A profile of dementia patients in a Serbian sample – experience from the center for dementia and memory disorders
Abstract
Background/Aim. In accordance with modern trends of organizing specialized service dealing with dementia, the first memory clinic in Serbia – Center for memory disorders and dementia was established in 2008 in Belgrade at Neurology Clinic – Clinical Center of Serbia (CCS) as a university-affiliated outpatient clinic for subjects with cognitive impairment and dementia. The aim of this report was to outline the frequency of diagnosis, sociodemographic and medical characteristics of patients referring to the Center for memory disorders and dementia. Methods. The sample consisted of patients registered between 2008 and 2016 who underwent comprehensive and specialized diagnostic procedures in the Center. Results. A total of 3,873 visits were made for 2,198 patients, 39.6% of which proceed to annually follow-up visits. The majority of the sample (65.3%) was women. The mean age was 69.8 ± 12.1 years (range 29–89 years) and the average education level was 12.1 ± 3.3 years. Of this total number, at the moment of the first visit, 44.4% of the patients were fulfill criteria for Mild cognitive impairment (MCI), 28.2% had dementia due to Alzheimer’s disease (AD), 7.8% had dementia secondary to a vascular pathology (VaD), 7.3% had frontotemporal dementia (FTD), 0.6% had dementia with Lewy bodies (DLB), and 1.7% had dementia due to Parkinson's disease (PDD). The mean Mini Mental test score in the whole sample was 22.6 ± 6.8 points. Conclusion. The data collected through the activity of the Center enabled an insight into the demographic and medical characteristics of patients, as well as planning further activities in the health care system. The systemic introduction of more standardized diagnostic practices, establishing and networking of similar centers will improve the accuracy and rate of dementia diagnosis in the Serbian population.
References
Arie T. The first year of the Goodmayes psychiatric service for old people. Lancet 1970; 2(7684): 1179–82.
Pitt B. Psychogeriatrics: An Introduction to the Psychiatry of Old Age. Edinburgh:Chuchill-Livingstone; 1975.
Benbow SM, Jolley D. Organisation of mental health services for older people. In: Pathy M, Sinclair A, Morley E, editors. Principles and Practice of Geriatric Medicine. 4th ed. Chichester: John Wiley; 2006; p. 1163–71.
Fraser M. Memory clinics and memory training. Chapter 10. In: Arie T, editor. Recent advances in psychogeriatrics 2. Edinburgh: Churchill Livingstone; 1992. p. 105–16.
Ames D, Flicker L, Helme R. A memory clinic at a geriatric hospital: Rationale, routine and results from the first 100 patients. Med J Aust 1992; 156(9): 618–22.
Jolley D, Moniz-Cook E. Memory clinics in context. Indian J Psychiatry 2009; 51(Suppl 1): S70–6.
Hejl A, Hogh P, Waldemar G. Potentially reversible conditions in 1000 memory clinic patients. J Neurol Neurosurg Psychiatry 2002; 73(4): 390–4.
Freter S, Bergman H, Gold S, Chertkow H, Clarfield AM. Pre¬va-lence of potentially reversible dementias and actual reversibility in a memory clinic cohort. CMAJ 1998; 159(6): 657–62.
Vernooij-Dassen MJ, Moniz-Cook ED, Woods RT, De Lepeleire J, Leuschner A, Zanetti O, et al. Factors affecting the timely recognition and diagnosis of dementia across Europe: from awareness to stigma. Int J Geriatr Psychiatry. 2005; 20(4): 377–86.
van Hout HP, Vernooij-Dassen MJ, Hoefnagels WH, Grol RP. Measuring the opinions of memory clinic users: patients, relatives and general practitioners. Int J Geriatr Psychiatry 2001; 16(9): 846–51.
Streams ME, Wackerbarth SB, Maxwell A. Diagnosis seeking at subspecialty memory clinics: trigger events. Int J Geriatr Psychiatry 2003; 18(10): 915–24.
Dautzenberg PL, van Marum RJ, van Der Hammen R, Paling HA. Patients and families desire a patient to be told the diagnosis of dementia: a survey questionnaire of a Dutch memory clinic. Int J Geriatr Psychiatry 2003; 18(9=: 777–9.
