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Dominguez J, de Guzman MF, Chen SHA, Sano M, Waldemar G, Phung TKT. Filipino Multicomponent Intervention to Maintain Cognitive Performance in High-Risk Population (FINOMAIN): Study Protocol for a Cluster Randomized Controlled Trial. Front Neurol 2021; 12:685721. [PMID: 34557142 PMCID: PMC8453078 DOI: 10.3389/fneur.2021.685721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/20/2021] [Indexed: 12/03/2022] Open
Abstract
Background: More than half of the people with dementia live in lower-middle income countries (LMIC), yet we lack research and evidence-based knowledge to guide health promotion and prevention strategies for cognitive decline. In the Philippines, the prevalence of mild cognitive impairment (MCI) and cardiovascular risk factors among older persons are high, making this population at high risk for developing dementia. This protocol describes a cluster randomized controlled trial that aims to investigate the efficacy of a multicomponent intervention to maintain cognitive performance among high-risk population. Methods: This is a cluster-randomized, two-arm, single-blind trial of a multicomponent intervention that combines dance called INDAK (Improving Neurocognition through Dance and Kinesthetics), nutrition counseling, and vascular risk management. The intervention arm will receive 12 months (1-h, twice per week) of INDAK and every 3 months of nutrition counseling and intensive vascular risk management and monitoring. The control group will receive the usual vascular care advice and referral. A total of 605 (20–25 clusters per arm) community-dwelling Filipino older adults aged ≥ 60 years old with MCI will participate in the study and will be assessed at baseline, 6th- and 12th-month follow-up. The primary outcome is cognitive performance assessed by the Alzheimer's Disease Assessment Scale—Cognitive (ADAS-Cog), Mnemonic Similarity Tasks (MST), and executive function composite (EFC). Secondary outcomes are functional connectivity assessed through brain imaging, and measures of behavioral, functional level, and quality of life. Discussion: The study aims to provide scientific evidence on a public health intervention that is contextualized in a community setting to reduce dementia risk among older adults with MCI. This model can be an ecological, low-cost, and effective program, thereby conducive to widespread implementation in the Philippines as well as in other low-resource settings with similar public health challenges. The pilot phase was underway with eight villages (clusters), but temporarily interrupted by the pandemic. The full study is anticipated to start after community restrictions are eased.
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Affiliation(s)
- Jacqueline Dominguez
- St. Luke's Medical Center, Institute for Neurosciences, Quezon City, Philippines.,Institute for Dementia Care Asia, Quezon City, Philippines
| | | | - S H Annabel Chen
- Center of Research and Development in Learning, Psychology, School of Social Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Mary Sano
- Department of Psychiatry, Mt. Sinai Alzheimer's Disease Research Center, Icahn School of Medicine, New York, NY, United States
| | - Gunhild Waldemar
- Danish Dementia Research Center, Rigohospitalet, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thien Kieu Thi Phung
- Danish Dementia Research Center, Rigohospitalet, University of Copenhagen, Copenhagen, Denmark
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Dominguez J, Jiloca L, Fowler KC, De Guzman MF, Dominguez-Awao JK, Natividad B, Domingo J, Dominguez JD, Reandelar M, Ligsay A, Yu JR, Aichele S, Phung TKT. Dementia Incidence, Burden and Cost of Care: A Filipino Community-Based Study. Front Public Health 2021; 9:628700. [PMID: 34055712 PMCID: PMC8160123 DOI: 10.3389/fpubh.2021.628700] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 04/12/2021] [Indexed: 11/26/2022] Open
Abstract
Background: In the midst of competing priorities and limited resources in low-middle-income countries (LMIC), convincing epidemiological evidence is critical for urging governments to develop national dementia plans. The majority of primary epidemiological studies on dementia are from high income countries (HIC). Implications for developing countries are typically extrapolated from these outcomes through modeling, meta-analyses, and systematic reviews. In this study, we directly assessed the incidence of dementia, disability adjusted life years (DALYs), and cost of care among community-dwelling Filipino elderly. Methods: This was a follow-up study of the prospective cohort Marikina Memory Ageing Project (MMAP). Baseline assessment was performed in 2011–2012, and follow-up was done in 2015–2016 (N = 748 at follow-up). Incident dementia was determined. Disease burden was computed using the incidence rates and DALYs. Both indirect and direct (medical and non-medical) costs of dementia care were computed. Results: The crude incidence rate was 16 (CI: 13–20) cases per 1,000 person-years (pyr) with 17 (CI: 12–21) per 1,000 pyr for females and 14 (CI: 9–21) per 1,000 pyr for males. Based on this incidence, we project an estimation of 220,632 new cases in 2030, 295,066 in 2040, and 378,461 in 2050. Disease burden was at 2,876 DALYsper 100,000 persons. The economic burden per patient was around Php 196,000 annually (i.e., ~4,070 USD, or 36.7% of average family annual income in the Philippines). The majority (86.29%) of this care expense was indirect cost attributed to estimated lost potential earning of unpaid family caregivers whereas direct medical cost accounted for only 13.48%. Conclusions: We provide the first Filipino community-based data on the incidence of dementia, DALYs, and cost of care to reflect the epidemiologic and economic impact of disease. The findings of this study serve to guide the development of a national dementia plan.
