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March 12, 1997, Vol 277, No. 10 >
ARTICLE | March 12, 1997

Frequency and Characteristics of Silent Dementia Among Elderly Japanese-American Men: Title and subTitle BreakThe Honolulu-Asia Aging Study FREE

G. Webster Ross, MD; Robert D. Abbott, PhD; Helen Petrovitch, MD; Kamal H. Masaki, MD; Carolyn Murdaugh, RN, PhD; Carol Trockman, RN; J. David Curb, MD; Lon R. White, MD
[+] Author Affiliations

Reprints: G. Webster Ross, MD, Honolulu Heart Program, Honolulu-Asia Aging Study, 347 N Kuakini St, Honolulu, HI 96816.


JAMA. 1997;277(10):800-805. doi:10.1001/jama.1997.03540340034029
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Article
References

Objective.  —To determine the frequency of unrecognized dementia in a group of men found to have dementia by population survey, and to identify factors associated with the failure of a family informant to recognize significant memory impairment.

Design and Setting.  —The Honolulu-Asia Aging Study, a population-based study of dementia among elderly Japanese-American men living on the island of Oahu, Hawaii. Data for this study were from the dementia prevalence survey, 1991-1993.

Study Participants.  —A total of 191 noninstitutionalized men with dementia who had a reliable family informant.

Main Outcome Measures.  —Failure of family informants to recognize a problem with thinking or memory in subjects with dementia.

Results.  —A total of 21% of family informants failed to recognize a problem with memory among subjects subsequently found to have dementia. Among subjects with very mild dementia, 52% of family informants failed to recognize a significant memory problem compared with 13% among more severely demented subjects. Of the subjects with dementia whose family informants did recognize a memory problem, 53% failed to receive a medical evaluation for this problem. For all family informants, increasing age, fewer years of education, less severe dementia, fewer behavioral complications, fewer functional disabilities, and better performance on certain tests of memory and language were significantly associated with the family informant's failure to recognize a problem with memory. When the family informants were wives living with husbands, less severe dementia, fewer behavioral complications, fewer functionaldisabilities, and intact remote memory were associated with unrecognized dementia.

Conclusions.  —Unrecognized dementia was common in our population, especially among mild cases. Cognitive screening programs for the elderly and public education policies designed to increase awareness of early signs of dementia are needed if interventions for individuals with potentially treatable dementias are to be implemented.

