Teguh Yudo Wicaksono*, Endra Dwi M* Caregivers' knowledge on dementia, the Prevalence and Risk Factors of Dementia: Evidence from a large-scale survey in Yogyakarta, Indonesia Ni Wayan Suriastini*, Yuda Turana**   Firman Witoelar*, Bondan Supraptilah* Teguh Yudo Wicaksono*, Endra Dwi M*   *SurveyMETER **Atma Jaya Catholic University of Indonesia & Alzheimer's Indonesia Scientific Committee Presented at Alzheimer 2016 Conferenece, New Zealand, 3-5 November 2016

background With increasing life-expectancy, the elderly population in Indonesia has been growing steadily, causing higher prevalence of degenerative diseases like dementia There is no definite information about how many elderly who suffer from dementia Alzheimer in Indonesia With increasing life-expectancy, the elderly population in Indonesia has been growing steadily, causing higher prevalence of degenerative diseases like dementia, UNFORTUNATely There is no definite information about how many elderly who suffer from dementia Alzheimer in Indonesia

objective To determine the prevalence of dementia and its risk factors and to describe caregiver knowledge of the early symptoms of dementia in Yogyakarta. ( The province of Yogyakarta has the largest elderly population in the country and is suitable to represent patients with dementia in the whole of Indonesia.)   To determine the prevalence of dementia and its risk factors and to describe caregiver knowledge of the early symptoms of dementia in Yogyakarta

Methodology: Conduct Large-Scale Household Survey December 2015 to January 2016 Drew 100 villages in all districts in DI Yogyakarta Conducted to 1976 elderly and 1415 caregivers from 1500 households December 2015 to January 2016

Multi stage random sampling procedure 1. 100 villages were selected randomly in each district in Yogyakarta (Yogyakarta has 5 districts and each district on average has 150 villages (i.e. the lowest administrative unit)); 2. After selecting the villages, we listed all households in the villages and randomly picked 20 households. Included in this study were those with elderly in household. The sampling resulted in 1500 households consisting of 1976 elderly and 1415 caregivers. To determine the prevalence of dementia and its risk factors and to describe caregiver knowledge of the early symptoms of dementia in Yogyakarta

Methods The study contains information on : multi-stage random sampling procedure: 1. 100 villages were selected randomly in each district in Yogyakarta (Yogyakarta has 5 districts and each district on average has 150 villages (i.e. the lowest administrative unit)); 2. After selecting the villages, we listed all households in the villages and randomly picked 20 households. Included in this study were those with elderly in household. The sampling resulted in 1500 households consisting of 1976 elderly and 1415 caregivers. Methods The study contains information on : basic socio-demographic characteristics (education, employment, residence and household characteristics), self-reported health and social participation, and cognitive assesment. Inclusion criteria: No previous history of any significant hearing and visual disturbances, and the subjects are willing to be included in this study. To determine the prevalence of dementia and its risk factors and to describe caregiver knowledge of the early symptoms of dementia in Yogyakarta

instruments Mini Mental State Examination (MMSE) AD8 Instrumental Activity Daily Living (IADL) Dementia if below MMSE average, unable to perform one activity IADL and scores AD8 ≥ 2 We administer 3 instrument : MMSE, AD8 and IADL. And operational definition of dementia were : below MMSE average ( based on age and level of education ) unable to perform 1 activity IADL and AD8 >/= 2

8-item informant interview to differentiate aging and dementia 8-item informant interview to differentiate aging and dementia*(PPV = 87% for CDR 0 vs CDR ≥ 0.5) Report only a change caused by memory and thinking difficulties: 1. Is there repetition of questions, stories, or statements? 2. Are appointments forgotten? 3. Is there poor judgment (eg, buys inappropriate items, poor driving decisions)? 4. Is there difficulty with financial affairs (eg, paying bills, balancing checkbook)? 5. Is there difficulty in learning or operating appliances (eg, television remote control, microwave oven)? 6. Is the correct month or year forgotten? 7. Is there decreased interest in hobbies and usual activities? 8. Is there overall a problem with thinking and/or memory? *Adapted from Galvin et al, “The AD8: A Brief Informant-Interview to Detect Dementia”, Neurology. 2005;65:559-564.