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Affiliation(s)
- Jacqueline Dominguez
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines.,Institute for Dementia Care Asia, Quezon City, Philippines
| | - Leo Jiloca
- Geriatric Center, St. Luke's Medical Center, Quezon City, Philippines
| | - Krizelle Cleo Fowler
- Research and Biotechnology Division, St. Luke's Medical Center, Quezon City, Philippines
| | - Ma Fe De Guzman
- Research and Biotechnology Division, St. Luke's Medical Center, Quezon City, Philippines
| | - Jhozel Kim Dominguez-Awao
- Institute for Dementia Care Asia, Quezon City, Philippines.,Department of Internal Medicine, St. Louis University Hospital, Baguio, Philippines
| | - Boots Natividad
- Research and Biotechnology Division, St. Luke's Medical Center, Quezon City, Philippines
| | - Jeffrey Domingo
- Institute for Dementia Care Asia, Quezon City, Philippines.,Research and Biotechnology Division, St. Luke's Medical Center, Quezon City, Philippines
| | - Jayvee Dyne Dominguez
- Institute for Dementia Care Asia, Quezon City, Philippines.,Research and Biotechnology Division, St. Luke's Medical Center, Quezon City, Philippines
| | - Macario Reandelar
- Research and Biotechnology Division, St. Luke's Medical Center, Quezon City, Philippines
| | - Antonio Ligsay
- Section of Clinical Research, St. Luke's Medical Center - College of Medicine, Quezon City, Philippines
| | - Jeryl Ritzi Yu
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Stephen Aichele
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, United States
| | - Thien Kieu Thi Phung
- Danish Dementia Research Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Moral MCOD, Dominguez JC, Phung TKT, Guzman MFP, Moral RMOD. Baseline findings of the Filipino Multicomponent Intervention to Maintain Cognitive Performance among High‐Risk Populations (FINOMAIN) study. Alzheimers Dement 2020. [DOI: 10.1002/alz.046657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cano J, Guzman MFP, Phung TKT, Dominguez JC. CAIDE dementia risk score and cognitive correlates among Filipinos with mild cognitive impairment. Alzheimers Dement 2020. [DOI: 10.1002/alz.045630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Dominguez JC, De Guzman MFP, Guevarra ACD, Yu JMF, Sales MPL, Orense CL, Montalvo MJY, Decena J, Natividad BP, Citron RLB, Galvez FJ, Marra K, Phung TKT. Filipino Multicomponent Intervention to Maintain Cognitive Performance among High‐Risk Populations (FINOMAIN): Challenges in design and delivery of complex interventions. Alzheimers Dement 2020. [DOI: 10.1002/alz.046653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
| | | | | | - Justine Megan F Yu
- Institute for Neurosciences St. Luke's Medical Center Quezon City Philippines
| | - Ma Paz Lugay Sales
- Nutritionist Dietitians and Association of the Philippines Makati City Philippines
| | - Consuelo Luber Orense
- Food & Nutrition Research Institute Department of Science & Technology Taguig City Philippines
| | | | | | | | | | - Francy Joy Galvez
- Institute of Neurosciences St Luke's Medical Center Quezon City Philippines
| | - Kate Marra
- Institute for Dementia Care Asia Quezon Philippines
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Dominguez JC, Citron RLB, De Guzman MFP, Guevarra ACD, Yu JMF, Galvez FJ, Natividad BP, Phung TKT. Cognitive test norms and comparison to normal cognition and mild cognitive impairment: A population‐based study among community‐dwelling Filipinos. Alzheimers Dement 2020. [DOI: 10.1002/alz.044303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | | | | | - Justine Megan F. Yu
- Institute for Neurosciences St. Luke's Medical Center Quezon City Philippines
| | - Francy Joy Galvez
- Institute of Neurosciences St Luke's Medical Center Quezon City Philippines
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Guevarra ACD, De Guzman MFP, Galvez FJ, Rodriguez A, Citron RLB, Yu JMF, Rivamonte V, Phung TKT, Dominguez JC. Vascular risk and neuroimaging profile of MCI patients in the FINOMAIN Study. Alzheimers Dement 2020. [DOI: 10.1002/alz.042814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
| | | | - Francy Joy Galvez
- Institute of Neurosciences St Luke's Medical Center Quezon City Philippines
| | | | | | - Justine Megan F Yu
- Institute for Neurosciences St. Luke's Medical Center Quezon City Philippines
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Nabe-Nielsen K, Rod NH, Hansen ÅM, Prescott E, Grynderup MB, Islamoska S, Ishtiak-Ahmed K, Garde AH, Gyntelberg F, Mortensen EL, Phung TKT, Waldemar G, Westendorp RGJ. Perceived stress and dementia: Results from the Copenhagen city heart study. Aging Ment Health 2020; 24:1828-1836. [PMID: 31184203 DOI: 10.1080/13607863.2019.1625304] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objectives: We investigated if perceived stress in midlife increased the risk of dementia. Furthermore, we explored differences between subgroups related to sex, age and employment status when reporting stress.Methods: In this longitudinal study, we used information on perceived stress from 10,814 participants (mean age 56.7 years). Participants were followed through Danish national registers for development of dementia. Participants were considered at risk of dementia from the date they turned 60 years. Perceived stress was assessed as a combination of self-reported intensity and frequency of stress, and categorized into low (score 0-1), medium (score 2-4), and high stress (score 5-6). We used Poisson regression to estimate incidence rate ratios (IRR) and their 95% confidence intervals (CI) and adjusted for sociodemographic factors and psychiatric morbidity at baseline (main model) as well as cardio/cerebrovascular diseases and health behaviors at baseline (additional model).Results: The mean follow-up time was 13.8 years, and 1,519 participants were registered with dementia. Dementia risk was higher in participants reporting medium stress (IRR = 1.11, 95% CI: 0.99-1.24) and high stress (IRR = 1.36, 95% CI: 1.13-1.65). Adjustment for cardio/cerebrovascular diseases and health behaviors did not alter the results. We did not find strong support for differences between subgroups, although the association between stress and dementia was stronger for those who were employed at the time of reporting high stress.Conclusion: Our results provide empirical support for an effect of perceived stress on the risk of dementia in old age.
