Prevalence of very mild to severe dementia in Denmark

Sensitivity enhancement of magneto-optical Faraday effect immunoassay method based on biofunctionalized γ-Fe2O3@Au core-shell magneto-plasmonic nanoparticles for the blood detection of Alzheimer's disease

In this work, we conducted a proof-of-concept experiment based on biofunctionalized magneto-plasmonic nanoparticles (MPNs) and magneto-optical Faraday effect for in vitro Alzheimer's disease (AD) assay. The biofunctionalized γ-Fe₂O₃@Au MPNs of which the surfaces are modified with the antibody of Tau protein (anti-τ). As anti-τ reacts with Tau protein, biofunctionalized MPNs aggregate to form magnetic clusters which will hence induce the change of the reagent's Faraday rotation angle. The result showed that the γ-Fe₂O₃@Au core-shell MPNs can enhance the Faraday rotation with respect to the raw γ-Fe₂O₃ nanoparticles. Because of their magneto-optical enhancement effect, biofunctionalized γ-Fe₂O₃@Au MPNs effectively improve the detection sensitivity. The detection limit of Tau protein as low as 9 pg/mL (9 ppt) was achieved. Furthermore, the measurements of the clinical samples from AD patients agreed with the CDR evaluated by the neurologist. The results suggest that our method has the potential for disease assay applications.

The Prevalence of Dementia: A Systematic Review and Meta-Analysis

Dementia is a severe neurodegenerative disorder and it can be categorized into several subtypes by different pathogenic causes. We sought to comprehensively analyzed the prevalence of dementia from perspectives of geographic region (Asia, Africa, South America, and Europe/North America), age, and gender. We searched PubMed and EMBASE for relevant articles on dementia published from January 1985 to August 2019. In these studies, analyses were stratified by geographic region, age, and gender. Meta-regression was conducted to identify if there were significant differences between groups. We included forty-seven studies. Among the individuals aged 50 and over in the community, the pooled prevalence for all-cause dementia, Alzheimer's disease, and vascular dementia were 697 (CI95%: 546-864) per 10,000 persons, 324 (CI95%: 228-460) per 10,000 persons, and 116 (CI95%: 86-157) per 10,000 persons, respectively. In our study, the prevalence of all-type dementia in individuals aged 100 years and older (6,592 per 10,000 cases) is 244 times higher than in those aged 50-59 (27 per 10,000 cases). The number of people living with dementia approximately doubles every five years. The prevalence was greater in women than in men (788 cases versus 561 cases per 10,000 persons) in overall analysis. In individuals aged 60 to 69 years, AD prevalence in females was 1.9 times greater than that in males (108 cases versus 56 cases per 10,000 persons), while the prevalence of VaD was 1.8 times greater in males than in females (56 cases versus 32 cases per 10,000 persons). Prevalence rate was higher in Europe and North America than in Asia, Africa, and South America.

Estimates of the prevalence, incidence and severity of dementia in Ireland

OBJECTIVES

In this paper we provide revised estimates of the prevalence of dementia in Ireland, the number of new cases per year and the severity mix. These estimates are a necessary input for any assessment of the potential demand for services and supports for people with dementia across all care settings in Ireland.

METHODS

The prevalence, incidence and severity stage of dementia are calculated by applying rates from prominent international studies to population data from the 2016 census.

RESULTS

We show that the total number of people with dementia in Ireland ranges between 39 272 and 55 266, depending on the international rates used to measure prevalence. The incidence of dementia in Ireland has increased as the population has aged, to at least 7752 new cases per year. We estimate that there are at least 11 175 people living at home in the community in Ireland with dementia who have a serious functional impairment, based on an Activities of Daily Living measurement, of which an estimated 1876 are chair or bedbound.

CONCLUSIONS

Without a national prevalence study it is not possible to be precise about the estimates of the number of people with dementia in Ireland. However, having credible upper and lower bound estimates for the number of people with dementia, the potential number of new cases per year and severity rates is useful for planners and those charged with the responsibility of making resource allocation decisions in dementia.

Pneumonia-associated death in patients with dementia: A systematic review and meta-analysis

BACKGROUND

Pneumonia is a serious disease associated with mortality among patients with dementia. However, the reported frequency of pneumonia as a cause of death in patients with dementia varies, the reason for which has not been fully elucidated.

METHODS

We conducted a systematic search in PubMed and the Cochrane Database of Systematic Reviews (inception to December 2016). Two authors independently determined the suitability of studies and potential bias and extracted the data. The primary outcome was frequency of pneumonia-associated death in patients with dementia. Stratified subgroup analysis was conducted among studies grouped according to type of mortality cause (immediate or underlying), information source of mortality cause (autopsy or death certificate), and study setting (clinic, hospital, or nursing home).

RESULTS

We included 7 studies reporting the cause of death among patients with dementia and 12 studies comparing the cause of death among patients with and without dementia. The frequency of pneumonia-associated death among 19 eligible studies was 29.69% (95% confidence interval [CI], 25.86-33.53). Those frequencies differed according to whether the source for information about cause of death was an autopsy confirmation (49.98%; 95% CI, 43.75-56.71) or death certificate (19.65%; 95% CI, 15.48-23.83) and according to whether the type of mortality cause was an indirect cause of death (13.96%; 95% CI, 9.42-18.51) or direct cause of death (44.45%; 95% CI, 29.81-50.10). The risk of pneumonia-associated death in patients with dementia was twice as high as among those without dementia (odds ratio, 2.15; 95% CI, 1.63-2.83; p < 0.001).

CONCLUSION

The various frequencies of pneumonia-associated death in patients with dementia were associated with the information source, type of mortality cause, and study setting. Patients with dementia in the terminal stages urgently require careful clinical management of pneumonia, to maximize patient life expectancy and quality.

The Cretan Aging Cohort: Cohort Description and Burden of Dementia and Mild Cognitive Impairment

Our aim was to explore the burden of dementia in the Cretan Aging Cohort, comprised of 3140 persons aged ≥60 years (56.8% women, 5.8 ± 3.3 years formal education, 86.2% living in rural areas) who attended selected primary health-care facilities on the island of Crete, Greece. In the first study phase, a formal diagnosis of dementia had been reached in 4.0% of the participants. However, when selected 505 participants underwent thorough neuropsychiatric evaluation in the second phase of this study (344 with Mini-Mental State Examination [MMSE] <24 and 161 with MMSE ≥24), and results were extrapolated to the entire cohort, the prevalence of dementia and mild cognitive impairment was estimated at 10.8% (9.7%-11.9%) and 32.4% (30.8%-34.0%), respectively. Using both the field diagnostic data and the extrapolated data, the highest dementia prevalence (27.2%) was found in the 80- to 84-year-old group, who also showed the lowest educational level, apparently due to lack of schooling during World War II.

