Abstract
BackgroundA strong inverse relationship of functional limitation and socioeconomic status has been established in western ageing society. Functional limitation can be related to chronic diseases, disuse, cognitive decline, and ageing. Among chronic diseases in the Thai population, cerebrovascular diseases, diabetes, and arthritis are common. These factors are known to contribute to disability and poor quality of life in the elder population. Neuropsychiatric problems, cognitive decline, dementia, and cultural issues in elderly people also can alter the quality of life of the elderly.MethodsThe Dementia and Disability Project in Thai Elderly (DDP) aims at comprehensively assessing community dwelling Thai elderly to understand the relationship between disability and motor function, neuropsychiatric symptoms, cognitive function, and chronic diseases. The DDP is the first study to look at the prevalence and etiology of dementia and of mild cognitive impairment (MCI) in Thai elders and to explore the relationship of cognition, disability, small vessel diseases and cortical degeneration with neuroimaging in Thai elderly people. 1998 Thai elders were screened in 2004–2006 and diagnosed as having MCI or dementia. 223 elders with MCI or dementia and cognitively normal elderly had brain magnetic resonance imaging (MRI) or at baseline. 319 elders from the 3 groups had blood tests to investigate the risks and possible etiologies of dementia including genotyping at baseline.ResultsThe mean age of elders in this study is 69.51(SD=6.71, min=60, max=95) years. 689(34.9%) are men and 1284(65.1%) are women. Mean body weight was 58.36(SD=11.20) kgs. The regression model reveals that performance on gait and balance and serum triglyceride predicts activity of daily living performance (adjusted r2 = 0.280, f=2.644, p=0.003). The majority of abnormal gait in Thai elders was lower level gait disturbance. Only 1.5% (29/1952) had highest level gait disorders. 39.5% of 1964 subjects were free of chronic diseases. Treatment gap (indicating those who have untreated or inadequate treatment) of diabetes mellitus and hypertension in Thai elders in this study was 37% and 55.5% respectively. 62.6% of Thai elders have ApoE3E3 allele. Prevalence of positive ApoE4 gene in this study is 22.85%. 38.6% of Thai elders who had MRI brain study have moderate to severe white matter lesions.ConclusionThe large and comprehensive set of measurements in DDP allows a wide-ranging explanation of the functional and clinical features to be investigated in relation to white matter lesions or cortical atrophy of the brain in Thai elderly population. An almost 2 year follow up was made available to those with MCI and dementia and some of the cognitively normal elderly. The longitudinal design will provide great understanding of the possible contributors to disability in the elderly and to the progression of cognitive decline in Thai elders.
Highlights
A strong inverse relationship of functional limitation and socioeconomic status has been established in western ageing society
Deep cerebral small vessel disease caused by aging, arterial hypertension, diabetes mellitus, smoking and other factors is a vasculopathy leading to mobility problems and to disability [1,2]
We found that 37% of those elders with abnormal Fasting Blood Sugar (FBS) either did not have hypoglycemic treatment or knew that they had DM but did not take medication [Chi square p= 0.044, df = 2 (6.229)] and 63% [(560+669)/1951] of elders had either under diagnosed hypertension or inadequate treatment of hypertension [Chi Square p
Summary
A strong inverse relationship of functional limitation and socioeconomic status has been established in western ageing society. Functional and clinical abnormalities in patients with cerebral small vessel disease, shown as white matter hyperintensities (WMHs) or white matter lesions (WMLs) in brain magnetic resonance imaging (MRI), have shown an association with global or selective cognitive deficits, depression, and motor abnormalities [3]. These features can contribute to disability in the elderly. Motor deficits, including rigidity, gait apraxia and impaired balance on walking, increase risk of falls [5] Physical illness such as back pain or osteoarthritis of the knees can cause mobility problems. Disabilities in daily function and in general health are a possible consequence of an interaction between cognition, neuropsychiatric disorders, and chronic diseases in elderly persons
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