Browsing by Person "Stephan, Blossom CM"

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34 Gender Difference in the Association between Handgrip Strength and Cognitive Performance of Older Adults in Rural Malaysia
(Oxford University Press, 2019-12-20) Moffat, Emily; Stephan, Blossom CM; Allotey, Pascale; Reidpath, Daniel
Introduction Handgrip strength is an easy and safe measurement to evaluate the physical functioning of older adults. Lower hand grip strength is associated with cognitive decline, and can be used as an effective method for early detection of cognitive impairment. Objective This study aimed to evaluate the gender differences in association between hand grip strength and cognitive performance among older adults in rural Malaysia Methods This was a cross-sectional study done among 200 community dwelling older adults (100 men and 100 women) aged ≥ 50 years. The study was embedded in the ongoing longitudinal study of South East Asia Community Observatory (SEACO) in Segamat district of Johor, Malaysia. Data was collected by trained data collectors during home visits. Cognitive performance was assessed using Mini Mental State Examination (MMSE). Hand grip strength was measured using digital grip dynamometer. Results The mean age of study participants was 61.5 years (SD= 8.4). Women had lower mean hand grip strength (19.8, SD=5.6) compared to men (33.4, SD= 8.2). The mean MMSE score for women and men were 23 (SD= 4.5) and 25.1(SD=3) respectively. Cognitive impairment was detected in 26% of men and 21% of women. Hand grip strength showed positive association with MMSE score, among women (ß coefficient= 0.302, p<0.001), but not among men (p= 0.077). Hand grip strength was significantly association with MMSE score among women (ß coefficient=0.162, 95% CI = 0.026- 0.298; p=0.02) after controlling for age, level of education and body mass index. Conclusion The study shows that lower hand grip strength is associated with poor cognitive performance among women, while hand grip strength is not associated with cognitive performance among men.
The economic burden of dementia in low- and middle-income countries (LMICs): a systematic review
(BMJ Publishing Group, 2022-04-04) Mattap, Siti Maisarah; Mohan, Devi; McGrattan, Andrea Mary; Allotey, Pascale; Stephan, Blossom CM; Reidpath, Daniel; Siervo, Mario; Robinson, Louise; Chaiyakunapruk, Nathorn
Introduction More than two-thirds of people with dementia live in low- and middle-income countries (LMICs), resulting in a significant economic burden in these settings. In this systematic review, we consolidate the existing evidence on the cost of dementia in LMICs. Methods Six databases were searched for original research reporting on the costs associated with all-cause dementia or its subtypes in LMICs. The national-level dementia costs inflated to 2019 were expressed as percentages of each country’s gross domestic product (GDP) and summarised as the total mean percentage of GDP. The risk of bias of studies was assessed using the Larg and Moss method. Results We identified 14 095 articles, of which 24 studies met the eligibility criteria. Most studies had a low risk of bias. Of the 138 LMICs, data were available from 122 countries. The total annual absolute per capita cost ranged from US$590.78 for mild dementia to US$25 510.66 for severe dementia. Costs increased with the severity of dementia and the number of comorbidities. The estimated annual total national costs of dementia ranged from US$1.04 million in Vanuatu to US$195 billion in China. The average total national expenditure on dementia estimated as a proportion of GDP in LMICs was 0.45%. Indirect costs, on average, accounted for 58% of the total cost of dementia, while direct costs contributed 42%. Lack of nationally representative samples, variation in cost components, and quantification of indirect cost were the major methodological challenges identified in the existing studies. Conclusion The estimated costs of dementia in LMICs are lower than in high-income countries. Indirect costs contribute the most to the LMIC cost. Early detection of dementia and management of comorbidities is essential for reducing costs. The current costs are likely to be an underestimation due to limited dementia costing studies conducted in LMICs, especially in countries defined as low- income. PROSPERO registration number The protocol was registered in the International Prospective Register of Systematic Reviews database with registration number CRD42020191321.
