Psychiatric Psychiatric presentation of presentation of

Alzheimer’s in JordanAlzheimer’s in JordanPreliminary survey Preliminary survey

Jamal Khatib MDJamal Khatib MD

Consultant PsychiatristConsultant Psychiatrist

Jordanian Alzheimer Jordanian Alzheimer AssociationAssociation

Jordan Alzheimer's Jordan Alzheimer's AssociationAssociation

• Initiated this summer 2005 by an Initiated this summer 2005 by an initiative of Prof Kurdi .initiative of Prof Kurdi .

•On the short term major On the short term major objectives are objectives are

•public awareness. public awareness.

•Studying the nature and pattern Studying the nature and pattern of dementia in Jordanof dementia in Jordan

Public awarenessPublic awareness

• MediaMedia

• Brochures Brochures

• Lectures ,public meetings .Lectures ,public meetings .

StudiesStudies

• Problems of alzheimers disease in Problems of alzheimers disease in the arab world .the arab world .

• study on prevalence of Alzheimer's .study on prevalence of Alzheimer's .

• Diagnosis and management Diagnosis and management

• Psychiatric presentation.Psychiatric presentation.

• ``Behavioural and psychological symptoms ``Behavioural and psychological symptoms in dementia (BPSD) are the clinically most in dementia (BPSD) are the clinically most significant symptoms of the illness. They significant symptoms of the illness. They

are non-cognitive and include apathy, are non-cognitive and include apathy, agitation, aggression, anxiety, agitation, aggression, anxiety,

hallucinations and delusions….BPSDs are hallucinations and delusions….BPSDs are widespread and often critical with regard to widespread and often critical with regard to

life quality for the patient as well as life quality for the patient as well as caregiver stress. The frequency of BPSD caregiver stress. The frequency of BPSD

increases as the dementing disorder increases as the dementing disorder progresses.` progresses.`

• Of the 329 participants with dementia, 214 Of the 329 participants with dementia, 214 (65%) had Alzheimer's disease, 62 (19%) (65%) had Alzheimer's disease, 62 (19%) had vascular dementia, and 53 (16%) had had vascular dementia, and 53 (16%) had another DSM-IV dementia diagnosis; another DSM-IV dementia diagnosis; 201 201 (61%) had exhibited one or more (61%) had exhibited one or more

mental or behavioral disturbances mental or behavioral disturbances in the past monthin the past month. Apathy (27%), . Apathy (27%),

depression (24%), and agitation/aggression depression (24%), and agitation/aggression (24%) were the most common in participants (24%) were the most common in participants

with dementia. These disturbances were with dementia. These disturbances were almost four times more common in almost four times more common in

participants with dementia than in those participants with dementia than in those without….. without….. Am J Psychiatry. 2000 May;157(5):708-14 Am J Psychiatry. 2000 May;157(5):708-14 ....

Dear colleague I’m studying the pattern of psychiatric presentation of dementia Please respond to the following 1-Patients mostly Refer themselves Referred by family Referred by physician 2-Referring physicians are mostly General practitioners Neurologists Internists 3-Most common presentation Memory problems Behavioral problems Mood problems Personality change Sleep disturbance Drug side effects 4-Patients are Already diagnosed Not diagnosed 5-On what you relay more in diagnosis Clinical Neuropsychiatry testing Imaging Lab tests 6- Do you use cognitive testing ? Yes….what test? No 7- Drugs you prescribe are mostly Anticolinesterase inhibitors Antipsychotics Antidepressants Anxiolytics Sedatives Mood stabilizers Gincobiloba Vit E Anti-inflamatory Others …specify 8-Other comment

1- Patients mostly1- Patients mostly   

A- Refer themselves A- Refer themselves 0.00%0.00%

B- Referred by family B- Referred by family 95.65%95.65%

C- Referred by physicianC- Referred by physician 6.52%6.52%

2- Referring physicians are mostly2- Referring physicians are mostly  

A- General practitioners A- General practitioners 50.00%50.00%

B- NeurologistsB- Neurologists 21.74%21.74%

C- InternistsC- Internists 30.43%30.43%

3- Most common presentation3- Most common presentation   

A- Memory problemsA- Memory problems 30.43%30.43%

B- Behavioral problemsB- Behavioral problems 63.04%63.04%

C- Mood problems C- Mood problems 2.17%2.17%

D- personality change D- personality change 15.22%15.22%

E- Sleep disturbance E- Sleep disturbance 10.87%10.87%

F- Drug side effectsF- Drug side effects 0.00%0.00%

4- Patients are mostly4- Patients are mostly   

A- Already diagnosed A- Already diagnosed 15.22%15.22%

B- Not diagnosed B- Not diagnosed 84.78%84.78%

5- On what you relay more in diagnosis5- On what you relay more in diagnosis   

A- ClinicalA- Clinical 82.61%82.61%

B- Neuropsychiatry testing B- Neuropsychiatry testing 23.91%23.91%

C- Imaging C- Imaging 4.35%4.35%

D- Lab tests D- Lab tests 2.17%2.17%

6- Do you use cognitive testing6- Do you use cognitive testing??   

AA- Yes ........... What test ?- Yes ........... What test ? 73.91% MMSE73.91% MMSE

B- No B- No 21.74%21.74%

7- Drugs you prescribe are mostly7- Drugs you prescribe are mostly  

A- Anticolinesterase inhibitors A- Anticolinesterase inhibitors 26.09%26.09%

B- AntipsychoticsB- Antipsychotics 65.22%65.22%

C- AntidepressantsC- Antidepressants 19.57%19.57%

D- Anxiolytics D- Anxiolytics 8.70%8.70%

E- Sedatives E- Sedatives 4.35%4.35%

F- Mood stabilizers F- Mood stabilizers 8.70%8.70%

G- GincobilobaG- Gincobiloba 2.17%2.17%

H- Vit E H- Vit E 2.17%2.17%

I- Anti - inflaamatory I- Anti - inflaamatory 0.00%0.00%

J- Others ............. Specify J- Others ............. Specify 4.35%4.35%

Discussion and Discussion and conclusionconclusion• The major problem with dementia patient is The major problem with dementia patient is

behavioural and almost all the patients are behavioural and almost all the patients are taken to doctors rather than referring taken to doctors rather than referring themselves with antipsychotic as the themselves with antipsychotic as the

mostly prescribed drugs, this reflects some mostly prescribed drugs, this reflects some how a late onset time of consult , and rather how a late onset time of consult , and rather advanced illness at the time of diagnosisadvanced illness at the time of diagnosis

as most of patient who reach the as most of patient who reach the psychiatrists are not yet diagnosed although psychiatrists are not yet diagnosed although

behaviorally disturbed.behaviorally disturbed.• Thus awareness about the illness and the Thus awareness about the illness and the

aim to catch patients at earlier stage is the aim to catch patients at earlier stage is the first priority of the Jordanian Alzheimer first priority of the Jordanian Alzheimer

Association..Association..

Thank you Thank you شكراشكرا

JamalJamal