Geographical Distribution and Diversity of Gut Microbial NADH:Ubiquinone Oxidoreductase Sequence Associated with Alzheimer's Disease

Earlier we reported induction of neurotoxicity and neurodegeneration by tryptophan metabolites that link the metabolic alterations to Alzheimer's disease (AD). Tryptophan is a product of Shikimate pathway (SP). Human cells lack SP, which is found in human gut bacteria exclusively using SP to produce aromatic amino acids (AAA). This study is a first attempt toward gene-targeted analysis of human gut microbiota in AD fecal samples. The oligonucleotide primers newly-designed for this work target SP-AAA in environmental bacteria associated with human activity. Using polymerase chain reaction (PCR), we found unique gut bacterial sequence in most AD patients (18 of 20), albeit rarely in controls (1 of 13). Cloning and sequencing AD-associated PCR products (ADPP) enables identification of Na(+)-transporting NADH: Ubiquinone reductase (NQR) in Clostridium sp. The ADPP of unrelated AD patients possess near identical sequences. NQR substrate, ubiquinone is a SP product and human neuroprotectant. A deficit in ubiquinone has been determined in a number of neuromuscular and neurodegenerative disorders. Antibacterial therapy prompted an ADPP reduction in an ADPP-positive control person who was later diagnosed with AD-dementia. We explored the gut microbiome databases and uncovered a sequence similarity (up to 97%) between ADPP and some healthy individuals from different geographical locations. Importantly, our main finding of the significant difference in the gut microbial genotypes between the AD and control human populations is a breakthrough.

Improving clarity and transparency in cognitive assessment: conversion of the Cambridge Cognition Examination to the International Classification of Functioning, Disability and Health

BACKGROUND

A variety of screening, diagnostic and assessment tools have been developed for use in dementia research and care. However, there is no consensus which tool to use and moreover there is no transparency in communication between countries and disciplines.

OBJECTIVE

To contribute to a more uniform assessment in dementia, the Cambridge Cognition Examination (CAMCOG) was converted to the International Classification of Functioning, Disability and Health (ICF).

METHODS

In a qualitative design, CAMCOG-items and -scoring-system were converted to the ICF addressing 3 ICF domains: global and specific mental functions and general tasks and demands. Construct and discriminative validity was checked in a sample of 25 cognitively healthy elderly (CHE), 25 persons with Mild Cognitive Impairment (MCI) and 25 patients with mild Alzheimer's Disease (mAD).

RESULTS

A significant correlation was observed between CAMCOG/ICF-CAMCOG (r = - 0.987; p < 0.01). The areas under the curve (AUC) of the ICF-CAMCOG were between 0.819 and 0.978; comparable with the original CAMCOG. Only a significant difference between the AUC of the CHE versus MCI (0.911 vs. 0.819; p = 0.0094) was observed in favour of CAMCOG.

CONCLUSION

The clinical use of the ICF-CAMCOG looks promising offering a more detailed and interpretable scoring and may allow for better planning of resources to aid patients with dementia.

Development and validation of a dementia screening tool for primary care in Taiwan: Brain Health Test

Objectives

To develop a simple dementia screening tool to assist primary care physicians in identifying patients with cognitive impairment among subjects with memory complaints or at a high risk for dementia.

Design

The Brain Health Test (BHT) was developed by several experienced neurologists, psychiatrists, and clinical psychologists in the Taiwan Dementia Society. Validation of the BHT was conducted in the memory clinics of various levels of hospitals in Taiwan.

Participants

All dementia patients at the memory clinics who met the inclusion criteria of age greater or equal to 50 years were enrolled. Besides the BHT, the Mini-Mental State Examination and Clinical Dementia Rating were used to evaluate the cognition state of the patients and the severity of dementia.

Results

The BHT includes two parts: a risk evaluation and a cognitive test (BHT-cog). Self or informants reports of memory decline or needing help from others to manage money or medications were significantly associated with cognitive impairment. Among the risk factors evaluated in the BHT, a total risk score greater or equal to 8 was defined as a high risk for dementia. The total score for the finalized BHT-cog was 16. When the cutoff value for the BHT-cog was set to 10 for differentiating dementia and a normal mental state, the sensitivity was 91.5%, the specificity was 87.3%, the positive predictive value was 94.8%, and the negative predictive value was 80.1% The area under the receiver operating characteristic curve between dementia and healthy subjects was 0.958 (95% CI = 0.941–0.975).

Conclusions

The BHT is a simple tool that may be useful in primary care settings to identify high-risk patients to target for cognitive screening.

Fun cube based brain gym cognitive function assessment system

The aim of this study is to design and develop a fun cube (FC) based brain gym (BG) cognitive function assessment system using the wireless sensor network and multimedia technologies. The system comprised (1) interaction devices, FCs and a workstation used as interactive tools for collecting and transferring data to the server, (2) a BG information management system responsible for managing the cognitive games and storing test results, and (3) a feedback system used for conducting the analysis of cognitive functions to assist caregivers in screening high risk groups with mild cognitive impairment. Three kinds of experiments were performed to evaluate the developed FC-based BG cognitive function assessment system. The experimental results showed that the Pearson correlation coefficient between the system's evaluation outcomes and the traditional Montreal Cognitive Assessment scores was 0.83. The average Technology Acceptance Model 2 score was close to six for 31 elderly subjects. Most subjects considered that the brain games are interesting and the FC human-machine interface is easy to learn and operate. The control group and the cognitive impairment group had statistically significant difference with respect to the accuracy of and the time taken for the brain cognitive function assessment games, including Animal Naming, Color Search, Trail Making Test, Change Blindness, and Forward / Backward Digit Span.

Factors Associated with Pneumonia-caused Death in Older Adults with Autopsy-confirmed Dementia

Objective A better understanding of risk factors for pneumonia-caused death may help to improve the clinical management of dementia. Methods A retrospective observational study was conducted by reviewing the medical charts and autopsy reports of 204 patients who were admitted to hospital, underwent a post-mortem examination, and who were neuropathologically diagnosed with dementia. The risk factors for pneumonia-caused death were examined both as underlying and immediate causes of death using logistic regression models. Results A high frequency of pneumonia-caused death was observed both in underlying- (37.3%) and immediate- (44.1%) cause of death, but varied according to the subtypes of dementia. The factors related to pneumonia-caused death (underlying) were subtypes of dementia; Alzheimer's disease (odds ratio [OR], 2.891; 95% confidence interval [CI], 1.459-5.730); argyrophilic grain disease (OR, 3.148; 95% CI, 0.937-10.577); and progressive supranuclear palsy (OR, 34.921; 95% CI, 3.826-318.775), dysphagia (OR, 2.045; 95% CI, 1.047-3.994), diabetes mellitus (OR, 3.084; 95% CI, 1.180-8.061) and conversely related with heart failure (OR, 0.149; 95% CI, 0.026-0.861). Factors relating to pneumonia-caused death (immediate) were incidence of pneumonia during hospitalizations (OR, 32.579; 95%CI, 4.308-246.370), gender-male (OR, 2.060; 95% CI, 1.098-3.864), and conversely related with malignant neoplasm (OR, 0.220; 95% CI, 0.058-0.840). Conclusion The different factors relating to the pneumonia-caused death were evaluated depending on whether pneumonia was the underlying- or immediate-cause of death. Strengthening clinical management on dysphagia and diabetes mellitus, and preventing incidence of pneumonia during hospitalization appear to be the important for the terminal stage of hospitalized patients with dementia.

Dementia Diagnosis, Treatment, and Care in Specialist Clinics in Two Scandinavian Countries: A Data Comparison between the Swedish Dementia Registry (SveDem) and the Danish Dementia Registry

BACKGROUND

Two dementia quality registries have been developed in Denmark and Sweden with the aim to assess quality of dementia care based on adherence to national guidelines.

OBJECTIVE

To compare patient characteristics, diagnostics, treatment, and quality indicators of dementia care among patients referred to specialist units in Sweden and Denmark.

METHODS

Data from the Swedish Dementia Registry (SveDem) and the Danish Dementia Registry were merged. Newly diagnosed dementia cases referred to memory clinics during 2007-2012 were included (19,629 Swedish and 6,576 Danish patients).

