Faculty of Medicine, Siriraj Hospital, Mahidol University, 2 Prannok Rd., Bangkok, Thailand.
BMC Neurol. 2013 Jan 10;13:3. doi: 10.1186/1471-2377-13-3.
A 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.
The 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.
The 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.
The 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.
在西方老龄化社会中，功能障碍与社会经济地位之间存在着很强的反比关系。功能障碍可能与慢性疾病、不用、认知能力下降和衰老有关。在泰国人群中的慢性疾病中，脑血管疾病、糖尿病和关节炎较为常见。这些因素已知会导致老年人群的残疾和生活质量下降。神经精神问题、认知能力下降、痴呆和老年人的文化问题也会改变老年人的生活质量。
泰国老年人的痴呆症和残疾项目（DDP）旨在全面评估社区居住的泰国老年人，以了解残疾与运动功能、神经精神症状、认知功能和慢性疾病之间的关系。DDP 是第一个研究泰国老年人痴呆症和轻度认知障碍（MCI）患病率和病因的研究，并探讨认知、残疾、小血管疾病和皮质变性与泰国老年人的神经影像学之间的关系。1998 名泰国老年人在 2004-2006 年进行了筛查，并被诊断为患有 MCI 或痴呆症。223 名患有 MCI 或痴呆症和认知正常的老年人在基线时有脑部磁共振成像（MRI）或脑部 MRI。来自 3 组的 319 名老年人进行了血液检查，以调查包括基因分型在内的痴呆症的风险和可能病因。
本研究中老年人的平均年龄为 69.51（SD=6.71，min=60，max=95）岁。689 名（34.9%）为男性，1284 名（65.1%）为女性。平均体重为 58.36（SD=11.20）公斤。回归模型显示，步态和平衡以及血清甘油三酯的表现预测日常生活活动表现（调整后的 r2=0.280，f=2.644，p=0.003）。泰国老年人异常步态主要为较低水平的步态障碍。只有 1.5%（29/1952）有最高水平的步态障碍。1964 名受试者中 39.5%没有慢性疾病。本研究中泰国老年人糖尿病和高血压的治疗差距（表明有未治疗或治疗不足的患者）分别为 37%和 55.5%。62.6%的泰国老年人携带 ApoE3E3 等位基因。本研究中 ApoE4 基因阳性的患病率为 22.85%。38.6%进行了脑部 MRI 研究的泰国老年人有中度至重度的白质病变。
DDP 进行了大量全面的测量，允许广泛解释功能和临床特征，以研究泰国老年人群的大脑白质病变或皮质萎缩。对于 MCI 和痴呆症以及一些认知正常的老年人，有近 2 年的随访。纵向设计将有助于更好地了解老年人残疾的可能原因，以及泰国老年人认知能力下降的进展。
