RISK ASSESSMENT OF ALZHEIMER DISEASE AMONG ATTENDANTS OF GENERAL HOSPITALS IN Al-QASSIM

* Ibtehal Al-Harbi, Atheer Al-Hujilan, Hajar Al_Akeel, Lina Alyousif, Maha Al-Shetwi, Monira Al-Nasser and Lamees Al-Habeeb. Qassim University, KSA. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History

The more individuals advance in age the higher is the risk they will develop Alzheimer disease. Because more and more people live longer lives this disease is becoming a serious concern. The age-specific incidence rates for Alzheimer disease demonstrate a doubling of incidence for about every six years of added life, which indicates an exponential increasing risk with increasing age. (Medicines for Europe and the World -2013) Another strong risk factor is family history. Those who have a parent, brother, sister or child with Alzheimer's are more likely to develop the disease. The risk increases if more than one family member has the illness. When diseases tend to run in families, either heredity (genetics) or environmental factors, or both, may play a role. In the other hand, several studies indicate a role for environmental effects on AD development. Diabetes, hypertension, smoking, obesity, and dyslipidemia have all been found to increase risk as well a history of brain trauma, cerebrovascular disease, and vasculopathies. . (Alzheimer's association-2013).
In Saudi Arabia, there is a complete lack of information that estimates current prevalence and cost of care as well as other aspects of the disease, such as care settings, treatment, detection, diagnosis and the current understanding of the disease. Patient and caregiver perspectives that may reveal the daily struggle of living and dealing with the disease are missing. The risk factors that associated with AD (i.e. lifestyle choices and Environmental factors) are not exactly determined (Saudi Alzheimer's disease association). Regarding to this fact about Saudi Arabia, we like to recognize the risk factors associated with Alzheimer's disease and the significance of some factors.

Research Question:
What is the prevalence of symptoms of Alzheimer among the age group 50 to 80 and the associated risk factors?
Objectives:-General Objectives: To detect the occurrence of Alzheimer symptoms among group of individuals aged 50-80 attended to general hospital in Al-Qassim. ( Buridah, Unizah, Arass ) Specific Objectives: 1. To measure the level of Alzheimer. 2. To assess the associated risk factors.

Methodology:-
 Study design and setting: A Cross sectional study among attendants of general hospital in Al-Qassim. ( Buridah, Unizah, Arass )  Study population: Attendants of general Hospital (Arass General Hospital, King Saud hospital, King Fahad specialist hospital) aged between 50-80 male and females.  Sampling: All the attendants in the age group during the 2 days of data collection were included (72 participants).  Data Collection: A questionnaire was designed includes: socio-demographic data, risk factors and tool of assessment. SMMSE, a standardized approach to scoring and interpreting older people's cognitive function, 1845 provides a global score of cognitive ability that correlates with daily function. Careful interpretation of results of the SMMSE, together with history and physical assessment, can assist in differential diagnosis of cognitive impairment resulting from Alzheimer's disease. Repeated measurements can be used to assess change over time and response to treatment. The students in the research group interviewed the participants.  The aims of the research were explained to the participants and they were assured that their responses to the questionnaires will be confidential. There was no obligation for participation and we had a verbal consent. Statistical Analysis: All values will be analyzed using software statistical Package of Social Science (SPSS 20 for window-Evaluation version). Descriptive statistics included frequency tables and graphs. Analysis of the data using X 2 test and P value for comparison between groups.

Discussion and Results:-
The table below shows the stages of cognitive impairment that relate to SMMSE scores. A total score of 30 indicates no impairment. Scores between 26 and 30 are considered normal in the general population. Patients who score between 25 and 20 have mild cognitive impairment and will be experiencing problems with the instrumental activities of daily living, such as shopping, finances, medication use, and meal preparation, but can usually live on their own with support. Those who score between 20 and 10 have moderate cognitive impairment, usually cannot live independently, and are starting to have problems with basic activities, such as grooming, dressing, and using the toilet. Scores between 9 and 0 denote severe cognitive impairment; patients will be having problems with all basic activities, including eating and walking. The following tables and figure will discuss the relation of each risk factor to either a high or low score on the MMSE.  Figure 2: Showed that there was a male predominance in the group that scored (30-26), while there was female predominance in the group that scored (25-20) and (19-10). However, the P value indicates that no significant risk factor was detected.