RESULTS

The median duration between initial assessment and confirmed diagnosis was 56 and 57 days in Sweden and Denmark, respectively. Brain imaging using MRI was twice as common in Sweden. A diagnosis of dementia was established at an average MMSE of 21. An etiological diagnosis was concluded in 89.6% of the Swedish and 87.3% of the Danish cases. Alzheimer's disease (AD) was the most common disorder (47.7% in Denmark and 36.6% in Sweden); however, more cases were diagnosed as mixed AD in Sweden (24.7% versus 10.6% ). More than 80% of patients with AD, dementia with Lewy bodies, and Parkinson's disease with dementia were treated with anti-dementia drugs.

CONCLUSION

The targets of several quality indicators in both registries were met, such that structural brain imaging and MMSE were performed in >90% and an etiological diagnosis was concluded in >80% of the patients. However, there were also results of concern. The diagnosis of dementia was established at a mean MMSE of 21, which is already late in the course of most dementia disorders. A higher chance of vascular findings following the higher rate of MRI in Sweden may have resulted in more mixed AD diagnosis, which could be one explanation for diagnostic differences but also highlights the need to harmonize diagnostic criteria.

Improving the experience of dementia and enhancing active life--living well with dementia: study protocol for the IDEAL study

BACKGROUND

Enabling people with dementia and carers to 'live well' with the condition is a key United Kingdom policy objective. The aim of this project is to identify what helps people to live well or makes it difficult to live well in the context of having dementia or caring for a person with dementia, and to understand what 'living well' means from the perspective of people with dementia and carers.

METHODS/DESIGN

Over a two-year period, 1500 people with early-stage dementia throughout Great Britain will be recruited to the study, together with a carer wherever possible. All the participants will be visited at home initially and again 12 months and 24 months later. This will provide information about the way in which well-being, life satisfaction and quality of life are affected by social capitals, assets and resources, the challenges posed by dementia, and the ways in which people adjust to and cope with these challenges. A smaller group will be interviewed in more depth.

DISCUSSION

The findings will lead to recommendations about what can be done by individuals, communities, health and social care practitioners, care providers and policy-makers to improve the likelihood of living well with dementia.

Improving the experience of dementia and enhancing active life--living well with dementia: study protocol for the IDEAL study

BACKGROUND

Enabling people with dementia and carers to 'live well' with the condition is a key United Kingdom policy objective. The aim of this project is to identify what helps people to live well or makes it difficult to live well in the context of having dementia or caring for a person with dementia, and to understand what 'living well' means from the perspective of people with dementia and carers.

METHODS/DESIGN

Over a two-year period, 1500 people with early-stage dementia throughout Great Britain will be recruited to the study, together with a carer wherever possible. All the participants will be visited at home initially and again 12 months and 24 months later. This will provide information about the way in which well-being, life satisfaction and quality of life are affected by social capitals, assets and resources, the challenges posed by dementia, and the ways in which people adjust to and cope with these challenges. A smaller group will be interviewed in more depth.

DISCUSSION

The findings will lead to recommendations about what can be done by individuals, communities, health and social care practitioners, care providers and policy-makers to improve the likelihood of living well with dementia.

A nationwide survey of mild cognitive impairment and dementia, including very mild dementia, in Taiwan

An increasing population of dementia patients produces substantial societal impacts. We assessed the prevalence of mild cognitive impairment (MCI) and all-cause dementia, including very mild dementia (VMD), in Taiwan. In a nationwide population-based cross-sectional survey, participants were selected by computerized random sampling from all 19 Taiwan counties and were enrolled between December 2011 and March 2013. Cases were identified through in-person interviews based on the National Institute on Aging-Alzheimer’s Association clinical criteria. Demographic data and histories involving mental status and function in daily living were collected. The principal objective assessments were the Taiwanese Mental Status Examination and Clinical Dementia Rating. In all, 10,432 people aged 65 years or older (mean age 76.2±6.7, 52.3% women) were interviewed. The age-adjusted prevalence of all-cause dementia was 8.04% (95% CI 7.47–8.61), including a 3.25% (95% CI 2.89–3.61) prevalence of VMD; that of MCI was 18.76% (95% CI 17.91–19.61). Women had a higher prevalence than men of both all-cause dementia (9.71% vs. 6.36%) and MCI (21.63% vs. 15.57%). MCI affects a considerable portion of the population aged 65 and above in Taiwan. The inclusion of VMD yields dementia prevalence rates higher than those previously reported from Taiwan. Old age, female gender, and a low educational level are significant associated factors.

The cumulative load of depressive illness is associated with cognitive function in the remitted state of unipolar depressive disorder

OBJECTIVE

To investigate whether the cumulative number, duration and subtypes (severity and presence of psychotic features) of previous episodes of depression in patients with unipolar depressive disorder in a remitted state are associated with decreased global cognitive function.

METHODS

Via the Danish registers individuals between 40 and 80 years of age were identified: (1) patients with a diagnosis of unipolar disorder at their first discharge from a psychiatric hospital in the period 1994 to 2002, and (2) gender and age matched control individuals. The participants were assessed with the Cambridge Cognitive Examination (CAMCOG), which provides a composite measure of global cognitive function.

RESULTS

A total of 88 patients and 50 controls accepted our invitation to participate, fulfilled the selection criteria and were included in the study. The cumulative duration of depressive episodes was associated with a decreased CAMCOG score adjusted for age, gender, education, premorbid IQ and residual depressive symptoms (B=-0.14, 95% C.I. (-0.26, -0.02), R(2)adj=0.31, P=.02). Significant associations were also found between CAMCOG score and the cumulative duration and total number of depressive episodes with psychotic features, respectively.

CONCLUSION

Our findings suggest that cognitive dysfunction is associated with the cumulative duration of depressive episodes, and that, in particular, depressive episodes with psychotic features in the course of illness may be a significant predictor of future impairment of cognitive function.

Cost of disorders of the brain in Europe 2010

BACKGROUND

The spectrum of disorders of the brain is large, covering hundreds of disorders that are listed in either the mental or neurological disorder chapters of the established international diagnostic classification systems. These disorders have a high prevalence as well as short- and long-term impairments and disabilities. Therefore they are an emotional, financial and social burden to the patients, their families and their social network. In a 2005 landmark study, we estimated for the first time the annual cost of 12 major groups of disorders of the brain in Europe and gave a conservative estimate of €386 billion for the year 2004. This estimate was limited in scope and conservative due to the lack of sufficiently comprehensive epidemiological and/or economic data on several important diagnostic groups. We are now in a position to substantially improve and revise the 2004 estimates. In the present report we cover 19 major groups of disorders, 7 more than previously, of an increased range of age groups and more cost items. We therefore present much improved cost estimates. Our revised estimates also now include the new EU member states, and hence a population of 514 million people.

AIMS

To estimate the number of persons with defined disorders of the brain in Europe in 2010, the total cost per person related to each disease in terms of direct and indirect costs, and an estimate of the total cost per disorder and country.

