Epidemiological Study of Mild Cognitive Impairment and Dementia in Taiwan. Yu Sun MD. PhD April 19, 2013

Transcription

1 Epidemiological Study of Mild Cognitive Impairment and Dementia in Taiwan Yu Sun MD. PhD April 19, 2013

2 Epidemiology of dementia worldwide 35.6 million people with dementia worldwide in 2010 nearly double every 20 years 65.7 million in million in 2050 New cases worldwide: 7.7 million /year 1 case/4 seconds

3 Epidemiology of dementia The prevalence doubles with every fiveyear increment at age after 65

4 Prevalence of dementia

5 Past reports of dementia prevalence in the elderly in Taiwan 林宗義台灣 rural/urban % 林宗義台灣 rural/urban % 林信男恆春 rural % 劉秀枝台灣 (rural/urban 1988 (2.0%) 葉炳強台北 rural/urban) 1991 (1.9% 劉秀枝金門 rural % 劉景寬高雄 urban % 林瑞泰南台灣 (rural/urban) 1993 (3.7% 李朝雄宜蘭 rural % 劉景寬高屏 urban % /12677 = 3.38% 應用心理研究 2000 劉秀枝主編

6 Background and Purpose No nationwide epidemiological study of dementia in Taiwan in the past 20 years To survey the prevalence of mild cognitive impairment, very mild dementia, and all dementia To evaluate the associated factors of dementia

7 Methods Computerized random sampling on the census data of all the 19 counties or cities in Taiwan Door-to-door survey using structured questionnaire Time: January 2011 to December 2012 Demographic data, socioeconomic status, life style, co-morbidities and mental tests Mental function screening tools Mini-Mental Status Examination (MMSE) Clinical Dementia Rating (CDR)

8 sample visit % 宜蘭縣 % 台北市 1,316 1, % 台中市 905 1, % 台東縣 % 台南市 867 1, % 花蓮縣 % 南投縣 % 屏東縣 % 苗栗縣 % 桃園縣 % 高雄市 1, % 基隆市 % 雲林縣 % 新北市 1, % 新竹市 % 新竹縣 % 嘉義市 % 嘉義縣 % 彰化縣 % total 9,761 8, % 台北市,113.91% 新北市,55.89% 桃園,51.08% 新竹市,7.69% 新竹縣,1.72% 苗栗縣,24.58% 台中,180.11% 彰化,15.21% 南投,6.99% 雲林,92.38% 嘉義市,123.14% 嘉義縣,125.66% 台南,191.12% 高雄,81.55% 屏東,37.47% 花蓮,47.95% 台東,30.08% 基隆市,8.14% 宜蘭縣,50.41%

9 Results 28,600 aged 65 yrs screened 8337 with complete interview Mean age: ± 6.76 yrs Female: 4330 (52%)

10 Demographic data of study participants (n=8337) Categorical variables, n, % n % Women Age group 65- <75 y/o <85 y/o y/o Body Mass Index (BMI) <= <BMI <BMI > Education Illiterate Literate or primary school Junior or senior high school College or University Marriage, married and live with spouse Life style and habit Vegetarian Tea Coffee Betel nut Drinking Smoking Taking nap Regular exercise Active social network Categorical variables, n, % n % Comorbidities Hypertension Diabetes mellitus Cerebrovascular disease Hyperlipidemia Lung disease Liver disease Gastritis or peptic ulcer Cities Taipei New Taipei Taichung Tainan Kaohsiung Others Areas North Central South East

11 Prevalence of elderly people with abnormal cognitive function (n=8337) Dementia defined by MMSE and CDR n % CDR scoring MMSE Normal, MMSE Abnormal, MMSE < MMSE with cutpoint adjusted by education Normal Abnormal Education adjusted MMSE Normal MMSE defined as 25 in literacy or educated 14 in illiteracy

12 Criteria for all-cause dementia -- Recommendations from the National Institute on Aging-Alzheimer s Association (NIAAA) The cognitive or behavioral impairment 2 of the following domains: a. Impaired ability to acquire and remember new information b. Impaired reasoning and handling of complex tasks, poor judgment c. Impaired visuospatial abilities d. Impaired language functions e. Changes in personality, behavior, or comportment McKhann GM, et al. Alzheimer s & Dementia 2011

13 Algorithm for Classification N= 8337 scdr=0 scdr=0.5 scdr 1 Normal MMSE MMSE > 24 in literate MMSE >13 in illiterate Abnormal MMSE Dementia N=414 Normal N=5975 Exclude scdr M and O and JPS=0 scdr M or O or JPS at least one 0.5 Others all = 0 scdr M or O or JPS only one 0.5 Others at least one > 0 scdr M or O or JPS at least two 0.5 Others at least one > 0 M: memory O: orientation JPS: judgment and problem solving CA: community affairs HH: home hobbies PC: personal care Unclassified N=347 MCI N=1337 VMD N=264 MCI: mild cognitive impairment; VMD: very mild dementia