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Affiliation(s)
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | | | - Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Finn Gyntelberg
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Thien Kieu Thi Phung
- Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Ishtiak-Ahmed K, Hansen ÅM, Mortensen EL, Garde AH, Brødsgaard Grynderup M, Gyntelberg F, Islamoska S, Lund R, Phung TKT, Prescott E, Waldemar G, Nabe-Nielsen K. Midlife Forgetfulness and Risk of Dementia in Old Age: Results from the Danish Working Environment Cohort Study. Dement Geriatr Cogn Disord 2020; 47:264-273. [PMID: 31319407 DOI: 10.1159/000500184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 04/06/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite the current evidence of a high prevalence of forgetfulness in middle-aged individuals, and the evidence of a link between midlife memory complaints and biological changes in the brain, no previous study has yet investigated midlife forgetfulness in relation to risk of dementia in old age. AIMS We investigated whether midlife forgetfulness was an indicator of an increased risk of dementia in old age. METHODS We used data from 3,136 employed men and women who participated in the Danish Work Environment Cohort Study in 1990. These data were linked to Danish national registers. Participants were asked whether their closest relative had ever told them that they were forgetful. Incidence rate ratios (IRR) were estimated using Poisson regression analysis. RESULTS At baseline, 749 (24%) study participants were categorized as forgetful, and 86 (2.7%) participants were diagnosed with dementia during a total of 31,724 person-years at risk. After adjusting for sociodemographic factors, comorbidities, and work-related factors, midlife forgetfulness was associated with a higher risk of dementia (IRR = 1.82; 95% CI: 1.12-2.97). CONCLUSIONS This study is the first to investigate midlife forgetfulness and dementia, and the results suggest that midlife forgetfulness is an early indicator of an increased risk of dementia in old age.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark,
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,The National Research Centre for the Working Environment, Copenhagen, Denmark
| | | | - Finn Gyntelberg
- The National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rikke Lund
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Thien Kieu Thi Phung
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Dominguez JC, Phung TKT, de Guzman MFP, Fowler KC, Reandelar M, Natividad B, Waldemar G, Nielsen TR, Pamintuan Aquial MR, Holandez RL, Ligsay AD. Determining Filipino Normative Data for a Battery of Neuropsychological Tests: The Filipino Norming Project (FNP). Dement Geriatr Cogn Dis Extra 2019; 9:260-270. [PMID: 31572422 PMCID: PMC6751438 DOI: 10.1159/000500519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 01/12/2023] Open
Abstract
Background Filipino normative data for neuropsychological tests are lacking. Objectives This study aimed to determine the Filipino normative data for the Filipino Norming Project (FNP) Neuropsychological Battery, combining the Alzheimer's Disease Assessment Scale – Cognitive (ADAS-Cog) and the Neuropsychological Test Battery from the Uniform Dataset of Alzheimer's Disease Center (UDS-ADC). Methods We recruited participants 60 years and older with normal cognition (MMSE score of 25 and above and did not fulfill criteria for dementia according to DSM-IV criteria). Psychologists administered the tests to the study participants. We conducted multivariate analyses to study the effect of age, gender, and education on test performance. Results A total of 191 participants underwent the FNP Neuropsychological Test Battery. The mean age was 68.8 years (SD 5.4). The majority were female (84.1%). The mean score of ADAS-Cog was 9.98 (SD 4.74). The effect of education was prominent throughout the cognitive domains tested while the effect of age was limited to a few cognitive domains. The mean ADAS-Cog scores were 11.80 ± 4.40 for primary education, 9.93 ± 5.08 for secondary, and 8.15 ± 3.95 for tertiary. On average, women scored 2.75 points lower than men and performed better on the verbal components. Men performed better on the constructional praxis component. The same effect of education and gender was observed for the UDS-ADC. Conclusion For the first time, normative data are available for the ADAS-Cog and UDS-ADC for a Filipino older population. This study stresses the importance of establishing population-specific normative data, taking into account the specific sociocultural and linguistic context of that population.
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Affiliation(s)
| | - Thien Kieu Thi Phung
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Krizelle Cleo Fowler
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Macario Reandelar
- Research and Biotechnology Division, St. Luke's Medical Center, Quezon City, Philippines
| | - Boots Natividad
- Institute for Neurosciences, St. Luke's Medical Center, Quezon City, Philippines
| | - Gunhild Waldemar
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Rune Nielsen
- Danish Dementia Research Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Dominguez J, Fe de Guzman M, Reandelar M, Thi Phung TK. Prevalence of Dementia and Associated Risk Factors: A Population-Based Study in the Philippines. J Alzheimers Dis 2019; 63:1065-1073. [PMID: 29710725 DOI: 10.3233/jad-180095] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The Philippines is experiencing rapid demographic aging and with it, the dementia epidemic. Prevalence of dementia and associated risk factors have not been studied in the Philippines. OBJECTIVES The study aimed to provide a reliable estimate of dementia prevalence and identify associated risk factors in the Filipino population. METHODS 1460 participants 60 years and older were randomly selected from the Marikina City's senior registry. A multidisciplinary team (nurse, psychologist, and neurologist) administered a comprehensive assessment to the study population: health history, neurological examination, Geriatric Depression Scale, Neuropsychiatric Inventory, Disability Assessment for Dementia, Alzheimer's Disease 8, and Clinical Dementia Rating Scale. The neurologist analyzed all clinical data to diagnose dementia based on the DSM-IV criteria, Alzheimer's Disease (AD) on the NINCDS-ADRDA criteria, vascular dementia (VaD) on the Hachinski Ischemic Scale, cognitive impairment no dementia (CIND) on a CDR score of 0.5 and not fulfilling DSM-IV criteria for dementia. Risk factors were correlated with dementia prevalence using multivariate binary logistic regression. RESULTS 1460 persons were randomly selected. 1367 agreed to participate and underwent all assessments. The response rate was 93.6%. Dementia prevalence was found to be 10.6% (95% CI 9.0 to 12.4) with the breakdown 85.5% AD, 11.7% VaD, and 2.7% other dementias. In this population, 82.0% of men and 70.4% of women had at least one cardiovascular risk factor (hypertension, diabetes, dyslipidemia, smoking), which was associated with VaD prevalence but not AD. CONCLUSION The prevalence of dementia, CIND, and cardiovascular risk factors are high in the Philippines.
