Community Based Cross-sectional Study on the Risk Factors of Dementia among the Elderly in a City

도시지역 노인의 치매 위험요인에 관한 단면연구

  • Kim, Jung-Soon (Department of Nursing, College of Medicine, Pusan National University) ;
  • Chun, Byung-Chul (Department of Preventive Medicine, Medical College, Korea University) ;
  • Cho, Eu-Soo (The Institute for Policy Development, Busan Metropolitan City) ;
  • Jeong, Ihn-Sook (Department of Nursing, College of Medicine, Pusan National University)
  • 김정순 (부산대학교 의과대학 간호학과) ;
  • 천병철 (고려대학교 의과대학 예방의학교실) ;
  • 초의수 (부산시 정책개발실) ;
  • 정인숙 (부산대학교 의과대학 간호학과)
  • Published : 2002.12.01

Abstract

Objectives : To identify the risk factors of dementia among the elderly in a large city. Methods : A cross-sectional study was conducted in July 2001, with potential participants selected by stratified two stage cluster sampling of the elderly population of Keumgog dong, Busan. A total of 452 elderly people aged 65 years and over, underwent a two phase diagnostic procedure. Mini-mental State Examination-Korean (MMSE-K) and Samsung Dementia Questionnaire were used for the 1st stage, and the Clinical Dementia Rating Scale (CDR), the Bartel ADL, and IADL Index, the Korean Geriatric Depression Scale (KGDS), the Modified Hatchinski Ischemic Scale (MHIS), and other laboratory tests were used for the 2nd stage. Results : Of the 446 participants finally chosen, 45 were confirmed with dementia, and 363 as normal, with the rests not confirmed with dementia or as normal, were excluded from the analysis. According to the logistic regression analysis, the risk of dementia was significantly higher In: people aged 80 and above (OR=4.36, 95% CI=1.97-9.62), illiterate (OR=3.58, 95% CI=1.71-7.46), who had a history of strokes (OR=6.35, 95% CI=2.71-14.87), or who had 3 history of hyperlipidemia (OR=4.74, 95% CI=1.65-13.61), compared to their counterparts. Conclusions : These results suggest that efforts to prevent strokes and hyperlipidemia can significantly decrease the risk of dementia.

