Review Article

Epidemiology of Alzheimer’s Disease and Dementia in Arab Countries: A Systematic Review

Table 3

Studies on dementia risk factors.

AuthorYearCountryStudy designOutcome measureSample sizeSetting/sampling techStudy key findings

Chaaya et al. [29]2018Lebanon (Beirut, Shouf, and Aley)Cross-sectional secondary analysis of Chahine et al. [21][1] 10/66 DRG, modified CERAD, animal naming tests modified 10-word list recall, GMS, CSI-D
[2] Self-reported on HTN, DM, CVD, smoking, PA
[3] 3 consecutive measurements of blood pressures
Households
Multi-stage cluster sampling
Age: OR 75–84
(95% CI: 1.46, 10.95); OR 85+ (1.84, 27.03) compared to age group 64-74 years
Perceived insufficient income (vs. sufficient income): OR 3.90 (95% CI: 1.58, 9.60)
No formal education (vs. formal education): OR 3.39 (95% CI: 1.71, 6.70)
Uncontrolled hypertension (vs. no hypertension): OR 6.35 (95% CI: 1.60, 25.10)

Farrag et al. [17]1998Egypt (Assiut Governorate)3-stage cross-sectionalMMSE
Clinical diagnosis
Lab investigation
2000Household, systematic random of total elderly years ()Occupation and residence did not affect the prevalence or severity of dementia
Age-specific dementia prevalence tends to double every 5 years after age 75 years and above

Ouanes et al. [24]2014TunisCross-sectionalMoCA77Manouba nursing home
All 116 residents (mean )
Prevalence of dementia did not differ significantly by gender, age, marital status, level of education, profession, current financial situation, or depending on the participation in the activities at the center

El Tallawy et al. [19]2014Egypt (Al-Quseir city)Cross-sectionalMMSE, clinical exam, investigations8,173 (≥50)Household
All persons
()
Prevalence of dementia significantly higher among illiterate than educated participants (3.6% vs. .79%)

Khedr et al. [20]2015EgyptCross-sectionalMES and MMSE
Neuro exam of all positive cases—DSM-IV, Hachinski ischemic score
691Household, multistage probability random samplingCPRs were significantly higher in the following:
Illiterate than literate participants (10.12 vs. 2.25 cases per 100 population, )
Urban than rural areas (7.1 versus 3.27%, )
Industrial than nonindustrial areas (13.23 vs. 1.99; )

Al-Khateeb et al. [30]2014JordanCase controlMMSE, Clock Drawing Test102Senior homes and Jordan University Hospital (52 dementia patients and 50 controls) >60 yrsRisk for dementia:
Educational —OR 3.29 ()
Illiterate—OR 6.29 () compared to education level more than 12 years
No significant correlation between serum copper, lipid profile, and cognitive decline in elderly Jordanians
Coffee intake has a protective effect against cognitive decline (6.25-fold lower risk)

Alaama et al. [31]2016Saudi Arabia (Jeddah)Cross-sectionalMoCA, RUDAS241King Abdulaziz University Hospital volunteers
171 outpatients with DM, matched with 70 controls without DM
Age
Diabetics more likely to have cognitive impairment than nondiabetics (16% vs. 3%; ). With MoCA, 85% of the cases and 78% of the controls had abnormal results (). Among diabetics, there was no statistically significant effect found for glycemic control or DM duration on either test

Haithem et al. [32]2018TunisiaCase control200 dementia patients and 300 controlsAssociation between dementia risk and all the studied polymorphisms except PON1-Q192R was found to be significant
APOE e4 allele—OR 4.32 ()
ACE I and PON1-L55M T alleles—OR 2.58 and 2.11 ( and )
GTICC haplotype associated with 9-fold dementia risk (), whereas AADTT seems to reduce dementia risk by 80% ()

Albugami et al. [3]2018Saudi ArabiaRetrospective, cohortNo standardized diagnostic protocol418Medical records of patients have dementia at tertiary care hospital from 1995 to 2010
Mean age
78.8
Comorbidities:
27.44% of patients have more than 3 risk factor comorbidities
High prevalence of mixed dementia could be related to high prevalence of CVD risk factors like hypertension, dyslipidemia, and diabetes mellitus among Saudis
Stroke is reported in 15.03%

Shamieh et al. [34]2018LebanonCross-sectional591 individualsPrevalence of APOE genotypes in Lebanon was similar to that seen in Asian populations
APOE genotypes not associated with hypercholesterolemia
A significant difference between APOE genotypes in AD cases versus controls and versus Lebanese general population was seen
E4 allele was approximately threefold higher in Alzheimer’s disease study patients when compared with the remaining individuals

MMSE: modified mini-mental state examination; CPR: crude prevalence rate; VaD: vascular dementia; MES: Memory and Executive Screening test; GDS: Geriatric Depression Scale; NINCDS-ADRDA: National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association; NINDSAIREN: National Institute of Neurological Disorders and Stroke (NINDS) and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences; SMQ: short-memory questionnaire; BCST: Brookdale Cognitive Screening Test; A-IQCODE 16: Arabic Version of 16-item Informant Questionnaire on Cognitive Decline for the older adults; DRG: Dementia Research Group; MoCA: Montreal Cognitive Assessment; GMS: Geriatric Mental State Interview; CERAD: Consortium to Establish a Registry of Alzheimer’s Disease; NEUROEX: physical assessment and brief neurological examination; RUDAS: Rowland Universal Dementia Assessment Scale.