LoGiudice D, Hassett A, Cook R, Flicker L, Ames D. Equity of access to a memory clinic in Melbourne? Non-English speaking background attenders are more severely demented and have increased rates of psychiatric disorders. Int J Geriatr Psychiatry 2001; 16(3): 327–34.
Logiudice D, Waltrowicz W, Brown K, Burrows C, Ames D, Flicker L. Do memory clinics improve the quality of life for carers. A randomised pilot trial? Int J Geriatr Psychiatry 1999; 14(8): 626–32.
Thomas Antérion C, Gely-Nargeot MC, Pancrazi MP. Management of memory disorders in anxious patients consulting a memory clinic. Rev Neurol (Paris) 2000; 156(8–9): 775–9. (French)
Damian M, Krumm B, Syren M, Hentschel F. Is there a referral bias in the diagnoses of patients of a memory clinic? Z Gerontol Geriatr 2003; 36(3): 197–203. (German)
Walstra GJ, Derix MM, Hijdra A, van Crevel H. An outpatient clinic for memory disorders: initial experiences. Ned Tijdschr Geneeskd 1992; 136(7): 328–32. (Dutch)
Werner P, Heinik J, Aharon J. Process and organisational characteristics of memory clinics in Israel: a national survey. Arch Gerontol Geriatr 2001; 33: 191–201.
Rösler A, Gönnenwein C, Müller N, Sterzer P, Kleinschmidt A, Frölich L. The fuzzy frontier between memory complaints and early dementia: a survey of patient management in German memory clinics. Dement Geriatr Cogn Disord 2004; 17(3): 222–30.
Diehl J, Staehelin H, Wiltfang J, Hampel H, Calabrese P, Monsch A, et al. German-speaking memory clinics: the state of the art. Z Gerontol Geriatr 2003; 36(3): 189–96. (German)
Monsch AU, Ermini-Fünfschilling D, Mulligan R, Meier D, Juillerat AC, Michel JP, et al. Memory clinics in Switzerland. Collaborative group of Swiss memory clinics. Ann Med Interne (Paris) 1998; 149(4): 221–7.
Cheung G, Strachan J. A survey of memory clinics in New Zealand. Australas Psychiatry 2008; 16(4): 244–7.
Verhey FR, Ramakers I, Jolles J, Scheltens P, Vernooij-Dassen M, Olde Rikkert M. Development of memory clinics in the Netherland. Tijdschr Geronotol Geriatr 2007; 38(5): 237–45. (Dutch)
Kopelman M, Crawford S. Not all memory clinics are dementia clinics. Neuropsychol Rehabil 1996; 6(3): 187–202.
Matthews FE, Arthur A, Barnes LE, Bond J, Jagger C, Robinson L, et al. Medical Research Council Cognitive Function and Ageing Collaboration. A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet 2013; 382(9902): 1405–412.
Qiu C, von Strauss E, Bäckman L, Winblad B, Fratiglioni L. Twenty-year changes in dementia occurrence suggest decre-asing incidence in central Stockholm, Sweden. Neurology 2013; 80(20): 1888–94.
Christensen K, Thinggaard M, Oksuzyan A, Steenstrup T, Andersen-Ranberg K, Jeune B, McGue et al. Physical and cognitive functioning of people older than 90 years: A comparison of two Danish cohorts born 10 years apart. Lancet 2013; 382(9903): 1507–13.
Lobo A, Saz P, Marcos G, Dia JL, De‐la‐Camara C, Ventura T, et al. Prevalence of dementia in a southern European population in two different time periods: The ZARADEMP Project. Acta Psychiatr Scand 2007; 116(4): 299–307.
Krysinska K, Sachdev P, Brodaty H. Dementia registries around the world: a review and recommendations 2016. Available from: https://cheba.unsw.edu.au/sites/default/files/Krysinska% 20et%20al%20-%20Dementia%20registries%20around% 20the%20world%20report%20November%202016.pdf
Centers for Disease Control and Prevention. International Clas-sification of Diseases, Injuries, and Causes of Death. Ninth Revision (ICD-9). Atlanta, GA: CDC/National Center for Health Statistics; 1979.
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of alzheimer’s disease: Report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on alzheimer’s disease. Neurology 1984; 34(7): 939–44.
