Organised by: Co-Sponsored: Malaysian Healthy Ageing Society
DR ZURRAINI ARABI
Ageing population Dementia
forget forget forget?dementia????normal ageing
Singapore 4.2-9.8% 2 Malaysia 6% 1 WHO region 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 Memory Challenge Knowledge Diagnostic tests 1. De Lepeire et al,1998 2. Illiffe et al, 2003
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)
SPECIFIC 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 Inclusion criteria: Elderly patients age 60 years and above Universal sampling on registered person aged 60 years and above 160 patients selected with informant identified 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) Dementia M-MMSE -7 No dementia
160 elderly patients selected Informant -face to face, 70 (45.2%) - by phone, 85 (54.8%) 155 (96.9%) respondents GDS 5 EDQ 8 : 81 (52.3%) MMSE 21: 24 (15.5%) 5 ( 3.1%) non respondents Informant not contactable to complete questionnaire
90 84.5% 80 70 60 50 52.3% 47.7% EDQ 40 30 MMSE 20 15.5% 10 0 Dementia No dementia
SENSITIVITY AND SPECIFICITY OF EDQ COMPARED TO MMSE EDQ MMSE 1 Sensitivity 79.0% 88.5% Specificity 53.0% 75.3% 1. Positive predictive value (PPV) 23% - Negative predictive value (NPV) 93% - 1. Norlinah et al. 2009
120 100 80 60 98.8% 82.7% 87.7% 40 20 0 49.4% 32.1% 30.9%
DEMENTIA SYMPTOMS BASED ON EDQ AND ITS ASSOCIATION WITH POSSIBLE DEMENTIA Symptoms (subdomains) Memory Yes No Concentration Yes No Physical symptoms Yes No Emotions Yes No Scoring from EDQ χ2 P-value No dementia n(%) 59 (42.4) 15 (93.8) 19 (22.1) 55 (79.7) 9 (25.7) 65 (54.2) 42 (37.2) 32 (76.2) Possible dementia n (%) 80 (57.6) 1 (6.2) 67 (77.9) 14 (20.3) 26 (74.3) 55 (45.8) 71 (62.8) 10 (23.8) - 0.000 b 50.941 0.000 a 8.792 0.003 a 18.688 0.000 a
Symptoms (subdomains) Sleep disturbance Yes No Others Yes No Scoring from EDQ χ2 P-value No dementia n (%) 13 (24.5) 61 (59.80 6 (19.4) 68 (54.8) Possible dementia n (%) 40 (75.5) 41 (40.2) 25 (80.6) 56 (45.2) 17.396 0.000 a 12.516 0.000 a
MULTIVARIATE LOGISTIC REGRESSION FOR PREDICTING POSSIBLE DEMENTIA Variables P value Exp (B) 95% Confidence Interval Lower Upper Memory 0.012 26.216 2.033 338.137 Concentration 0.000 14.331 5.533 37.119 Physical symptoms 0.312 1.718 0.602 4.905 Emotions 0.004 4.752 1.635 13.806 Sleep disturbance 0.026 3.135 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 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: OR 26.22 followed by Concentration: OR 14.33 Emotions: OR 4.75 and Sleep disturbances: OR 3.14
Retrospective information Recall bias EDQ is unable to differentiate MCI cases High false positive rate
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