METHODS

The best available estimates of the prevalence and cost per person for 19 groups of disorders of the brain (covering well over 100 specific disorders) were identified via a systematic review of the published literature. Together with the twelve disorders included in 2004, the following range of mental and neurologic groups of disorders is covered: addictive disorders, affective disorders, anxiety disorders, brain tumor, childhood and adolescent disorders (developmental disorders), dementia, eating disorders, epilepsy, mental retardation, migraine, multiple sclerosis, neuromuscular disorders, Parkinson's disease, personality disorders, psychotic disorders, sleep disorders, somatoform disorders, stroke, and traumatic brain injury. Epidemiologic panels were charged to complete the literature review for each disorder in order to estimate the 12-month prevalence, and health economic panels were charged to estimate best cost-estimates. A cost model was developed to combine the epidemiologic and economic data and estimate the total cost of each disorder in each of 30 European countries (EU27+Iceland, Norway and Switzerland). The cost model was populated with national statistics from Eurostat to adjust all costs to 2010 values, converting all local currencies to Euro, imputing costs for countries where no data were available, and aggregating country estimates to purchasing power parity adjusted estimates for the total cost of disorders of the brain in Europe 2010.

RESULTS

The total cost of disorders of the brain was estimated at €798 billion in 2010. Direct costs constitute the majority of costs (37% direct healthcare costs and 23% direct non-medical costs) whereas the remaining 40% were indirect costs associated with patients' production losses. On average, the estimated cost per person with a disorder of the brain in Europe ranged between €285 for headache and €30,000 for neuromuscular disorders. The European per capita cost of disorders of the brain was €1550 on average but varied by country. The cost (in billion €PPP 2010) of the disorders of the brain included in this study was as follows: addiction: €65.7; anxiety disorders: €74.4; brain tumor: €5.2; child/adolescent disorders: €21.3; dementia: €105.2; eating disorders: €0.8; epilepsy: €13.8; headache: €43.5; mental retardation: €43.3; mood disorders: €113.4; multiple sclerosis: €14.6; neuromuscular disorders: €7.7; Parkinson's disease: €13.9; personality disorders: €27.3; psychotic disorders: €93.9; sleep disorders: €35.4; somatoform disorder: €21.2; stroke: €64.1; traumatic brain injury: €33.0. It should be noted that the revised estimate of those disorders included in the previous 2004 report constituted €477 billion, by and large confirming our previous study results after considering the inflation and population increase since 2004. Further, our results were consistent with administrative data on the health care expenditure in Europe, and comparable to previous studies on the cost of specific disorders in Europe. Our estimates were lower than comparable estimates from the US.

DISCUSSION

This study was based on the best currently available data in Europe and our model enabled extrapolation to countries where no data could be found. Still, the scarcity of data is an important source of uncertainty in our estimates and may imply over- or underestimations in some disorders and countries. Even though this review included many disorders, diagnoses, age groups and cost items that were omitted in 2004, there are still remaining disorders that could not be included due to limitations in the available data. We therefore consider our estimate of the total cost of the disorders of the brain in Europe to be conservative. In terms of the health economic burden outlined in this report, disorders of the brain likely constitute the number one economic challenge for European health care, now and in the future. Data presented in this report should be considered by all stakeholder groups, including policy makers, industry and patient advocacy groups, to reconsider the current science, research and public health agenda and define a coordinated plan of action of various levels to address the associated challenges.

RECOMMENDATIONS

Political action is required in light of the present high cost of disorders of the brain. Funding of brain research must be increased; care for patients with brain disorders as well as teaching at medical schools and other health related educations must be quantitatively and qualitatively improved, including psychological treatments. The current move of the pharmaceutical industry away from brain related indications must be halted and reversed. Continued research into the cost of the many disorders not included in the present study is warranted. It is essential that not only the EU but also the national governments forcefully support these initiatives.

The size and burden of mental disorders and other disorders of the brain in Europe 2010

AIMS

To provide 12-month prevalence and disability burden estimates of a broad range of mental and neurological disorders in the European Union (EU) and to compare these findings to previous estimates. Referring to our previous 2005 review, improved up-to-date data for the enlarged EU on a broader range of disorders than previously covered are needed for basic, clinical and public health research and policy decisions and to inform about the estimated number of persons affected in the EU.

METHOD

Stepwise multi-method approach, consisting of systematic literature reviews, reanalyses of existing data sets, national surveys and expert consultations. Studies and data from all member states of the European Union (EU-27) plus Switzerland, Iceland and Norway were included. Supplementary information about neurological disorders is provided, although methodological constraints prohibited the derivation of overall prevalence estimates for mental and neurological disorders. Disease burden was measured by disability adjusted life years (DALY).

RESULTS

Prevalence: It is estimated that each year 38.2% of the EU population suffers from a mental disorder. Adjusted for age and comorbidity, this corresponds to 164.8million persons affected. Compared to 2005 (27.4%) this higher estimate is entirely due to the inclusion of 14 new disorders also covering childhood/adolescence as well as the elderly. The estimated higher number of persons affected (2011: 165m vs. 2005: 82m) is due to coverage of childhood and old age populations, new disorders and of new EU membership states. The most frequent disorders are anxiety disorders (14.0%), insomnia (7.0%), major depression (6.9%), somatoform (6.3%), alcohol and drug dependence (>4%), ADHD (5%) in the young, and dementia (1-30%, depending on age). Except for substance use disorders and mental retardation, there were no substantial cultural or country variations. Although many sources, including national health insurance programs, reveal increases in sick leave, early retirement and treatment rates due to mental disorders, rates in the community have not increased with a few exceptions (i.e. dementia). There were also no consistent indications of improvements with regard to low treatment rates, delayed treatment provision and grossly inadequate treatment. Disability: Disorders of the brain and mental disorders in particular, contribute 26.6% of the total all cause burden, thus a greater proportion as compared to other regions of the world. The rank order of the most disabling diseases differs markedly by gender and age group; overall, the four most disabling single conditions were: depression, dementias, alcohol use disorders and stroke.

CONCLUSION

In every year over a third of the total EU population suffers from mental disorders. The true size of "disorders of the brain" including neurological disorders is even considerably larger. Disorders of the brain are the largest contributor to the all cause morbidity burden as measured by DALY in the EU. No indications for increasing overall rates of mental disorders were found nor of improved care and treatment since 2005; less than one third of all cases receive any treatment, suggesting a considerable level of unmet needs. We conclude that the true size and burden of disorders of the brain in the EU was significantly underestimated in the past. Concerted priority action is needed at all levels, including substantially increased funding for basic, clinical and public health research in order to identify better strategies for improved prevention and treatment for disorders of the brain as the core health challenge of the 21st century.

Impact of sociodemographic and health variables on mini-mental state examination in a community-based sample of older people

The mini-mental state examination (MMSE) has been widely used as a screening instrument for cognitive disorders. Age, schooling and many other sociodemographic and health variables may be associated with a worse performance on the MMSE. The objectives of this study were to investigate the distribution of MMSE percentiles in a large Brazilian community-based elderly sample, divided according to age and schooling, and to evaluate the impact of sociodemographic and health variables on groups of elderly people with lower cognitive performance. The MMSE was applied to a sample of 2,708 adults, aged 60 years and older. Of this population, 1,563 individuals were living in the city of São Paulo, while 1,145 were living in the city of Ribeirão Preto. The subjects were divided into six groups according to the amount of schooling that they had received (no formal education, 1-4 and ≥5 years) and age (<75 and ≥75 years old). To each one of the subgroups a stepwise logistic regression was applied, considering the following dependent variable: subjects who scored under or above the 15th percentile on MMSE. High scores on a depression scale, high scores on a memory complaints scale and low socio-economic levels were associated with poorer performance on the MMSE. Being currently employed and being married were related to higher scores on the test. Many sociodemographic and health variables can influence MMSE performance, with impacts depending on age and schooling. Clinicians and primary care physicians should pay attention to variables that may be associated with worse cognitive performance.