Román GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH,et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology 1993; 43(2): 250–60.
McKeith IG, Galasko D, Kosaka K, Perry EK, Dickson DW, Hansen LA, et al. Consensus guidelines for the clinical and pathologic diagnosis of dementia with lewy bodies (DLB): Report of the consortium on DLB international workshop. Neurology 1996; 47(5): 1113–24.
McKhann GM, Albert MS, Grossman M, Miller B, Dickson D, Trojanowski JQ. Work Group on Frontotemporal Dementia and Pick's Disease. Clinical and pathological diagnosis of frontotemporal dementia: report of the Work Group on Frontotemporal Dementia and Pick's Disease. Arch Neurol 2001; 58(11): 1803–9.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. (DSM-IV). Washington DC, American Psychiatric Association; 1994.
Folstein MF, Folstein SE, McHugh TR. “Mini-Mental State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189–98.
Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrooke’s Cognitive Examination Revised (ACE-R): a brief cognitive testbattery for dementia screening. Int J Geriatr Psychiatry 2006; 21(11): 1078–85.
Mattis S. Dementia rating scale: professional manual. Odessa, Fl: Psychological Assessment Resources; 1988.
Freedman M, Leach L, Kaplan E, Winocur G, Shulman K, Delis DC. Clock-drawing: a neuropsychological analysis. New York, NY: Oxford University Press; 1994.
Lezak MD. Neuropsychological assessment. New York, NY: Oxford University Press; 1995.
Buschke H. Cued recall in amnesia. J Clin Neuropsychol 1984; 6(4): 433–40.
Grober E, Buschke H. Genuine memory deficits in dementia. Dev Neuropsychol 1987; 3(1): 13–36.
Kaplan E, Goodglass H, Weintrab S. The Boston Naming Test. Philadelphia: Lea & Febiger; 1983.
Reisberg B, Finkel S, Overall J, Schmidt-Gollas N, Kanowski S, Lehfeld H, et al. The Alzheimer's disease activities of daily living international scale (ADL-IS). Int Psychogeriatr 2001; 13(2): 163–81.
Seshadri S, Wolf PA, Beiser A, Au R, McNulty K, White R, et al. Lifetime risk of dementia and Alzheimer's disease. The impact of mortality on risk estimates in the Framingham Study. Neurology 1997; 49(6): 1498–504.
Podcasy JL, Epperson CN. Considering sex and gender in Alzheimer disease and other dementias. Dialogues Clin Neurosci 2016; 18(4): 437–46.
Azad NA, Al Bugami M, Loy-English I. Gender differences in dementia risk factors. Gend Med 2007; 4(2): 120–9.
Camarda C, Pipia C, Azzarello D, Battaglini I, Romeo G, Chiodi M, et al. Vascular risk factors, vascular diseases, and imaging findings in a hospital-based cohort of mild cognitive impair-ment types. Curr Alzheimer Res 2018; 15(7): 679–90.
Bartels C, Wagner M, Wolfsgruber S, Ehrenreich H, Schneider A. Alzheimer’s disease neuroimaging initiative. Impact of SSRI therapy on risk of conversion from mild cognitive impairment to Alzheimer's dementia in individuals with previous de-pression. Am J Psychiatry 2018; 175(3): 232–41.
Caselli RJ, Langlais BT, Dueck AC, Henslin BR, Johnson TA, Woodruff BK, et al. Personality Changes During the Transition from Cognitive Health to Mild Cognitive Impairment. J Am Geriatr Soc 2018; 66(4): 671–8.
Seltman RE, Matthews BR. Frontotemporal lobar degeneration: epidemiology, pathology, diagnosis and management. CNS Drugs 2012; 26(10): 841–70.
Iliffe S, De Lepeleire J, Van Hout H, Kenny G, Lewis A, Vernooij-Dassen M. DIADEM Group. Understanding obstacles to the recognition of and response to dementia in different European countries: a modified focus group approach using multi¬na-tional, multi-disciplinary expert groups. Aging Ment Health 2005; 9(1): 1–6.
Martinez-Lage P, Frolich L, Knox S, Berthet K. Assessing physician attitudes and perceptions of Alzheimer's disease across Europe. J Nutr Health Aging 2010; 14(7): 537–44.
