P4‐237: Headaches and Dementia in the Oldest‐Old: The Monzino 80‐Plus Population‐Based Study

Headache is one of the most prevalent disorders affecting some 20-40% of the elderly population. Headaches have been linked to an increased risk of stroke and white matter hyperintensities which, in turn, have been associated with a higher risk of dementia. A few studies have investigated the relationship between migraine and cognitive decline or dementia in the young-old with mostly negative findings. Recently, any headache was more likely to be reported by young-old individuals who were later included in a Norwegian dementia registry. Aim of the present study was to prospectively investigate the association between history of headache and the occurrence of dementia among the oldest-old in a population-based study of 80-years and older residents in Varese province, Italy (Monzino 80-plus Study). At initial visit, history of headache was ascertained administering a standardized questionnaire to the subject and primary informant, usually a family member. Diagnosis of dementia was made according to DSM-IV criteria. At first visit, information on history of headache was available from 2,184 participants (mean age: 90 years; mean education: 5 years). Women (72.7%) were more likely to report a history of headache than men (23.0% versus 13.8%, p<0.0001). At baseline, prevalence of headache was significantly higher among oldest-old without dementia (22.7% versus 16.8%; OR: 1.46, 95%CI: 1.17-1.83; p=0.0008). After adjustment for age, sex and education, this difference was no longer significant (OR: 1.19, 95%CI: 0.94-1.52; p=0.1498). Among the 1,120 participants free of dementia at baseline and with at least one follow-up available, the frequency of incident cases of dementia during the following 13 years (3.9 years on average) was significantly higher among the oldest-old who had not reported a history of headache at first visit (HR: 1.30, 95%CI: 1.06-1.60; p=0.0119). This association was no longer significant when age, sex and education were entered into a multivariable Cox model relating headache to dementia (HR: 1.20, 95%CI: 0.98-1.49; p=0.0824). Limiting the analyses to the oldest-old with a past and current history of headache (7.7%) gave similar results. In the present prospective population-based study, history of headache was not independently associated with dementia among the oldest-old.