diagnosing and treating alzheimer disease: a jordanian experience

8/14/2019 Diagnosing and Treating Alzheimer Disease: A Jordanian Experience

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Diagnosing And TreatingDiagnosing And TreatingAlzheimer Disease:Alzheimer Disease:

A JordanianA Jordanian

ExperienceExperienceMarina Hadidi, M.D., Ph.D.Marina Hadidi, M.D., Ph.D.

Amman, JordanAmman, Jordan

Istanbul, September 2005Istanbul, September 2005


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Facts about Jordan:Facts about Jordan:

Population:Population: 5,7 mln (2005)5,7 mln (2005)

Capital:Capital: Amman (1,8 mln)Amman (1,8 mln)

Life expectancy:Life expectancy: M - 71 y, F 74M - 71 y, F 74

y.y.

Population growth rate:Population growth rate: 2,8% per2,8% per

yearyear

Annual income per capita: 1,813Annual income per capita: 1,813

$$


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Jordan: Majority ofJordan: Majority of

population is under the agepopulation is under the age

of 35of 35


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Current Situation: Diagnosis ofCurrent Situation: Diagnosis of

ADAD

Low awareness about AD in the populationLow awareness about AD in the population

No data about incidence or prevalence ofNo data about incidence or prevalence of

MCI and dementia of Alzheimer type butMCI and dementia of Alzheimer type but

professionals dealing with it has a commonprofessionals dealing with it has a commonimpression of increasing incidenceimpression of increasing incidence

No studies about prevalence of differentNo studies about prevalence of different

types of dementiatypes of dementia

Lack of validated psychometric tests.Lack of validated psychometric tests.

Individually modified MMSE, clock drawingIndividually modified MMSE, clock drawing

and 3 word recall test are most often used.and 3 word recall test are most often used.


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Current Situation: TreatmentCurrent Situation: Treatment

of ADof AD Patients with AD are treated mostlyPatients with AD are treated mostlyby neurologists and psychiatristsby neurologists and psychiatrists

Rivastrigmin, Galantamin andRivastrigmin, Galantamin and

Donepezil are officially registered inDonepezil are officially registered inJordan/Jordan/

Memantin is in the process ofMemantin is in the process of

registrationregistrationThere are very few geriatric nursingThere are very few geriatric nursing

homes and no specialized centers forhomes and no specialized centers forAD patients so they stay with theAD patients so they stay with thefamily till very late stages .family till very late stages .


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Illiteracy: potentialIlliteracy: potential

implicationsimplications

Still a very common phenomenonStill a very common phenomenon Associated with age > 65, female gender,Associated with age > 65, female gender,

non-urban dwellingnon-urban dwelling (Gomez et al 2001, Bowirrat(Gomez et al 2001, Bowirratet al, 2001)et al, 2001)

Strongly associated with life expectancy inStrongly associated with life expectancy in

both developed and developing countriesboth developed and developing countries(Messias, 2003)(Messias, 2003)

Major socio-economic risk factor forMajor socio-economic risk factor fordevelopment of dementia in differentdevelopment of dementia in different

ethnic groupsethnic groups (Carnero-Pardo, 2000, Bowirrat,(Carnero-Pardo, 2000, Bowirrat,Friedland 2002)Friedland 2002)


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Prevalence of Illiteracy inPrevalence of Illiteracy in

Middle East Countries:Middle East Countries:(United Nations Statistics(United Nations StatisticsDivision, 2005)Division, 2005)

19,3%

56,4%21,5%30,5%14,1%F

24,4%

32,8%5,6%15,9%4,5%M

UAEEgyptTurkey

SaudiArabi

a

Jordan

Country


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Retrospective Analysis OfRetrospective Analysis Of

70 Consecutive Patients70 Consecutive Patients

Diagnosed As AD In OurDiagnosed As AD In OurClinic In 2002-2005Clinic In 2002-2005

Age 57 80 y (mean age 68 y)Age 57 80 y (mean age 68 y)

Jordanian residents only; patientsJordanian residents only; patients

from other Arab countries notfrom other Arab countries not

includedincluded

M 46 %, F 54 %M 46 %, F 54 %

Total illiteracy 20 % (M 13%, F Total illiteracy 20 % (M 13%, F

26%)26%)


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Does Illiteracy Affect TimeDoes Illiteracy Affect Time

Of Diagnosis?Of Diagnosis?

