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)
 Life expectancy: M - 71 y, F – 74
y.
 Population growth rate: 2,8% per
year
 Annual income per capita: 1,813
$
 Jordan: Majority of
population is under the age
of 35
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.
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 .
 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)
 Prevalence of Illiteracy in
Middle East Countries:
(United Nations Statistics
Division, 2005)

Countr Jorda Saudi Turke Egypt UAE

y n Arabi y
a
M 4,5% 15,9% 5,6% 32,8% 24,4
%

F 14,1% 30,5% 21,5% 56,4% 19,3

%
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%)
 Does Illiteracy Affect Time
Of Diagnosis?
Stage At Literate Illiterate
Diagnosis
Mild 12 (85%) 24 (43%)

Moderate 2 (15%) 30 (53%)

Severe - 2 (4%)
 Does Illiteracy Affect
Treatment Choice and
Compliance?
Literate Illiterate

Started on 50 12 (85%)
AChEI (90%)
Reported 38 2 (15%)
positive chan- (70%)
ges after 3 m
Uninterrupted 34 1 (7%)
treatment for (60%)
> 9 months
 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
 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
 Converging Pathogenic
Mechanisms Of Vascular
Dementia And Stroke VS
Neurodegenerative Dementia
AD

Hypertension
Diabetes
Hyperlipidemia
VaD Stroke
 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 (Forette et al, 2002)
 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).
 Modifiable Risk Factors
In 1st Ever
Ischemic Stroke
UK : Jordan:
 Hypertension -52% - 57%
 CAD or MI - 36%
-38%
- 41%
 Current smoking - 55%
-27%
- 5%
 Diabetes Mellitus
-10%
 TIA
M.Hadidi,200
-14% 1
 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 )
 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
THANK YOU