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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