Physicians appeals on the dangers of mobile communication--what is the evidence? Assessment of public health data

In October 2002 German physicians appealed to persons in the field of health care, politicians and the public with "great concern" ("Freiburger Appell", "Appeal of Freiburg") claiming "soaring incidences of symptoms and diseases in the general population" to be causally related to the "commence of radio (wave) burden", i.e. due to mobile radio technology. This first example was followed by several further appeals published nationally and Europe-wide up until today. The aim of the present paper is an evaluation of the scientific literature and databases to check incidence and prevalence of symptoms and diseases stated in the appeals to have "dramatically increased" or to have appeared in "greater frequency" in adults. If the allegations were true a clear time-trend should show up since the start of widely-used mobile communication technology. The following health conditions were considered: Alzheimer's disease, dementia, sleep disturbances, tinnitus, cerebrovascular disease, ischemic heart-diseases, headache, migraine. Data on the incidence of these conditions were assessed from 1993 through at least 2005. For this, a systematic search by keywords was performed in the online-database of the National Library of Medicine (pubmed) and other national and international (European and US) databases. For none of the considered symptoms or diseases a "dramatic increase" was found to have occurred since 1993. Because of the different diagnoses and terms used in the studies, direct comparability is somewhat difficult. Indeed, with the data available no time related increases and surely no "dramatic increase" can be identified, even if the limited comparability is considered. This analysis strongly suggests that the allegations of the quoted appeals are not supported by public health data.

Cambridge Cognitive Examination: performance of healthy elderly Brazilians with low education levels

This study aimed to estimate the quartile distribution on the cognitive assessment of normal elderly with low education as measured by the Cambridge Cognitive Examination (CAMCOG). A sample of 292 elderly (> 65 years of age), screened for dementia and depression, were assessed using the CAMCOG. The CAMCOG scores of normal subjects (n = 206) were stratified according to age (65-69, 70-74, 75-79, > 80) and schooling (illiterate, 1-4, and > 5 years of formal education). Mean age was 72.8 (± 3.5) and mean schooling was 3.5 years (± 3). The mean score on the CAMCOG was 71 (± 12.7). The scores at the first quartile for illiterate/1-4 years of schooling were 58/62 (65-69 years), 52/63 (70-74 years), 48/67 (75-79 years) and 46/64 (> 80 years), respectively. There was a significant difference in the CAMCOG quartiles according to education and age. This study provides normative data on the CAMCOG of elderly people with low educational levels which may be clinically useful.

Prevalence of cognitive and functional impairment in a community sample from São Paulo, Brazil

AIMS

To present the prevalence of cognitive and functional impairment (CFI) in community-dwelling elderly subjects from the city of São Paulo.

METHODS

The population was aged 60 years and older (n = 1,563; 68.7% women and 31.3% men) and lived in different socioeconomic areas. The following instruments were administered to the elderly: the Mini Mental State Examination and the Fuld Object Memory Evaluation. The Informant Questionnaire on Cognitive Decline in the Elderly and the Bayer-Activities of Daily Living scale were administered to an informant.

RESULTS

The prevalence of CFI (n = 250) was 16% (95% confidence interval, CI: 14.2-17.8%) or 15.8% (95% CI: 13.8-17.8%). In regression models, the increase in the odds ratio (OR) of CFI was associated with age, for elderly individuals aged 75 years or older, illiterates or with 1-4 years of schooling, and with a history of stroke and diabetes mellitus. On the other hand, for subjects with a tumor history, the OR of CFI was significantly reduced.

CONCLUSION

CFI was high and increased at older ages and in subjects with low education. Potentially changeable factors were identified (stroke and diabetes), and the possible 'protective effect' of tumor/cancer against CFI should be further investigated by longitudinal studies.

Prevalence and pattern of cognitive impairment in a community cohort of men in South Wales: methodology and findings from the Caerphilly Prospective Study

BACKGROUND/AIMS

The prevalence of dementia and cognitive impairment not dementia was investigated in the Caerphilly Prospective Study cohort (men currently aged 65-84 years).

METHODS

Of 1,633 men eligible for cognitive screening, 1,225 (75%) were seen, with those failing the screening criteria (CAMCOG <83 or decline in CAMCOG >9) being neurologically examined.

RESULTS

For dementia, diagnosed by DSM-IV criteria, the population prevalence was 5.2% rising to 6.1% in the screened population. For cognitive impairment not dementia, the prevalence in the screened population was 15.6% giving an overall prevalence of cognitive impairment of 21.8%. Prevalence rose fivefold between ages of 65 and 84 years to reach over 50%.

CONCLUSION

These figures are likely to underestimate actual prevalence in this population, and developing effective interventions should be a public health priority.

The prevalence of dementia in an urban Turkish population

A cross-sectional, population-based, 2-stage prevalence study was conducted in a sample of 1019 community-dwelling persons over the age of 70 years living in Istanbul. In the first phase, participants were screened with the Mini-Mental State Examination for evidence of cognitive impairment. In the second phase, 79% of those who screened positive (n = 322) and 9% of screen-negatives (n = 63) underwent a standardized diagnostic workup. Diagnosis of dementia and Alzheimer's disease (AD) was made according to established criteria. Ninety-three cases of dementia were identified, 58 of whom were diagnosed with probable AD. Based on these numbers, the prevalence rates of probable AD and dementia were calculated to be 11.0% (95% CI, 7.0% to 15.0%) and 20.0% (95% CI, 14.0% to 26.0%), respectively, in this population. Prevalence rates of dementia and AD in Istanbul, Turkey, are comparable with those seen in the Western world.

Systematic review of dementia prevalence 1994 to 2000

Ageing has occurred in all regions of the world, with impact on neuropsychiatric disorders, particularly dementia. However, previous meta-analysis and reviews have shown high variability in world dementia prevalence rates.

Prevalence of cognitive and functional impairment in a community sample in Ribeirão Preto, Brazil

OBJECTIVE

This study aimed at estimating the prevalence of cognitive and functional impairment (CFI) in a community sample in Ribeirão Preto, Brazil, evaluating its distribution in relation to various socio-demographic and clinical factors.

METHODS

The population was a representative sample aged 60 and older, from three different socio-economic classes. Cluster sampling was applied. Instruments used to select CFI (a syndromic category that does not exclude dementia): 'Mini Mental State Examination' (MMSE), 'Fuld Object Memory Evaluation' (FOME), 'Informant Questionnaire on Cognitive Decline in the Elderly' (IQCODE), 'Bayer Activities of Daily Living Scale' (B-ADL) and clinical interviews. The data obtained were submitted to bivariate and logistic regression analysis.

RESULTS

A sample of 1.145 elderly persons was evaluated, with a mean age of 70.9 years (60-100; DP: 7.7); 63.4% were female, and 52.8% had up to 4 years of schooling. CFI prevalence was 18.9% (n = 217). Following logistic regression analysis, higher age, low education, stroke, epilepsy and depression were associated with CFI. Female sex, widowhood, low social class and head trauma were associated with CFI only on bivariate analysis.

CONCLUSION

CFI prevalence results were similar to those found by studies in Brazil, Puerto Rico and Malaysia. Cognitive and functional impairment is a rather heterogeneous condition which may be associated with various clinical conditions found in the elderly population. Due to its high prevalence and association with higher mortality and disability rates, this clinical syndrome should receive more attention on public health intervention planning.

