Advertisement
Research Article| Volume 160, ISSUE 1, P67-75, September 18, 1998

Download started.

Ok

Prevalence and subtypes of dementia in southern Taiwan: Impact of age, sex, education, and urbanization

  • Ruey-Tay Lin
    Affiliations
    Department of Neurology, Kaohsiung Medical College, 100 Shih-Chuan 1st Road, San-Min District, Kaohsiung, Taiwan 80731, ROC
    Search for articles by this author
  • Chiou-Lian Lai
    Affiliations
    Department of Neurology, Kaohsiung Medical College, 100 Shih-Chuan 1st Road, San-Min District, Kaohsiung, Taiwan 80731, ROC
    Search for articles by this author
  • Chih-Ta Tai
    Affiliations
    Department of Neurology, Kaohsiung Medical College, 100 Shih-Chuan 1st Road, San-Min District, Kaohsiung, Taiwan 80731, ROC

    Graduate Institute of Behavioral Sciences, Kaohsiung Medical College, Kaohsiung, Taiwan, ROC
    Search for articles by this author
  • Ching-Kuan Liu
    Correspondence
    Corresponding author. Department of Neurology, Kaohsiung Medical College, Kaohsiung, Taiwan, 80731, ROC. Tel.: +886 7 3153175; fax: +886 7 3162158.
    Affiliations
    Department of Neurology, Kaohsiung Medical College, 100 Shih-Chuan 1st Road, San-Min District, Kaohsiung, Taiwan 80731, ROC

    Graduate Institute of Behavioral Sciences, Kaohsiung Medical College, Kaohsiung, Taiwan, ROC
    Search for articles by this author
  • Yea-Yin Yen
    Affiliations
    Graduate Institute of Behavioral Sciences, Kaohsiung Medical College, Kaohsiung, Taiwan, ROC
    Search for articles by this author
  • Shen-Long Howng
    Affiliations
    Department of Neurosurgery and Graduate Institute of Medicine, Kaohsiung Medical College, Kaohsiung, Taiwan, ROC
    Search for articles by this author

      Abstract

      To determine the prevalence and subtypes of dementia in southern Taiwan, a two-phase study consisting of a phase I screening survey using the Mini-Mental Status Examination (MMSE) and a phase II diagnostic examination using the CERAD neuropsychological battery and the neurobehavioral examination was conducted. According to the household records, stratified random sampling by the degree of urbanization of the community was used, and 2915 inhabitants aged 65 and over participated in this study. The ICD-10NA criteria for dementia, NINCDS-ADRDA guidelines for Alzheimer's disease (AD), and NINDS-AIREN criteria for vascular dementia (VaD) were employed. Three hundred and ninety-eight persons who had MMSE scores below the cutoff values were recruited into the phase II study, of whom 108 had dementia. The prevalence rate (PR) of dementia was 3.7%, increasing from 1.3% in people 65–69 years old to 16.5% in people 85 years old and older. The age-standardized PR (ASPR) was 4.0%. AD (58 cases, 53.7%, PR=2.0%, ASPR=2.3%) was the most common cause of dementia, followed by VaD (25 cases, 23.1%, PR=0.9%, ASPR=0.9%), and mixed dementia (eight cases, 7.4%). After adjusting for age, sex and education using logistic regression analysis, aging was a significant risk factor for AD, VaD and total dementia. Female sex and illiteracy were significant risk factors for AD only. We concluded that the prevalence of dementia in Taiwan is lower than in the developed countries, which could be due to a relatively young elderly population and a high mortality from dementia in Taiwan. AD is the leading cause of dementia in Taiwan. Considering the high stroke prevalence, the relatively lower prevalence of VaD in Taiwan deserves further investigation.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Amaducci L
        • Baldereschi M
        • Amato M.P
        • Lippi A
        • Nencini P
        • Maggi S
        • Litvak J
        The World Health Organization cross-national research program on age-associated dementia.
        Aging. 1991; 3: 89-96
      1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd rev. ed. Washington, DC: American Psychiatric Association, 1987:103–7.