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Affiliation(s)
| | | | | | - Thien Kieu Thi Phung
- Danish Dementia Research Center, Rigshospitalet, University of Copenhagen, Denmark
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Nabe-Nielsen K, Hansen ÅM, Ishtiak-Ahmed K, Grynderup MB, Gyntelberg F, Islamoska S, Mortensen EL, Phung TKT, Rod NH, Waldemar G, Westendorp RGJ, Garde AH. Night shift work, long working hours and dementia: a longitudinal study of the Danish Work Environment Cohort Study. BMJ Open 2019; 9:e027027. [PMID: 31129586 PMCID: PMC6538206 DOI: 10.1136/bmjopen-2018-027027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Shift work and long working hours are potential risk factors for dementia, but previous studies on shift work, long working hours and dementia are sparse and their findings are conflicting. Therefore, we investigated the effect of night shift work and long working hours on dementia. DESIGN A longitudinal study. SETTING Denmark. PARTICIPANTS 3435 occupationally active men and women from the general working population. METHODS Work schedule covered day work (reference) and shift schedules without/with night work. Working hours covered <27, 28-36, 37 (reference), 38-44, and ≥45 hours/week. As the primary outcome, we used register-based information about dementia, and estimated incidence rate ratios (IRR) and 95% CI. Estimates were adjusted for gender, age, psychosocial work factors and cardiovascular risk factors. RESULTS We identified 85 dementia cases during a mean of 9.8 years of follow-up. We found a positive, but statistically insignificant association between night shift work and dementia (IRR=2.01; 95% CI: 0.87-4.65). Post hoc analyses indicated that this was only due to a higher risk in permanent night workers (IRR=3.25; 95% CI: 1.35-7.83). The dementia risk was also significantly higher among participants working 38-44 hours/week (IRR=2.08; 95% CI: 1.11-3.90) compared with those working 37 hours/week. We found no indications of a higher risk of dementia in participants working <37 hours/week or ≥45 hours/week. CONCLUSION We did not find arguments that night shift work or long working hours increased dementia risk in general. However, we found a higher risk of dementia in specific subgroups, that is, permanent night workers and employees with moderately longer weekly working hours than the standard.
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Affiliation(s)
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Finn Gyntelberg
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Thien Kieu Thi Phung
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Rudi G J Westendorp
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Anne Helene Garde
- National Research Centre for the Working Environment, Copenhagen, Denmark
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Zakarias JK, Jensen-Dahm C, Nørgaard A, Roos P, Gasse C, Phung TKT, Waldemar G. Geographical Variation in the Diagnostic Rate and Quality of Dementia Diagnoses. J Alzheimers Dis 2019; 69:513-520. [DOI: 10.3233/jad-190030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Johanne Købstrup Zakarias
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Jensen-Dahm
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ane Nørgaard
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Roos
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christiane Gasse
- National Centre for Register-based Research, Aarhus University, Aarhus, Denmark
- Department of Depression and Anxiety/Psychosis Research Unit, Aarhus University Hospital, Department of Psychiatry, Risskov, Denmark
| | - Thien Kieu Thi Phung
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Ishtiak-Ahmed K, Hansen ÅM, Mortensen EL, Garde AH, Nørgaard A, Gyntelberg F, Rod NH, Islamoska S, Lund R, Phung TKT, Prescott E, Waldemar G, Nabe-Nielsen K. Prolonged or serious conflicts at work and incident dementia: a 23-year follow-up of the Copenhagen City Heart Study. Int Arch Occup Environ Health 2019; 92:165-173. [PMID: 30370497 PMCID: PMC6341042 DOI: 10.1007/s00420-018-1365-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/21/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Only a few studies have investigated the impact of negative aspects of social relations on cognitive function, and they have shown mixed results. Conflicts at work are part of the negative aspects of social relations, but the impact of experiencing conflicts at work has not yet been investigated as a risk factor for dementia. Therefore, we investigated whether experiencing prolonged or serious conflicts with a supervisor or colleagues at work was associated with incident dementia in old age. METHODS We analyzed data of 6,436 men and women from the third survey of the Copenhagen City Heart Study. At baseline in 1991-1994, the participants reported whether they had ever had a prolonged or serious conflict at work. The participants were followed until 2014. We used Poisson regression to estimate incidence rate ratios (IRR) and their 95% confidence intervals (CI). RESULTS After adjusting for potential confounders, the IRR for dementia was 1.53 (95% CI 0.77-3.03) among participants who had reported having prolonged or serious conflicts both with a supervisor and colleagues compared with participants who had never had such conflicts. In separate analyses stratified by sex, the IRRs were 2.14 (95% Cl 0.97-4.71) for men and 0.98 (95% Cl 0.29-3.32) for women. CONCLUSIONS Our findings did not support an overall association between experiencing prolonged or serious conflicts at work and incident dementia. However, because of the large differences in the point estimates for men and women, future research could aim at investigating potential sex differences regarding the association between conflicts at work and dementia.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark.