REFERENCES

1 +
Peck JC, Benson DF, Scheibel AB, Spar JE, Rubenstein LZ.  Dementia in the elderly: the silent epidemic . Ann Intern Med . 1982;;97:231-241.
2 +
Callahan CM, Hendrie HC, Tierney WM.  Documentation and evaluation of cognitive impairment in elderly primary care patients . Ann Intern Med . 1995;;122:422-429.
3 +
Henon H, Durieu I, Lucas C, Godefroy O, Pasquier F, Leys D.  Dementia in stroke . Neurology . 1996;;47:852.
4 +
White L, Petrovitch H, Ross GW, et al.  Prevalence of dementia in older Japanese-American men in Hawaii: the Honolulu-Asia Aging Study . JAMA . 1996;;276:955-960.
5 +
Syme SL, Marmot MU, Kagan A, Kato H, Rhoads G.  Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: introduction . Am J Epidemiol . 1975;; 102:477-480.
6 +
Teng EL, Hasegawa K, Homma A, et al.  The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia . Int J Psychogeriatr . 1994;;6:45-58.
7 +
Hasegawa K.  The clinical assessment of dementia in the aged: a dementia screening scale for psychogeriatric patients . In: Bergener M, Lehr U, Lang E, Schmitz-Scherzer R, eds. Aging in the Eighties and Beyond . New York, NY: Springer Publishing Co Inc; 1983;:207-218.
8 +
Folstein MF, Folstein SE, McHugh PR.  Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;;12:189-198.
9 +
Teng EL, Chui HC.  The Modified Mini-Mental State (3MS) Examination . J Clin Psychiatry . 1987;; 48:314-387.
10 +
Graves AB, Larson EB, Kukull WA, White LR, Teng E L.  Screening for dementia in the community in cross-national studies: comparison between the Cognitive Abilities Screening Instrument and the Mini-Mental State Examination . In: Corain B, Iqbal K, Nicolini M, Winblad B, Wisniewski H, Zatta P, eds. Alzheimer's Disease: Advances in Clinical and Basic Research . New York, NY: John Wiley & Sons Inc; 1992;:113-119.
11 +
Jorm AF, Jacomb PA.  The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms . Psychol Med . 1989;;19:1015-1022.
12 +
Jorm AF, Scott R, Cullen JS, MacKinnon AJ.  Performance on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening test for dementia . Psychol Med . 1991;;21:785-790.
13 +
Cummings JL, Benson DF. Dementia: A Clinical Approach . 2nd ed. Boston, Mass: Butterworth; 1992;:1-17.
14 +
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM.  Report of the NINCDSADRDA work group under the auspices of Department of Health and Human Services task force on Alzheimer's disease . Neurology . 1984;;34:939-944.
15 +
Chiu HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R.  Criteria for the diagnosis of ischemic vascular dementia proposed by the state of California Alzheimer's Disease Diagnostic and Treatment Centers . Neurology . 1992;;42:473-480.
16 +
Berg L.  Mild dementia of the Alzheimer type: diagnostic criteria and natural history . Mt Sinai J Med . 1988;;55:87-96.
17 +
Dooneief G, Marder K, Tang M, Stern Y.  The Clinical Dementia Rating scale: community-based validation of 'profound' and 'terminal' stages . Neurology . 1996;;46:1746-1749.
18 +
Morris JC, Heyman A, Mohs RC, et al, and the CERAD investigators.  The Consortium to Establish a Registry for Alzheimer's Disease (CERAD), part 1: clinical and neuropsychological assessment of Alzheimer's disease . Neurology . 1989;;39:1159-1165.
19 +
Moss MB, Albert MS, Butters N, Payne M.  Differential patterns of memory loss among patients with Alzheimer's disease, Huntington's disease, and alcoholic Korsakoff's syndrome . Arch Neurol . 1986;;43:239-246.
20 +
Hamilton M.  A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;;23:56-61.
21 +