        • Bachman D.L
        • Wolf P.A
        • Linn R
        • Knoefel J.E
        • Cobb J
        • Belanger A
        • D'Agostino R.B
        • White L.R
        Prevalence of dementia and probable senile dementia of the Alzheimer type in the Framingham study.
        Neurology. 1992; 42: 115-119
        • Blessed G
        • Tomlinson B.E
        • Roth M
        The association between quantitative measures of dementia and of senile change in the cerebral gray matter of elderly subjects.
        Br J Psychiatry. 1968; 114: 797-811
        • Chadwick C
        The MRC multi-centre study of cognitive function and aging: a EURODEM incidence study in progress (on behalf of MRC study group).
        Neuroepidemiology. 1992; 11: 37-43
        • Evans D.A
        • Funkenstein H.H
        • Albert M.S
        • Scherr P.A
        • Cook N.R
        • Chown M.J
        • Hebert L.E
        • Hennekens C.H
        • Taylor J.O
        Prevalence of Alzheimer's disease in a community population of older person: higher than previous reported.
        J Am Med Assoc. 1989; 262: 2551-2556
        • Folstein M.F
        • Folstein S.E
        • McHugh P.R
        Mini-mental state: a practical method for grading the cognitive state of patients for the clinical use.
        J Psychiatr Res. 1975; 12: 189-198
        • Fratiglioni L
        • Grut M
        • Forsell Y
        • Viitanen M
        • Grafstrom M
        • Holmen K
        • Ericsson K
        • Backman L
        • Ahlbom A
        • Winblad B
        Prevalence of Alzheimer's disease and other dementia in an elderly urban population: Relationship with age, sex, and education.
        Neurology. 1991; 41: 1886-1892
        • Friedland R.P
        Epidemiology, education, and the ecology of Alzheimer's disease.
        Neurology. 1993; 43: 246-249
        • Hachinski V.C
        • Hiff L.D
        • Zilhaka E
        • Du Boulay G.H
        • McAllister V.L
        • Marshall J
        • Russell R.W.R
        • Symon L
        Cerebral blood flow in dementia.
        Arch Neurol. 1975; 32: 632-637
        • Hasegawa K
        • Homma A
        • Imai Y
        An epidemiological study on age-related dementia in the community.
        Int J Geriatr Psychiatry. 1986; 1: 45-55
        • Heeren T.J
        • Lagay A.M
        • Hijmans W
        • Rooymans H.G.M
        Prevalence of dementia in an oldest old of a Deutch community.
        J Am Geriatr Soc. 1991; 39: 755-759
        • Hofman A
        • Rocca W.A
        • Brayne C
        • Breteler M.M.B
        • Clarke M
        • Cooper B
        • Copeland J.R.M
        • Dartigues J.F
        • Droux A.D.S
        • Hagnell O
        • Heeren T.J
        • Engedal K
        • Joker C
        • Lindesay J
        • lobo A
        • Mann A.H
        • Molsa P.K
        • Morgan K
        • O'Connor D.W
        • Sulkava R
        • Kay D.W.K
        • Amaducci L
        • For the EURODEM Prevalence Research Group
        The prevalence of dementia in Europe: a collaborative study of 1980–1990 findings.
        Int J Epidemiol. 1991; 20: 736-748
        • Hu H.H
        • Chu F.L
        • Chiang B.N
        • Lan C.F
        • Sheng W.Y
        • Lo Y.K
        • Wong W.J
        • Lu Y.O
        Prevalence of stroke in Taiwan.
        Stroke. 1989; 20: 858-863
        • Hughes C.P
        • Berg L
        • Danziger W.L
        • Cohen L.A
        • Martin R.L
        A new clinical scale for the staging of dementia.
        Br J Psychiatry. 1992; 140: 566-572
        • Jorm A.F
        • Korten A.E
        • Handeson A.S
        The prevalence of dementia: a quantitative integration of the literature.
        Acta Psychiatr Scand. 1987; 6: 465-479
        • Katzman R
        • Zhang M.Y
        • Qu Q.Y
        • Wang Z
        • Liu W.T
        • Yu E
        • Wong S.C
        • Salmon D.P
        • Grant I
        A Chinese version of the Mini-Mental Status Examination: impact of literacy in a Shanghai dementia survey.
        J Clin Epidemiol. 1988; 41: 971-978
        • Katzman R
        Education and the prevalence of dementia and Alzheimer's disease.
        Neurology. 1993; 43: 13-20
        • Kokmen E
        • Beard M
        • Offord K.P
        • Kurland L.F
        Prevalence of medically diagnosed dementia in a defined United States Population: Rochester Minnesota, January 1, 1975.
        Neurology. 1989; 39: 773-776
        • Kua E.H
        The prevalence of dementia in elderly Chinese.
        Acta Psychiatr Scand. 1991; 83: 350-352
        • Li G
        • Shen Y.C
        • Chen C.H
        • Zhao Y.W
        • Li S.R
        • Lin M
        An epidemiological survey of age-related dementia in an urban area of Beijing.
        Acta Psychiatr Scand. 1989; 79: 557-563
        • Liu C.K
        • Lin R.T
        • Chen Y.F
        • Tai C.T
        • Yen Y.Y
        • Howng S.L
        Prevalence of dementia in an urban area in Taiwan.
        J Formos Med Assoc. 1996; 95: 762-768
        • Liu C.K
        • Lin R.T
        • Howng S.L
        • Ueng T.S
        • Wang F.M
        • Chang C
        Types of dementia in Taiwan: a prospective study.
        Kaohsiung J Med Sci. 1992; 8: 290-298
        • Liu H.C
        • Lin K.N
        • Teng E.L
        • Wang S.J
        • Fuh J.L
        • Guo N.-W
        • Chou P
        • Hu H.H
        • Chiang B.N
        Prevalence and subtypes of dementia in Taiwan: a community survey of 5297 individuals.
        J Am Geriatr Soc. 1995; 43: 144-149
        • Liu H.C
        • Lin K.N
        • Wang S.J
        • Ful J.L
        • Lin H.C
        • Liu C.Y
        • Wu G.S
        • Larson E.B
        • White L.R
        • Graves A.B
        • Teng E.L
        Assessing cognitive abilities and dementia in a predominantly illiterate population of older individuals in Kinmen.
        Psychol Med. 1994; 24: 763-770
        • Liu H.C
        • Tsou H.K
        • Lin K.N
        • Yan S.H
        • Guo N.W
        • Wang C.L
        • Chiang B.N
        Evaluation of 110 consecutive patients with dementia: a prospective study.
        Acta Neurol Sand. 1991; 84: 421-425
        • Mckhann G
        • Drachman D
        • Folstein M
        • Katzman R
        • Price D
        • Stadlan E.M
        Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of the Department of Health and Human Service task force on Alzheimer's disease.
        Neurology. 1984; 34: 939-944
      2. Ministry of the Interior of the Republic of China. 1993 Taiwan-Fukien demographic fact book. Taipei: The Ministry, 1994:22–45.