| | - Åse Marie Hansen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Anne Helene Garde
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Ane Nørgaard
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen Section 6911, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Finn Gyntelberg
- The National Research Centre for the Working Environment, Lersø Parkallé 105, 2100, Copenhagen, Denmark
| | - Naja Hulvej Rod
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Sabrina Islamoska
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
| | - Rikke Lund
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Thien Kieu Thi Phung
- Center for Healthy Aging, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - Gunhild Waldemar
- Department of Neurology, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen Section 6911, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Kirsten Nabe-Nielsen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen, Denmark
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Phung TKT, Siersma V, Vogel A, Waldorff FB, Waldemar G. Self-rated versus Caregiver-rated Health for Patients with Mild Dementia as Predictors of Patient Mortality. Am J Geriatr Psychiatry 2018; 26:375-385. [PMID: 28760512 DOI: 10.1016/j.jagp.2017.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 06/03/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Self-assessment of health is a strong and independent predictor of mortality for cognitively intact people. Because the ability of patients with dementia to rate their own health is questionable, caregiver-rated health for patients may serve as a proxy. The authors aimed to validate and compare self- and caregiver-rated health for patients with dementia as independent predictors of patient mortality. METHODS This was a post-hoc analysis of data from The Danish Alzheimer's Disease Intervention Study, a randomized controlled trial of psychosocial intervention for 330 patients with mild dementia and their caregivers with a 36-month follow-up. Patients and caregivers rated patients' health on the Euro Quality of Life Visual Analog Scale (EQ-VAS) from 0 (worst) to 100 (best). The ability of self- and caregiver-rated health for the patient to predict patient mortality was analyzed as hazard ratios (HRs) from Cox proportional hazard regression models, controlling for age, depression, comorbidities, functional level, quality of life, and randomization group. RESULTS Compared with the highest scores of 80-100, caregiver-rated EQ-VAS scores < 50 had an HR of 9.8 (95% CI: 2.9-33.1), scores between 50 and 64 had an HR of 3.8 (95% CI: 1.2-12.3), and scores between 65 and 79 had an HR of 4.6 (95% CI: 1.4-14.7). Self-rated EQ-VAS did not statistically significantly predict mortality. CONCLUSION Caregiver-rated health for patients with mild dementia using the EQ-VAS was shown to be an independent predictor of patient mortality with a dose-response pattern but patient-rated EQ-VAS was not.
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Affiliation(s)
- Thien Kieu Thi Phung
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Volkert Siersma
- Research Unit and Department of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Asmus Vogel
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Frans Boch Waldorff
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; Research Unit and Department of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark; The Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Nabe-Nielsen K, Garde AH, Ishtiak-Ahmed K, Gyntelberg F, Mortensen EL, Phung TKT, Rod NH, Waldemar G, Westendorp RG, Hansen ÅM. Shift work, long working hours, and later risk of dementia: A long-term follow-up of the Copenhagen Male Study. Scand J Work Environ Health 2017; 43:569-577. [PMID: 28707697 DOI: 10.5271/sjweh.3660] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objectives The aim of this study was to investigate the effect of shift work and long working hours in midlife on the risk of dementia in old age. Methods The present study comprised 4766 participants from the Copenhagen Male Study. We used information on shift work (collected in 1970-1971 and 1985-1986), long working hours defined as >45 hours per week (collected in 1970-1971), socioeconomic status, sleep, stress, and cardiovascular risk factors. Information about dementia diagnoses was obtained from registers. Participants were followed until 2014 (mean length of follow-up was 17.8 years). We employed Poisson regression for the survival analyses and estimated incidence rate ratios (IRR) and their 95% confidence intervals (CI). Results We found no statistically significant association between shift work (IRR 0.86, 95% CI 0.70-1.05) or long working hours (IRR 0.97, 95% CI 0.79-1.19) and dementia. Adjustment for potential confounders and mediators did not change the estimates. Working shifts at both time points of exposure assessment was not associated with a higher incidence of dementia compared with non-shift workers at both time points (IRR 0.99, 95% CI 0.69-1.42). The lowest incidence of dementia was observed among participants who reported shift work at one time point (only in 1985-1986: IRR 0.44, 95% CI 0.16-1.23 and only in 1970-1971: IRR 0.58, 95% CI 0.31-1.11). Conclusion We did not find positive evidence of an association between shift work or long working hours and the incidence of dementia, but the negative findings may reflect the crude assessment of shift work and long working hours, which is a major limitation of the present study.
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Affiliation(s)
- Kirsten Nabe-Nielsen
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014 Copenhagen, Denmark. E-mail:
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Thi Phung TK, Chaaya M, Prince MJ, Waldemar G. [P4–390]: THE ASSOCIATION BETWEEN HEAD CIRCUMFERENCE WITH DEMENTIA PREVALENCE. Alzheimers Dement 2017. [DOI: 10.1016/j.jalz.2017.06.2261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Monique Chaaya
- Faculty of Health SciencesAmerican University of BeirutBeirutLebanon
| | - Martin J. Prince
- Institute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUnited Kingdom
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Nielsen TR, Phung TKT, Chaaya M, Mackinnon A, Waldemar G. Combining the Rowland Universal Dementia Assessment Scale and the Informant Questionnaire on Cognitive Decline in the Elderly to Improve Detection of Dementia in an Arabic-Speaking Population. Dement Geriatr Cogn Disord 2016; 41:46-54. [PMID: 26613533 DOI: 10.1159/000441649] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS The aim of this study was to assess whether combining the Rowland Universal Dementia Assessment Scale (RUDAS) and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) could improve diagnostic accuracy when screening for dementia in an Arabic-speaking population with low levels of literacy. METHODS Based on data from 225 elderly participant and informant dyads, the screening performances of the two instruments were compared and three methods for combining them--'or', 'and' and 'weighted sum' rules--were assessed. RESULTS The 'weighted sum' method had a significantly better area under the curve value compared to the RUDAS used alone. The 'weighted sum' method and the 'and' rule had the highest specificity, while the 'or' rule had the best sensitivity. CONCLUSION Harnessing the RUDAS and IQCODE increased diagnostic accuracy when screening for dementia in this study population.