Williams JBW.  A structured interview guide for the Hamilton Depression Rating Scale . Arch Gen Psychiatry . 1988;;45:742-747.
22 +
Reisberg B, Borenstein J, Salob SP, et al.  Behavioral symptoms in Alzheimer's disease: phenomenology and treatment . J Clin Psychiatry . 1987;; 48( (5,suppl) ):9-15.
23 +
Blessed G, Tomlinson BE, Roth M.  The association between quantitative measures of dementia and senile change in the cerebral grey matter of elderly subjects . Br J Psychiatry . 1968;;114:797-811.
24 +
Morris J, Mohs RC, Rogers H, Fillenbaum G, Heyman A.  Consortium to Establish a Registry for Alzheimer's Disease (CERAD) clinical and neuropsychological assessment of Alzheimer's disease . Psychopharmacol Bull . 1988;;24:641-652.
25 +
Kagan A, Popper J, Reed DM, MacLean CJ, Grove JS.  Trends in stroke incidence and mortality in Hawaiian Japanese men . Stroke . 1994;;25:1170-1175.
26 +
Hosmer DW, Lemeshow S. Applied Logistic Regression . New York, NY: John Wiley & Sons Inc; 1989;.
27 +
Ishida D Inouye J.  Japanese Americans . In: Giger JN, Davidhizar RE, eds. Transcultural Nursing Assessment and Intervention . New York, NY: Mosby; 1995;:317-345.
28 +
McDermott JF, Tseng WS, Maretzki TW. People and Cultures of Hawaii: A Psychocultural Profile . Honolulu: John A. Burns School of Medicine and the University of Hawaii Press; 1973;.
29 +
Sagar HJ, Cohen EV, Sullivan EV, Corkin S, Growdon JH.  Remote memory function in Alzheimer's disease and Parkinson's disease . Brain . 1988;; 111:525-539.
30 +
McGlone J, Gupta S, Humphrey D, Oppenheimer S, Mirsen T, Evans DR.  Screening for early dementia using memory complaints from patients and relatives . Arch Neurol . 1990;;47:1189-1193.
31 +
Rubin EH, Morris JC, Grant EA, Vendegna T.  Very mild senile dementia of the Alzheimer type, I: clinical assessment . Arch Neurol . 1989;;46:379-382.
32 +
Masur DM, Sliwinski M, Lipton RB, Blau AD, Crystal HA.  Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons . Neurology . 1994;;44:1427-1432.
33 +
Jacobs DM, Sano M, Dooneief G, Marder K, Bell KL, Stern Y.  Neuropsychological detection and characterization of preclinical Alzheimer's disease . Neurology . 1995;;45:957-962.
34 +
Bronner LL, Kanter DS, Manson JE.  Primary prevention of stroke . N Engl J Med . 1995;;333:1392-1400.
35 +
Meyer JS, Judd BW, Tawaklna T, Rogers RL, Mortel KF.  Improved cognition after control of risk factors for multi-infarct dementia . JAMA . 1986;; 256:2203-2209.
36 +
Meyer JS, Rogers RL, McClintic K, Mortel KF, Lofti J.  Randomized clinical trial of aspirin therapy in multi-infarct dementia: a pilot study . J Am Geriatr Soc . 1989;;37:549-555.
37 +
McGeer PL, Rogers J.  Anti-inflammatory agents as a therapeutic approach to Alzheimer's disease . Neurology . 1992;;42:447-449.
38 +
Henderson VW, Paganini-Hill A, Emanuel CK, Dunn ME, Buckwalter JG.  Estrogen replacement therapy in older women: comparisons between Alzheimer's disease cases and nondemented control subjects . Arch Neurol . 1994;;51:896-900.
39 +
Tang MX, Jacobs D, Stern Y, et al.  Effect of oestrogen during menopause on risk and age at onset of Alzheimer's disease . Lancet . 1996;;348:429-432.
40 +
Drickamer MA, Lachs MS.  Should patients with Alzheimer's disease be told their diagnosis? N Engl J Med . 1992;;326:947-951.
41 +
Cooper PJ, Tallman K, Tuokko H, Beattie BL.  Vehicle crash involvement and cognitive deficit in older drivers . J Safety Res . 1993;;24:9-17.
42 +
Preston SH, Martin LG.  Introduction . In: Martin LG, Preston SH, eds. Demography of Aging . Washington, DC: National Academy Press; 1994;:1-7.

