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Diagnosing And Treating Alzheimer Disease: A Jordanian Experience

Diagnosing And Treating Alzheimer Disease: A Jordanian Experience. Marina Hadidi, M.D., Ph.D. Amman, Jordan Istanbul, September 2005. Jordan: Area – 97, 740 km2. Facts about Jordan:. Population: 5,7 mln (2005) Capital: Amman (1,8 mln)

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Diagnosing And Treating Alzheimer Disease: A Jordanian Experience

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  1. Diagnosing And Treating Alzheimer Disease: A Jordanian Experience Marina Hadidi, M.D., Ph.D. Amman, Jordan Istanbul, September 2005

  2. Jordan: Area – 97, 740 km2

  3. Facts about Jordan: • Population: 5,7 mln (2005) • Capital: Amman (1,8 mln) • Life expectancy: M - 71 y, F – 74 y. • Population growth rate: 2,8% per year • Annual income per capita: 1,813 $

  4. Jordan: Majority of population is under the age of 35

  5. Current Situation: Diagnosis of AD • Low awareness about AD in the population • No data about incidence or prevalence of MCI and dementia of Alzheimer type but professionals dealing with it has a common impression of increasing incidence • No studies about prevalence of different types of dementia • Lack of validated psychometric tests. Individually modified MMSE, clock drawing and 3 word recall test are most often used.

  6. Current Situation: Treatment of AD • Patients with AD are treated mostly by neurologists and psychiatrists • Rivastrigmin, Galantamin and Donepezil are officially registered in Jordan/ • Memantin is in the process of registration • There are very few geriatric nursing homes and no specialized centers for AD patients so they stay with the family till very late stages .

  7. Illiteracy: potential implications • Still a very common phenomenon • Associated with age > 65, female gender, non-urban dwelling (Gomez et al 2001, Bowirrat et al, 2001) • Strongly associated with life expectancy in both developed and developing countries (Messias, 2003) • Major socio-economic risk factor for development of dementia in different ethnic groups (Carnero-Pardo, 2000, Bowirrat, Friedland 2002)

  8. Prevalence of Illiteracy in Middle East Countries: (United Nations Statistics Division, 2005)

  9. Retrospective Analysis Of 70 Consecutive Patients Diagnosed As AD In Our Clinic In 2002-2005 • Age 57 – 80 y (mean age 68 y) • Jordanian residents only; patients from other Arab countries not included • M – 46 %, F – 54 % • Total illiteracy – 20 % (M – 13%, F – 26%)

  10. Does Illiteracy Affect Time Of Diagnosis?

  11. Does Illiteracy Affect Treatment Choice and Compliance?

  12. Limitations: Our group is not representative of the whole population of Jordanian patients with dementia because of: - small size of group - patients seeking help from a private doctor - predominantly urban patients

  13. Illiteracy in Jordanian patients with AD (preliminary conclusions) • Illiteracy is more common in female than male AD patients • Illiterate patients were more often diagnosed in moderate and severe stage, as opposed to mild • Illiterate patients and their relatives less often report improvement on treatment with AChEI and are less probable to remain on it for the prolonged period of time

  14. Converging Pathogenic Mechanisms Of Vascular Dementia And Stroke VS Neurodegenerative Dementia

  15. Hypertension: • Elevated midlife systolic blood pressure is an independent risk factor for AD, according to several prospective population-based studies (Kivipelto et al, 2001, Skoog et al, 1996) • Antihypertensive treatment may protect against demetia in older patients with systolic HTN, according to Syst-Eur study (Foretteetal, 2002)

  16. Diabetes Mellitus: • Diabetes increases risk of AD according to epidemiological studies (Knopman et al, 2002; Arvanitakis et al, 2004) • Possible mechanisms may include IDE (insulin-degrading enzyme) which hydrolyses several regulatory peptides including insulin, glucagone, Ab and APP intracellular domain (Duckworth et al 1998, Tanzi et al 2004).

  17. UK : Hypertension -52% CAD or MI -38% Current smoking -27% Diabetes Mellitus -10% TIA -14% P.A.G.Sandercock et.al,1989 Jordan:- 57% - 36% - 41% - 55% - 5% M.Hadidi,2001 Modifiable Risk Factors In 1st Ever Ischemic Stroke

  18. Prevalence of Diabetes Mellitus In 70 Jordanian Patients Diagnosed With AD in 2002-2005 • Alzheimer Patients - 21% • Ischemic Stroke Patients - 55% • Controls (non-stroke, non- - 17% AD patients )

  19. Future Steps • Jordanian Alzheimer Association is in the process of establishing. It will include interested professionals, caregivers and social workers. • Epidemiological study evaluating prevalence of MCI and dementia in Jordanian population and investigation into a possible risk factors is underway

  20. THANK YOU

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