Age-Varying Association Between Blood Pressure and Risk of Dementia in Those Aged 65 and Older: A Community-Based Prospective Cohort Study

OBJECTIVES

To assess variation in the association between blood pressure (BP) and risk for dementia across a spectrum of older ages and to examine BP changes before dementia onset.

DESIGN

Prospective cohort study.

SETTING

A large health maintenance organization in Seattle, Washington.

PARTICIPANTS

A cohort of 2,356 members of a large health maintenance organization aged 65 and older who were initially without dementia.

MEASUREMENTS

Dementia diagnosis was assessed biennially, and systolic (SBP) and diastolic BP (DBP) were measured at baseline and at four follow-up assessments. Cox proportional hazards models were used to estimate hazard ratios (HRs) for dementia and Alzheimer's disease (AD) associated with baseline BP in different age groups.

RESULTS

Within the youngest age group (65-74 at enrollment) a greater risk for dementia was found in participants with high SBP (> or = 160 mmHg) (hazard ratio (HR) = 1.60, 95% confidence interval (CI) = 1.01-2.55) or borderline-high DBP (80-89 mmHg) (HR = 1.59, 95% CI = 1.07-2.35) than for those with normal BP (SBP < 140 mmHg and DBP < 80 mmHg). The dementia risk associated with SBP declined with increasing age (SBP-by-age interaction, P=.01). SBP declined similarly with aging in subjects who developed dementia and those who did not. Thus, in this sample, the association between SBP and dementia risk was not dependent on when BP was measured in relation to onset of dementia.

CONCLUSION

High SBP was associated with greater risk of dementia in the young elderly (< 75) but not in older subjects. Adequate control of hypertension in early old age may reduce the risk for dementia.

Serum surfactant protein D is correlated to development of dementia and augmented mortality

Development of dementia, including Alzheimer's disease (AD), is associated with lipid dysregulation and inflammation. As the host defense lectin surfactant protein D (SP-D) has multiple effects in lipid homeostasis and inflammation, the correlation between SP-D concentrations and development of dementia was investigated. A total of 418 non-demented persons were included in the study and cognitively re-examined after 3 years, while survival was followed for 11 years. Serum SP-D concentrations were measured at baseline. Logistic regression analysis controlling for age, gender, smoking status, and CRP showed that Odds Ratio for developing dementia was 2.62 (1.12-6.15) with an SP-D concentration in the highest quartile compared to the other quartiles. The risk of AD was 2.55 (0.95-6.90). Cox regression controlling for the same variables showed that hazard ratio of death was 1.43 (1.06-1.92) in the highest quartile. SP-D concentration thus correlates to development of dementia as well as to augmented mortality.

Cerebrovascular disease and dementia

Cerebrovascular disease (CVD) is an important cause of psychiatric disability in the elderly. Much of this disability can be attributed to dementia and lesser degrees of cognitive impairment, which result from strokes and other forms of cerebrovascular pathology. While vascular dementia is common, estimates of its frequency vary due to its clinical and pathologic heterogeneity, the challenges involved in its measurement and its frequent co-occurrence with Alzheimer's disease. Nevertheless the clinical features and natural histories of vascular dementia can be described, and risk factors have been identified and include hypertension, diabetes mellitus, hyperlipidaemia, other conditions that promote atherosclerosis, and rare genetic mutations. While vascular dementia is not curable, treatments are available. For example, a few recent clinical trials suggest that cholinesterase inhibitors have some efficacy. Our knowledge of the risk factors has also provided opportunities for the primary and secondary prevention of vascular dementia, and indicates promising avenues for research.

Dementia in subjects aged 75 years or over within the PAQUID cohort: prevalence and burden by severity

BACKGROUND/AIMS

To analyze the prevalence of dementia by severity and to describe the sociodemographic characteristics of people with dementia in the community, as well as the consequences of this disease in terms of disability and institutionalization.

METHODS

This study was based on the PAQUID community-based cohort study of 1,461 subjects aged 75 years or over. Severity of dementia was assessed using the Mini-Mental State Examination (MMSE).

RESULTS

The prevalence of dementia was estimated to be 17.8%, with about 43% at a moderately severe or more severe stage of the disease (MMSE <or= 15). About 39% of the people with dementia lived in an institution. Among the institutionalized residents, 71.6% were diagnosed as demented. About 57% of the people with dementia were ADL disabled. In this over-75 population, people with dementia accounted for 74% of the ADL-disabled subjects. The consequences of dementia were particularly frequent among the subjects who were at least at a moderately severe stage of dementia, with 59.6% of them living in institution and 87.2% being ADL disabled.

CONCLUSION

These results confirm the high prevalence of dementia in subjects aged over 75 and illustrate the devastating consequences of this disease in terms of disability and institutionalization.

The state of mental health in old-age across the 'old' European Union-- a systematic review

OBJECTIVE

The paper provides the first syllabus on the prevalence of mental disorders in old-age focusing on surveys conducted in the 15 countries, which comprised the 'old' European Union.

METHOD

A systematic search of the literature published from 1990 onwards was conducted.

RESULTS

Mental disorders in old-age are common. The most serious threats to mental health in old-age are posed by dementia and depression. It is a clear cut finding that dementia exponentially increases with age. The basic issue of whether depression increases or decreases with age remains unsolved. Databases on substance use, mild cognitive impairment, psychotic syndromes, anxiety, and somatoform disorders in old-age are much smaller, making conclusions difficult to draw.

CONCLUSION

Numerous questions in the field remain to be answered. Concerted action is needed to produce comparable data across Europe.

Prevalence of dementia in the elderly in Europe

Dementia is an important public health problem as it is one of the most common diseases in the elderly and a major cause of disability and mortality. This review on dementia is restricted to European Union countries where the overwhelming majority of studies have been undertaken, and will also refer to the EURODEM publications which may be considered to be the principal European reference point in this area. In subjects aged over 65, crude prevalence rates for dementia varied between 5.9% and 9.4%. We discuss the major problems limiting the use of these estimations, limits which may differ according to the area of application, be it etiological research or care provision.

Relationship of Leukoaraiosis to Cognitive Decline and Cognitive Aging

OBJECTIVE

Leukoaraiosis (LA) is a common finding on MRI scans of the elderly. However, its exact relationship to cognitive decline and dementia is in dispute. Because LA involves the paracallosal white matter, we sought to determine if LA, uncomplicated by ischemic lesions or complaints of cognitive impairment, is associated with cognitive loss or difficulties with interhemispheric integration of behavioral functions.

METHODS

Two hundred fifty-seven MRI scans with deep white matter changes were screened. After a chart review, 38 patients had uncomplicated LA, and 31 gave informed consent to undergo cognitive and behavioral testing.

RESULTS

LA severity was not related to any of the cognitive or behavioral assessments. However, some dependent measures showed medium effect sizes that were in keeping with published findings, indicating that LA has a marginal impact on cognition. In comparison, robust relationships with age were found for certain tasks, suggesting that our cohort size was sufficient to detect meaningful clinical relationships.

CONCLUSION

Based on statistical interpretations using effect sizes, LA severity may be better viewed as a biomarker for physiological brain aging that is in advance of chronological age, leaving the elderly individual at greater risk for developing dementia.

Depression and the Risk of Alzheimer Disease

BACKGROUND

Several epidemiologic studies have examined depression as a risk factor for Alzheimer disease with conflicting results. Most studies relied on self-reported depression, but the agreement between self-reported depression and clinical diagnosis has been reported to be weak, thereby diluting the association.