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Affiliation(s)
- T Rune Nielsen
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Chaaya M, Phung TKT, El Asmar K, Atweh S, Ghusn H, Khoury RM, Prince M, Nielsen TR, Waldemar G. Validation of the Arabic Rowland Universal Dementia Assessment Scale (A-RUDAS) in elderly with mild and moderate dementia. Aging Ment Health 2016; 20:880-7. [PMID: 25984584 DOI: 10.1080/13607863.2015.1043620] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Validated screening tests for dementia in Arabic are lacking. Given the low levels of education among elderly in the Middle East and North Africa region, the commonly used screening instrument, the Mini Mental State Examination, is not best suited. Alternatively, the Rowland Universal Dementia Assessment Scale (RUDAS) was especially designed to minimize the effects of cultural learning and education. The aim of this study was to validate the RUDAS in the Arabic language (A-RUDAS), evaluate its ability to screen for mild and moderate dementia, and assess the effect of education, sex, age, depression, and recruitment site on its performance. METHODS A-RUDAS was administered to 232 elderly aged ≥65 years recruited from the communities, community-based primary care clinics, and hospital-based specialist clinics. Of these, 136 had normal cognition, and 96 had dementia. Clinicians diagnosed dementia according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria. Interviewers, blind to the cognitive status of participants, administered A-RUDAS. The psychometric properties of A-RUDAS were examined for three cutoffs. RESULTS At the cutoff of ≤22, A-RUDAS exhibited good sensitivity (83%) and specificity (85%) with an area under the receiver operating characteristic curve of 83.95%. Adjusting for age, sex, education, depression, and recruitment site, A-RUDAS score demonstrated a high level of accuracy in screening for mild and moderate dementia against DSM-IV diagnosis. CONCLUSION The A-RUDAS is proposed for dementia screening in clinical practice and in research in Arabic-speaking populations with an optimal cutoff of ≤22.
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Affiliation(s)
- M Chaaya
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - T K T Phung
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
| | - K El Asmar
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - S Atweh
- c Department of Neurology , American University of Beirut Medical Center , Beirut , Lebanon
| | - H Ghusn
- d Department of Geriatrics , American University of Beirut Medical Center , Beirut , Lebanon
| | - R M Khoury
- a Department of Epidemiology and Population Health, Faculty of Health Sciences , American University of Beirut , Beirut , Lebanon
| | - M Prince
- e Department of Health Service and Population Research , Institute of Psychiatry , King's College London , London , UK
| | - T R Nielsen
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
| | - G Waldemar
- b Department of Neurology, Danish Dementia Research Center, The Neuroscience Center , University of Copenhagen , Copenhagen , Denmark
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Phung TKT, Chaaya M, Asmar K, Atweh S, Ghusn H, Khoury RM, Prince M, Waldemar G. Performance of the 16-Item Informant Questionnaire on Cognitive Decline for the Elderly (IQCODE) in an Arabic-Speaking Older Population. Dement Geriatr Cogn Disord 2015; 40:276-89. [PMID: 26338716 PMCID: PMC5756546 DOI: 10.1159/000437092] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIM The North African and Middle Eastern region has high illiteracy rates among older people, making direct cognitive testing challenging. Validated screening instruments for dementia in Arabic are lacking. We aimed to validate the Arabic version of the 16-item Informant Questionnaire on Cognitive Decline for the Elderly (A-IQCODE 16) for screening for dementia through an informant. METHODS 236 Lebanese participants older than 65 years, 143 with normal cognition and 93 with mild-to-moderate dementia according to the DSM-IV criteria, and their informants were recruited. Half of the participants had no formal education. Interviewers blinded to the cognitive status of the participants administered the A-IQCODE 16 to the informants. The ability of the A-IQCODE 16 to screen for dementia was evaluated against the DSM-IV diagnoses. RESULTS The A-IQCODE 16 had excellent overall predictive power (area under the receiver operator characteristic curve = 0.96). A cutoff point of >3.34 yielded the best sensitivity (92.5%) and specificity (94.4%) for dementia screening. At this cutoff point, the discriminatory ability of the A-IQCODE 16 was comparable between participants with and those without formal education. CONCLUSION The A-IQCODE 16 is not biased by education and is therefore useful as a brief screening tool for dementia among Arabic-speaking older adults with low education.