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Peck JC, Benson DF, Scheibel AB, Spar JE, Rubenstein LZ.  Dementia in the elderly: the silent epidemic . Ann Intern Med . 1982;;97:231-241.
2 +
Callahan CM, Hendrie HC, Tierney WM.  Documentation and evaluation of cognitive impairment in elderly primary care patients . Ann Intern Med . 1995;;122:422-429.
3 +
Henon H, Durieu I, Lucas C, Godefroy O, Pasquier F, Leys D.  Dementia in stroke . Neurology . 1996;;47:852.
4 +
White L, Petrovitch H, Ross GW, et al.  Prevalence of dementia in older Japanese-American men in Hawaii: the Honolulu-Asia Aging Study . JAMA . 1996;;276:955-960.
5 +
Syme SL, Marmot MU, Kagan A, Kato H, Rhoads G.  Epidemiologic studies of coronary heart disease and stroke in Japanese men living in Japan, Hawaii and California: introduction . Am J Epidemiol . 1975;; 102:477-480.
6 +
Teng EL, Hasegawa K, Homma A, et al.  The Cognitive Abilities Screening Instrument (CASI): a practical test for cross-cultural epidemiological studies of dementia . Int J Psychogeriatr . 1994;;6:45-58.
7 +
Hasegawa K.  The clinical assessment of dementia in the aged: a dementia screening scale for psychogeriatric patients . In: Bergener M, Lehr U, Lang E, Schmitz-Scherzer R, eds. Aging in the Eighties and Beyond . New York, NY: Springer Publishing Co Inc; 1983;:207-218.
8 +
Folstein MF, Folstein SE, McHugh PR.  Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician . J Psychiatr Res . 1975;;12:189-198.
9 +
Teng EL, Chui HC.  The Modified Mini-Mental State (3MS) Examination . J Clin Psychiatry . 1987;; 48:314-387.
10 +
Graves AB, Larson EB, Kukull WA, White LR, Teng E L.  Screening for dementia in the community in cross-national studies: comparison between the Cognitive Abilities Screening Instrument and the Mini-Mental State Examination . In: Corain B, Iqbal K, Nicolini M, Winblad B, Wisniewski H, Zatta P, eds. Alzheimer's Disease: Advances in Clinical and Basic Research . New York, NY: John Wiley & Sons Inc; 1992;:113-119.
11 +
Jorm AF, Jacomb PA.  The Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): socio-demographic correlates, reliability, validity and some norms . Psychol Med . 1989;;19:1015-1022.
12 +
Jorm AF, Scott R, Cullen JS, MacKinnon AJ.  Performance on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) as a screening test for dementia . Psychol Med . 1991;;21:785-790.
13 +
Cummings JL, Benson DF. Dementia: A Clinical Approach . 2nd ed. Boston, Mass: Butterworth; 1992;:1-17.
14 +
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM.  Report of the NINCDSADRDA work group under the auspices of Department of Health and Human Services task force on Alzheimer's disease . Neurology . 1984;;34:939-944.
15 +
Chiu HC, Victoroff JI, Margolin D, Jagust W, Shankle R, Katzman R.  Criteria for the diagnosis of ischemic vascular dementia proposed by the state of California Alzheimer's Disease Diagnostic and Treatment Centers . Neurology . 1992;;42:473-480.
16 +
Berg L.  Mild dementia of the Alzheimer type: diagnostic criteria and natural history . Mt Sinai J Med . 1988;;55:87-96.
17 +
Dooneief G, Marder K, Tang M, Stern Y.  The Clinical Dementia Rating scale: community-based validation of 'profound' and 'terminal' stages . Neurology . 1996;;46:1746-1749.
18 +
Morris JC, Heyman A, Mohs RC, et al, and the CERAD investigators.  The Consortium to Establish a Registry for Alzheimer's Disease (CERAD), part 1: clinical and neuropsychological assessment of Alzheimer's disease . Neurology . 1989;;39:1159-1165.
19 +
Moss MB, Albert MS, Butters N, Payne M.  Differential patterns of memory loss among patients with Alzheimer's disease, Huntington's disease, and alcoholic Korsakoff's syndrome . Arch Neurol . 1986;;43:239-246.
20 +
