ME-JAA

ISSN 1449-8677

ME-JAA

Middle East Journal of Age and Ageing

Contents

Volume 7, Issue 4 August 2010

Editorial

Chief Editor: Abdulrazak Abyad MD, MPH, AGSF, AFCHS Email: [email protected]

1

From the Editor Abdulrazak Abyad

Original Contribution/Clinical Investigation 3

Cognitive and Executive Functions in Hypertensive Elderly Egyptians Moatassem S. Amer, Shereen M. Mousa, Ahmed S. Mohammedin

8

Prevalence of Cataract in Osteoarthritis Patients in Relation to Age and Body Mass Index Samer I. Alawneh, Zaid M. Dahamsheh, Ahmed E.Khatatbeh, Awni S. Alhadeed, Mohammad A. Al-droos, Zaid A. Aleyadah, Fakhry S. Athamneh

12

18

Prevalence of Parkinsonian Features in Egyptian Elderly Patients with Mild Cognitive Impairment Heba T. Mousa, Mohamad A. Al Sadany, Shereen M. Mousa, Mohamad H. El Banouby The Prevalence of Diabetic Foot and Its Risk factors among Jordanian Diabetics Wasfi Salayta, Samer Al- Ghzawi

Case Report 21

First successful femoral pacemaker implantation in the Middle East Amin Daoulah, Eijaz Ul Haq, Majed Mazen Malak, Uthman Al-Uthman

Publisher: Ms Lesley Pocock medi+WORLD International 11 Colston Avenue Sherbrooke Australia 3789 Tel: +61 (3) 9755 2266 Fax: +61 (3) 9755 2266 Email: [email protected] Editorial enquiries: [email protected] Advertising enquiries: [email protected] While all efforts have been made to ensure the accuracy of the information in this journal, opinions expressed are those of the authors and do not necessarily reflect the views of The Publishers, Editor or the Editorial Board. The publishers, Editor and Editorial Board cannot be held responsible for errors or any consequences arising from the use of information contained in this journal; or the views and opinions expressed. Publication of any advertisements does not constitute any endorsement by the Publishers and Editors of the product advertised. The contents of this journal are copyright. Apart from any fair dealing for purposes of private study, research, criticism or review, as permitted under the Australian Copyright Act, no part of this program may be reproduced without the

Middle East Journal of Age and Ageing 2009; Volume 6, Issue 5

Editorial __________________________________________________________ Dr Abdulrazak Abyad Chief editor

A prospective study from Jordan attempted to find the prevalence of cataract in osteoarthritis patients in relation to age and body mass index. The authors showed that as age and body mass index increase the prevalence of cataract increases. The overall prevalence of cataract in Jordanian individuals aged between 40 and 80 years is 22.7%. In addition there is no increase in prevalence of cataract in patients with osteoarthritis. ?

This is the fourth issue this year and has a number of good papers from the region. There is a growing interest in geriatric research in the region and in particular from Egypt.

A prospective study was performed in King Hussein Medical Centre on diabetic patients between June 2008 and Jan. 2010. The aim was to determine the prevalence and risk factors for foot complications among diabetic patients. The authors showed that tight control of blood sugar and associated risk factors is important to prevent the development of diabetic complications. Treating physicians should be encouraged to exert more attention and care to foot examination.

A paper from Egypt looked at the Prevalence Of Parkinsonian Features In Egyptian Elderly Patients With Mild Cognitive Impairment. A total of 507 elderly participants were randomly selected and subjected to neuropsychological assessment to detect MCI patients. Those patients with MCI underwent cognitive assessment and neurological assessment using the modified version of Unified Parkinson Disease Rating Scale for detection of Parkinsonian features. The authors showed that 66% of their participants had Parkinsonian features. They concluded that Parkinsonian features are prevalent in MCI patients. A case report from King Faisal Specialist Hospital & Research Center, Jeddah, discussed the first successful femoral pacemaker implantation in the Middle East. This is a major achievement for Saudi Arabia and the region. The authors described a case of a pacemaker implantation via the femoral vein in an octogenarian with obstructed superior vena cava (SVC). A case control study from Ain Shams University looked at the relationship between hypertension and cognitive/executive functions in elderly Egyptians. A total of one Hundred and Twenty elderly, aged 60 years and older, were divided into a cases group and a controls group. The authors concluded that uncontrolled hypertension may increase the risk for worsening of cognitive function.

Middle EastEast Journal of Ageof and Ageing Issue 4,Volume August 2010 Middle Journal Age andVolume Ageing7,2009; 6, Issue

5

Original Contribution/Clinical Investigation

Cognitive and Executive Functions in Hypertensive Elderly Egyptians _____________________________________________________ Authors: Moatassem S. Amer MD, Shereen M. Mousa MD, Ahmed S. Mohammedin MS Geriatrics & Gerontology Department, Faculty of Medicine, Ain Shams University Corresponding Author: Prof. Moatassem S. Amer MD (Internal Medicine) Professor of Geriatric Medicine & Internal Medicine Address: Geriatrics & Gerontology Department, Faculty of Medicine, Ain Shams University, Abbassyia, 11566, Cairo, Egypt Tel: +20123100373 Fax: +2024826726 Email: [email protected]

ABSTRACT Background: The objective is to study the relationship between hypertension and cognitive/executive functions in elderly Egyptians. Method: Case-control study. Setting: Outpatient clinics of Ain Shams University Hospital. Participants: One hundred and twenty elderly aged 60 years and older divided into cases group (60 known hypertensive subjects) and controls group (60 non hypertensive subjects). Elderly with conditions affecting cognition were excluded. Measurements: Comprehensive geriatric assessment, blood pressure measurement, and cognitive/executive tests including: Mini-Mental Status Examination (MMSE), Block Design (BD), Digit Span Forward (DSF), Digit Span Backward (DSB), Letter Verbal Fluency (LVF), Animal Verbal Fluency (AVF), and Contrasting Program (CP) tests. Results: There was no statistically significant difference between hypertensive and non hypertensive subjects regarding their performance in different cognitive/executive tests (p > 0.05), but comparing the performance of controlled hypertensives (28 subjects), uncontrolled hypertensives (32 subjects), and non hypertensives (60 subjects) as the three separate groups revealed better performance among controlled hypertensives and worse among uncontrolled hypertensives, especially in the MMSE (P < 0.001), DSF (P < 0.001), DSB (P = 0.024), LVF (P = 0.012), and CP (P < 0.001). Conclusion: Having uncontrolled hypertension is a risk for worse cognitive\executive performance rather than being hypertensive or not hypertensive. Key words: Cognitive functions, Executive functions, Elderly, Hypertension, Egypt