        • Morris J.C
        • Heyman A
        • Mohs R.C
        • Hughes J.P
        • van Belle G
        • Fillenbaum G
        • Mellits E.D
        • Clark C
        • The CERAD investigators
        The consortium to establish a registry for Alzheimer's disease (CERAD): Part I clinical and neuropsychological assessment of Alzheimer's disease.
        Neurology. 1989; 39: 1159-1165
        • O'Connor D.W
        • Pollitt P.A
        • Hyde J.B
        • Fellows J.L
        • Miller N.D
        • Brook C.P.B
        • Reiss B.B
        • Roth M
        The prevalence of dementia a measured by the Cambridge Mental Disorder for the Elderly Examination.
        Acta Psychiatr Scand. 1989; 79: 190-198
        • Plum F
        Dementia: an approaching epidemic.
        Nature. 1979; 279: 372-373
        • Radloff L.S
        The CES-D scale: a self-report depression for research in general population.
        Appl Psychol Measures. 1977; 1: 385-401
        • Resiberg B
        • Borenstein J
        • Salob S.P
        • Ferris S.H
        • Franssen E
        • Georgotas A
        Behavioral symptoms in Alzheimer's disease: phenomenology and treatment.
        J Clin Psychiatry. 1987; 48: 9-15
        • Ritchie K
        • Kildea D
        • Robin J.M
        The relationship between age and the prevalence of senile dementia: a meta-analysis of recent data.
        Int J Epidemiol. 1992; 21: 763-769
        • Rocca W.A
        • Bunaiuto S
        • Lippi A
        • Luciani P
        • Turtu F
        • Cavarzeran F
        • Amaducci L
        Prevalence of clinically diagnosed Alzheimer's disease and other dementing disorders: a door-to-door survey in Appignano, Macerata, Italy.
        Neurology. 1990; 40: 626-631
        • Roman G.C
        • Tatemichi T.K
        • Erkinjuntti T
        • For The 31 Workshop Pannels
        Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop.
        Neurology. 1993; 43: 250-260
        • Rorsman B
        • Hagnell O
        • Lanke J
        Prevalence and incidence of senile and multi-infarct dementia in the Lundby: a comparison between the time period 1947–1957 and 1957–1972.
        Neuropsychobiology. 1986; 15: 122-129
        • Shih Y.L
        • Liu C.K
        • Lin R.T
        • Tai C.T
        Validation of Chinese version of the Mini-Mental Status Examination in a clinical setting (abstract).
        Bull Neurol Soc ROC (Taiwan). 1994; 19: 26
        • Stern Y
        • Gurland B
        • Tatemichi T.K
        • Tang M.X
        • Wilder D
        • Mayeux R
        Influence of education and occupation on the incidence of Alzheimer's disease.
        J Am Med Assoc. 1994; 271: 1004-1010
        • Sulkava R
        • Wikstrom J
        • Aromaa A
        • Raitasalo R
        • Lehtinen V
        • Lahtela K
        • Palo J
        Prevalence of severe dementia in Finland.
        Neurology. 1985; 35: 1025-1029
        • Ueda K
        • Kawano H
        • Hasuo Y
        • Fujishima M
        Prevalence and etiology of dementia in a Japanese community.
        Stroke. 1992; 23: 798-803
      3. US Bureau of the Census. Statistical abstract of the United States, 116th ed. Washington, DC: The Bureau, 1994.

