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

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Malaysian Healthy Ageing Society

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DR R ZURR RRAIN INI I ARA RABI

Ageing population Dementia

????Normal ageing

forget forget forget

?dementia

Prevalence

Singapore 4.2-9.8%2 Malaysia 6%1 WHO region 1.6-6.4% 3

• 1. Krishnaswamy, 1997
• 2. Ng TP et al, 2010
• 3. Ferri et al, 2005

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

Challenge

Vague symptoms Knowledge Diagnostic tests Memory

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 registered person aged 60 years and above 160 patients selected with informant identified Inclusion criteria: Elderly patients age 60 years and above Exclusion criteria: Patients who are

• aphasic
• already

diagnosed with dementia or depression

• having severe

hearing impairment

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

160 elderly patients selected GDS ≤ 5 155 (96.9%) respondents 5 ( 3.1%) non respondents Informant not contactable to complete questionnaire EDQ ≥ 8 : 81 (52.3%) MMSE ≤ 21: 24 (15.5%) Informant

• face to

face , 70 (45.2%)

• by phone,

85 (54.8%)

10 20 30 40 50 60 70 80 90 Dementia No dementia EDQ MMSE

15.5% 47.7% 84.5% 52.3%

SENSIT ITIVI VITY TY AND SPECIFI IFICIT CITY Y OF EDQ Q COMPAR ARED TO MMSE

1.

• 1. Norlinah et al. 2009

EDQ EDQ MMSE1 Sensitivity 79.0% 88.5% Specificity 53.0% 75.3% Positive predictive value (PPV) 23%

• Negative

predictive value (NPV) 93%

20 40 60 80 100 120

98.8% 82.7% 32.1% 30.9% 49.4% 87.7%

DEMENTIA SYMPTOMS BASED ON EDQ AND ITS ASSOCIATION WITH POSSIBLE DEMENTIA Symptoms

ms (subdo bdomains ains) Scoring ng from EDQ χ2 P-val alue ue No dementia n(%) Possible dementia n (%) Memory Yes No 59 (42.4) 15 (93.8) 80 (57.6) 1 (6.2)

• 0.000b

Concentration Yes No 19 (22.1) 55 (79.7) 67 (77.9) 14 (20.3) 50.941 0.000a Physical symptoms Yes No 9 (25.7) 65 (54.2) 26 (74.3) 55 (45.8) 8.792 0.003a Emotions Yes No 42 (37.2) 32 (76.2) 71 (62.8) 10 (23.8) 18.688 0.000a

Symptoms ms (subdo bdomains ains) Scoring ng from EDQ χ2 P-val alue ue No dementia n (%) Possible dementia n (%) Sleep disturbance Yes No 13 (24.5) 61 (59.80 40 (75.5) 41 (40.2) 17.396 0.000a Others Yes No 6 (19.4) 68 (54.8) 25 (80.6) 56 (45.2) 12.516 0.000a

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 symptoms 0.312 1.718 0.602 4.905 Emotions 0.004 04 4.752 52 1.635 13.806 Sleep disturbance 0.026 26 3.135 35 1.148 8.564 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 disorders1 – 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

• Recall bias

Retrospective information

• High false positive rate

EDQ is unable 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

EDQ as a screening tool

 Preliminary

results