METHODS

A population-based cohort in Odense, Denmark, of 3346 persons age 65-84 years was examined at baseline (1992-1994) and after 2 years (1994-1996) and 5 years (1997-1999). History of depression was collected at baseline as self-report. We used logistic regression models to estimate odds ratios (ORs) and 95% confidence intervals (CIs).

RESULTS

Persons with a history of depression had an increased risk of Alzheimer disease both at baseline (OR = 1.7; CI = 1.0-2.7) and at follow up (at 2 years, 1.9 [1.0-3.3] and at 5 years, 1.6 [0.9-2.7]).

CONCLUSIONS

Depression was associated with an increased risk of Alzheimer disease. The odds ratios were lower than generally reported from follow-up studies and are similar to cross-sectional studies.

Traitement anticholinestérasique de la maladie d’Alzheimer en Picardie

INTRODUCTION

Despite numerous advances in the management of patients with Alzheimer's disease (AD), the proportion of patients treated according to current recommendations remains unknown.

METHODS

In order to examine this point, we performed a study assessing the proportion of AD patients receiving one acetylcholinesterase inhibitor. This study was performed in Picardy (1.9 millions of inhabitants) in 2000 and 2001. The number of patients receiving one acetylcholinesterase inhibitor (tacrine, donepezil, rivastigmine and galantamine) was determined using data from health insurance and from pharmaceutical companies.

RESULTS

The prevalence of AD was estimated to vary from 10751 patients in 2000, to 10990 in 2001. The number of treated patients was 1798 in 2000 and 2572 in 2001 and this corresponded to 16.7 percent (95CI: 2.5) and 23.4 percent (95CI: 3.4) of prevalent cases, respectively. Following the exclusion of patients with moderate to severe AD (estimated to represent 25 percent of patients), the proportion of treated patients reached 22.4 percent (95CI: 2.3) in 2000 and 31.3 percent (95CI: 3.1) in 2001.

CONCLUSIONS

Despite a significant increase between 2000 and 2001, this study shows that less than a third of AD patients with mild to moderate dementia were treated with acetylcholinesterase inhibitors. Although numerous factors might have affected our estimations, this study shows that effective care of AD patients remains largely insufficient.

Ability to perform activities of daily living is the main factor affecting quality of life in patients with dementia

Background

Dementia is a chronic illness associated with a progressive loss of cognitive and intellectual abilities, such as memory, judgment and abstract thinking.

The objective of this study was to assess the health utilities of patients with dementia in Europe and identify the key factors influencing their Health-Related Quality of Life (HRQol).

Methods

This study used cross-sectional data from the Odense study; a Danish cohort of patients aged 65–84 living in Odense, Denmark. A total of 244 patients with mild to severe dementia were interviewed together with a caregiver about their health status and activities of daily living (ADL). Alzheimer's disease was diagnosed according to the NINCDS-ADRDA criteria for probable dementia. Vascular dementia and other types of dementia were diagnosed according to the DSM-IIIR criteria. Severity of dementia was defined by score intervals on the Mini Mental State Examination score: mild (MMSE 20–30), moderate (MMSE 10–19), and severe (MMSE 0–9). Based on the ADL information, the patients' dependency level was defined as either dependent or independent. Questions from the Odense Study were mapped into each of the five dimensions of the EQ-5D in order to assess patients' HRQol. Danish EQ-5D social tariffs were used to value patients' HRQol.

A regression analysis of EQ-5D values was conducted with backward selection on gender, age, severity, ADL level and setting in order to determine the main factor influencing HRQoL.

Results

The EQ-5D weight in patients independent upon others in ADL was 0.641 (95% CI: [0.612–0.669]), and in those dependent upon others was 0.343 (95% CI: [0.251–0.436]).

Conclusion

Dependency upon others to perform ADL was the main factor affecting HRQoL.

Prevalence and cognitive performances of clinical dementia rating 0.5 and mild cognitive impairment in Japan. The Tajiri project

The borderline zone condition between normal aging and dementia is a major issue of concern. Although the term mild cognitive impairment (MCI) is popular, its prevalence and neuropsychological features have not been fully investigated. We investigated the prevalence and neuropsychological features for Clinical Dementia Rating (CDR) 0.5 and MCI. For normal aging, the effects of age and educational level on cognitive performance were examined. We examined 1501 older residents (46.8%) in Tajiri 65 years of age and older. They performed the Cognitive Abilities Screening Instrument (CASI). Depressive scores and subjective memory complaints were also evaluated. There was no age effect but an educational effect on cognitive performance in healthy adults. We found the overall prevalence of CDR 0.5 to be 30.2%, whereas that of MCI was only 4.9%. All CASI domains were deteriorated except for long-term memory and visual construction in the CDR 0.5 participants compared with healthy adults, suggesting that CDR 0.5 is similar to very mild Alzheimer disease. Memory complaints' data suggested that it would be better to exclude memory complaints from the MCI criteria. We considered that the concept of CDR 0.5 would be more applicable to community residents rather than that of the MCI.

Cost of dementia: impact of disease progression estimated in longitudinal data

AIMS

Several studies have shown that health care costs are higher for demented than for non-demented persons and that health care costs are higher for more severe demented persons than less severe demented persons. However, most studies report on cross-sectional study designs, and thus fail to examine the influence of disease progression on changes in health care costs to individual persons. The objective of this study was, using longitudinal data, to examine changes in total health care costs with disease progression in demented persons.

METHODS

We assumed that disease progression could be characterised by transitions between different states of dementia which reflected the degree to which the disease progressed over time. Then, changes in health care costs were regressed on a set of explanatory variables including disease progression. A total of 465 demented and non-demented persons were interviewed twice. The time between interviews was about three years. Before each interview, the participant was examined for dementia and classified by type of dementia (Alzheimer's disease, vascular or other types of dementia) and degree of dementia (very mild, mild, moderate, severe).

RESULTS

The results of this longitudinal study confirmed that health care costs increased over time for non-demented as well as for demented persons and that health care costs increased with disease progression. In particular, the health care costs increased when the disease had progressed into the severe state of the dementia. Also, decline in functional abilities was an important factor for explaining changes in health care costs.

Performance and normative values of a concise neuropsychological test (CAMCOG) in an elderly population sample

BACKGROUND

CAMCOG is a widely used brief neuropsychological test. To date no normative values are available for English speaking individuals representative of the general population.

OBJECTIVES

The aims of the study were to describe the population distribution of performance on CAMCOG, and to provide normative data derived from a representative population sample.

METHODS

CAMCOG was administered at the assessment stage of the MRC Cognitive Function and Ageing Study. MRC CFAS is a multi-centre population-based study in England and Wales in respondents aged 65 years and older. Initial screening provided provisional identification of cognitive impairment. The subsequent assessment interview provided an algorithmic diagnosis of dementia, or other disorders, in a 20% sub-sample.

RESULTS

There were large differences between demented and non-demented groups on the CAMCOG total score and on all CAMCOG subscales. Charts of normative values for CAMCOG are presented by age group, sex and education for the non-demented population (n = 1 914, representing 11 008 individuals screened).

CONCLUSIONS

Population-derived normative data are valuable for comparing an individual's score to the score which would be expected of the general population, given the individual's specific demographic characteristics.

