Risk Factors for Dementia and Impaired Cognitive Status in Thai Elderlyt
VORAPUN SENANARONG, M.D., M.R.C.P. (UK.)*, PIYANUCH JAMJUMRUS, B.Sc.*, KAMONTIP HARNPHADUNGKIT, M.D.**, SATHIT V ANNASAENG, M.D.***, SUTHIPOL UDOMPUNTHURAK, M.Sc****, NARAPORN PRAYOONWIWAT,M.D.*, NIPHON POUNGVARIN, M.D., F.R.C.P. (London)*
Affiliation : * Division of Neurology, Department of Medicine, ** Department of Rehabilitation Medicine, *** Division of Endocrinology, Department of Medicine, **** Division of Clinical Epidemiology, Department of Research and Development, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand. t This study was supported by grants from the National Research Council of Thailand, 1997-1999 fiscal years There are two forms of dementia, rever Our study aimed to examine the relation sible and non-reversible. Two related factors are ship between blood pressure (BP), physical, important: the prevalence of reversible demen haematological and biochemical risk factors and tia and the outcome of treatment of reversible cognitive status in Thai elderly. dementia. Clarfield published a monograph stating that partial recovery was seen in 8 per cent MATERIAL AND METHOD and full recovery in 3 per cent of patientsO). This study was part of the Integrated Treatment of reversible dementia has the best Health Research Project for Thai Elderly at the results in its most frequent causes: depression Faculty of Medicine Siriraj Hospital conducted and drug intoxicationC2). Blood tests looking for from 1997 to 1999. A door to door survey and etiology of reversible dementia in every patient record of the elderly dwelling in the area within 10 with dementia are still recommended. km around Siriraj Hospital, Bangkok, was per Another traditional assumption is that formed. Names of these elders were recorded as there are two forms of dementia Alzheimer's participants in the study. Their ages were fifty-five disease (AD) and vascular dementia (VaD). Recent years and older. Of these 550 subjects were epidemiological evidence shows that vascular recruited for our case-control study. We catego risk factors may possibly be important in the rised the elders into the dementia group, the etiology of dementia in general and of both VaD cognitive impairment group and the normal group. and ADC3-5). Blood pressure (BP) has been an Thai Mental State Examination (TMSE)(ll) was interesting focus on cognitive function and is applied as a screening cognitive test for all viewed as a potential reversible risk factor for subjects. Those whose score being less than dementia. Elevated BP and hypertension are or equal to 24 out of 30 but did not meet the known to be associated with the presence and criteria for diagnosis of dementia, were defined as with amount of white matter hyperintensities cognitively impaired. Dementia was diagnosed (WMHis)C6-8) and cerebral atrophy(9). Evidence according to the DSM IV criteriaC12). suggests that larger volumes of WMHI are asso Arterial blood pressure was measured ciated with lower levels of cognitive function(lO). with a mercury sphygmomanometer with subjects
Objective : To examine the association of physical and biochemicaJ risk factors for dementia and cognitive status in an urban population based Thai elderly.
Materials and Methods : This study was part of an integrated health research project from 1997 to 1999. Subjects were 550 elders who lived in a community within 10 km from Siriraj Hospital, Bangkok, Thailand. They were 55 years and older. Thai mental state exami nation (TMSE) was applied to all subjects as the screening test for dementia. Those who scored less than or equal to 24 out of 30 were categorised as having cognitive impairment or suspected of having dementia, and they were then examined in detail for the diagnosis of dementia using the DSM IV criteria. Blood pressure and body weight were recorded. Blood was drawn for biochemical and haematological analysis including the serology for syphilis and thyroid function test as the basic screening investigation for dementia. Descriptive data, expressed as the mean, standard deviation, Pearson Chi square and ANOV A tests were analysed with SPSS 9.0 in the study.
Results : Of 550 subjects, 261 ( 4 7.45%) were classified as the normal subjects group, 49 (8.91 %) as the cognitively impaired group, and 240 (43.82%) as the dementia group. 377 subjects (68.55%) were female and the distribution of females in each subgroup ranged from 63.3 - 75.5 per cent. The mean age in the normal group was 67.47 ± 6.05 years, the cognitively impaired group was 70.14 years and the dementia group was 69.63 ± 9.21 years. Systolic blood pressure (BP), diastolic BP, serum cholesterol, SOOT, GOT, serum albumin, haemoglobin, MCHC, neutrophil counts and weight were statistically significant factors that were associated with cognitive status. Both systolic and diastolic BP were high in the higher cognitive status group. Serum albumin, serum cholesterol levels and body weight were also higher in the high cognitive status group. Coilclusion : This study demonstrated an association between nutritional status and cognitive status in Thai elderly. Poorer nutritional factor in lower cognitive function individuals might explain a lower of both systolic and diastolic BP in the dementia subjects compared to the healthy subjects.
Keywords : Risk Factors, Dementia, Cognitive Impairement, Thai Elderly