Middle EastEast Journal of Age of andAge Ageing Issue 4,Volume August 2010 Middle Journal andVolume Ageing7, 2009; 6, Issue

5

O R I G I N A L CO N T R I B U T I O N A N D C L I N I C A L I N V E S T I G AT I O N

Introduction

Cognitive functions are defined as the ability to think and understand the world, and are divided into: Attention (the ability to focus and sustain thought and perception); Orientation to time and place; Memory, which involves learning (registration) or recalling what has been learned; Language function; Praxis (the ability to perform learned motor tasks) and Executive functions(1). Executive function is defined as the ability to plan, initiate, sequence, monitor, and inhibit complex behavior(2). Another simple definition of Executive functions is the ability to plan one’s behaviour to achieve a goal (3). The relationship between hypertension (HTN) and cognitive/executive functions is of growing interest because of the high prevalence of both hypertension and cognitive/executive functions decline in the elderly. In Egypt the prevalence of HTN in the population was 26.3% in 1998. The prevalence rate was 59.4% in the 65-74 years age group. HTN prevalence increased progressively with age, with the exception of the oldest age group >75 years. HTN highest prevalence rate was in greater in the Cairo area (31.0%), and only one third (37.5%) of all hypertensive individuals were aware of their disease with an estimated number of hypertensive individuals receiving pharmacological treatment in Egypt of 23.9% and an estimated percentage of hypertensive individuals whose blood pressure (BP) was under control, of 8% (4). In a study conducted in seven geriatric centers of the Egyptian ministry of health and population, it was found that hypertension is the major health problem of the elderly in Egypt (5). With the increase in life expectancy in Egypt (71.8 year in 2008) (6) Egypt is expected to have more elderly with hypertension in the future. The deleterious effect of HTN on white matter and brain volume was reported by Raz et al., (7) who reported that these effects are not global, and they appear to be confined to the frontal regions of the brain and more specifically to the prefrontal cortex and the underlying white matter leading to cognitive changes that suggest isolated vulnerability of some executive functions to HTN. However other studies denied any effect of HTN on cognitive/executive functions.(8) Failure of identification of medically ill patients with executive impairments has important clinical consequences, as regards medication adherence, preservation of autonomy, relapse prevention, post discharge placement, and potentiality for rehabilitation.(2). Thus our aim was to study the relationship between HTN and cognitive/executive functions in elderly Egyptians.

Materials and Methods Participants and study design A case-control study was conducted at Ain Shams University Hospital’s outpatient clinics on a sample of 120 subjects (79 male and 41 female) with a mean age of (65.2 ±4.92) years were eligible for the study. Eligible cases were elderly aged >60 years who were known hypertensives. Eligible controls were elderly aged >60 years who were non-hypertensives. History and clinical examination was done to all

subjects to exclude conditions that affected cognitive/executive functions as neuropsychiatric disorders, cardiovascular diseases, alcoholism, drug abuse, cognitive impairment or delirium. Measurements Blood pressure (BP) measurement was performed according to the Seventh Report of the Joint National Committee of Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC VII).(9) At least two measurements were made. Systolic Blood Pressure (SBP) was defined as the point at which the first of two or more sounds is heard, and Diastolic Blood Pressure (DBP) as the point before the disappearance of sounds. Pulse pressure (PP) was calculated by subtracting the DBP from the SBP, while Mean Arterial Pressure (MAP) was calculated by summation of DBP and one third of the pulse pressure.(10) Cognitive/executive functions were tested by a battery of tests that included: MMSE Arabic version(11), Block design test (BD), of the Wechsler adult intelligence scale-revised version (WAIS-R) Arabic version(12), Digit span subtest-forward (DSF) of the WAIS-R Arabic version(12), Digit span subtest-Backward (DSB) Arabic version(12), Letter verbal fluency test (LVF) (13), Animal (Category) verbal fluency test (AVF) (14), Contrasting program test (CP) (15) Statistical Analysis Description of all data in the form of mean (M) and standard deviation (SD) for quantitative variables was done. Frequency and percentage was done for qualitative variables. Comparison between quantitative variables was done using ttest to compare two groups and ANOVA (analysis of variance) to compare more than two groups. Post Hoc test was done to detect the least significant difference. Comparison of qualitative variables was done using the Chi-square test.

Ethics This study had the approval of the ethics committee of the Ain Shams Faculty of medicine. All subjects consented (orally or written) to participation in the study.

Results

There was no statistically significant difference between cases and controls as regards age, gender, educational level, and the performance in the Activity of Daily Living (ADL) and the Instrumental Activity of Daily Living (IADL) (P > 0.05) (Table 1), thus the effect of HTN on cognitive/executive functions was easily studied between the two groups independently of those variables. Results revealed that cognitive/ executive performance did not show statistically significant

Middle EastEast Journal of Ageofand Ageing Issue 4,Volume August 2010 Middle Journal Age and Volume Ageing7,2009; 6, Issue

5


*SD = Standard deviation. † ADL = Activities of daily living. ‡IADL = Instrumental activities of daily living. § MMSE = Mini Mental Status Examination. BD = Block Design. # DSF = Digit Span Forward. ** DSB = Digit Span Backward. †† LVF = Letter Verbal Fluency. ‡‡ AVF = Animal Verbal Fluency. §§ CP = Contrasting program

Table 1: Description and demography of cases and controls and mean scores of cognitive/executive tests; MMSE, BD, DSF, DSB, LVF, AVF, and CP

Middle EastEast Journal of Ageof and Ageing Issue 4,Volume August 2010 Middle Journal Age andVolume Ageing7,2009; 6, Issue

5

* SBP = Systolic Blood Pressure.

PP = Pulse Pressure.

‡‡ DSB = Digit Span Backward.

† SD = Standard deviation.

# MMSE = Mini Mental Status Examination.

§§ LVF = Letter Verbal Fluency.

** BD = Block Design.

# CP = Contrasting program

‡DBP = Diastolic Blood Pressure. §MAP = Mean Arterial Pressure.

†† DSF = Digit Span Forward.

AVF = Animal Verbal Fluency.

Table 2: Comparison between controlled, uncontrolled hypertensive, and non hypertensive subjects as regards their mean SBP, DBP, MAP, PP, and the mean scores of the following tests; MMSE, BD, DSF, DSB, LVF, AVF, and CP

* SBP = Systolic Blood Pressure.

PP = Pulse Pressure.

‡‡ DSB = Digit Span Backward.