Diagnosing dementia in a developing nation: an evaluation of the GMS-AGECAT algorithm in an older Korean population

BACKGROUND

Numbers of older people are increasing rapidly in many developing nations and there is a pressing need for epidemiological studies of psychiatric morbidity, particularly dementia. Valid methods for case identification are an important first step. The Geriatric Mental State (GMS) is a widely used diagnostic instrument but has received little formal evaluation in developing nations. The objective of this study was to investigate the screening properties of GMS organic disorder with respect to clinically diagnosed dementia in an older Korean population, about half of whom have received no formal education.

METHODS

746 people aged 65+ in Kwangju, South Korea who were participants in a community survey of psychiatic morbidity, completed a GMS interview (with diagnoses assigned through the AGECAT computerised algorithm) and, independently, received a clinical assessment for dementia.

RESULTS

GMS organic disorder was diagnosed in 262 participants (35%) and DSM-IV dementia in 110 (15%). Increased age, female gender and lower education independently predicted disagreement between the two diagnoses. In these groups, GMS sensitivity to a clinical diagnosis of dementia remained high but specificity was markedly reduced.

CONCLUSIONS

Dementia may be overestimated in developing nations if the GMS-AGECAT diagnosis of organic disorder is used alone. The validity of other diagnoses, such as affective disorder, may also be affected if the hierarchical diagnostic algorithm is used (i.e. where the diagnosis of organic disorder affects the likelihood of other diagnoses).

Cognitive function and acute care utilization

OBJECTIVES

Little is known about variation in cognitive function across the aged population, or how use and costs of health care vary with cognitive impairment. This study was designed to create a typology of cognitive function in a nationally representative sample, and evaluate acute care use in relation to cognitive function, holding constant confounding factors. By including proxy assessments of cognitive function, this is the first study to include individuals unable to respond themselves.

METHODS

We analyzed the baseline year of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey, sponsored by the National Institute on Aging, to create three levels of cognitive function, using direct measures for self-respondents (n = 6,651) and proxy evaluations for the others (n = 792). We used a two-part model to predict the likelihood of using various health services and to evaluate intensity of care among users.

RESULTS

Sixteen percent, 64%, and 20% of the sample fell into the low, moderate, and high cognitive function groups, respectively, that differed significantly on almost all demographic and health status measures, and some utilization measures. Controlling for other health and functional status measures, lower cognitive function had a significant and negative effect on outpatient services, but did not affect hospital use directly.

DISCUSSION

Lower cognitive function may be a barrier to outpatient care, but these analyses should be repeated using administrative use and cost data.

Mild cognitive impairment--a review of prevalence, incidence and outcome according to current approaches

OBJECTIVE

Mild cognitive impairment is associated with an increased risk of developing dementia. However, agreement needs to be reached on clearly specified diagnostic criteria for mild cognitive impairment. The present paper critically reviews the different constructs of mild cognitive impairment on the basis of the available empirical evidence.

METHOD

All published papers on mild cognitive impairment during the last 15 years on Medline and other databases were reviewed.

RESULTS

Age-specific prevalence and incidence rates according to the different constructs as well as the prognostic significance of the different constructs concerning the development of dementia are reported. Furthermore, a brief summary of recent research on possible risk factors for a negative course of mild cognitive impairment is provided.

CONCLUSION

As there is no construct to date that pools all efforts of defining mild cognitive impairment, the review provides suggestions for an agreement on constructive terminology and research practice.

Mixed dementia: epidemiology, diagnosis, and treatment

Alzheimer's disease (AD) and vascular dementia (VaD) are the most frequent causes of dementia in older people. Although AD can be diagnosed with a considerable degree of accuracy, the distinction between isolated AD, VaD, and mixed dementia (MD), where both pathologies coexist in the same patient, remains a controversial issue and one of the most difficult diagnostic challenges. Although MD represents a very frequent pathology, especially in older people, as reported in neuropathological studies, the respective importance of degenerative and vascular lesions, their interaction in the genesis of dementia, and the mere existence of MD are still debated. Accurate diagnosis of MD is of crucial significance for epidemiological purposes and for preventive and therapeutic strategies. Until recently, pharmacological studies have generally focused on pure disease, AD or VaD, and have provided little information on the best therapeutic approach to MD. This article provides an overview of MD in older people. A retrospective review of the recent literature on prevalence, incidence, course, risk factors, diagnosis, and treatment of MD was performed. The article also emphasizes the need for further studies, including neuropsychological and functional evaluations, and neuroimaging and clinicopathological correlations to develop a better understanding of MD, which appears to be one of the most common forms of dementia.

[Prevalence of dementia in several regions of the world: analysis of epidemiologic studies from 1994 to 2000]

OBJECTIVE

To analyse the prevalence studies of dementia from 1994 to 2000.

METHODS

The papers were searched on Medline and Lilacs and the inclusion criteria were: to be an original study, that estimated dementia prevalence and investigated community samples.

RESULTS

thirty-eight studies were evaluated from all continents. The mean age-specific prevalence rates of dementia were 1,17% for the 65-69 years group, and 54,83% over 95 years. The results were strongly influenced by age. Dementia prevalence rates were higher on women on 75% of the papers reviewed. The Alzheimer's disease/vascular dementia ratio was higher in South America and lower in Asia.

DISCUSSION

Methodological advances were found, specially regarding the homogeneity of diagnostic criteria. The effect of age on the rates of dementia prevalence was pronounced, up to 90 years of age.

A review of the epidemiological transition in dementia--cross-national comparisons of the indices related to Alzheimer's disease and vascular dementia

OBJECTIVE

To examine temporal changes in the prevalence of dementia and associated factors.

METHOD

All publications on the epidemiology of dementia were identified using a medline search for the years 1966-1999.

RESULTS

Alzheimer's disease (AD) has become nearly twice as prevalent as vascular dementia (VaD) in Korea, Japan, and China since transition in early 1990s. Prior to this, in the 1980s, VaD was more prevalent than AD in these countries. In Nigeria, the prevalence of dementia was low. Indian studies were contradictory, with both AD and VaD being more prevalent in different studies. American and European studies consistently reported AD to be more prevalent than VaD.

CONCLUSION

A theoretical model of transition from low incidence-high mortality society to high incidence-high mortality society to low incidence-low mortality society may explain these findings. Rigorous testing in prospective, longitudinal and population-based cross-national studies using culture-fair diagnostic instruments is required.

Are cognitively impaired individuals adequately represented in community surveys? Recruitment challenges and strategies to facilitate participation in community surveys of older adults. A review

BACKGROUND

Dementia is the most important age-related disorder and subject to a substantial body of epidemiological research. However, field work in elderly populations faces special challenges which may reduce response rates and invalidate survey results. Therefore, this paper will review more recent prevalence studies of dementia to examine how recruitment issues and their influence on the study outcome have been addressed.

METHODS

Field studies of the elderly with the main focus on prevalence of dementia published over the last 10 years will be systematically reviewed. The review concerns sampling frames, ways to include institutionalised individuals, response rates and strategies to deal with special challenges of field work in elderly populations such as mortality, fragility and sensory impairment. Furthermore, papers were evaluated regarding the extent to which recruitment outcomes were discussed.

RESULTS

The literature is characterised by a disregard of recruitment issues to a varying extent. Mortality, functional dependency and sensory impairment (all positively related to dementia) are barely taken into account in the study design and rarely discussed. As a consequence, cognitively impaired individuals are likely to be underrepresented in most community studies.

CONCLUSION

Strategies to deal with special challenges of field work in the elderly in a systematic manner and to facilitate participation in population surveys of the elderly are crucial and will be outlined. Communication on recruitment issues is essential to improve the validity of study outcomes.