Hausner L, Frölich L, Gardette V, Reynish E, Ousset PJ, Andrieu S, et al. On Behalf Of The Ictus-Eadc Study Group. Regional variation on the presentation of Alzheimer's disease patients in memory clinics within Europe: data from the ICTUS study. J Alzheimers Dis 2010; 21(1): 155–65.
Iliffe S, Robinson L, Brayne C, Goodman C, Rait G, Manthorpe J, et al. Primary care and dementia: 1. diagnosis, screening and disclosure. Int J Geriatr Psychiatry 2009; 24(9): 895–901.
Pope C, Mays N. Qualitative research in health care. 2nd ed. London: BMJ Books; 1999.
Amity. Life without memory. Available from: http://www.amity-yu.org/wp-content/uploads/2017/02/ zivot_bez_secanja_istrazivanje_potrebe_za_dnevnim_centrom_za_dementne_policy_amity.pdf (Serbian)
Chui HC, Ramirez-Gomez L. Clinical and imaging features of mixed Alzheimer and vascular pathologies. Alzheimers Res Ther 2015; 7(1): 21.
Moore V, Cahill S. Diagnosis and disclosure of dementia--a comparative qualitative study of Irish and Swedish General Practitioners. Aging Ment Health. 2013; 17(1): 77–84.
Kalaria RN, Maestre GE, Arizaga R, Friedland RP, Galasko D, Hall K, et al. Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors. World Federation of Neurology Dementia Research Group. Lancet Neurol 2008; 7(9): 812–26.
Forette F, Boller F. Hypertension and the risk of dementia in the elderly. Am J Med 1991; 90(3A): 14S–19S.
Rizzi L, Rosset I, Roriz-Cruz M. Global epidemiology of dementia: Alzheimer's and vascular types. Biomed Res Int. 2014; 2014: 908915.
Vita AJ, Terry RB, Hubert HB, Fries JF. Aging, health risks, and cumulative disability. N Engl J Med 1998; 338(15): 1035–41.
Van der Mast RC, Vinkers DJ, Stek ML, Bek MC, Westendorp RG, Gussekloo J, et al.. Vascular disease and apathy in old age. The Leiden 85-Plus Study. Int J Geriatr Psychiatry 2008; 23(3): 266–71.
Van Dalen JW, Van Wanrooij LL, Moll van Charante EP, Richard E, van Gool WA. Apathy is associated with incident dementia in community-dwelling older people. Neurology 2018; 90(1): e82–e89.
Aarsland D, Zaccai J, Brayne C. A systematic review of pre-valence studies of dementia in Parkinson's disease. Mov Disord 2005; 20(10): 1255–63.
Vasconcellos LF, Pereira JS. Parkinson's disease dementia: Diagnostic criteria and risk factor review. J Clin Exp Neuro-psychol 2015; 37(9): 988–93.
Custodio N, Montesinos R, Lira D, Herrera-Pérez E, Bardales Y, Valeriano-Lorenzo L. Mixed dementia: A review of the evidence. Dement Neuropsychol 2017; 11(4): 364–70.
Vann Jones SA, O’Brien JT. The prevalence and incidence of dementia with Lewy bodies: a systematic review of population and clinical studies. Psychol Med 2014; 44(4): 673–83.
Kane JPM, Surendranathan A, Bentley A, Barker SAH, Taylor JP, Thomas AJ, et al. Clinical prevalence of Lewy body dementia. Alzheimers Res Ther 2018; 10(1): 19.
Stefanova E, Pavlović A, Semnic M, Janjić V, Petrović V, Milošević V, et al. Vodič za Alchajmerovu bolest 2013.god. Beograd: Ministrastvo zdravlja ; 2013. (Serbian)
Aprahamian I, Martinelli JE, Neri AL, Yassuda MS. The accuracy of the Clock Drawing Test compared to that of standard screening tests for Alzheimer's disease: results from a study of Brazilian elderly with heterogeneous educational backgrounds. Int Psychogeriatr 2010; 22(1): 64–71.
Henry JD, Crawford JR, Phillips LH. Verbal fluency performance in dementia of the Alzheimer's type: a meta-analysis. Neuropsychologia 2004; 42(9): 1212–22.