Transcript Diagnosing And Treating Alzheimer Disease: A Jordanian

Diagnosing And Treating
Alzheimer Disease:
A Jordanian Experience
Marina Hadidi, M.D., Ph.D.
Amman, Jordan
Istanbul, September 2005
Jordan: Area – 97, 740 km2
Facts about Jordan:
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Population: 5,7 mln (2005)
Capital: Amman (1,8 mln)
Life expectancy: M - 71 y, F – 74 y.
Population growth rate: 2,8% per year
Annual income per capita: 1,813 $
Jordan: Majority of population
is under the age of 35
Current Situation: Diagnosis of AD
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Low awareness about AD in the population
No data about incidence or prevalence of MCI and
dementia of Alzheimer type but professionals
dealing with it has a common impression of
increasing incidence
No studies about prevalence of different types of
dementia
Lack of validated psychometric tests. Individually
modified MMSE, clock drawing and 3 word recall
test are most often used.
Current Situation: Treatment of AD
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Patients with AD are treated mostly by
neurologists and psychiatrists
Rivastrigmin, Galantamin and Donepezil
are officially registered in Jordan/
Memantin is in the process of registration
There are very few geriatric nursing
homes and no specialized centers for AD
patients so they stay with the family till
very late stages .
Illiteracy: potential implications
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Still a very common phenomenon
Associated with age > 65, female gender, nonurban dwelling (Gomez et al 2001, Bowirrat et al, 2001)
Strongly associated with life expectancy in both
developed and developing countries (Messias, 2003)
Major socio-economic risk factor for development
of dementia in different ethnic groups (CarneroPardo, 2000, Bowirrat, Friedland 2002)
Prevalence of Illiteracy in
Middle East Countries:
(United Nations Statistics Division, 2005)
Country Jordan Saudi
Arabia
Turkey Egypt UAE
M
4,5%
15,9% 5,6%
32,8% 24,4%
F
14,1%
30,5% 21,5%
56,4% 19,3%
Retrospective Analysis Of
70 Consecutive Patients
Diagnosed As AD In Our Clinic
In 2002-2005
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Age 57 – 80 y (mean age 68 y)
Jordanian residents only; patients from
other Arab countries not included
M – 46 %, F – 54 %
Total illiteracy – 20 % (M – 13%, F –
26%)
Does Illiteracy Affect Time Of
Diagnosis?
Stage At
Diagnosis
Literate
Illiterate
Mild
12
(85%)
24
(43%)
Moderate
2
(15%)
30
(53%)
Severe
-
2
(4%)
Does Illiteracy Affect Treatment
Choice and Compliance?
Literate
Started on AChEI 50
(90%)
Reported positive 38
chan-ges after 3 (70%)
m
Uninterrupted
34
treatment for > 9 (60%)
months
Illiterate
12
(85%)
2
(15%)
1
(7%)
Limitations:
Our group is not representative of the
whole population of Jordanian patients
with dementia because of:
- small size of group
- patients seeking help from a private
doctor
- predominantly urban patients
Illiteracy in Jordanian patients
with AD (preliminary conclusions)
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Illiteracy is more common in female than
male AD patients
Illiterate patients were more often
diagnosed in moderate and severe stage,
as opposed to mild
Illiterate patients and their relatives less
often report improvement on treatment
with AChEI and are less probable to
remain on it for the prolonged period of
time
Converging Pathogenic
Mechanisms Of Vascular Dementia
And Stroke VS Neurodegenerative
Dementia
AD
Hypertension
Diabetes
Hyperlipidemia
VaD
Stroke
Hypertension:
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Elevated midlife systolic blood pressure is
an independent risk factor for AD,
according to several prospective
population-based studies (Kivipelto et al,
2001, Skoog et al, 1996)
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Antihypertensive treatment may protect
against demetia in older patients with
systolic HTN, according to Syst-Eur study
(Forette et al, 2002)
Diabetes Mellitus:
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Diabetes increases risk of AD according to
epidemiological studies (Knopman et al, 2002;
Arvanitakis et al, 2004)
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Possible mechanisms may include IDE
(insulin-degrading enzyme) which
hydrolyses several regulatory peptides
including insulin, glucagone, Ab and APP
intracellular domain (Duckworth et al 1998,
Tanzi et al 2004).
Modifiable Risk Factors
In 1st Ever Ischemic Stroke
UK :
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Hypertension
CAD or MI
Current smoking
Diabetes Mellitus
TIA
Jordan:
-52%
-38%
-27%
-10%
-14%
P.A.G.Sandercock et.al,1989
- 57%
- 36%
- 41%
- 55%
- 5%
M.Hadidi,2001
Prevalence of Diabetes Mellitus
In 70 Jordanian Patients
Diagnosed With AD in 20022005
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Alzheimer Patients
Ischemic Stroke Patients
Controls (non-stroke, nonAD patients )
- 21%
- 55%
- 17%
Future Steps
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Jordanian Alzheimer Association is in the
process of establishing. It will include
interested professionals, caregivers and
social workers.
Epidemiological study evaluating
prevalence of MCI and dementia in
Jordanian population and investigation
into a possible risk factors is underway
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