        • White L
        • Petrovitch H
        • Ross W
        • Masaki K.H
        • Abbott R.D
        • Teng E.L
        • Rodriguez B.L
        • Blanchette P.L
        • Havlik R.J
        • Wergowske G
        • Chiu D
        • Foley D.J
        • Murdaugh C
        • Curb J.D
        Prevalence of dementia in older Japanese–American men in Hawaii: The Honolulu–Asia Aging Study.
        J Am Med Assoc. 1996; 276: 955-960
      4. White LR. The Ni-Hon-Sea demented project: description and progress report. In: Orimo H, Fukuchi Y, Kuramoto K, Iriki M, editors. New Horizons in Aging Science. Tokyo: University of Tokyo Press, 1992:324–5.

        • Williams J.B.W
        A structured interview guide for the Hamilton Depression Scale.
        Arch Gen Psychiatry. 1988; 45: 727-747
      5. World Health Organization (WHO). The Neurological Adaptation of the International Classification of Disease (ICD-10NA). World Health Organization, Geneva, draft, 1991.

        • Yip P.K
        • Shyu T.I
        • Lee J.Y
        • Chen R.C
        Prevalence of dementia in the elderly in an urban district of Taipei.
        Acta Neurol Sin. 1992; 1: 347-354
        • Zhang M
        • Katzman R
        • Salmon D
        • Jin H
        • Cai G
        • Wang Z
        • Qu G
        • Grant I
        • Yu E
        • Levy P
        • Klauber M.R
        • Liu W.T
        The prevalence of dementia and Alzheimer's disease in Shanghai, China: impact of age, gender, and education.
        Ann Neurol. 1990; 27: 428-437