Sains Malaysiana 41(5)(2012): 641–647

 

Factors Associated with Mild Cognitive Impairment among Elderly Patients Attending Medical Clinics in Universiti Kebangsaan Malaysia Medical Centre

(Faktor-Faktor yang Berkaitan dengan Kecelaan Kognitif Ringan di Kalangan Pesakit Warga Tua yang Menghadiri Klinik-Klinik Perubatan di Pusat Perubatan Universiti Kebangsaan Malaysia)

Rosdinom Razali*, Azlin Baharudin, Nik Ruszyanei Nik Jaafar, Hatta Sidi, Abdul Hadi Rosli Khoo Boo Hooi, Lee Tyan Shin, Noor Hafizah Samsudin Bahari & Noralia Anis Elias

Department of Psychiatry, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Bandar Tun Razak, 56100, Kuala Lumpur, Malaysia

 

Diserahkan: 4 Ogos 2011 / Diterima: 2 November 2011

 

ABSTRACT

Mild cognitive impairment (MCI) is a common condition among the elderly and is believed to be a precursor to Alzheimer disease. This study aims to detect the prevalence of MCI and factors associated with it. A cross-sectional study was conducted on a group of elderly patients attending various medical clinics in Universiti Kebangsaan Malaysia Medical Centre (UKMMC) in 2010. Only patients aged 60 years and above, literate with no hearing or visual impairments were included. Screening instruments included the Mini Mental State Examination (MMSE) and a questionnaire on sociodemographic and clinical data. The cut-off points for MMSE for MCI was 21/30 to 28/30. The prevalence rate based on MMSE score for ‘normal’ and MCI were 35.3% and 64.7%, respectively. Most of the 346 patients (33.9%) had only one type of medical illness and on one type of medication. MCI was significantly associated with low educational achievement (p<0.05) and rheumatological diseases (p= 0.05). However, it is not associated with the number of medical illnesses suffered by patients and the number of medications prescribed. This study highlighted that MCI was a common condition among the elderly UKMMC Medical clinic attendees and was significantly associated with their low education level.

 

Keywords : Elderly; impairment; mild cognitive MCI; medical illness; MMSE

 

ABSTRAK

Kecelaan kognitif ringan (MCI) adalah satu keadaan yang sering terdapat di kalangan warga tua dan dipercayai adalah tanda awal penyakit Alzheimer. Kajian ini bertujuan untuk mengesan prevalen MCI dan faktor-faktor yang berkaitan dengannya. Satu kajian menggunakan kaedah keratan rentas telah dikendalikan di kalangan sekumpulan pesakit luar warga tua di klinik perubatan di Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM). Hanya pesakit yang berumur 60 tahun ke atas yang tiada penyakit Demensia, boleh membaca dan tiada kecacatan pendengaran serta penglihatan dimasukkan dalam kajian ini. Alat saringan terdiri daripada Mini Mental State Examination (MMSE) dan soal-selidik yang mengandungi data sosio-demografi dan data klinikal. Titik keratan untuk MCI menggunakan MMSE adalah 21/30 hingga 28/30. Kadar prevalen untuk gejala kognitif yang ‘normal’ dan MCI adalah masing-masing 35.3% dan 64.7%. Kebanyakan daripada 346 (33.9%) pesakit mempunyai hanya sejenis penyakit dan mengambil hanya sejenis ubatan. MCI dikaitkan secara signifikan dengan tahap pelajaran yang rendah (p<0.05) dan penyakit rheumatik (p= 0.05). Walau bagaimanapun, MCI tiada kaitan dengan bilangan penyakit dan bilangan ubatan yang diambil oleh pesakit. Kajian ini menunjukkan bahawa MCI adalah satu keadaan yang sering terdapat di kalangan warga tua pesakit luar klinik perubatan UKM dan ianya berkait secara signifikan dengan tahap pelajaran mereka yang rendah.

 

Kata kunci: Kecelaruan kognitif ringan; MCI; MMSE; penyakit perubatan; warga tua

RUJUKAN

Bickel, E. H., Mösch, E. Seigerschmidt, M. Siemen, H. & Förstl, H.2006. Prevalence and Persistence of Mild Cognitive Impairment among elderly patients in General Hospitals. Dement. Geriatr. Cogn. Disord. 21: 242–250.

Chenderes, R.M., Podea, D.M., Nanu, P.D. & Mila, C. 2009. Mild cognitive impairment and intellectual activity in the elderly. Eur. Psychiatry. 24: 1094.

Crook, T., Bartus, R. T., Ferris, S. H. Whitehouse, P. Cohen, G. D. & Gershon, S. 1986. Report of the National Institute of Mental Health Work Group. Age-associated memory impairment: proposed criteria and measures of clinical change. Dev Neuropsychol. 2: 261–276.

Ellison, J.M. 2008. A 60-year-old woman with mild memory impairment: review of mild cognitive impairment. JAMA 300 (13): 1566-1574.

Feil, D., Marmon, T., Unützer, J. 2003. Cognitive Impairment, Chronic Medical Illness, and Risk of Mortality in an Elderly Cohort. Am. J. Geriatr. Psychiatry. 11:551-560.

Fisk, J.D., Merry, H.R., Rockwood, K. 2003. Variations in case definition affect prevalence but not outcomes of mild cognitive impairment. Neurology 61: 1179–1184.