† SD = Standard deviation.

# MMSE = Mini Mental Status Examination.

§§ LVF = Letter Verbal Fluency.

** BD = Block Design.

# CP = Contrasting program

‡DBP = Diastolic Blood Pressure. §MAP = Mean Arterial Pressure.

†† DSF = Digit Span Forward.

AVF = Animal Verbal Fluency.

Table 3: Comparison of subjects as regard BP control, treatment category, education, blood pressure variables and cognitive executive test



difference between the two groups (P > 0.05) in all cognitive/executive tests (Table 1). As regards the results of hypertensive subjects, they did not perform worse than the non hypertensive (Table 2). The uncontrolled subjects performed much worse than the controlled subjectss with a statistically significant difference. The studied population was divided into 3 groups: the controlled hypertensive, the uncontrolled hypertensive, and the non hypertensive group. The comparison between the 3 groups revealed that the controlled hypertensive subjects had better scores in MMSE (P < 0.001), DSF (P < 0.001), DSB (P = 0.024), LVF (P = 0.012), and CP (P < 0.001) than the uncontrolled and the non hypertensive (Table 2).

normal subjects. This finding raises the question of why did the controlled hypertensive patients perform better? There may be several possibilities. One of these is; they had the ideal BP measurements for the best cognitive/executive performance which in our study were 127.5±8.44 for SBP, 75.71±6.34 for DBP, 101.42±6.78 for MAP, and 51.78±7.72 for PP. But in fact these readings did not differ significantly from that of the uncontrolled; 160.47±8.64 for SBP, 89.22±7.84 for DBP, 125.15±6.65 for MAP, and 71.25±10.39 for PP; or the non hypertensive ones; 118±11.6 for SPB, 71.66±7.63 for DBP, 94.58±9.21 for MAP, and 46.5±7.98 for PP; thus this may be individualized; each person may have his ideal BP measurements for better cognitive/executive performance.

When comparing BP control, education treatment category and cognitive /executive tests by ANOVA, BP control showed a statistically significant relation with all tests: MMSE (P < 0.001), BD (P < 0.001) DSF (P= 0.018), DSB (P < 0.001), LVF (P = 0.01), CP (P = 0.001) except AVF (P = 0.09). Treatment category showed significant relation with only BD (P =0.005), DSF (P =0.042) and CP (P =0.012); Education showed a statistically significant relation with all cognitive/ executive tests: BD (P = 0.001), DSB (P = 0.006), LVF (P < 0.001), CP (P = 0.05), AVF (P < 0.001) except MMSE (P = 0.12) and DSF (P=0.592) (Table 3).

Another important possibility may be the effect of the drugs used for BP control. ACE inhibitors were the most antihypertensive drugs used by the controlled patients (21 of the cases groups); who had the best cognitive/executive performance. Literature shows that antihypertensive that cross the blood brain barrier and affect the renin-angiotensin-aldosterone system (such as Captopril and Perindopril) control BP and provide protection against cognitive decline.(21) Also ACE inhibitors were found to be independently associated with the stability of cognitive function and were a protective factor for cognitive deterioration.(22) The relationship between different BP components of subjects and cognitive/executive tests showed that high SBP or MAP or PP was associated with worse performance in almost all tests. The DBP did not show such direct relation, but it may have an indirect effect through the MAP or PP. The specific cognitive functions affected by high blood pressure have not yet been thoroughly or unequivocally determined; however, high blood pressure is consistently related to deficits in attention(23), learning and memory(24), some visuospatial functions(25), and abstract reasoning and other executive functions.(26, 27) Another factor that might have influenced the performance of hypertensive subjects was the educational level. A highly statistical significant relation was found between having lower level of education (illiterate, below high school) and the worse performance in the following tests MMSE, BD, DSB, LVF, AVF, and CP. Waldstein et al.,(28) assessed attention, working memory, and executive function on 847 participants (503 men and 344 women), by using DSF test, DSB test and Category Fluency test, she reported that less-educated elderly, and nonmedicated (with anti-hypertensive drugs), cases were most vulnerable to negative effects of hypertension on the selected cognitive/executive tests. She also states that higher levels of education and use of antihypertensive medications may protect against the neurobiological consequences of hypertension. Regarding the relationship between education and cognitive/executive tests(29) she concluded that a limited formal education is associated with less cognitive function. Also(30) found that in elderly Egyptians lack of education in early life enhanced later cognitive decline. In Egypt the percentage of elderly above 65 years who have completed secondary education was 7.5% in males and 2.8 % in females in 2005.(6)

Discussion HTN is the major health problem of elderly in Egypt.(5) The association between HTN and the decline in the Cognitive/executive functions was reported by several studies.(16,17) On the other hand Posner et al.,(18) reported that HTN is not associated with changes in memory, language or general cognitive functions over time. The mechanisms underlying HTN-related cognitive changes are complex and are not yet fully understood.(19) so the purpose of the study was to assess the relationship between HTN and cognitive/executive functions in elderly. According to the Research Committee of the American neuropsychiatric association, there is no established golden test for executive control function (ECF). This may be due to three reasons. Firstly, the frontal lobe represents so much of the brain’s weight and surface area; it seems unlikely that any one measure could assess its functions comprehensively. Secondly, the frontal system has many subcortical connections which are also relevant to ECF. Finally, the ECF has an intimate relationship with other cognitive functions. So, we are searching for an executive battery, not an executive measure,(20) This statement explains the diversity in literature discussing the effect of HTN on cognitive/executive functions. This could be due to the use of different cognitive/executive tests, so we selected a battery of the cognitive/executive tests: MMSE, BD, DSF, DSB, LVF, AVF, and CP. Results revealed no statistically significant difference between hypertensive and non hypertensive subjects as regards cognitive/executive performance, but comparing the studied population as 3 groups (controlled hypertensives, uncontrolled hypertensives, and non hypertensives) revealed that the controlled groups had better scores even than the

Education has a marked effect on neuropsychological test performance.(31) For example, the cutoff for “normal” performance on the Mini-Mental State Examination may

Middle EastEast Journal of Ageofand Ageing Issue 4,Volume August 2010 Middle Journal Age and Volume Ageing7,2009; 6, Issue

5


vary by as much as eight points depending on the individual’s educational level.(32) Education specific normative data are not available for most tests, and interpretation of test results in individuals with unusually high or low levels of education must be done with caution. (31) In conclusion our study revealed that HTN per se may not add to the burden of cognitive/executive dysfunction when compared to non hypertension but the risk lies in having high uncontrolled BP measurements. The conclusion that each individual might have an individualized BP measurement at which he/she performs better needs further assessment and studying. Finally the use of ACE inhibitors by hypertensive patients may have a beneficial effect on cognitive/executive functions but can this be applied on normal individuals? This needs still further investigation.

