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Prevalence of dementia in Eastern Europe

Prevalence of dementia

Background

One of the EURODEM goals was to harmonize the protocols used in their newly initiated, population-based follow-up studies. Unfortunately EURODEM did not include data from Middle and Eastern Europe. As a consequence, it is unknown what proportion of the total European population is affected by and suffer from dementia and whether these estimates differ by region, country and culture. Due to the lack of previous systematic inquiries in this domain, it is also unknown in which countries and for what types of dementia epidemiological studies have ever been conducted and to what degree these studies have come to similar results and conclusions. Acknowledging the pressing need for such data, we conducted a systematic analysis of all available epidemiological studies conducted in Middle and Eastern European countries.

Methods

We adopted a stepwise multimethod study approach consisting of iterative literature searches for epidemiological publications and subsequent data analyses of published material, reanalyses of existing accessible epidemiological data sets and expert inquiries in Eastern and Middle European countries, such as: Albania, Belarus, Bulgaria, Croatia, Czech Republic, Estonia, Hungary, Latvia, Lithuania, Montenegro, Poland, Republic of Moldavia, Romania, Russia, Serbia, Slovakia, Slovenia, Yugoslavia, Ukraine.

We conducted a literature search in scientific databases, conference proceedings, PhD theses, family associations, partner associations, funding organizations for original research articles published between 1990 and 2006. Systematic computer-assisted searches used the keywords: “dementia”, “Alzheimer”, “cognitive impairment”, „incidence”, “prevalence”, “epidemiology” in combination with the name of the relevant countries or “Europe” in English and Polish language. We supplemented the literature search with a review of the references in the articles that were identified during the initial search.

During the search process, we personally contacted numerous European experts or expert groups involved in dementia research from the chosen countries). These contacts were meant to ensure that no study was missed as well as to clarify whether significant information might be obtained by using unpublished data from ongoing or unpublished surveys. However despite considerable attempts we failed to reach experts from the following countries: Albania, Belarus, Bulgaria, Croatia, Hungary, Latvia, Lithuania, Romania, Russia, Serbia, Slovakia, Slovenia.

We excluded the articles that were primarily concerned with subcortical dementias (e.g. due to Huntington disease, Parkinson’s disease, AIDS, hypothyroidism, vitamin deficiency). Additionally we didn’t take under consideration data from population registers, because of the extremely high variability in diagnostic standards and reporting conventions of the register information.

Results

Country-specific population based studies concerning prevalence of dementia meeting the inclusion criteria of our review are listed in the Table 1 along with a core reference publication for each study listed.. We were able to find 8 publications – 5 studies were carried out in Poland, two in Russia and one in Albania. Sample sizes vary considerably between studies (from N = 100 to N > 7417 subjects), as do the age ranges (from >45 to >65 yr). There is also a considerable variation with regard to the spectrum of diagnoses covered in each study (Alzheimer dementia, vascular dementia, mixed dementia, secondary dementia). Most of the studies described are two-step studies with a screening procedure including most frequently MMSE, followed by a diagnostic examination for screen positives. There are also two studies – from Poland and from Estonia - which present only data from MMSE examination (Pajak et al. , 1998; Saks et al. , 2001).

Several studies were conducted assessing the prevalence dementia in special populations, e.g. among people from departments of internal medicine (Linka et al. , 2000; Klich-Raczka et al. , 2006), residential homes (Vincze et al. , 2007), neurological units (Klimkowicz et al. , 2002; Klimkowicz-Mrowiec et al. , 2006) and memory clinics (Sobow et al. , 2006). Most of the studies were cross-sectional and two of them were cohort studies (Klimkowicz-Mrowiec et al. , 2006; Vincze et al. , 2007). MMSE was the most widely used screening tool, followed by diagnosis according to DSM-III-R, DSM-IV, ICD?10 and NNCDS-ARDA criteria. The considerable heterogeneity of populations in which cognitive impairments were assessed and evaluated in the reviewed studies, as well as the great variety of conventions used to report findings, do not allow for joint analyses across studies of aggregated prevalences.