Keywords

References

  1. Fago JP. Dementia: Causes, evaluation, and management. Hosp Pract 2001; 36(1):67
  2. Byun YC, Han YJ, Lee SH, Park JH, Woo n, Lee JH. Development of Demintia Care Mapping. Korea Institute for Health and Social Affairs. 1995
  3. Kee BS, Yoon JH, Kim SK. A preliminary study on the risk factors between vascular dementa and Alzheimer's dimentia. J Korean Geriatr Psychiatry 1997; 1(1): 96-99 (Korean)
  4. Alloul K, Sauriol L, Kennedy W, Laurier C, Tessier G, Novosel S, Contandriopoulos A. Alzheimer's disease: A review of the disease, it's epidemiology and economic impact. Arch Gerontol Geriatr 1998; 27: 189-221 https://doi.org/10.1016/S0167-4943(98)00116-2
  5. Breteler M. Vascular risk factors for Alzheimer's disease: An epidemiologic perspective. Neurol Aging 2000; 21: 153-160
  6. Hatada K, Okazaki Y, Yoshitake K, Takada K, Nakane Y. Further evidence of westernization of dementia prevalence in Nagasaki, Japan, and family recognition. Int Psychogeriatrics 1999; 11: 123-138 https://doi.org/10.1017/S1041610299005682
  7. Li G, Shen YC, Chen CH, Zhao YW, Li SR, Lu M. An epidemiological survey of agerelated dementia in an urban area of Beijing. Acta Psychiatry Scand 1989; 79: 557-563 https://doi.org/10.1111/j.1600-0447.1989.tb10303.x
  8. Ogura C, Nakamoto H, Umea T, Yamamoto K, Yonemori T, Yoshimura T, the COSEPO Group. Prevalence of senile dementia in Okinawa, Japan. Int J Epidemiol 1995; 24: 373-380 https://doi.org/10.1093/ije/24.2.373
  9. Ott A, Breteler M, van Harskamp F, Claus JJ, van der Cammen T, Grobbee DE, Hoffman A. Prevalence of Alzheimer' s disease and vascular dementia: association with education. The Rotterdam study. BMJ 1995; 310: 970-973 https://doi.org/10.1136/bmj.310.6985.970
  10. Prencipe M, Casini AR, Ferretti C, Lattanzio MT, Fiorelli M, Cullasso F. Prevalence of dementia in an elderly rural population: Effects of age, sex, and education. J Neurol Neurosurg Psychiatry 1996; 60: 628-633 https://doi.org/10.1136/jnnp.60.6.628
  11. Shibayama H, Kasahara Y, Kobayashi H. Prevalence of dementia in a Japanese elderly population. Acta Psychiatr Scand 1986; 74: 144-151 https://doi.org/10.1111/j.1600-0447.1986.tb10598.x
  12. Yamada M, Sasaki H, Mimori Y, Kasagi F, Sudoh S, Ikeda J, Hosoda Y, Nakamura S, Kodama K. Prevalence and risks of dementia in the Japanese population: RERF' s adult health study Hiroshima Subjects. J Am Geriatr Soc 1999; 47(2): 189-195 https://doi.org/10.1111/j.1532-5415.1999.tb04577.x
  13. Zhang M, Katzman R, Salmon D, Jin H, Liu WT, Wang Z, Qu G, Grant I, Yu I, Levy P, Klauber MR, Liu WT. The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education. Ann Neurol 1990; 27: 428-437 https://doi.org/10.1002/ana.410270412
  14. Park JH, Ko HJ. Etiological classification of dementia and relative prevalence of important dementia among the elderly in a Myun area of Yungil County, Kyungpook Province. J Korean Neuropsychiatr Assoc 1991; 30(5): 885-891 (Korean)
  15. Woo n, Lee JH, Yoo KY, Hong JP, Kim CY, Kim YI, Lee JW. The prevalence of dementia among the elderly in a rural area of Korea. J Korean Neuropsychiatr Assoc 1997; 36: 92-101 (Korean)
  16. Suh GH. Prevalence and risk factors of dementia and depression in the elderly. Unpublished doctoral dissertation. Seoul National University. 1999
  17. Cho MJ, Hahm BJ, Ju JH, Bae IN,' Kweon JS. The prevalence of cognitive impariement and dementia among the elderly in a city. J Korean Neuropsychiatr Assoc 1998; 37(2): 352-362 (Korean)
  18. Kwak DI, Choi YK, Jung IK, Lee MS, Epidemiological Study of Dementia in a Korea Urban Area. J Korean Geriatric Psychiatry 1999; 3(1): 44-52 (Korean)
  19. Kwon YC, Park JH. Standardization of Mini-Mental State Examination- Korean version for the elderly(MMSE-K). J Korean Neuropsychiatr Assoc 1989; 28: 125-135 (Korean)
  20. Folstein MF, Folstein SE, McHugh PRo 'Mini-Mental State' : A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12: 189-198 https://doi.org/10.1016/0022-3956(75)90026-6
  21. Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Br J psychiatry 1982; 140: 566-572
  22. Jung IK, Kwak 01, Joe SH, Lee HS. A Study of Standardization of Korean Form of Geriatric Depression Scale(KGDS). J Korean Geriatr Psychiatry 1997; I: 6172 (Korean)
