Psychiatric presentation of Alzheimer’s in Jordan Preliminary survey Jamal Khatib MD Consultant Psychiatrist Jordanian Alzheimer Association

Jordan Alzheimer's Association Initiated this summer 2005 by an initiative of Prof Kurdi. Initiated this summer 2005 by an initiative of Prof Kurdi. On the short term major objectives are On the short term major objectives are public awareness. public awareness. Studying the nature and pattern of dementia in Jordan Studying the nature and pattern of dementia in Jordan

Public awareness Media Media Brochures Brochures Lectures,public meetings. Lectures,public meetings.

Studies Problems of alzheimers disease in the arab world. Problems of alzheimers disease in 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 in dementia (BPSD) are the clinically most significant symptoms of the illness. They are non-cognitive and include apathy, agitation, aggression, anxiety, hallucinations and delusions….BPSDs are widespread and often critical with regard to life quality for the patient as well as caregiver stress. The frequency of BPSD increases as the dementing disorder progresses.` ``Behavioural and psychological symptoms in dementia (BPSD) are the clinically most significant symptoms of the illness. They are non-cognitive and include apathy, agitation, aggression, anxiety, hallucinations and delusions….BPSDs are widespread and often critical with regard to life quality for the patient as well as caregiver stress. The frequency of BPSD increases as the dementing disorder progresses.`

Of the 329 participants with dementia, 214 (65%) had Alzheimer's disease, 62 (19%) had vascular dementia, and 53 (16%) had another DSM-IV dementia diagnosis; 201 (61%) had exhibited one or more mental or behavioral disturbances in the past month. Apathy (27%), depression (24%), and agitation/aggression (24%) were the most common in participants with dementia. These disturbances were almost four times more common in participants with dementia than in those without….. Am J Psychiatry May;157(5): Of the 329 participants with dementia, 214 (65%) had Alzheimer's disease, 62 (19%) had vascular dementia, and 53 (16%) had another DSM-IV dementia diagnosis; 201 (61%) had exhibited one or more mental or behavioral disturbances in the past month. Apathy (27%), depression (24%), and agitation/aggression (24%) were the most common in participants with dementia. These disturbances were almost four times more common in participants with dementia than in those without….. Am J Psychiatry May;157(5):

1- Patients mostly A- Refer themselves 0.00% B- Referred by family 95.65% C- Referred by physician 6.52%

2- Referring physicians are mostly A- General practitioners 50.00% B- Neurologists 21.74% C- Internists 30.43%

3- Most common presentation A- Memory problems 30.43% B- Behavioral problems 63.04% C- Mood problems 2.17% D- personality change 15.22% E- Sleep disturbance 10.87% F- Drug side effects 0.00%

4- Patients are mostly A- Already diagnosed 15.22% B- Not diagnosed 84.78%

5- On what you relay more in diagnosis A- Clinical 82.61% B- Neuropsychiatry testing 23.91% C- Imaging 4.35% D- Lab tests 2.17%

6- Do you use cognitive testing ? A - Yes What test ? 73.91% MMSE B- No 21.74%

7- Drugs you prescribe are mostly A- Anticolinesterase inhibitors 26.09% B- Antipsychotics 65.22% C- Antidepressants 19.57% D- Anxiolytics 8.70% E- Sedatives 4.35% F- Mood stabilizers 8.70% G- Gincobiloba 2.17% H- Vit E 2.17% I- Anti - inflaamatory 0.00% J- Others Specify 4.35%

Discussion and conclusion The major problem with dementia patient is behavioural and almost all the patients are taken to doctors rather than referring themselves with antipsychotic as the mostly prescribed drugs, this reflects some how a late onset time of consult, and rather advanced illness at the time of diagnosis as most of patient who reach the psychiatrists are not yet diagnosed although behaviorally disturbed. The major problem with dementia patient is behavioural and almost all the patients are taken to doctors rather than referring themselves with antipsychotic as the mostly prescribed drugs, this reflects some how a late onset time of consult, and rather advanced illness at the time of diagnosis as most of patient who reach the psychiatrists are not yet diagnosed although behaviorally disturbed. Thus awareness about the illness and the aim to catch patients at earlier stage is the first priority of the Jordanian Alzheimer Association.. Thus awareness about the illness and the aim to catch patients at earlier stage is the first priority of the Jordanian Alzheimer Association..

Thank you شكرا Jamal