Folstein, M.F., Folstein, S.E. & McHugh P.R. 1975. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12(3)189-198.

Graham, J.E., Rockwood, K., Beattie, B.L. Eustwosd, R., Gauthier, S., Tuokku, H. & McDowell, 1. 1997. Prevalence and severity of cognitive impairment with and without dementia in an elderly population. Lancet 349: 1793–1796.

Harrison, M. J. & Ravdin, L. D. 2006. Cognitive dysfunction in the patient with antiphospholipid antibodies: considerations for cause and treatment. Curr. Rheumatol. Rep. 8:89-94.

Kester, J. D., Benjamin, A. S., Castel, A. D. & Craik, F. I. M. 2002. Memory in elderly people. The handbook of memory disorder. (2nd ed) London: Wiley, pp 543-568.

Kluger, A, Gianutsos J. G., Golomb, J, Wagner, Jr A, Wagner D. 2008. Clinical features of MCI: motor changes. Int Psychogeriatr 20: 32–39

Kral, V.A. 1962. Senescent forgetfulness: benign and malignant. Can. Med. Assoc. J. 86: 257–260.

Krister Håkansson, Suvi Rovio, Eeva-Liisa Helkala, Vilska, A.R., Winbold, B., S. Ininen, H., Nissinen, A., Mohammad. A. H., & Kiripelts, M. 2009. Association between mid-life marital status and cognitive function in later life: population based cohort study. BMJ 339: b2462.

Kua, E. H. 1993. Dementia in elderly Malays- preliminary findings of community survey. Singapore Med. J. 34:26-28.

Levy, R. 1994. Aging-associated cognitive decline. Int. Psychogeriatr. 6: 63–68.

Lwanga S.K. & Lemeshow S. 1991. Sample size determination in health studies, a practical manual. WHO Geneva.

McGurk, S. R. & Mueser, K. T. 2003. Cognitive function and employment in severe mental illness. J. Nerv. Ment. Dis. 191: 789-798.

Morris, J. C, & Price, A. L. 2001. Pathologic correlates of nondemented aging, mild cognitive impairment, and early-stage Alzheimer’s disease. J. Mol. Neurosci. 17(2):101–118.

Nasreddine Z.S., Phillips N.A. & Bedirian V. Charbonneau, S., Whitehead, V., Collin. 1., Cummiags, J.L. & Chertlow, H. 2005. The Montreal Cognitive assessment, MoCA: A brief screening tool for mild cognitive impairment. Am. J. Geriatr. Soc. 53: 695-699.

Ng, W.K. & Tan C. T. 2006. The clinical stroke pattern in Malaysia: preliminary results of hospital based registry. Neuroepidemiology 21:28-35.

Norlinah M Ibrahim, Shamarina Shohaimi, Heng- Thay Chong, Abdul Hamid Abdul Rahman, Rosdinom Razali, Ebernezer Esther & Hamidon B. Basri. 2009. Validation Study of the Mini-Mental State Examination in a Malay-Speaking Elderly Population in Malaysia. Dement and Geriatr Cogn Disord. 27:247-253.

Oscar, L. L., Lewis, H. K., James, T. B., Corinne D., Robert, A. S., Michael, H. G. & Steven, T. D. 2007. Incidence of Dementia in Mild Cognitive Impairment in the Cardiovascular Health Study Cognition Study. Arch Neurol. 64(3):416-420.

Petersen, R., Smith, G., Waring, S. Irnik R.J., Tangalos, E.G. R. Kokmen, E. 1999. Mild cognitive impairment. Clinical characterization and outcome. Arch. Neuro. 56: 303–308.

Petersen, R. C. 2004a. MCI as a useful clinical concept. Geriatric Time 5(1):1–3.

Petersen, R.C. 2004b. Mild cognitive impairment as a diagnostic entity. J. Int. Med. 256: 183-194.

Ritchie, K. & Touchon, J. 2000. Mild cognitive impairment: conceptual basis and current nosological status. Lancet A 355: 225–228.

Rosdinom, Fazli, N.J., Nik Ruzyanei, Azlin, B. & Srijit, D. 2011. Factors associated with cognitive impairment in patients with Parkinson disease: an urban study. Clin Ter. 162(1): 23-29.

Salthouse, T. A. 2006. Mental exercise and mental aging. Psychol. Sci. 1: 68-87.

Sherina, M.S., Rampal, L. & Mustaqim 2004. Cognitive impairment among the elderly in a rural community in Malaysia. Med. J. Malaysia 59(2): 252-257.

Singh-Manoux, A., Richards, M., Marmot, M. 2003. Leisure activities and cognitive function in middle age: evidence from the Whitehall II study. J Epidemiol Community Health 57: 907-913.

Tasha, S., Nadia, G. & Clive, H. 2007. The Montreal Cognitive Assessment: Validity and Utility in a Memory Clinic Setting. The Canadian Journal of Psychiatry 52(5): 329-332.

Woodford, H. J. & George, J. 2007. Cognitive assessment in the elderly: a review of clinical methods. QJM 100: 469-484.

 

*Pengarang untuk surat-menyurat; email: rosdinom@ppukm.ukm.my

 

 

 

 

sebelumnya