  23. Rosen WG, Terry RD, Fuld PA, Katzman R, Pecj A. Pathological verification of ischemic score in differentiation of dementias. Ann Neurol 1980; 7: 486.488 https://doi.org/10.1002/ana.410070516
  24. Gurland BJ, Cross PS. Epidemiology of psychopathology in old age. PsychiCUn NAm 1982; 5(1): 11-25
  25. Livingston G, Hawkins A, Graham N, Blizard B, Mann A. The Gospel Oak Study : prevalence rates of dementia, depression and activity limitation among elderly residents in Inner London. Psychol Med 1990; 20: 137-146 https://doi.org/10.1017/S0033291700013313
  26. Park JH. Dementia: Introduction and Epidemiology. 2nd Symposium of Neurology Research Meeting. 1997
  27. Canadian Study of Health and Aging Working Group. Canadian study of health and aging: study methods and prevalence of dementia. CMAJ 1994; 150: 899-913
  28. Hahm BJ, Kim JK, Cho MJ. Prevalence, Incidence, and Risk Factors of Dementia and Depressive Disoreders of the Elderly Residing in the Community: A Two Stage One-year Follow-up Study. J Korean Geriatric Psychiatry 1999; 3(2): 140-148 (Korean)
  29. Jorm AF, Korten AE, Henderson AS. The prevalence of dementia : A quantitative integration of the literature. Acta Psychiatr Scand 1987; 76: 465-479 https://doi.org/10.1111/j.1600-0447.1987.tb02906.x
  30. Park JH, Cho SW. Etiological Classi-fication and Epidemiology of Dementia. J Korean Geriatr Psychiatry 1997; 1(1): 16-22 (Korean)
  31. Letenneur L, Com menges D, Dartigues JF, Barberger-Gateau P. Incidence of dementia and Alzheimer' s disease in elderly community residents of southwestern France. lnt J Epidemiol 1994; 23: 1256-1261
  32. Nyenhuis D, Gorelick P. Vascular dementia: A contemporary review of epidemiology, diagnosis, prevention, and treatment. J Am Geriatr Soc 1998; 46(11): 1437-1448 https://doi.org/10.1111/j.1532-5415.1998.tb06015.x
  33. Newhouse PA, Sunderland T, Tariot PN, Blumhardt CL, Weingartner H, Mellow A, Murphy DL. Intravenous nicotine in Alzheimer' s disease: a pilot study. Psychopharmacology 1988; 95: 171-175
  34. Graves AB, van Duijn CM, Chandra V, Fratiglioni L, Heyman A, Jorm AF, Kokmen E, Kondo K, Mortimer JA, Rocca WA. Alcohol and tobacco consumptions as risk factors for Alzheimer' s disease: a collaborative reanalysis of case-control studies. lnt J Epidemiol 1991; 20(suppI 2): S48--S57 https://doi.org/10.1093/ije/20.Supplement_2.S48
  35. Prince M, Cullen M, Mann A. Risk factors for Alzheimer's disease and dementia: a case-control study based on the MRC elderly hypertension trial. Neurology 1994; 44: 97-104 https://doi.org/10.1212/WNL.44.1.97
  36. Saunders PA, Copeland JR, Dewey ME, Davidson IA, McWilliam C, Sharma V, Sullivan C. Heavy drinking as a risk factor for depression and dementia in elderly men: findings from the Liverpool Longitudinal Community Study. BIP 1991; 159: 213-216
  37. Fratiglioni L, Ahlborn A, Viitanen M, Winblad B. Risk factors for late-onset Alzheimer's disease: a populationbased, case-control study. Ann Neurol 1993; 33(3): 258-266 https://doi.org/10.1002/ana.410330306
  38. Skoog I, Nilsson L, Palmertz B, Andreasson LA, Svanborg A. A population based study of dementia in 85year- olds. N Eng J Med 1993; 328: 153-158 https://doi.org/10.1056/NEJM199301213280301
  39. Tatemichi TK, Desmond DW, Paik M, Figueroa M, Gropen Tl, Stern Y, Sano M, Remien R, Williams JB, Mohr JP. Clinical determinants of dementia related to stroke. Ann Neurol 1993; 33: 568-575 https://doi.org/10.1002/ana.410330603
  40. Chen X, Xia Y, Chen X. The CYP2D6B allele is associated with a milder synaptic pathology in Alzheimer's disease. Ann Neurol 1995; 38: 653-658 https://doi.org/10.1002/ana.410380415
  41. Merz B. Is boxing a risk factor for Alzheimer' s?(News). JAMA 1989; 261: 2597-2598 https://doi.org/10.1001/jama.261.18.2597
  42. Heyman A, Wilkinson WE, Stafford JA, Helms MJ, Sigmon AH, Weinberg T. Alzheimer' s disease : a study of epidemiologicial aspects. Ann Neural 1984; 15: 335-341 https://doi.org/10.1002/ana.410150406
  43. Foster DP, Newens AJ, Kay DW, Edwardson JA. Risk factors in clinically diagnosed presenile dementia of the Alzheimer's type: a case-control study in northern England. J Epidemiol Community Health 1995 ; 49: 253-258 https://doi.org/10.1136/jech.49.3.253
  44. Kelsey JL, Thompson W, Evans AS. Methods in observational epidemiology. New York: Oxford University Press; 1986