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The Clinical Profile of Dementia in Indonesia's National General Hospital

Poster · October 2019

DOI: 10.13140/RG.2.2.15321.88161

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Muhammad Khifzhon Azwar Siti Setiati

University of Indonesia cipto mangunkusumo hospital
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 Background
Forty percent of Southeast Asian elderly people live in Indonesia.
The national dementia data currently relies on the expert consensus
result.1 It is crucial for Indonesia as an aging society to have its own
clinical profile of dementia. Cipto Mangunkusumo Hospital (CMH)
as the national general hospital has underdeveloped electronic
medical record system and local clinical profile of dementia is
lacking. This study was conducted to show the clinical profile in
CMH.
Methods
Hand-picked medical record books of patients aged 60 and older in
outpatient geriatric medicine clinic in CMH from 2014 to 2017 were
utilized in this descriptive study. Types of dementia, as well as history
of hypertension and diabetes were documented. Other dementia-
related risk factors were also taken into account, including history of
low educational level, smoking history, history of hearing loss,
abnormal body mass index (BMI) and history of depression.2 The
utilized test to assess cognitive function in CMH is Mini Mental State
Examination (MMSE) in accordance with many other countries.
Results
Prevalence of dementia among patients attending outpatient
geriatric medicine clinic in 2014-2017 was 0.29%; 95% CI [0.288,
0.292]. Vascular dementia (VD) cases contributed to 56% of all
cases. Among the elderly with dementia (n=100), 55% of them
were male patients.
Among all of the dementia patients, 72% and 52% of them had
history of hypertension and diabetes, respectively. The median
length of hypertensive state prior to dementia diagnosis was 6.5
years (range 1, 36), whereas it was 14.5 years (range 1, 37) for
diabetes. The majority of the demented older people however had
normal body mass index (46%), higher education completion
(45%), no smoking history (69%), no history of depression (84%),
and no history of hearing loss (72%).
Types of Dementia
1%2%
25%
56%
16%
Educational Attainment
4%
23%
No completed formal education
45% Primary school completion
Junior high school completion
5%
Senior high school completion
Higher education completion
23%
Hypertension Diabetes
No history of hypertension No history of diabetes
Positive history of hypertension Positive history of diabetes
28%
52%
72%
View publication stats
Discussion
•Underdetection may be the cause of lower estimated prevalence
rate compared to the global prevalence rate. Underdetection rate
in Asia was 93.2% (90.3%-95.3%) and the rate may be associated
with low income and male gender.3 Risk factors for VD are more
common in males.4
•Hypertension and diabetes were present in more than half of
dementia patients. There were positive correlation both between
hypertension and mild cognitive impairment, and between
hypertension and visuospatial and executive function impairment
in study conducted in Taiwan (n=1576)5 and Indonesia (n=62)6,
respectively, although differences in hypertension definition,
cognitive function assessment tool, and research method resulted
in contradicting study results.7
•In CMH, nearly half of dementia patients completed higher
education. Only 4% and 23% of the patients had no formal
education and primary school completion, respectively. A study in
Jakarta showed no correlation between the education attainment
and memory impairment.8 As the biggest city nationwide, Jakarta
has the highest net enrollment ratio of junior and senior high
school among other provinces,9 making the use of sensitive test
Addenbrooke’s Cognitive Examination-Revised (ACE-R)
suggested.2
•A majority of dementia patients had normal body mass index, no
smoking history, no history of depression, and no history of
hearing loss. There is ongoing case control study to understand
the relationships better.
•National dementia screening guideline is crucial in the
absence of a cure. This may allow timely diagnosis and early
intervention.10
Conclusion
• This is a preliminary result of a local as well as national multicenter
study about dementia.
• Prevalence of dementia among patients attending outpatient
geriatric medicine clinic 2014-2017 was 0.29%. Male individuals
account for 55% of the dementia patients. VD is the most
common dementia type.
• Among all of the dementia patients, a majority had history of
Unspecified Dementia hypertension and diabetes. However a majority had normal body
mass index, higher education completion, no smoking history, no
history of depression, and no history of hearing loss.
Alzheimer's Disease
Vascular Dementia
• ACE-R is suggested in cognitive impairment detection in
population with high educational level, such as in Jakarta.
Dementia with Lewy Body Underdetection may cause the lower prevalence compared to
global prevalence rate.
Frontotemporal Dementia
• In the absence of a cure, national dementia screening guideline is
crucial to allow timely diagnosis and early intervention.
References
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Alzheimer report 2015—the global impact of dementia: an analysis of prevalence, incidence,
cost and trends. London, UK: Alzheimer’s Disease International (ADI); 2015.
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Burns A, Cohen-Mansfield J, Cooper C, Fox N, Gitlin LN, Howard R, Kales HC, Larson EB, Ritchie
K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbaek G, Teri L, Mukadam N. Dementia
prevention, intervention, and care. Lancet. 2017 Dec 16; 390(10113): 2673-734.
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Underweight Normal
Conf. Ser.: Earth Environ. 2018; 125(2018): 012177.
Overweight Obesity 7. Wu L, He Y, Jiang B, Liu M, Wang J, Yang S, Wang Y. The association between the prevalence,
treatment and control of hypertension and the risk of mild cognitive impairment in an elderly
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15%
24% 8. Turana Y, Handajani YS, Widjaja NT. Association between APOE E4 Genotype and Memory
Impairment in Elderly with Normal Global Cognitive Assessment. Diagnostics. 2015; 5(4): 615-
48%
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9. Ministry of Education and Culture. Indonesia Education Statistics in Brief 2017/2018. Jakarta, ID:
15%
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46%
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