14 Prevalence of dementia in elderly people ( 65 yrs / 70 yrs) with abnormal cognitive function Dementia defined by MMSE and CDR 65 yrs (n=8337) 70 yrs (n=6856) n % n % Cognitive function defined by CDR and MMSE Normal with CDR= Abnormal with CDR= Mild cognitive impairment (MCI) Normal MMSE Abnormal MMSE Unclassified Very mild dementia Dementia with CDR

15 Prevalence of MCI and dementia in different age groups (n=8337) Age (yrs) MCI Very mild dementia Dementia with CDR>=1 n % n % n % 65- <70 (n= 1481) <75 (n=2348) <80 (n=1964) <85 (n=1474) <90 (n=759) (n= 311) Gender subgroup Male n % n % n % 65- <70 (n= 675) <75 (n=1081) <80 (n=940) <85 (n=746) <90 (n=419) (n= 146) Female n % n % n % 65- <70 (n= 806) <75 (n=1267) <80 (n=1024) <85 (n=728) <90 (n=340) (n= 165)

16 Dementia prevalence increase with age Prevalence (%) Age VMD Dementia VMD+Dementia

17 Prevalence of dementia between Gender (Include very mild dementia) Prevalence (%) Age Men Women Total

18 Prevalence of MCI and dementia in different age groups (n=8337)

19 Prevalence of dementia growth from 1992 to 2012 in Taiwan Year Total population >=65 yrs Dementia VMD and dementia ,802,622 1,415,842 (6.81%) 47,855 (3.38%) ,315,822 2,600,152 (11.12%) 129,228 (4.97%) 211,652 (8.14%) Dementia population in 2012 Dementia population in 1992 = / = 2.7 VMD: very mild dementia P opulation of elderly aged 65 yrs or more x D ementia D ementia VMD and D ementia Y ear

20 Dementia (include VMD) Comparison of dementia prevalence between countries (%) Age (yrs) USA (2007) Taiwan (2013) Hong Kong (2007) Very mild dementia Mild dementia 8.9 Mild to severe dementia 5.72 MCI VMD: very mild dementia: CIND: cognitive impairment no dementia Singapore (2012) Mild CIND Moderate to severe CIND Neuroepideimiology 2007; Int Psychogeriatrics 2008; JNNP 2013

21 ADI consensus estimates for the prevalence of dementia (%) by WHO region and age group December 2008

22 ADI consensus estimates for the prevalence of dementia (%) by WHO region and age group Taiwan >=85 VMD CDR>= Dementia

23 Comparison between normal participants and people with dementia using univariate analyses (include VMD, but not include MCI) Categorical variables, n, % Normal Dementia n % n % p Sex < Women Men Age group < <75 y/o < >= Body Mass Index (BMI) <= <BMI<= <BMI<= > Education < Illiterate Literate or primary school Junior or senior high school College or University Marriage, married and live with spouse <0.0001

24 Comparison between normal participants and people with dementia using univariate analyses (include VMD, but not include MCI) Categorical variables, n, % Normal Dementia n % n % p Life style and habit Vegetarian Tea < Coffee < Betel nut Drinking Red Wine Smoking Taking nap Regular exercise < Active social network < Comorbidities Hypertension with treatmemt Diabetes mellitus < Cerebrovascular disease < Hyperlipidemia Lung disease < Liver disease Gastritis or peptic ulcer

25 Associated factors for dementia (multiple logistic regression model, MCI not included) 95% confidence Adjusted ORs Variables interval p value Age 85 y/o or older < Female Gender BMI 18 or less Illiteracy < Marriage, married and live with spouse Life style and habit Vegetarian Tea < Coffee Drinking Smoking Regular exercise < Active social network Comorbidities Hypertension Diabetes mellitus < Cerebrovascular disease < Hyperlipidemia Lung disease Gastritis or peptic ulcer

26 Associated factors for abnormal cognitive function (MCI included) 95% confidence Adjusted ORs Variables interval p value Age 85 y/o or older < Female Gender BMI 18 or less Illiteracy < Marriage, married and live with spouse Life style and habit Vegetarian Tea < Coffee Drinking Smoking Regular exercise < Active social network Comorbidities Hypertension Diabetes mellitus < Cerebrovascular disease < Hyperlipidemia Lung disease Gastritis or peptic ulcer

27 Conclusions Dementia in the elderly ( 65 yrs): 8.14 % Very mild dementia: 3.17% Dementia with CDR 1: 4.97% MCI: 16.04% Diabetes mellitus, cerebrovascular and lung diseases might increase risk of MCI and dementia Maintenance of regular exercise and participating social activities seem to have benefit effects

28 Acknowledgments and Funding Grants from the Department of Health, Taiwan (DOH101E2012) We thank all the collaborators and staff of Taiwan Alzheimer s Disease Association (TADA) for their help in this study. Ming-Jang Chiu Huey-Jane Lee Shu-Chien Yang Ta-Fu Chen Ker-Neng Lin Chung-Chih Lin Pei-Ning Wang Li-Yu Tang

29 I TADA

30 Thank you for your attention