Hamilton M.  A rating scale for depression . J Neurol Neurosurg Psychiatry . 1960;;23:56-61.
21 +
Williams JBW.  A structured interview guide for the Hamilton Depression Rating Scale . Arch Gen Psychiatry . 1988;;45:742-747.
22 +
Reisberg B, Borenstein J, Salob SP, et al.  Behavioral symptoms in Alzheimer's disease: phenomenology and treatment . J Clin Psychiatry . 1987;; 48( (5,suppl) ):9-15.
23 +
Blessed G, Tomlinson BE, Roth M.  The association between quantitative measures of dementia and senile change in the cerebral grey matter of elderly subjects . Br J Psychiatry . 1968;;114:797-811.
24 +
Morris J, Mohs RC, Rogers H, Fillenbaum G, Heyman A.  Consortium to Establish a Registry for Alzheimer's Disease (CERAD) clinical and neuropsychological assessment of Alzheimer's disease . Psychopharmacol Bull . 1988;;24:641-652.
25 +
Kagan A, Popper J, Reed DM, MacLean CJ, Grove JS.  Trends in stroke incidence and mortality in Hawaiian Japanese men . Stroke . 1994;;25:1170-1175.
26 +
Hosmer DW, Lemeshow S. Applied Logistic Regression . New York, NY: John Wiley & Sons Inc; 1989;.
27 +
Ishida D Inouye J.  Japanese Americans . In: Giger JN, Davidhizar RE, eds. Transcultural Nursing Assessment and Intervention . New York, NY: Mosby; 1995;:317-345.
28 +
McDermott JF, Tseng WS, Maretzki TW. People and Cultures of Hawaii: A Psychocultural Profile . Honolulu: John A. Burns School of Medicine and the University of Hawaii Press; 1973;.
29 +
Sagar HJ, Cohen EV, Sullivan EV, Corkin S, Growdon JH.  Remote memory function in Alzheimer's disease and Parkinson's disease . Brain . 1988;; 111:525-539.
30 +
McGlone J, Gupta S, Humphrey D, Oppenheimer S, Mirsen T, Evans DR.  Screening for early dementia using memory complaints from patients and relatives . Arch Neurol . 1990;;47:1189-1193.
31 +
Rubin EH, Morris JC, Grant EA, Vendegna T.  Very mild senile dementia of the Alzheimer type, I: clinical assessment . Arch Neurol . 1989;;46:379-382.
32 +
Masur DM, Sliwinski M, Lipton RB, Blau AD, Crystal HA.  Neuropsychological prediction of dementia and the absence of dementia in healthy elderly persons . Neurology . 1994;;44:1427-1432.
33 +
Jacobs DM, Sano M, Dooneief G, Marder K, Bell KL, Stern Y.  Neuropsychological detection and characterization of preclinical Alzheimer's disease . Neurology . 1995;;45:957-962.
34 +
Bronner LL, Kanter DS, Manson JE.  Primary prevention of stroke . N Engl J Med . 1995;;333:1392-1400.
35 +
Meyer JS, Judd BW, Tawaklna T, Rogers RL, Mortel KF.  Improved cognition after control of risk factors for multi-infarct dementia . JAMA . 1986;; 256:2203-2209.
36 +
Meyer JS, Rogers RL, McClintic K, Mortel KF, Lofti J.  Randomized clinical trial of aspirin therapy in multi-infarct dementia: a pilot study . J Am Geriatr Soc . 1989;;37:549-555.
37 +
McGeer PL, Rogers J.  Anti-inflammatory agents as a therapeutic approach to Alzheimer's disease . Neurology . 1992;;42:447-449.
38 +
Henderson VW, Paganini-Hill A, Emanuel CK, Dunn ME, Buckwalter JG.  Estrogen replacement therapy in older women: comparisons between Alzheimer's disease cases and nondemented control subjects . Arch Neurol . 1994;;51:896-900.
39 +
Tang MX, Jacobs D, Stern Y, et al.  Effect of oestrogen during menopause on risk and age at onset of Alzheimer's disease . Lancet . 1996;;348:429-432.
40 +
Drickamer MA, Lachs MS.  Should patients with Alzheimer's disease be told their diagnosis? N Engl J Med . 1992;;326:947-951.
41 +
Cooper PJ, Tallman K, Tuokko H, Beattie BL.  Vehicle crash involvement and cognitive deficit in older drivers . J Safety Res . 1993;;24:9-17.
42 +
Preston SH, Martin LG.  Introduction . In: Martin LG, Preston SH, eds. Demography of Aging . Washington, DC: National Academy Press; 1994;:1-7.

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