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Affiliation(s)
- Thien Kieu Thi Phung
- Danish Dementia Research Center, Department of Neurology, The
Neuroscience Center, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
| | - Monique Chaaya
- Department of Epidemiology and Population Health, Faculty of Health
Sciences, American University of Beirut, Beirut, Lebanon
| | - Khalil Asmar
- Department of Epidemiology and Population Health, Faculty of Health
Sciences, American University of Beirut, Beirut, Lebanon
| | - Samir Atweh
- Department of Neurology, American University of Beirut Medical
Center, Beirut, Lebanon
| | - Husam Ghusn
- Department of Geriatrics, American University of Beirut Medical
Center, Beirut, Lebanon
| | - Rose Mary Khoury
- Department of Epidemiology and Population Health, Faculty of Health
Sciences, American University of Beirut, Beirut, Lebanon
| | - Martin Prince
- Department of Health Service and Population Research, Institute of
Psychiatry, King’s College London, London, UK
| | - Gunhild Waldemar
- Danish Dementia Research Center, Department of Neurology, The
Neuroscience Center, Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark
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Waldorff FB, Thi Phung TK, Klara Magdalena Bebe AC, Willadsen TG, Siersma V, Waldemar G. P3‐279: THE IMPACT OF MAJOR DEPRESSION IN PATIENTS NEWLY DIAGNOSED WITH MILD ALZHEIMER'S DISEASE: THE DANISH ALZHEIMER'S DISEASE INTERVENTION STUDY (DAISY). Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.1371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Frans Boch Waldorff
- Research Unit and Department of General PracticeInstitute of Public Health, University of CopenhagenCopenhagenDenmark
| | | | | | | | - Volkert Siersma
- The Research Unit for General Practice in CopenhagenCopenhagenDenmark
| | - Gunhild Waldemar
- Rigshospitalet ‐ Copenhagen University HospitalCopenhagenDenmark
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Nielsen TR, Thi Phung TK, Chaaya M, Atweh S, Prince M, Waldemar G. P3‐261: IMPROVING DETECTION OF DEMENTIA IN AN ARABIC SPEAKING POPULATION WITH LOW EDUCATION: COMBINING THE ROWLAND UNIVERSAL DEMENTIA ASSESSMENT SCALE AND THE INFORMANT QUESTIONNAIRE ON COGNITIVE DECLINE IN THE ELDERLY. Alzheimers Dement 2014. [DOI: 10.1016/j.jalz.2014.05.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Nielsen TR, Andersen BB, Kastrup M, Phung TKT, Waldemar G. Quality of dementia diagnostic evaluation for ethnic minority patients: a nationwide study. Dement Geriatr Cogn Disord 2011; 31:388-96. [PMID: 21720163 DOI: 10.1159/000327362] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Diagnostic evaluation of dementia for ethnic minority patients may be challenging. This study aimed to evaluate the quality of diagnostic evaluation of dementia for patients from ethnic minorities in Denmark. METHODS The Danish national hospital registers were used to identify patients from the main ethnic minority groups in Denmark, who were diagnosed with dementia in the period 2005-2007. Three raters independently reviewed the patients' medical records. Data were compared to data from a previous similar study in the general Danish population. RESULTS Fifty-seven medical records were reviewed. An acceptable diagnostic workup was documented in only 23% of the patients. Dementia diagnosis was confirmed in 35%. Significant differences in the quality of the diagnostic evaluation were found between patients from ethnic minorities and the general population. CONCLUSION There are significant ethnic disparities in the quality of diagnostic evaluations and outcome of dementia in the secondary healthcare sector.
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Affiliation(s)
- T Rune Nielsen
- Memory Disorders Research Group, Danish Dementia Research Center, Department of Neurology, Neuroscience Center, Copenhagen University Hospital, Rigshospitalet, Denmark. rune.nielsen @ rh.regionh.dk
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Nielsen TR, Vogel A, Phung TKT, Gade A, Waldemar G. Over- and under-diagnosis of dementia in ethnic minorities: a nationwide register-based study. Int J Geriatr Psychiatry 2011; 26:1128-35. [PMID: 21194100 DOI: 10.1002/gps.2650] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 09/20/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Among dementia professionals in several European countries, it is believed that dementia is under-diagnosed and under-treated to a greater extent among ethnic minorities than in the native population. It is unknown whether this belief holds true. The objective of this study was to compare the prevalence of register-based dementia diagnoses in the largest ethnic minority groups in Denmark with the prevalence of register-based dementia diagnoses in the general Danish population. METHODS By linking the Danish hospital registers with the Danish Civil Registration System, nationwide dementia cases for three main ethnic minorities were identified. Age- and gender-specific prevalence rates for dementia were calculated and compared to previously published data for the general population. RESULTS The study population consisted of 68 219 persons aged 20 and older. A total of 174 dementia cases were identified. The mean age at diagnosis was 57.7 years (SD = 16.2). Compared to the general population, there was a higher prevalence of dementia among those younger than 60 years, and a markedly lower prevalence of dementia among those 60 years and older. CONCLUSIONS Dementia is under-diagnosed to a greater extent among ethnic minorities in the age group 60 years and older but is over-diagnosed in the age group younger than 60 years. Several factors may contribute to this pattern, including cultural differences in help-seeking behaviour, and problems in navigating the health-care system. Furthermore, cross-cultural assessment of dementia can be difficult because of language barriers and cultural differences.
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Affiliation(s)
- T R Nielsen
- Memory Disorders Research Group, Department of Neurology, Neuroscience Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Phung TKT, Waltoft BL, Laursen TM, Settnes A, Kessing LV, Mortensen PB, Waldemar G. Hysterectomy, oophorectomy and risk of dementia: a nationwide historical cohort study. Dement Geriatr Cogn Disord 2010; 30:43-50. [PMID: 20689282 DOI: 10.1159/000314681] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND This study aimed to determine whether there is an association between hysterectomy and dementia. METHODS All female Danish residents born before 1966, alive on their 40th birthday and without a dementia diagnosis prior to 1977 (n = 2,313,388) were followed from January 1, 1977, or the age of 40, whichever came later, until dementia diagnosis, death, emigration or December 31, 2006, whichever came first. The relative risks (RR) for developing dementia in women with hysterectomy/oophorectomy compared to referent women were calculated. RESULTS Overall, hysterectomy did not increase the risk of dementia. When stratified by age at dementia diagnosis, hysterectomy was associated with an increased risk for early-onset dementia before the age of 50: hysterectomy alone (RR = 1.38, 95% confidence interval (CI) = 1.07-1.78), with unilateral oophorectomy (RR = 2.10, 95% CI = 1.28-3.45), with bilateral oophorectomy (RR = 2.33, 95% CI = 1.44-3.77). The younger the age at hysterectomy/oophorectomy, the greater was the risk. CONCLUSIONS Although statistically significant, the association between premenopausal hysterectomy and early-onset dementia is uncertain due to study limitations. Premenopausal bilateral oophorectomy is associated with a higher risk, suggesting a dose effect of premature estrogen deficiency on dementia. The age-dependent effect suggests that the younger brain is probably more vulnerable to estrogen deficiency.