Table 1. Population-based studies on prevalence of cognitive disorders and dementia

Country
(place)

Reference

Size of population sampled

Age range

Diagnostic procedure

Overall all dementia types
(M- males, F - females)

Alzheimer
(M-males, F-females)

Vascular
(M- males, F - females)

Other types of dementia
(M- males, F - females)

Poland (Warsaw district Mokotow)

(Gabryelewicz, 1999)

893

65-84

MMSE, CAMDEX

7,8%

2,3%

2,7%

Mixed 0,5%
Secondary 0,2%

Poland (District ?wiebodzin)

(Rossa, 1997)

7,417

>=45

MMSE, MSQ, SPMSQ

M: 0,98%
F:2,56%
Total:3,57%

M: 0,23%
F: 1,17%

M: 0,51%
F: 1,01%

Mixed
M: 0,08%
F: 0,12%
Other
M: 0,16%
F: 0,28%

Poland (Town and commune Steszew)

(Wender et al., 1990)

1,000

>=45

neurological and psychological examination

-

1,1%
In the age group >65: 10,06%.

`-

-

Poland (rural area near Gda?sk, communes: Pruszcz gda?ski, Tr?bki Wielkie and Pszczó?ki)

(Bidzan and Turczynski, 2005)

1,000

>60

MMSE, ICD-10

M: 3,0%
F: 8,8%
Total: 6,7%

M: 1,1%
F: 4,0%

M: 1,9%
F: 3,5%

-

Poland (Warsaw)

(Parnowski et al., 1993)

100

>65

MMSE, IMC

1,1%

-

-

-

Albania (from the municipal registers of Tirana City)

(Kruja, 2002)

3,521

>60

MMSE, ICD-10

M: 4,83%
F: 11,45%
Total: 7,75%

-

-

-

Russia

(Sternberg and Gawrilowa, 1978)

-

>60

 

3,6%

-

-

-

Russia

(Gavrilova et al. , 1987)

-

>=60

 

moderate and severe dementia: 4.0% (M:4.1% F: 4%)
mild dementia 1.5%

-

-

-

Serbia (data from 16 public health centers)

(Stefanova et al. , 2004)

1,000

-

ICD-10

M: 2,8%
F: 3,9%
Total: 6,7%

-

-

-

Estonia

(Saks et al. , 2001)

1,000

>=65

MMSE

Cognitive disorders 23,1%

Poland (rural province Tarnobrzeg Voivodship)

(Pajak et al. , 1998)

943

65-78

MMSE

About 50% had cognitive impairment (MMSE=<25),
About 15% had severe cognitive impairment (MMSE=<21) with changes in the brain white matter confirmed by MRI.

Discussion

Eastern and Middle Europe consists of many countries from different language areas, each of which with different sociodemographic and socioeconomic characteristics, different cultural, legal, social and health care system-related traditions and different psychopathological traditions. All of these factors have been shown to complicate both the conduct of studies as well as interpretations of findings. Unlike the long US tradition of fairly regular, large-scale community and general population studies with uniform methods and designs, there is no such tradition yet in the Europe. During our search, we were able to find few regional and country-specific epidemiological studies of various kinds (population-based studies, cohort studies, cross-sectional studies, community studies) and conducted on different restricted population groups of patients (from neurological units, out-patients units, residential homes). No studies were identified from most of the countries taken under consideration and the ones we found were characterized by an immense diversity with a considerable degree of clinical and methodological variations. The few studies that there are suggest prevalence rates of dementia in Eastern Europe similar to those in Western Europe.

 

 
 

Last Updated: jeudi 08 octobre 2009

 

 
  • Acknowledgements

    The EuroCoDe project received financial support from the European Commission. Neither the European Commission nor any person acting on its behalf is responsible for any use that might be made of the following information. Alzheimer Europe also gratefully acknowledges the support it received from Fondation Médéric Alzheimer for this project.
  • European Union
  • Fondation Médéric Alzheimer
 
 

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