Acknowledgment The authors wish to thank study participants and staff of Ain Shams University hospital for their patience and help that made this study possible. This study was supported by Ain Shams University Faculty of medicine.

References [1] Beers M and Berkow R (2000), eds. The Merck Manual of Geriatrics. 3rd ed. Whitehouse Station, NJ: Merck Research Laboratories [2] Schillerstrom JE, Horton MS, Royall DR. (2005): The impact of medical illness on executive function: Psychogeriatrics; 46: 508-16..

[9] Chobanian A; Bakris G .; Black H; Cushman W; Green L; Izzo, Jr J; Jones D; Materson B; Oparil S; Wright, Jr J; Roccella E; the National High Blood Pressure Education Program Coordinating Committee. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003; 42: 1206-52. [10] Ganong W. Review of medical physiology. Lange medical publications. 21st ed California,1998. [11] El-Okl M. Prevalence of Alzheimer dementia and other causes of dementia in Egyptian elderly. MD thesis, Geriatrics Department, Ain Shams University library.2002. [12] Melika L. Wechsler Intelligence Scale for adults and adolescents. El-Nahda Egyptian library, Cairo 1991; 91:92-97-101. [13] Gladsjo JA, Schuman CC, Evans JD, Peavy GM, Miller SW, Heaton RK Norms for letter and category fluency: demographic corrections for age, education, and ethnicity. Assessment.1999;6:147-78. [14] Morris JC, Heyman A, Mohs RC, Hughes JP, van Belle G, Fillenbaum G, Mellits ED, Clark C The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part I: clinical and neuropsychological assessment of Alzheimer’s disease. Neurology.1989; 39:1159-65. [15] Stewart J. The frontal/subcortical dementias: Common dementing illnesses associated with prominent and disturbing behavioral changes. Geriatrics.2006; 61:23-7. [16] Tzourio C, Dufouil C, Ducimetière P, Alpérovitch A cognitive decline in individuals with high blood pressure, A longitudinal study in the elderly: EVA Study Group. Epidemiology of Vascular Aging. Neurology.1999; 53: 1948-52.

[3] Rose J and Colombo M (2005): Neural Correlates of Executive Control in the Avian Brain PLoS Biol; 3(6): e190.. [4] Ibrahim M, (2001): Manual of hypertension. Egyptian Hypertension Society, Cairo. [5] Badr S, Mansour E, Salah M, Mohammed M (2005). Geriatric health problems among attendants of the upgraded ministry of health and population geriatric health care centers. Reports of Egyptian ministry of health and population, 2005. [6] Kinsella K and Wan H (2009): An Aging World: 2008. U.S. Census Bureau, International Population Reports, P95/09-1, U.S. Government Printing Office, Washington, DC. Pp 34, 105 [7] Raz N, Rodrigue K, Acker J. Hypertension and the Brain: Vulnerability of the Prefrontal Regions and Executive Functions. Behav Neurosci.2003; 117, 1169- 80. [8] Morris MC, Scherr PA, Hebert LE, Glynn RJ, Bennett DA, Evans DA. Association of Incident Alzheimer Disease and Blood Pressure Measured From 13 Years Before to 2 Years After Diagnosis in a Large Community Study. Arch Neurol. 2001; 58:1640-6.

Middle EastEast Journal of Ageof and Ageing Issue 4,Volume August 2010 Middle Journal Age andVolume Ageing7, 2009; 6, Issue

5



Prevalence of Cataract in Osteoarthritis Patients in Relation to Age and Body Mass Index Authors: Samer I. Alawneh, MD** Zaid M. Dahamsheh, MD* Ahmed E.Khatatbeh, MD** Awni S. Alhadeed, MD* Mohammad A. Al-droos, MD** Zaid A. Aleyadah, MD *** Fakhry S. Athamneh, MD** * Rehabilitation Specialist, Department of Rrehabilitation, Royal Medical Services **Ophthalmologist, Department of Ophthalmology, Royal Medical Services ***Orthopedic Surgeon, Department of Orthopedics, Royal Medical Services Correspondence: Samer I. Alawneh Email : [email protected]

ABSTRACT Aim: To study the prevalence of cataract in osteoarthritis patients in relation to age and body mass index. Method: This is a prospective study done between 20th November 2009 and 20th January 2010, in the Royal Medical Services hospitals. 90 patients out of 150 patients (group A ) were diagnosed with osteoarthritis at the rehabilitation clinic, while the remaining 60 patients (group B ) did not have osteoarthritis and were included in the study as a control group. All of the 150 patients were between 40 and 80 years of age. After calculating the body mass index (BMI) all were sent to the ophthalmology clinic in order to check for the existence of senile cataract and its grade according to the Lens Opacities Classification System III. Results: The prevalence of cataract is 5.3% in patients aged between 40-49 years of age, in group A, and 0.0% in group B but it increased to 60.0% in patients aged between 70-79 years of age in group A and 55.6% in group B. The prevalence of cataract was 6.7% in group A and 0.0% in group B when body mass index was < 18.5 kg/m2 but it increased to 66.7% in group A and 50.0% in group B when body mass index was between 30.0 and 39.9 kg/m2. The overall prevalence of cataract in Jordanian individuals aged between 40 and 80 years is 22.7%. Conclusion: As age and body mass index increase, the prevalence of cataract increases. The overall prevalence of cataract in Jordanian individuals aged between 40 and 80 years is 22.7%. There is no increase in prevalence of cataract in patients with osteoarthritis. Posterior subcapsular lens opacity was more prominent in individuals with low to normal body mass index, but as body mass index increases nuclear and cortical cataract become more prevalent. Key words: senile cataract, osteoarthritis, body mass index.