Economic burden of dementia studies in low- and middle- income countries (LMICs): A systematic review
(Alzheimer's Association, 2021-12-31) Mattap, Siti Maisarah; Mohan, Devi; McGrattan, Andrea; Allotey, Pascale; Stephan, Blossom CM; Reidpath, Daniel; Siervo, Mario; Robinson, Louise; Chaiyakunapruk, Nathorn
More than two thirds of people with dementia are living in the low‐ and middle‐ income countries (LMICs). The growing dementia prevalence will result in significant economic burden in these countries. This systematic review aimed to summarise the evidence on the economic burden of dementia in LMICs. Seven databases (EconLit, EMBASE, PubMed, Cochrane Review (DARE), ERIC, PsycINFO and CINAHL) were searched from inception to September 2020 for original research articles reporting the economic burden or cost of illness for all‐cause dementia and/or its subtypes e.g., Alzheimer’s disease (AD), from any LMICs as defined by the World Bank. Two independent reviewers assessed studies for eligibility. Data on the location, study characteristics, cost estimation methods and estimated costs were extracted. The national level total, direct and indirect costs inflated to 2019, were expressed as a percentage of each country’s Gross Domestic Product (GDP) and were summarised using mean percentage of GDP. Study quality was assessed using the Larg and Moss method. The literature search identified 14092 articles, of which 22 studies met the eligibility criteria. The national cost of dementia was reported in 64% of the studies (from 120 countries). The remaining studies reported only patient level cost. Majority of the studies had low risk of bias. The average national dementia cost estimated as proportion of GDP was 0.42%. Informal care or indirect costs on average accounted for 62% of the total cost of dementia, while 38% was due to the direct cost. Dementia is a major cause of economic burden in LMICs. Cost of informal care or indirect cost is the major contributor of this cost. The cost of dementia in LMIC has doubled since first reported in the World Alzheimer Report in 2015 (0.2% of GDP). Acknowledgement: This research was funded by the National Institute for Health Research (NIHR) (16/137/62 ‐ Dementia Prevention and Enhanced Care (DePEC), Newcastle University, United Kingdom), using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.
Effects of Subjective Memory Complaints (SMCs) and Social Capital on Self-Rated Health (SRH) in a Semirural Malaysian Population
(Hindawi, 2019-04-10) Yap, Kwong Hsia; Mohan, Devi; Stephan, Blossom CM; Warren, Narelle; Allotey, Pascale; Reidpath, Daniel
Subjective memory complaints (SMCs) and social capital were known to be related to self-rated health (SRH). Despite this, no studies have examined the potential interaction of SMC and social capital on SRH. Using data from a cross-sectional health survey of men and women aged 56 years and above (n = 6,421), we examined how SMCs and social capital explained SRH in a population of community-dwelling older adults in a semirural area in Malaysia. We also evaluated whether SRH’s relationship with SMCs is moderated by social capital. The association of SMC and social capital with poor SRH was investigated using multivariable logistic regression. Social capital (OR = 0.86, 95% CI = 0.82–0.89), mild SMC (OR = 1.70, 95% CI = 1.50–1.94), and moderate SMC (OR = 1.90, 95% CI = 1.63–2.20) were found to be associated with poor SRH after adjustment for sociodemographic factors and depression in the initial regression model. SMC was found to have partial interaction effects with social capital which was included in the subsequent regression model. Unlike individuals with no SMC and mild SMC, those who reported moderate SMC did not show decreasing probabilities of poor SRH despite increasing levels of social capital. Nevertheless, this analysis suggests that social capital and SMC are independent predictors of poor SRH. Further research needs to be targeted at improving the understanding on how social capital and SMC moderate and interact with the perception of health in older adults.
