The dementia and disability project in Thai elderly: rational, design, methodology and early results

Abstract

BackgroundA strong inverse relationship of functional limitation and socioeconomic status has been established in western ageing society. Functional limitation can be related to chronic diseases, disuse, cognitive decline, and ageing. Among chronic diseases in the Thai population, cerebrovascular diseases, diabetes, and arthritis are common. These factors are known to contribute to disability and poor quality of life in the elder population. Neuropsychiatric problems, cognitive decline, dementia, and cultural issues in elderly people also can alter the quality of life of the elderly.MethodsThe Dementia and Disability Project in Thai Elderly (DDP) aims at comprehensively assessing community dwelling Thai elderly to understand the relationship between disability and motor function, neuropsychiatric symptoms, cognitive function, and chronic diseases. The DDP is the first study to look at the prevalence and etiology of dementia and of mild cognitive impairment (MCI) in Thai elders and to explore the relationship of cognition, disability, small vessel diseases and cortical degeneration with neuroimaging in Thai elderly people. 1998 Thai elders were screened in 2004–2006 and diagnosed as having MCI or dementia. 223 elders with MCI or dementia and cognitively normal elderly had brain magnetic resonance imaging (MRI) or at baseline. 319 elders from the 3 groups had blood tests to investigate the risks and possible etiologies of dementia including genotyping at baseline.ResultsThe mean age of elders in this study is 69.51(SD=6.71, min=60, max=95) years. 689(34.9%) are men and 1284(65.1%) are women. Mean body weight was 58.36(SD=11.20) kgs. The regression model reveals that performance on gait and balance and serum triglyceride predicts activity of daily living performance (adjusted r2 = 0.280, f=2.644, p=0.003). The majority of abnormal gait in Thai elders was lower level gait disturbance. Only 1.5% (29/1952) had highest level gait disorders. 39.5% of 1964 subjects were free of chronic diseases. Treatment gap (indicating those who have untreated or inadequate treatment) of diabetes mellitus and hypertension in Thai elders in this study was 37% and 55.5% respectively. 62.6% of Thai elders have ApoE3E3 allele. Prevalence of positive ApoE4 gene in this study is 22.85%. 38.6% of Thai elders who had MRI brain study have moderate to severe white matter lesions.ConclusionThe large and comprehensive set of measurements in DDP allows a wide-ranging explanation of the functional and clinical features to be investigated in relation to white matter lesions or cortical atrophy of the brain in Thai elderly population. An almost 2 year follow up was made available to those with MCI and dementia and some of the cognitively normal elderly. The longitudinal design will provide great understanding of the possible contributors to disability in the elderly and to the progression of cognitive decline in Thai elders.

Alzheimer's disease with cerebrovascular disease: current status in the Asia–Pacific region

“…Senanarong et al . found a dementia prevalence of 9.9% in Thailand , and moderate‐to‐severe white matter lesions in 38.6% of elderly Thais who had undergone MRI of the brain .…”

“…Table shows the prevalence of dementia in Asia by country . Caution should be used when interpreting these results, as the same methodologies and diagnostic criteria may not have been used in studies from different countries.…”

Comparison of Computerized and Standard Cognitive Test in Thai Memory Clinic

“…The most common cognitive test in Thai patients is Thai Mental State Examination (TMSE), which has been studied for the distribution of scores in a large aging population (4459 participants) across different age groups and educational levels and also in patients with dementia. [ 1 2 3 ] Due to the lack of well-trained health-care personnel, the larger number of aging population who require the cognitive test, and the busy and crowded situation of OPD, performing cognitive tests is difficult in routine practice. Computer-based Thai Cognitive test or cTMSE was developed aiming to help doctors to easily get the accurate results of TMSE in a routine, busy OPD.…”

“…Computer-based Thai Cognitive test or Computer-based Thai Mental State Examination (cTMSE) was developed aiming to help doctors to easily get the accurate results of TMSE[ 1 2 3 ] in a routine, busy outpatient clinics (OPD). cTMSE can assess memory, attention, language, executive, and visuospatial functions.…”

Medicinal Plants of Northern Thailand for the Treatment of Cognitive Impairment in the Elderly

“…In "elders" over 60 years old, 48% have memory complaints. This is not an official diagnosis, but notable as a potential trend, and 21% of them were diagnosed with MCI (Senanarong et al 2013). Treating dementia in this population is costing millions of dollars, and current research has not presented any promising remedies.…”