Middle East Journal of Ageofand Volume 7,2009; Issue 4, August 6, 2010 Middle East Journal AgeAgeing and Ageing Volume Issue

5


Introduction Senile cataract is an important cause of preventable blindness, affecting 12 to 15 million persons worldwide (1). I It is estimated that 20.5 million (17.2%) of Americans older than 40 years have cataract in either eye. The number of Americans affected by cataract and undergoing cataract surgery will dramatically increase over the next 20 years. (2) Previous epidemiological studies have enumerated lower education, decreased cloud cover, use of aspirin, diets low in selected nutrients, use of cheaper cooking fuels, lower levels of antioxidant index, cigarette smoking, increased UV - B radiation and diabetes as risk factors associated with senile cataract)(3,4). Osteoarthritis (OA) is one of the most prevalent and disabling chronic diseases affecting the elderly. Its most prominent feature is the progressive destruction of articular cartilage. The management of OA is largely palliative, focusing on the alleviation of symptoms. Current recommendations for the management of OA include a combination of non-pharmacological interventions (weight loss, education programs, exercise, and so on) and pharmacological treatments (paracetamol, non steroidal anti-inflammatory drugs and so on) (5,6). Since both osteoarthritis and senile cataract are diseases of the elderly and obesity is a risk factor for OA and cataract, the aim of this study is to see whether there is a relation between cataract and osteoarthritis and to study the prevalence of cataract in OA patients in relation to age and BMI.

Method This is a prospective study done between 20th November 2009 and 20th January 2010 in Royal Medical Services hospitals. Jordan. 90 patients out of 150 patients (group A ) were diagnosed as having osteoarthritis at the rehabilitation clinic, while the remaining 60 patients (group B ) did not have osteoarthritis and were included in the study as a control group. All 150 patients were between 40 and 80 years of age

and had no risk factors for cataract (e.g. diabetes, eye trauma, eye surgery, topical or systemic use of steroid , etc). Body weight was measured, body mass index (BMI) was calculated and all patients were examined in the ophthalmology clinic in order to check for the existence of senile cataract and its grade, according to the Lens Opacities Classification System III (LOCS III) (7) .

Results In each group the patients were further divided according to age, into 8 groups. They were checked for the presence of significant lens opacity (grade 3 of posterior subcapslar (P2), cortical (C3) or nuclear (NC3 lens opacity) according to the Lens Opacities Classification System III. The results are summarized in Table 1. The prevalence of cataract in group A and group B, regarding body mass index (BMI) is summarized in Table 2. (next page). The criteria for obesity was in accordance with the classification of the World Health Organization (8): under weight , a BMI of less than 18.50 kg/m2; normal, a BMI of 18.50 to 24.99 kg/m2; overweight, a BMI of 25.00 to 29.99; obesity, a BMI of 30.00 to 39.99; and extreme obesity, a BMI of 40.00 or more. As age and body mass index increase, the prevalence of cataract increases. The overall prevalence of cataract in Jordanian individuals aged between 40 and 80 years is 22.7%. There is no increase in prevalence of cataract in patients with osteoarthritis. Posterior subcapsular lens opacity was more prominent in low to normal BMI, but as BMI increases nuclear and cortical cataract become more prevalent.

Table 1: The prevalence of cataract in group A and group B regarding age

10

Middle EastEast Journal of Ageof and Ageing Issue 4,Volume August 2010 Middle Journal Age andVolume Ageing7, 2009; 6, Issue

5


Table 2: The prevalence of cataract in group A and group B regarding body mass index (BMI)

Figure 1: The prevalence of cataract in group A and group B regarding age

Figure 2: The prevalence of cataract in group A and group B regarding body mass index (BMI)

Middle East Journal of Ageofand Volume 7,2009; Issue 4, August 6, 2010 Middle East Journal AgeAgeing and Ageing Volume Issue

5

11


Regarding ,the distribution of lens opacity the most common type of cataract was the nuclear (64.7%) followed by the cortical type (26.5%) and posterior subcapsular (8.8%). Posterior subcapsular lens opacity was more prominent in low to normal BMI, but as BMI increases nuclear and cortical cataract become more prevalent.

Discussion It is clear that the prevalence of cataract among OA patients (group A) is very close to that in group B, as shown in Figure 1. Also it is noted that as age increases the prevalence of cataract increases. The prevalence was 5.3% in patients aged between 40-49 year of age in group A and 0.0% in group B but it increased to 60.0% in patients aged between 70-79 year of age in group A and 55.6% in group B. So there is no increase in risk of developing cataract in patients with OA. The overall prevalence of cataract in Jordanian individuals aged between 40 and 80 years is 22.7% which is higher than that found in some areas of the world, for example David S. Friedman et.al.(2) have found that the prevalence of cataract in Americans older than 40 years is 17.2%. This could attributed to the use of a different classification system (Lens Opacities Classification System II(9) instead of Lens Opacities Classification System III which was used in our study. Additionally you can find a large variation in prevalence among different parts of the world(10). This difference is also due to the use of a different classification system of lens opacity and even when some studies use the same classification system they consider different grades as significant lens opacity. Geographical variation also plays a role in the prevalence of cataract due to sunlight exposure (11) and Jordan is considered one of the low cloud cover countries. Regarding the prevalence of the cataract in group in relation to body mass index (BMI) it is also clear that the prevalence of cataract among OA patients is very close to that in group B as shown in Figure 2. Also it is noted that as BMI increases the prevalence of cataract increases. The prevalence was 6.7% in group A and 0.0% in group B when BMI was < 18.5 kg/m2 but it increased to 66.7% in group A and 50.0% in group B when BMI was between 30.0 and 39.9 kg/m2. So the difference in prevalence of cataract in both groups is not statistically significant. The increase in prevalence of cataract among obese patients could be attributed to the metabolic effect and the decreased sensitivity of the body cell to insulin despite not having diabetes. In addition to obesity may influence several physiological processes involved in cataract formation such as oxidative stress, glycosylation and osmotic stress(12). It should be mentioned that obesity is considered one of the risk factors for OA and weight reduction is one of the important treatment modalities for it(13). Like other studies (12,14)the most common type of cataract was the nuclear (64.7%) followed by the cortical type (26.5%) and the posterior subcapsular (8.8%), but unlike many studies, gender differences were statistically not significant for all types of cataract.(12) When we compare the distribution of the type of cataract regarding age there was no particular distribution in any age for all types of cataract, however when we compare the type of cataract regarding BMI, nuclear and

12

cortical type was associated with high BMI and posterior subcapsular cataract was more prominent in individuals with low and normal BMI. This is also different from what was found by J M Weintraub et al(12) who found that Obesity increases the risk of developing cataract overall, and of PSC cataract in particular. Laura E Caulfield (14) found that both BMI and stature are independent risk factors for cataracts but Tung-Mei Kuang et al .(15) found that Body mass index is an independent risk factor for nuclear and cortical opacities . This variation suggests that geography plays a role in the development of cataract type.

Conclusions As age and body mass index increase the prevalence of cataract increases. The overall prevalence of cataract in Jordanian individuals aged between 40 and 80 years is 22.7%. There is no increase in prevalence of cataract in patients with osteoarthritis. Posterior subcapsular lens opacity was more prominent in low to normal BMI, but as BMI increases nuclear and cortical cataract become more prevalent.

