Changes in the Neurocognitive Profile of Help-Seekers in a Dementia Early Detection Program: 2006 to 2013

Abstract

Background: A community-based, territory-wide dementia early detection program has been provided by the Hong Kong Alzheimer’s Disease Association (HKADA) from 2006 onward. The program accepts open referrals that the person with suspected dementia can receive an assessment with 1 to 2 weeks after a referral is registered. It is unclear whether the neurocognitive profile of help-seekers assessed in the early years is different from those assessed in the recent years. Methods: From 2006 to 2013 (8 years), 1788 people without pre-existing clinical diagnosis of dementia sought help from the early detection program provided by the HKADA. All help-seekers received a comprehensive battery of neurocognitive and psychological assessment, which included the Cantonese Mini-Mental State Examination (MMSE), Clock Drawing Test (CDT), Digit Span, and Fuld Object Memory Evaluation (FOME). Time since first notice of symptoms was ascertained by the person and/or an informant. Clinical Dementia Rating (CDR) was used to measure the severity of dementia symptoms. Results: The mean age of help-seekers did not significantly change over the 8 years, but the median time between first notice symptoms and assessment showed a decreasing trend: 24, 30, 24, 20, 12, 6, 12, and 12 months in 2006 – 2013, respectively (Kruskal-Wallis test, chi-square=158.7, d.f.=7, P<0.001). Adjusted for age and gender, MMSE score of help-seekers increased by 0.39 point in each succeeding calendar year (95% CI 0.26 to 0.53; P<0.001). The increasing trend was also observed in CDT drawing (coef.=0.16; 95% CI 0.09 to 0.23; P<0.001), FOME encoding (coef.=0.97; 95% CI 0.66 to 1.27; P<0.001), FOME immediate recall (coef.=0.93; 95% CI 0.62 to 1.24; P<0.001), FOME delayed recall (coef.=0.23; 95% CI 0.15 to 0.30; P<0.001), and Digit Span forward (coef.=0.12; 95% CI 0.08 to 0.16; P<0.001). The likelihood of mild or more severe symptoms of dementia (CDR 1) decreased by 8% (95% CI 2% to 13%) in each succeeding calendar year. Conclusion: Help-seekers in recent years tended to show less severe dementia symptoms and better cognitive functioning, potentially attributable to the increasing awareness of dementia in the community. Further public education is needed to strengthen the public recognition of dementia symptoms.