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Demographic Pattern of Alzheimer’s Disease in Bangladesh

Background: AD is the most common cause of dementia in elderly which causes economic burden for the affected individual, caregivers and society. The objective of this study was to see demographic characteristics among AD patients and it will provide magnitude of the problem and planning of health programme for prevention of disease. Methods: This observational analytical study was carried out in the Neurology ward, OPD and Dementia clinic of BSMMU, Dhaka from May’ 15 to February’ 17. A total of 45 patients were recruited as study population after satisfying all the criteria for enrollment. Results: A total of 27 male and 18 female with mean age of 69.20 ± 11.16 years, constituted as cases. Conclusion: The occurrence of AD found more after the age of 65 years. The present study found that lower educational level is associated with more chance of getting AD. Higher rate of Alzheimer’s disease was found in older man than

With the exception of cases of Alzheimer's caused by genetic abnormalities, experts believe that Alzheimer's, like other common chronic diseases, develops as a result of multiple factors rather than a single cause. The greatest risk factors for lateonset "sporadic" Alzheimer's are older age 2 , having a family history of Alzheimer's 3 and carrying the APOE-e4 gene 4 . Several studies on Alzheimer's disease and other types of dementia in different countries and continents have shown a steady increase in the incidence of dementia according to age and Alzheimer's disease is the main cause 5 . Several risk factors of dementia and Alzheimer's disease have been studied, sex is one of them. Female sex found affecting more than male. Previous prevalence surveys also found an increased risk among women 6 .
People with fewer years of formal education are at higher risk for Alzheimer's and other dementias than those with more years of formal education 7 . The effect of education on the risk of dementia and Alzheimer's disease is still controversial. Several studies have reported an increased prevalence of Alzheimer's disease in poorly educated people 8 , but several case-control or population based studies failed to confirm this association 9 . A higher incidence of Alzheimer's disease was found among subjects in the North Manhattan (New York) Study who had less than 8 years of education 10 . The aims and objectives of this study were to see demographic variations among the Alzheimer's disease patients.

Methods:
This observational analytical study was conducted in Neurology ward, OPD and Dementia clinic (besides general OPD services of neurology, there are six specialized clinics are running for patients of specific neurological diseases. Dementia clinic is one of them, where only patients of dementia are evaluated and managed by neurology consultants. This clinic provides service to the patients every Thursday from 11 am to 2:30 pm. About 20-30 patients per month are getting services from this clinic. Proper registrar is maintained in the Dementia clinic for research purpose of BSMMU, Dhaka during May' 15 to February' 17. All adult consecutive patients with clinical diagnosis of Alzheimer's disease at the place of study were study population. After ethical clearance from Institutional Review Board (IRB), patients having features of AD according to revised NINCDS-ADRDA criteria 11 were selected. Informed written consent was taken from each patient or his/her attendants. After taking proper history, physical, neurological examination including MMSE were done. The cognitive impairment was assessed by MMSE 12 score (Mild 20-24, Moderate 10-19, Severe <10). Relevant investigations including MRI of brain were done to diagnose AD and rule out other causes of dementia. 45 patients were taken as cases after satisfying all the criteria for enrollment. All data were recorded in semi structured data sheet. A semi-structured questionnaire was developed in English for recording of data and MMSE sheet was translated in Bengali version.

Results:
The study included 45 Alzheimer's disease patients.     Figure-2 shows that family history of dementia was present in 31% AD patients.   14,15,18,19 . In context of our country, lower proportion of female patients were enrolled in this study may be due to less preference for females for seeking medical attention. Among all the patients, a major portion of study population had the primary education accounting 33%, which is closely followed by graduation 22.% and illiteracy 20% in case group. 71% AD patients belongs to lower educational level (Illiterate upto SSC). It coincides with studies like 20, 21 where they found an association between low educational level and higher risk of developing AD. A significant number of AD patients (22%) completed graduation as because patients and their family members are more concern for seeking medical attention.
Family history of dementia was present in 31% in the AD patients. Outpatient department of neurology BSMMU runs a separate weekly dementia clinic where dementia patients attended.
Most of the patients presented with moderate dementia (60%) and the rest had the severe dementia (29%) and mild dementia (11%).

Conclusion:
AD patients found more after 65 yrs. Higher rate of AD was found in older man. Lower educated people affected more than higher educated.

Family History of Dementia
Absent 69% Present 31%