2 (4%)-Severe

30 (53%)2 (15%)Moderate

24 (43%)12 (85%)Mild

IlliterateLiterateStage AtDiagnosis


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Does Illiteracy AffectDoes Illiteracy Affect

Treatment Choice andTreatment Choice and

Compliance?Compliance?

1 (7%)34(60%)

Uninterruptedtreatment for

> 9 months

2 (15%)38(70%)

Reportedpositive chan-ges after 3 m

12 (85%)50(90%)

Started onAChEI

IlliterateLiterate


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Limitations:Limitations:

Our group is not representative of theOur group is not representative of thewhole population of Jordanianwhole population of Jordanian

patients with dementia because of:patients with dementia because of:

- small size of group- small size of group- patients seeking help from a private- patients seeking help from a private

doctordoctor

- predominantly urban patients- predominantly urban patients


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Illiteracy in JordanianIlliteracy in Jordanian

patients with ADpatients with AD (preliminary(preliminary

conclusions)conclusions) Illiteracy is more common in femaleIlliteracy is more common in female

than male AD patientsthan male AD patients Illiterate patients were more oftenIlliterate patients were more often

diagnosed in moderate and severediagnosed in moderate and severestage, as opposed to mildstage, as opposed to mild

Illiterate patients and their relativesIlliterate patients and their relatives

less often report improvement onless often report improvement ontreatment with AChEI and are lesstreatment with AChEI and are lessprobable to remain on it for theprobable to remain on it for theprolonged period of timeprolonged period of time


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Hypertension:Hypertension: Elevated midlife systolic bloodElevated midlife systolic blood

pressure is an independent riskpressure is an independent risk

factor for AD, according to severalfactor for AD, according to several

prospective population-based studiesprospective population-based studies(Kivipelto et al, 2001, Skoog et al, 1996)(Kivipelto et al, 2001, Skoog et al, 1996)

Antihypertensive treatment mayAntihypertensive treatment may

protect against demetia in olderprotect against demetia in olderpatients with systolic HTN, accordingpatients with systolic HTN, according

to Syst-Eur study (to Syst-Eur study (ForetteForetteetetalal,, 20022002))


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Diabetes Mellitus:Diabetes Mellitus:

Diabetes increases risk of ADDiabetes increases risk of AD

according to epidemiological studiesaccording to epidemiological studies(Knopman et al, 2002; Arvanitakis et al,(Knopman et al, 2002; Arvanitakis et al,

2004)2004) Possible mechanisms may includePossible mechanisms may include

IDE (insulin-degrading enzyme)IDE (insulin-degrading enzyme)

which hydrolyses several regulatorywhich hydrolyses several regulatorypeptides including insulin, glucagone,peptides including insulin, glucagone,

Ab and APP intracellular domainAb and APP intracellular domain(Duckworth et al 1998, Tanzi et al 2004).(Duckworth et al 1998, Tanzi et al 2004).

M difi bl Ri k F tM difi bl Ri k F t


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Modifiable Risk FactorsModifiable Risk Factors

In 1In 1stst EverEver

Ischemic StrokeIschemic StrokeUK :UK : Hypertension -52%Hypertension -52%

CAD or MICAD or MI-38%-38%

Current smokingCurrent smoking

-27%-27%

Diabetes MellitusDiabetes Mellitus

-10%-10%

TIATIA

-14%-14%

Jordan:Jordan:- 57%- 57%

- 36%- 36%

- 41%- 41%

- 55%- 55%

- 5%- 5%

M.Hadidi,200M.Hadidi,20011


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Prevalence of DiabetesPrevalence of Diabetes

Mellitus In 70 JordanianMellitus In 70 Jordanian

Patients Diagnosed With ADPatients Diagnosed With ADin 2002-2005in 2002-2005

Alzheimer Patients -Alzheimer Patients -21%21%

Ischemic Stroke Patients -Ischemic Stroke Patients -

55%55% Controls (non-stroke, non- -Controls (non-stroke, non- -

17% AD patients )17% AD patients )


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Future StepsFuture Steps

Jordanian Alzheimer Association is inJordanian Alzheimer Association is in

the process of establishing. It willthe process of establishing. It will

include interested professionals,include interested professionals,caregivers and social workers.caregivers and social workers.

Epidemiological study evaluatingEpidemiological study evaluating

prevalence of MCI and dementia inprevalence of MCI and dementia inJordanian population andJordanian population and

investigation into a possible riskinvestigation into a possible risk

factors is underwayfactors is underway


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diagnosing and treating alzheimer disease: a jordanian experience

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