References

1. Kupfer C. The conquest of cataract; a global challenge. Trans Ophthalmol Soc UK 104:1-10, 1984 2. David S. Friedman; Nathan G. Congdon; John H. Kempen; Benita J. O’Colmain .Prevalence of Cataract and Pseudophakia/Aphakia Among Adults in the United States .Arch Ophthalmol. 2004;122:487-494. 3. Sannapaneni Krishnaiah, Kovai Vilas, Bindiganavale R. Shamanna, Gullapalli N. Rao, Ravi Thomas, and Dorairajan Balasubramanian . Smoking and Its Association with Cataract: Results of the Andhra Pradesh Eye Disease Study from India .Investigative Ophthalmology and Visual Science. 2005;46:58-65. 4. P K Nirmalan,A L Robin,J KatzJ M Tielsch, R D Thulasiraj, R Krishnadas,R Ramakrishnan . Risk factors for age related cataract in a rural population of southern India: the Aravind Comprehensive Eye Study.Br J Ophthalmol 2004;88:989-994 . 5. Laurent G Ameye , Winnie SS Chee. Osteoarthritis and nutrition. From nutraceuticals to functional foods: a systematic review of the scientific evidence. Arthritis Research & Therapy 2006, 8:R127 6. T. MCALINDON and D. FELSON . Nutrition: risk factors for osteoarthritis. Ann Rheum Dis. 1997 July; 56(7): 397-400. 7. Chylack LT, Wolfe JK, Singer DM, et al. The lens opacities classification system III. Arch Ophthalmol. 1993;111:831-836 8. Shukla HC, Gupta PC, Mehta HC, Hebert JR. Descriptive epidemiology of body mass index of an urban adult population in western India. J Epidemiol Community Health. 2002;56:876-880. 9. Chylack LT Jr, Leske MC, McCarthy D, Khu P, Kashiwagi T, Sperduto R. Lens opacities classification system II (LOCS II). Arch Ophthalmol. 1989;107:991-997. ( ... continued page 20)

Middle East Journal of Age and Ageing Volume 7, Issue 4, August 2010




Prevalence of Parkinsonian Features in Egyptian Elderly Patients with Mild Cognitive Impairment Authors: Heba T. Mousa MS, Mohamad A. Al Sadany MD*, Shereen M. Mousa MD, Mohamad H. El Banouby MD. Department of Geriatrics, Faculty of medicine, Ain Shams University Dr. Shereen M. Mousa, Lecturer of Geriatric Medicine, Faculty of Medicine, Ain Shams University Prof. Mohammad H El-Banoby, Professor of neuropsychiatry and Geriatric medicine, Geriatrics Department, Faculty of Medicine, Ain Shams University. Heba T. Mousa, Geriatric medicine resident, Faculty of Medicine, Ain Shams University. Corresponding Author: Dr. Mohamad A. Al Sadany, Lecturer of Geriatric Medicine, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Tel: 0020102412671 FAX: 0020224826726 Mailing Address: Geriatric Medicine Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Email: [email protected]

ABSTRACT Background and Objectives: Parkinsonian Features are commonly associated with dementia and its severity increases over time; but it is not known whether they are associated with mild cognitive impairment (MCI) or not. The Objectives of this research were to determine prevalence of parkinsonian features, specifically (bradykinesia, rigidity, tremors, changes in posture, speech and facial expressions) in non-demented community-dwelling Egyptian elderly with MCI, and to study the correlation between Parkinsonian features and cognitive functions in elderly patients with MCI. Methods: 507 elderly participants residing in the selected geriatrics clubs and homes were randomly selected and subjected to neuropsychological assessment for detection of 100 MCI patients. Those patients with MCI underwent cognitive assessment and neurological assessment using the modified version of Unified Parkinson Disease Rating Scale for detection of Parkinsonian features. Results: 66% of our participants had Parkinsonian features. Such features were significantly related to the severity of MCI. The most affected cognitive function in those elderly was language and the presence of Parkinsonian features was significantly related to cerebrovascular risk factors. Conclusion: Parkinsonian features are prevalent in MCI patients. Key words: Parkinsonian, elderly, MCI, Egyptian, prevalence

Middle East Journal of Age and Ageing Volume 7, Issue 4, August 2010


13


Introduction Mild Parkinsonian signs (MPS) or extra-pyramidal signs, including rigidity, changes in axial function, and resting tremors, occur in 15 to 40% of community-dwelling elderly and are associated with functional impairment [1]. Extra-pyramidal signs in non-demented subjects are associated with higher mortality, increased functional impairment and the subsequent development of dementia [2]. It is unclear whether the emergence of MPS reflects an age associated decline in nigrostriatal dopaminergic activity or whether these motor signs are due to the presence of emerging dementia or subcortical cerebrovascular disease [3]. Longitudinal studies have shown that MPS increase in severity over time and they are associated with incident dementia [4]. Aging is an inevitable and undeniable process that impacts all aspects of life. It is associated with a broad range of physiological and psychological changes, including a decline in cognition which contributes to loss of independence and a lower quality of life [5]. Mild Cognitive Impairment (MCI) is thought to be a transitional state between normal aging and dementia [6]. The prevalence of MCI varies between 2 and 30% in the general population and between 6 and 85% in a clinical setting (average 40%) [7]. Individuals with amnestic-MCI progress to AD at a rate of 10% to 15% per year, compared with 1% to 2% per year in normal elderly persons [8]. Also, it was found that patients with MCI when followed over time may progress to non-AD dementia, for example; patients with Parkinson’s disease (PD) and MCI may be at higher risk of progressing to dementia than cognitively intact PD patients [9]. Identifying states that will predict the subsequent development of dementia has important implications for future therapeutic interventions. Much current focus is upon the entity of mild cognitive impairment [10]. Little is known about correlations of specific Parkinsonian signs with cognitive decline in AD. In some studies, the rates of change in bradykinesia, gait disorder, postural reflex impairment, and especially rigidity were strongly related to the rate of cognitive decline. In cross-sectional research on Parkinson disease, a somewhat similar pattern has been described with motor signs other than tremor showing modest correlations with cognitive function [11]. In a study on community-dwelling elderly participants aged 75 and over, abnormalities of gait including unsteadiness, frontal gait disorders and hemiparetic gaits predicted the development of non-Alzheimer dementias over a median period of 6.6 years [12].