Link Between Dietary Sodium Intake, Cognitive Function, and Dementia Risk in Middle-Aged and Older Adults: A Systematic Review
(IOS Press, 2020-08-18) Mohan, Devi; Yap, Kwong Hsia; Reidpath, Daniel; Soh, Yee Chang; McGrattan, Andrea; Stephan, Blossom CM; Robinson, Louise; Chaiyakunapruk, Nathorn; Siervo, Mario
Background: A key focus for dementia risk-reduction is the prevention of socio-demographic, lifestyle, and nutritional risk factors. High sodium intake is associated with hypertension and cardiovascular disease (both are linked to dementia), generating numerous recommendations for salt reduction to improve cardiovascular health. Objective: This systematic review aimed to assess, in middle- and older-aged people, the relationship between dietary sodium intake and cognitive outcomes including cognitive function, risk of cognitive decline, or dementia. Methods: Six databases (PubMed, EMBASE, CINAHL, Psych info, Web of Science, and Cochrane Library) were searched from inception to 1 March 2020. Data extraction included information on study design, population characteristics, sodium reduction strategy (trials) or assessment of dietary sodium intake (observational studies), measurement of cognitive function or dementia, and summary of main results. Risk-of-bias assessments were performed using the National Heart, Lung, and Blood Institute (NHLBI) assessment tool. Results: Fifteen studies met the inclusion criteria including one clinical trial, six cohorts, and eight cross-sectional studies. Studies reported mixed associations between sodium levels and cognition. Results from the only clinical trial showed that a lower sodium intake was associated with improved cognition over six months. In analysis restricted to only high-quality studies, three out of four studies found that higher sodium intake was associated with impaired cognitive function. Conclusion: There is some evidence that high salt intake is associated with poor cognition. However, findings are mixed, likely due to poor methodological quality, and heterogeneous dietary, analytical, and cognitive assessment methods and design of the studies. Reduced sodium intake may be a potential target for intervention. High quality prospective studies and clinical trials are needed.
Protocol of a feasibility study for cognitive assessment of an ageing cohort within the Southeast Asia Community Observatory (SEACO), Malaysia
(BMJ Publishing Group, 2017-01-19) Mohan, Devi; Stephan, Blossom CM; Allotey, Pascale; Jagger, Carol; Pearce, Mark; Servio, Mario; Reidpath, Daniel
Introduction There is a growing proportion of population aged 65 years and older in low-income and middle-income countries. In Malaysia, this proportion is predicted to increase from 5.1% in 2010 to more than 15.4% by 2050. Cognitive ageing and dementia are global health priorities. However, risk factors and disease associations in a multiethnic, middle-income country like Malaysia may not be consistent with those reported in other world regions. Knowing the burden of cognitive impairment and its risk factors in Malaysia is necessary for the development of management strategies and would provide valuable information for other transitional economies. Methods and analysis This is a community-based feasibility study focused on the assessment of cognition, embedded in the longitudinal study of health and demographic surveillance site of the South East Asia Community Observatory (SEACO), in Malaysia. In total, 200 adults aged ≥50 years are selected for an in-depth health and cognitive assessment including the Mini Mental State Examination, the Montreal Cognitive Assessment, blood pressure, anthropometry, gait speed, hand grip strength, Depression Anxiety Stress Score and dried blood spots. Discussion and conclusions The results will inform the feasibility, response rates and operational challenges for establishing an ageing study focused on cognitive function in similar middle-income country settings. Knowing the burden of cognitive impairment and dementia and risk factors for disease will inform local health priorities and management, and place these within the context of increasing life expectancy. Ethics and dissemination The study protocol is approved by the Monash University Human Research Ethics Committee. Informed consent is obtained from all the participants. The project's analysed data and findings will be made available through publications and conference presentations and a data sharing archive. Reports on key findings will be made available as community briefs on the SEACO website
Tackling dementia globally: the Global Dementia Prevention Program (GloDePP) collaboration
(International Society of Global Health, 2019-12) Chan, Kit Yee; Adeloye, Davies; Asante, Kwaku Poku; Calia, Clara; Campbell, Harry; Danso, Samuel O; Juvekar, Sanjay; Luz, Saturnino; Mohan, Devi; Terrera, Graciela Muniz; Nitrini, Ricardo; Noroozian, Maryam; Nulkar, Amit; Nyame, Solomon; Paralikar, Vasudeo; Rodriguez, Mario A Parra; Poon, Adrienne N.; Reidpath, Daniel; Rudan, Igor; Stephan, Blossom CM; Su, Tin Tin; Wang, Huali; Watermeyer, Tam; Wilkinson, Heather; Yassuda, Monica Sanches; Yu, Xin; Ritchie, Craig