Nelleen Baboolal

Factors affecting future choice of specialty among first‐year medical students of the University of the West Indies, Trinidad

Background  This study was conducted to determine factors that influence career choice among 1st‐year medical students.

Sialic acid, homocysteine and CRP: potential markers for dementia.

To investigate whether sialic acid could discriminate between healthy age matched controls and patients with dementias of the Alzheimers type (AD), and pure vascular dementia (VaD). 27 patients and 51 controls were administered the Mini-Mental State Examination (MMSE) and had blood analyzed for levels of total sialic acid, total homocysteine (tHcy), and C-reactive protein (CRP). Significant differences were found between the mean MMSE scores for patients with dementia compared with controls. Sialic acid levels were significantly higher in patients with AD compared with controls and homocysteine levels were higher in VaD. Sialic acid levels discriminated between patients with dementia of the Alzheimers type and healthy controls only. The MMSE could discriminate between controls and patients with dementia but not between the subtypes and homocysteine was significant for patients with VaD.

Potential biomarkers for dementia in Trinidad and Tobago

Biomarkers that could possibly discriminate between healthy controls and patients with dementias of the Alzheimers type (AD) and vascular dementia (VaD) were investigated. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition TR (DSM IV TR) was used to diagnose for dementia in Trinidad. Healthy seniors greater than 60 years old were controls. All participants were administered the Mini-Mental State Examination (MMSE) and had blood analyzed for levels of C-reactive protein (CRP), total homocysteine (tHcy) and microglial antibodies (MgAb). Plasma tHcy was determined on the Abbot AxSym, serum CRP concentrations were measured using the Tina-Quant sCRP (Latex) high sensitive immunoturbidimetric assay and serum MgAb were examined on frozen rat brain sections. The study was carried out on 29 patients that fulfilled the inclusion criteria and 46 controls. Of the patients 65.5% had AD and 34.5% had VaD. Significant differences were found between the mean MMSE scores of the different types of dementias and controls. MgAb presence as well as tHcy were able to distinguish between controls and dementia of the AD and VaD type, respectively. The MMSE is a good discriminative tool for dementias. Serum MgAbs are a possible biomarker for Alzheimer disease pathology and tHcy is elevated in patients with vascular dementia.

Dementia prevalence in a population at high vascular risk: the Trinidad national survey of ageing and cognition

Objective To investigate the dementia prevalence in a country with high levels of cardiovascular risk factors Design and methods Older people in Trinidad are recognised to have particularly high levels of cardiovascular risk factors. We carried out a survey in a nationally representative sample of people aged ≥70 years using household enumeration. Dementia status was ascertained using standardised interviews and algorithms from the 10/66 schedule and age-specific prevalence were compared with identically defined output from the 10/66 surveys of 16 536 residents in eight other low-income and middle-income countries. Results Of 1832 participants (77.0% response rate), dementia was present in 442 (23.4%). Prevalences were 12.0% in persons aged 70–74 years, 23.5% at 75–79, 25.8% at 80–84, 41.3% at 85–89 and 54.0% in those aged ≥90 years. Prevalence ratios compared with averages from 10/66 surveys in these age groups were 2.2, 2.6, 1.6, 1.7 and 1.6, respectively, and were 2.7, 2.8, 1.7, 1.4 and 0.8, respectively, compared with previously published consensus estimates for the Latin American region. Dementia was significantly associated with reported stroke and diabetes in logistic regression models adjusted for sociodemographic status and other vascular risk factors (OR (95% CI) 4.40 (2.70 to 7.19) and 1.56 (1.20 to 2.03), respectively). Projected national numbers of people with dementia (18 206) were 70%–100% higher than those estimated using most recent regional consensus prevalences. Conclusion In a nation with high levels of vascular risk, dementia prevalence is higher than expected, particularly at the lower end of the 70+ age range. International prevalence projections may need to take into account risk status as well as age structures.

