Drinking: n=34 (25.8%)
Smoking: n=54 (40.9%)
96 caregivers (72.7%) reported full awareness of the need to control cerebrovascular risk

10. Assessed Variables ρ YES (n=96) NO (n=36) variable present
Table 1 – Relationships between awareness of the need to control cerebrovascular risk and studied variables
Assessed Variables
Patients’ and/or Caregivers’ awareness of the need to control cerebrovascular risk ρ
YES (n=96)
NO (n=36)
variable present
variable absent
Systemic Hypertension 87 9 27
0.042
Hypercholesterolemia 73 23 20 16
0.031
Diabetes mellitus 29 67 7
0.275
Obesity 80 4 32
0.588
Alcohol abuse 24 72 10 26
0.824
Smoking 36 60 18
0.234
Dietary therapy 35 61 6 30
0.035
Physical activity 13 83 1
0.111
Pharmacological therapy 94 2 28 8
<.001
Family history of Alzheimer’s disease 38 58 11 25
0.420
Family history of other neuropsychiatric disorders
0.999
Family history of cardiovascular diseases 37 59
0.041

11. Results
122 patients (89.7%) were under pharmacological control of their cerebrovascular risk factors regardless of being aware of its importance
41 patients (31.1%) followed a strict diet
14 patients (10.6%) underwent regular physical activity
When caregivers were aware of the importance to control cerebrovascular risk, patients were more likely to accept pharmacological therapy (ρ<0.001) or to follow a diet (ρ=0.035)
Only 8 patients (6.1%) were under pharmacological therapy and reported following a diet and practicing regular physical activity at the same time

12. Dietary Therapy ρ YES (n=41) NO (n=91) 0.012 0.034 0.031
Table 2 – Relationships between cerebrovascular risk and adherence to dietary therapy
Variables of cerebrovascular risk or pharmacological treatment
Dietary Therapy ρ
YES (n=41)
NO (n=91)
variable present
variable absent
Systemic Hypertension 40 1 74 17
0.012
Hypercholesterolemia 32 9 61 30
0.223
Diabetes mellitus 14 27 22 69
0.291
Obesity 11 80
0.189
Physical inactivity 33 8 85 6
0.034
Pharmacological therapy 41 81 10
0.031

13. Regular Physical Activity
Table 3 – Relationships between cerebrovascular risk and regular practice of physical activity
Variables of cerebrovascular risk or treatment options
Regular Physical Activity ρ
YES (n=14)
NO (n=118)
variable present
variable absent
Systemic Hypertension 13 1
101 17
0.691
Hypercholesterolemia 80 38
0.064
Diabetes mellitus 3 11 33 85
0.757
Obesity 19 99
0.694
Dietary therapy 8 6
0.034
Pharmacological therapy 14
108 10
0.599

14. Conclusions
Caregiver awareness of the need to control cerebrovascular risk has a positive impact on the lifestyles of people with dementia due to Alzheimer’s disease
People with Alzheimer’s disease and their caregivers should be educated in regard to pharmacological and non-pharmacological control of cerebrovascular risk

15. Acknowledgments To our patients
To the multidisciplinary team at the Behavioural Neurology Section of Hospital São Paulo – UNIFESP
To the staff at the Laboratory of Genetics of the Federal University of São Paulo – UNIFESP

16. Thank you very much!
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