Malaysian Healthy Ageing Society DR R ZURR RRAIN INI I ARA RABI - PowerPoint PPT Presentation

Organised by: Co-Sponsored: Malaysian Healthy Ageing Society

DR R ZURR RRAIN INI I ARA RABI

Dementia Ageing population

forget forget forget ?dementia ????Normal ageing

Malaysia 6% 1 WHO Singapore region 4.2-9.8% 2 1.6-6.4% 3 Prevalence 1. Krishnaswamy, 1997 2. Ng TP et al, 2010 3. Ferri et al, 2005

>50% Mild to moderate dementia Diagnosis Boustani et al, 2003

Vague symptoms Challenge Memory Knowledge Diagnostic tests 1. De Lepeire et al,1998 2. Illiffe et al, 2003

GE GENERAL  To screen for dementia among elderly patients in primary care practices using a newly developed Early Dementia Questionnaire (EDQ) and comparing it with a standard and popular assessment tool; the Mini Mental State Examination (MMSE)

SP SPECIF CIFIC IC • To determine the prevalence of dementia using the EDQ and compare it with MMSE. • To compare the sensitivity and specificity between EDQ as a screening tool and MMSE as a gold standard for dementia. • To determine the domains highly affected by dementia from the EDQ.

• Based on expert opinion, literature review and standardized assessment tool. • 3 sections: – Patient/Informant identification – Sociodemographic data – Symptoms of early dementia • Memory ( 5 questions) • Concentration (4 questions) • Physical symptoms (3 questions) • Sleep disturbance (2 questions) • Others (2 questions)

• Scoring : Likert Scale of 0-3 • A score ≥ 8 - possible dementia • Content validation - 2 psychiatrists • Face validation - 20 respondents • Cronbach’s Alpha – 0.689

Cross sectional quantitative study done in primary health care centre Universal sampling on Exclusion registered person aged 60 criteria: years and above Patients who are -aphasic -already Inclusion criteria: diagnosed with Elderly patients age dementia or 60 years and above depression - having severe hearing 160 patients selected with impairment informant identified

Geriatric Depression Scale (GDS) GDS≤5 GDS≥ 5 Early Dementia Questionnaire (EDQ) Dementia M-MMSE -7 No dementia

160 elderly patients selected GDS ≤ 5 Informant -face to 5 ( 3.1%) face , 70 155 (96.9%) non (45.2%) respondents respondents - by phone, 85 (54.8%) EDQ ≥ 8 : 81 Informant not (52.3%) contactable to complete questionnaire MMSE ≤ 21: 24 (15.5%)

90 84.5% 80 70 60 52.3% EDQ 47.7% 50 40 MMSE 30 15.5% 20 10 0 Dementia No dementia

SENSIT ITIVI VITY TY AND SPECIFI IFICIT CITY Y OF EDQ Q COMPAR ARED TO MMSE EDQ EDQ MMSE 1 Sensitivity 79.0% 88.5% 1. Specificity 53.0% 75.3% Positive 23% - predictive value (PPV) Negative 93% - predictive value (NPV) 1. Norlinah et al. 2009

120 100 98.8% 80 87.7% 82.7% 60 40 49.4% 20 32.1% 30.9% 0

DEMENTIA SYMPTOMS BASED ON EDQ AND ITS ASSOCIATION WITH POSSIBLE DEMENTIA Symptoms ms Scoring ng from EDQ χ 2 P-val alue ue (subdo bdomains ains) No dementia Possible n(%) dementia n (%) Memory Yes 59 (42.4) 80 (57.6) - 0.000 b No 15 (93.8) 1 (6.2) Concentration Yes 19 (22.1) 67 (77.9) 50.941 0.000 a No 55 (79.7) 14 (20.3) Physical symptoms Yes 9 (25.7) 26 (74.3) 8.792 0.003 a No 65 (54.2) 55 (45.8) Emotions Yes 42 (37.2) 71 (62.8) 18.688 0.000 a No 32 (76.2) 10 (23.8)

Symptoms ms Scoring ng from EDQ χ 2 P-val alue ue (subdo bdomains ains) No dementia Possible n (%) dementia n (%) Sleep disturbance Yes 13 (24.5) 40 (75.5) 17.396 0.000 a No 61 (59.80 41 (40.2) Others Yes 6 (19.4) 25 (80.6) 12.516 0.000 a No 68 (54.8) 56 (45.2)

MULTIVARIATE LOGISTIC REGRESSION FOR PREDICTING POSSIBLE DEMENTIA Variables les P value Exp (B) 95% Confidence ence Interv rval al Lower Upper Memory 0.012 12 26.216 216 2.033 338.137 Concentration 0.000 00 14.331 331 5.533 37.119 Physical 0.312 1.718 0.602 4.905 symptoms Emotions 0.004 04 4.752 52 1.635 13.806 Sleep 0.026 26 3.135 35 1.148 8.564 disturbance Others 0.209 2.287 0.630 8.308

 The prevalence of dementia in this study was 52.3% using EDQ and 15.5% using MMSE only. This high prevalence could be due the presence of mild cognitive impairment (MCI) cases in this population.  Unable to differentiate MCI and early dementia which shares similar symptoms in early part of the disease.

• EDQ: sensitivity 79%, specificity 53%, PPV 24%, NPV 93% – About 47% of false positive rate – High false positive rate is a characteristic of screening instruments used to detect low prevalence disorders 1 – High sensitivity reflects EDQ as a good screening tool although it cannot accurately diagnose dementia – High NPV can accurately rule out early dementia in those who screened negative by EDQ 1. Anstey et al, 2010

 The strongest predictor of having dementia: Memory ry: OR 26.22 followed by Concentr ntrat ation ion: OR 14.33 Emotio ions ns: OR 4.75 and Sl Sleep dis isturban rbances es: OR 3.14

Retrospective • Recall bias information EDQ is unable • High false positive rate to differentiate MCI cases

• EDQ is able to detect early dementia but not as specific as MMSE • Simple and easy to be administered, user friendly, not fully patient dependent and not influenced by cultural or educational background • A promising alternative to MMSE for screening of dementia in primary care

 Preliminary results EDQ as a screening tool