14

Hence it was important to begin research reporting on such an important topic in the Egyptian elderly. The purpose of this study was to determine prevalence of Parkinsonian features specifically (bradykinesia, rigidity, tremors, changes in posture, speech and facial expressions) in non-demented community-dwelling Egyptian elderly with MCI, and to study the correlation between Parkinsonian features and cognitive functions in those MCI patients.

Methodology Study design A cross sectional study was conducted to assess Parkinsonian features in Egyptian elderly patients with MCI. The study was carried out in six geriatric clubs and three geriatric homes located in Cairo. Those clubs and homes were chosen randomly from a list supplied by the social workers in the geriatrics department, Ain Shams University. This list was updated regularly from the Ministry of Social Affairs. For each of those geriatric clubs and homes, lists of their elderly residents were assessed for selection in the study. Methods The number of MCI patients required for the study was determined as One hundred patients. To reach this required number of participants the study passed through two stages. Stage I: A total number of 542 elderly participants (507 after exclusion) both men and women, residing in the selected geriatrics clubs and homes were randomly selected. The selected participants were ambulant at the time of assessment, not previously diagnosed as demented and had no evidence of impairment in their activities of daily living. After taking consent, they were subjected to a structured interview including demographic data, past medical history, list of medications used, physical examination, neurological examination, cognitive function assessment using Mini Mental Status Examination (MMSE) [14] and Montreal Cognitive Assessment (MoCA) [15], functional assessment using ADL (Activities of Daily Living ) [18] and IADL (Instrumental Activities of Daily Living) [19] and Screening for depression using Geriatric depression scale-15 items (GDS-15)[20]. Montreal Cognitive Assessment is a screening instrument reportedly to be capable of distinguishing MCI from age-related cognitive decline. It is a one-page 30-item point test administered in 10 minutes. Thirty-five elderly participants were excluded from the study, and the total number of elderly participants needed for detection of MCI patients and were eligible for the study was 507 elderly participants. The exclusion criteria were: subjects with Parkinson’s disease or Parkinson plus syndrome or any other clinically evident neurological disorder, subjects with severe musculoskeletal disorders, subjects who did not complete their assessment, subjects receiving neuroleptic drugs, subjects with MMSE [14] score 1; or (ii) one UPDRS rating >2 [1]. Statistical Analysis The data was collected, coded and entered into a personal computer (PC). The data was analyzed with the program (SPSS) Statistical Package for Social Science under Windows version 13.0. Description of all data in the form of mean (M) and standard deviation (SD) for all quantitative variables was done. Frequency and percentage were done for all qualitative variables. Comparison of qualitative variables was done using the Chi-square test. Correlation coefficient was also used to find linear relation between different variables using r-test or Spearman correlation co-efficient. P value was always set as significant at P12 years education while the remaining 39% of study population had 6-12 years of education. Also, it shows that 63% were smokers, 57% had hypertension, 31% had diabetes, 24% had heart diseases, and 10% had other diseases, while 18% of the study population had no co-morbidity (Table 1 - opposite page). Results revealed that 66% of the MCI participants had Parkinsonian features in any form that were distributed as follows: bradykinesia in 63% of participants, stooped posture in 49%, rigidity in 22%, speech affection in 14%, facial expression (hypomimia) in 13%, and resting tremors in only 3% of MCI participants (Table 2). We found that Parkinsonian features were significantly related to poorer performance in both MOCA and MMSE tests with a p value of (0.038) and (0.016) respectively (Table 3 - opposite page). The most affected cognitive domain of MoCA test was language (P value = 0.005), while other cognitive domains such as executive, attention, calculation, abstraction, and delayed recall did not show such significance (Table 4 - page 17). A statistically significant negative correlation was found between both total MOCA score (P = 0.045) and its sub-item (language) score (P = 0.001) and UPDRS score of the studied Parkinsonian features (Table 5 page 17). Finally presence of Parkinsonian features were significantly related to vascular risk factors such as smoking (P value =0.018), hypertension (P value =0.007), and ischemic heart disease (P value =0.04) (Table 6 page 17).

Discussion Mild Parkinsonian signs (MPS) include gait and balance changes, rigidity, bradykinesia, and tremor which can occur commonly during the clinical examination of older people who do not have known neurological disease, with prevalence estimates for MPS as a whole ranging from 15% to 95%. MPS are generally progressive and they are coupled with functional difficulties, impaired gait and balance, and increased risks of mild cognitive impairment, dementia, and mortality [21]. The aim of the current study was to assess the prevalence of Parkinsonian features among individuals with MCI and to find any correlation between the presence and severity of Parkinsonian features and the degree of MCI. Our results revealed that 66% of the study population has Parkinsonian features. The wide range of MPS among normal elderly and the fact that such signs are coupled with MCI and dementia patients may explain the high prevalence that was observed in our population.

Middle East Journal of Ageofand Ageing Issue 4,Volume August 2010 Middle East Journal Age and Volume Ageing7,2009; 6, Issue

5

15


Table 1: Demographic characteristics of the study population

Table 2: Parkinsonian features among the studied MCI participants

Table 3: Comparison between participants with and without Parkinsonian features as regards their MOCA and MMSE tests scores

16

Middle EastEast Journal of Age of andAge Ageing 7, Issue August 2010 Middle Journal andVolume Ageing 2009;4, Volume 6, Issue

5


Table 4: Comparison between participants with and without Parkinsonian features as regards the score of different cognitive domains of the MOCA test

Table 5: Correlation between UPDRS score and the MOCA total and sub-items cognitive domains scores

Table 6: Relation between presence of Parkinsonian Features and different co-morbidities Middle East Journal of Ageofand Ageing Issue 4,Volume August 2010 Middle East Journal Age and Volume Ageing7,2009; 6, Issue