Trinidad and Tobago. A decade of dementia research

In 2003, academic staff members at The University of the West Indies Faculty of Medical Sciences St Augustine Trinidad and Tobago combined their expertise to make strides in Alzheimers and Dementia research in Trinidad and Tobago. Dr. Nelleen Baboolal, Dr. Gershwin Davis and Professor Amanda McRae began developing a project that has produced significant results by examining not only the epidemiology of dementia, but the associated risk factors; caregiver burden and ultimately establishing biomarkers for the disease. This review is an account of our results from a decade of dementia research and how they are contributing toward mitigating the dementia tsunami in Trinidad and Tobago.

Comparisons between different elements of reported burden and common mental disorder in caregivers of ethnically diverse people with dementia in Trinidad

Objective Culture plays a significant role in determining family responsibilities and possibly influences the caregiver burden associated with providing care for a relative with dementia. This study was carried out to determine the elements of caregiver burden in Trinidadians regarding which interventions will provide the most benefit. Methods Seventy-five caregivers of patients diagnosed with dementia participated in this investigation. Demographic data were recorded for each caregiver and patient. Caregiver burden was assessed using the Zarit Burden Interview (ZBI), and the General Health Questionnaire (GHQ) was used as a measure of psychiatric morbidity. Statistical analyses were performed using Stata and SPSS software. Associations between individual ZBI items and GHQ-28 scores in caregivers were analyzed in logistic regression models; the above-median GHQ-28 scores were used a binary dependent variable, and individual ZBI item scores were entered as 5-point ordinal independent variables. Results The caregiver sample was composed of 61 females and 14 males. Caregiver burden was significantly associated with the participant being male; there was heterogeneity by ethnic group, and a higher burden on female caregivers was detected at borderline levels of significance. Upon examining the associations between different ZBI items and the above-median GHQ-28 scores in caregivers, the strongest associations were found with domains reflecting the caregiver’s health having suffered, the caregiver not having sufficient time for him/herself, the caregiver’s social life suffering, and the caregiver admitting to feeling stressed due to caregiving and meeting other responsibilities. Conclusions In this sample, with a majority of female caregivers, the factors of the person with dementia being male and belonging to a minority ethnic group were associated with a greater degree of caregiver burden. The information obtained through the association of individual ZBI items and above-median GHQ-28 scores is a helpful guide for profiling Trinidadian caregiver burden.

DEMENTIA PREVALENCE IN THE OLDEST OLD IN TRINIDAD AND MEDICAL COMORBIDITIES

elderly with dementia tends to change dietary behavior. The purpose of this study was to investigate the cognitive function, health-related lifestyle, and dietary habit score of the elderly with dementia using daytime care centers in Korea. Methods: This cross-sectional study was conducted using questionnaires by an investigator-based interview to elderly and guardian in 2015. The subjects were 40 elderly with dementia (men:women1⁄414:26) using daytime care centers in Korea. The anthropometric characteristics of subjects were measured. Mini-Mental State Examination-Dementia Screening (MMSE-DS) was examined to assess cognitive function. The higher score of MMSE-DS was indicative of better cognitive function. Statistical analyses were performed using SPSS 20.0. for Windows. Results: The average of age and height of elderly men were 78.2 years and 160.7cm and those of elderly women were 80.3 years and 147.1cm, respectively. The percentage of the overweight and obesity (BMI 23) in the elderly was 62.5% and all the subjects have lived with family (average 2.0 persons). Total score of MMSE-DS was 18.1 points and there was no significant difference by sex, but the score of judgement and abstract thinking in elderly women were significantly higher than those of elderly men (p<0.05). The frequency of non-drinking alcohol, non-smoking, and non-drinking coffee were 82.5%, 97.5%, and 52.5%, respectively and there were no significant differences in MMSE-DS scores according to drinking alcohol, smoking, and drinking coffee. There was no significant correlation between MMSE-DE score and dietary habit score. The scores of total dietary habit (p<0.05), eating fruit (p<0.05), and avoiding fried food (p<0.01) of elderly men were significantly higher compared to elderly women. However, the average dietary habit score of eating fast, choosing fish than meat, eating soybean food and eating fruit were low in both elderly men and women. Conclusions:These results show that health-related lifestyle of the elderly with dementia was not bad, whereas they had poor dietary habit score. Therefore, appropriate nutrition education about meals with diverse food and eating speed is needed to family or guardian as well as elderly with dementia in Korea.