Martial Status
Unmarried Married Table 4, Figure 4: Showed that individuals in big cities scored in the range (25-20) with the percentage of (39.1%) Where individuals in small cities scored in the range (30-26) with the percentage of (44.7%) And individuals in rural areas scored in the range (25-20) with the percentage of (45.5%) In conclusion: individuals who lived in big and small cities tend to have a higher score than those who lived in rural areas. However, the P value indicates that no significant risk factor was detected.  1849 Showed that illiterate individuals were more likely to score in the range (19-10) with the percentage of (66.7%). Where individuals who can read and write or have some sort of education were more likely to score in the ranges of (30-20). The P value indicates that a significant risk factor was detected. Showed that employed individuals scored in the range (30-26) with the percentage of (57.1%) where unemployed individuals showed an inclination in the ranges (25-20) with a percentage of (41.9%) and (19-10) with a percentage of (32.6%) The P value indicates that a significant risk factor was detected.

Employment Status
Unemployed Employed Showed that individuals who participated in mental work had a score of (30-25) with a percentage of (80%) where individuals who participated in physical labor scored in the range of (25-20) with a percentage of (40%) The P value indicates that a significant risk factor was detected. Showed that individuals with low income had scored in the range of (25-20) with a percentage of (48%) and in the range (19-10) with a percentage of (44%). Where individuals with average income scored in the ranges of  and individuals with high income scored in the range (30-26) with a percentage of (82.4%) The P value indicates that a significant risk factor was detected.   Showed that when the individuals themselves earned the income they tend to score in the range (30-26) with a percentage of (48.6%) Where when the family earned the income, the individuals scored in the range (25-20) with a percentage of (43.8%) However, the P value indicates that no significant risk factor was detected.

Monthly income * Score Level
Physical activity * Score Level

Source of Income
The Family The Individual Showed that the individuals who participated in physical activity scored in the range of (30-26) with a percentage of (45%). Where individuals who did not participated in physical activity scored in the range of (19-10) with a percentage of (37.5%) However, the P value indicates that no significant risk factor was detected.  Figure 11 Showed that there is no difference between regular and irregular physical activity.

Kind of physical activity * Score Level
The P value indicates that no risk factor was detected.

Regular Irregular
Table 12, Figure 12 Showed that individuals who participated in a physical activity everyday for less than an hour scored exclusively in the ranges of (30-20) However, P value indicates that no significant risk factor was detected.
Hours  Figure 13 Showed that individuals who exercised for 3 hours or more a week scored in the ranges of (30-20) where individuals who exercised for 2 hours or less a week scored in the range (19-10) However, the P value indicates that no significant risk factor was detected.    Figure 15 Showed that individuals who used medication for their diseases scored in the range (25-20) with a percentage of (37.5%) Where individuals who did not use medication scored in the range of (30-26) with a percentage of (71.4%) The P value indicates that a significant risk factor was detected. Showed that individuals who took their medication regularly scored in the range (19-10) with a percentage of (37.5%) Where the individuals who did not take their medication regularly scored in the range (30-26) with a percentage of (40%) However, the P value indicates that no significant risk factor was detected. BMI

Yes
No  Figure 18 Showed those individuals who lived with family members scored in the ranges of (30-20) where individuals who lived alone scored in the ranges of (25-10) However, the P value indicates that no significant risk factor was detected.  Figure 19 Showed that there was a relation between individuals how had a high score (30-20) and those how participated in social activity i.e. (family visits, sport club, social club) While there was a relation between individuals with a low score (19-10) and those who engaged in no social activities.  Showed that individuals who had a family member diagnosed with Alzheimer's disease scored in the ranges of (30-20) Where individuals who did not have a family member with the disease also scored in the same range. No significant risk factor was detected.

Conclusion:-
We concluded the following: 1. Differences in education level, employment status, type of work, monthly income, chronic diseases association, social activity and use of medications significantly affected the AD risk score for individuals from 50 to 80 years of age. 2. Individuals with higher education had significantly higher risk scores than their counterparts. 3. Employed individuals, and those with jobs that require mental effort had significantly higher risk scores than their unemployed and physical workers respectively. 4. Individuals with higher monthly income had significantly higher risk scores than the ones with low income. 5. Individuals who have do not have chronic diseases had significantly higher risk scores than other individuals who had chronic disease such as DM, HTN and heart disease. 6. Individuals who participated more in social activities had significantly higher risk scores than their counterparts. 7. Individuals who did not use medications had significantly higher risk scores than individuals who used medication. 8. Effect of age, sex, marital status on the AD risk score was statically insignificant.

Recommendation:-
The impact of AD in Saudi Arabia deserves further epidemiological and clinical research to enable early detection, treatment, and caregiver support. Education of individuals at risk about AD and its prevention via seminars, internet, TV, PHC health care providers and health pamphlets about measures to delay the development, such efforts will no doubt promote greater awareness, refine the policy agenda, and lead to a call for concerted action.