5

17


Boyle and colleague [22] found that among individuals with MCI, lower levels of cognitive function particularly in perceptual speed, were associated with higher levels of Parkinsonian signs which are related to the severity and type of cognitive impairment. Our study revealed almost the same results; there was a statistical significant relation between MCI and Parkinsonian features with a mean score of MOCA being higher in patients without Parkinsonian features (23.74±1.831), than those with Parkinsonian features (22.73± 2.459). Also the severity of MCI was closely related to the presence and the severity of Parkinsonian features and this was obvious by the statistically significant negative correlation between total MCI score and UPRD score. The most common Parkinsonian features that were observed in our population are bradykinesia and stooped posture; they affected almost 50% of our study population. This agrees with Boyle et al. [22] who found that MCI is associated with multiple Parkinsonian signs, including bradykinesia, gait disturbance and rigidity but disagrees with Louis et al., [1] who found that rigidity rather than tremor or bradykinesia was most strongly associated with MCI (amnestic type). This may be due to the fact that they did not include the assessment of appendicular bradykinesia so it is possible that they may have underestimated the correlates of Parkinsonian signs, and both of the previously mentioned studies included patients without MCI, which is lacking in our study. The most affected cognitive function in our sample was language which was found to be significantly related to Parkinsonian features. Critchley [23] in a study of speech disorders in Parkinsonism reported that it is a paradigm of the integration of phonation, articulation, and language in production of speech, and as language is considered one of the deficiencies and diagnostic criteria of MCI so it was expected to be one of the most affected functions in our patients. Other cognitive function did not show such significant correlation. Finally it was observed that Parkinsonian features were significantly related to the presence of smoking, hypertension and ischemic heart disease. Being risk factors for cerebrovascular disease, the three previously mentioned conditions could represent the relation between MCI and Parkinsonian features and cerebrovascular disease. This association was reported in a lot of the literature, such as Bennett et al., [24] who reported that cerebrovascular involvement in mild cognitive impairment is intermediate between that seen in ageing and early Alzheimer’s disease. Also, Louis et al., [1] found that Parkinsonian features were associated with vascular risk factors like hypertension, as well as there being an association between vascular risk factors and MCI, and both suggest that cerebrovascular disease may be contributing to both Parkinsonian features and MCI.

References 1. Louis ED, Schupf N, Manly J, Marder K Tang MX, Mayeux R. Association between mild parkinsonian signs and mild cognitive impairment in a community. Neurology 2005, 64(7), 1157-61. 2. Richards M, Touchon J, Ledesert B, Ritchie K. Mild extrapyramidal signs and functional impairment in ageing. Int J Geriatr Psychiatry 2000; 17:150-3. 3. Yamanouchi H, Nagura H. Neurological signs and frontal white matter lesions in vascular parkinsonism. A clinicopathologic study. Stroke 1997; 28(5):965-9. 4. Louis ED, Tang MX, Mayeux R. Parkinsonian signs in older people in the community: risk of incident dementia. Arch

18

Neurol 2004; 61(8):1273-76. 5. DeCarli C. Mild cognitive impairment: prevalence, prognosis, etiology, and treatment. Lancet Neurol 2003; 2(1): 15-21. 6. Gauthier S, Reisberg B, Zaudig M, Petersen RC, Ritchie K, Broich K, Belleville S, Brodaty H, Bennett D, Chertkow H, Cummings JL, de Leon M, Feldman H, Ganguli M, Hampel H, Scheltens P, Tierney MC, Whitehouse P, Winblad B. Mild cognitive impairment. Lancet; 2006 367(9518):1262-70. 7. Visser PJ. Predictors of Alzheimer Type Dementia in Subjects with Mild Cognitive Impairments; Neuropsych 2000; Publishers, Maastricht. 8. Winblad B, Palmer K, Kivipelto M Jelic V, Fratiglioni L, Wahlund LO, Nordberg A, Bäckman L, Albert M, Almkvist O, Arai H, Basun H, Blennow K, de Leon M, DeCarli C, Erkinjuntti T, Giacobini E, Graff C, Hardy J, Jack C, Jorm A, Ritchie K, van Duijn C, Visser P, Petersen RC. Mild cognitive impairment-beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004; 256(3):240-6. 9. Janvin CC, Larsen JP, Aarsland D, Hugdahl K. Subtypes of mild cognitive impairment in Parkinson’s disease: progression to dementia. Mov Disord 2006; 21(9):1343-49. 10. Petersen R, Smith GE, Waring SC, Ivnik RJ, Kokmen E, Tangelos EG. Mild cognitive impairment: clinical characterisation and outcome. Arch Neurol 1999; 56:303-8. 11. Portin R, Koivusalo A, Laihinen A, Rinne U. Cognitive deficits, motor disability and duration of illness in early Parkinson’s disease [abstract]. J Clin Exp Neuropsychology 1989; 11:369 12. Verghese J, Lipton RB, Hall CB, Kuslansky G, Katz MJ, Buschke H. Abnormality of gait as a predictor of non-Alzheimer’s dementia. New Engl J Med 2002; 347:1761- 68. 13. Petersen RC, Doody R, Kurz A, Mohs RC, Morris JC, Rabins PV, Ritchie K, Rossor M, Thal L, Winblad B. Current concepts in mild cognitive impairment. Arch Neurol 2001; 58(12):198592. 14. Folstein MF, Folstein SE, McHugh PR. Mini Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12:189-98. 15. Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005; 53(4):695-9. 16. Fahn S, Marsden C, Goldstein M, Calne D. Recent developments in Parkinson’s disease 1987; vol. 12. Florham Park, NJ: MacMillan Healthcare Information; 153-63. 17. Stern MB. The clinical characteristics of Parkinson’s disease and parkinsonian syndromes: diagnosis and assessment. In: Stern MB, Hurtig HI, eds. The comprehensive management of Parkinson’s disease. New York: PMA Publishing Corp. 1978: 34-39. 18. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of illness in the aged. The index of ADL: A standardized measure of biological and psychosocial function. JAMA. 1963; 21; 185:914-9. 19. Lawton MP, Brody EM. Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist 1969: 9(3), 179-86. 20. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey M, Leirer VO. Development and validation of a geriatric depression screening scale: a preliminary report. J Psychiatr Res. 1983; 17(1):37-49. (... continued page 20)

Middle EastEast Journal of Age of and Ageing Issue 4,Volume August 2010 Middle Journal Age andVolume Ageing7, 2009; 6, Issue

5


The Prevalence of Diabetic Foot and its Risk factors among Jordanian Diabetics Authors: Wasfi Salayta, MD* Samer Al- Ghzawi, MD Surgery Department, Royal Medical Services Jordan Correspondence: Dr. Wasfi Salayta, Mobile: +962776577080, 11733 Prince Hamzeh Suburb P.O box: 134, Amman, Jordan Email: [email protected]

ABSTRACT Aim: to determine the prevalence and risk factors for foot complications among diabetic patients. Method: prospective study performed in King Hussein Medical Centre on Jordanian diabetic patients between June 2008 and January 2010. The following data was obtained from each patient : age, sex, duration and type of DM , smoking , presence of hypertension, the presence of diabetic foot, hyperlipedemia, retinopathy, nephropathy, Peripheral neuropathy, peripheral vascular disease , HbA1c level and body mass index. Result: Diabetic foot was present in 95 patients (19.0%). Amputation was done on 5 patients. Only 26.2% had HbA1C