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Affiliation(s)
- Thien Kieu Thi Phung
- Department of Neurology, Neuroscience Center, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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Phung TKT, Waltoft BL, Kessing LV, Mortensen PB, Waldemar G. Time trend in diagnosing dementia in secondary care. Dement Geriatr Cogn Disord 2010; 29:146-53. [PMID: 20150733 DOI: 10.1159/000269933] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND To study the trend of diagnosing dementia in the secondary health care sector over time, we conducted a nationwide longitudinal study of the incidence and prevalence of registered dementia diagnoses in the Danish national hospital registers. METHODS All Danish residents born before 1964 and alive at their 40th birthday were followed from their 40th birthday or January 1, 1970, whichever came later, to the date of the first dementia diagnosis recorded in the hospital registers, the date of emigration, date of death, or December 31, 2004, whichever came first. The age- and period-specific incidence and prevalence of dementia were calculated and compared to estimates from large community-based cohort studies in Europe. RESULTS The study population consisted of 4,723,838 persons with 81,090,583 person-years of follow-up. 154,152 dementia cases were registered from 1970 to 2004. The incidence and prevalence of registered dementia diagnoses showed an increasing trend over time. In 2003, the age-standardized incidence rate ratio was 0.66 when compared to estimates from large European community-based cohort studies. CONCLUSIONS The study shows a marked improvement in the diagnostic rate of dementia in secondary care over time and indicates that this sector can be an important point of entry for patients with dementia.
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Affiliation(s)
- Thien Kieu Thi Phung
- Memory Disorders Research Group, Department of Neurology, University Hospital of Copenhagen Rigshospitalet, Copenhagen, Denmark.
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Phung TKT, Andersen BB, Kessing LV, Mortensen PB, Waldemar G. Diagnostic evaluation of dementia in the secondary health care sector. Dement Geriatr Cogn Disord 2009; 27:534-42. [PMID: 19506375 DOI: 10.1159/000223664] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/23/2009] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We conducted a nationwide registry-based study of the quality of diagnostic evaluation for dementia in the secondary health care sector. METHOD Two hundred patients were randomly selected from the patient population (4,682 patients) registered for the first time with a dementia diagnosis in the nationwide hospital registries during the last 6 months of 2003. Through medical record review, we evaluated the completeness of the work-up on which the dementia diagnosis was based, using evidence-based dementia guidelines as reference standards. RESULTS Satisfactory or acceptable completion of the basic dementia work-up was documented in 51.3% of the patients. Only 11.5% of those with unsatisfactory work-up were referred to follow-up investigations. Dementia syndrome was confirmed in 88.5% of the cases, but correct subtypes were diagnosed in only 35.1%. CONCLUSION The adherence to clinical guidelines concerning dementia work-up is inadequate in the secondary health care sector. Our findings call for improvement in the organization of clinical dementia care, for education of specialists and for changes in attitude towards making a diagnosis of dementia.
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Affiliation(s)
- Thien Kieu Thi Phung
- Memory Disorders Research Group, Department of Neurology, Copenhagen University Hospital Rigshospitalet, DK-2100 Copenhagen, Denmark.
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Phung TKT, Andersen BB, Høgh P, Kessing LV, Mortensen PB, Waldemar G. Validity of dementia diagnoses in the Danish hospital registers. Dement Geriatr Cogn Disord 2007; 24:220-8. [PMID: 17690555 DOI: 10.1159/000107084] [Citation(s) in RCA: 208] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2007] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The validity of dementia diagnoses in the Danish nationwide hospital registers was evaluated to determine the value of these registers in epidemiological research about dementia. METHODS Two hundred patients were randomly selected from 4,682 patients registered for the first time with a dementia diagnosis in the last 6 months of 2003. The patients' medical journals were reviewed to evaluate if they fulfilled ICD-10 and/or DSM-IV criteria for dementia and specific dementia subtypes. The patients who were still alive in 2006 were invited to an interview. RESULTS One hundred and ninety-seven journals were available for review and 51 patients were interviewed. A registered diagnosis of dementia was found to be correct in 169 (85.8%) cases. Regarding dementia subtypes, the degree of agreement between the registers and the results of the validating process was low with a kappa of 0.36 (95% CI 0.24-0.48). CONCLUSION The validity of dementia syndrome in the Danish hospital registers was high and allows for epidemiological studies about dementia. Alzheimer's disease, although underregistered, also had a good validity once the diagnosis was registered. In general, other ICD-10 dementia subtypes in the registers had a low validity and are less suitable for epidemiological research.
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Affiliation(s)
- Thien Kieu Thi Phung
- Memory Disorders Research Group, Department of Neurology, The Centre of Neuroscience, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
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Phung TKT, Andersen K, Kessing LV, Waldemar G. [Lifestyle-related risk factors for dementia]. Ugeskr Laeger 2006; 168:3401-5. [PMID: 17032603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Emerging knowledge about modifiable risk factors for dementia has given rise to interventions that can potentially prevent or delay the onset of dementia and the possible target periods for intervention extend from prenatal period to old age. Factors during early life such as nutrition, education, and parental socioeconomic status can influence the development of dementia later in life. From mid to late life, a physically, socially, and intellectually active lifestyle is associated with reduced risk for dementia. Moreover, modification of cardiovascular risk factors during this period can potentially reduce risk for dementia.
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