The study also assesses : risks factors associated with dementia (socio-demographic characteristics, self-reported health status) Caregiver knowledge on the symptoms of dementia.

Analysis Relies on univariate, bivariate and multivariate analysis with variables associated with dementia Relies on univariate, bivariate and multivariate analysis with variables associated with dementia

Result: Dementia Prevalence

Prevalence of dementia in Yogyakarta is 20,1% Prevalence of dementia in Yogyakarta is 20,1%. Gunung Kidul have the higher prevalence compared to other districts N= 1976

Prevalence on female is higher than is on male Prevalence on female is higher than is on male. Living in rural shows higher prevalence In this picture, we comparing between gender and urban/rural. Female and rural were more higher than male and urban.

Higher prevalence is found on respondent who never attend formal education In this picture we can see also formal education has tight correlation with prevalence dementia

Higher prevalence is found in respondents who have hypertension, have stroke In this picture we can see that higher prevalence of dementia is found in respondents who have hypertension and stroke. We can see Significant correlation between stroke and dementia. Fifty percent who have stroke will become dementia.

Higher prevalence is also found on respondents who do not work We can see also almost 32 % who didnt work will developed dementia comparing than 10 % who work.

Among those who are field of work in agriculture significantly have highest prevalence of dementia

People worked more than 8 hours tend to correlate with less dementia than those who are working 8 hours or less but not significant N= 1976 N= 1091

Prevalence in Yogyakarta is higher than global prevalence

Result: Risk Factors

Risk factors of dementia Male Male older adults age 80-84 year and 90 and above, correlate 2-4 time higher than age 60-64 Education, at least having graduated primary education ( 8 years of education) lower their correlation to demented 0,3 -0,5 time Famale Female older adult age 65 years are significantly more demented than male alder adults Same as male older adults adding education significantly correlated with declining demented, mainly having 9 years of education.

Risk factors of dementia Male Living in Gunung Kidul district correlated with higher 2,3 time demented compare with the one live in Bantul district Working male older adults significantly correlated with lower dementia Male older adults with stroke significantly correlate 3,7 time demented Famale Being in Gunung Kidul Female older adults two times higher correlate with demented than male ( 4.7 time for female) Same as male, female older adults negatively correlate with working status Positively correlated with having stroke but in higher degree

Risk factors of dementia Female In contrast with male older adults Income significantly correlate with female older adult demented

Results: caregiver’s knowledge about early signs of dementia

Knowledge toward 10 early signs of dementia: Dementia is still considered as part of normal aging In this graphic we r comparing the knowledge toward 10 early signs of dementia , between caregiver (elderly with dementia and elderly without dementia). And ask whether these 10 early signs were signs of dementia alzheimer. In this graphic we can saw that the knowledge of early signs of dementia were very low. Like only less than 10 % caregiver and elderly know that memory lost was a part of demensia alzheimer.

Conclusion Prevalence of dementia in Yogyakarta is high Risk factor for female older adults are different in several dimensions than male older adults The common risk factors are: age, living in more rural area, low education, stroke and not working Elderly and caregiver’s knowledge about 10 early signs of dementia alzheimer is very low Prevalence of dementia in Yogyakarta is high Risk factor for female older adults are different in several dimensions than male older adults The common risk factors are: age, living in more rural area, low education, stroke and not working Elderly and caregiver’s knowledge about 10 early signs of dementia alzheimer is very low Data on prevalence and level of knowledge about Alzheimer should provide evidence-based information to all stakeholders, and should be sound enough to initiate self-introspection, improve promotion on symptoms, early prevention and treatment of dementia Alzheimer All these efforts are necessary to make better living for the elderly in the future.