DISCUSSION
We found a high prevalence of MCI and dementia among Albanian older
patients in our study, detected by using different tests. However, using
the MoCA test and adjusting for the level of education, the prevalence
of dementia was 4,37 % which is consistent with the global
prevalence found for those aged 60 years or older by Prince et alin 2013, ranging from 5 to 7 % in most world regions.(14) The systematic review by Russ et al found
extended evidence of variations in the prevalence of dementia by
geographical regions. (15)
Our study was conducted among older patients in two cities, Shkoder, the
larger city in north Albania and Tirana, capital and central city of
Albania. According to both tests employed, prevalence of MCI was higher
in Shkoder compared to Tirana. Few studies have estimated the prevalence
of dementia in Albania. In a study conducted in 1999 in Tirana, the
total prevalence of dementia for people aged more than 60 years old
resulted 7.75%, which is similar to our findings. In this case, the
MMSE was used as screening test, followed by clinic and radiological
evaluations according to ICD 10 diagnostic criteria for dementia.(16)
Another study performed in 2012 in two geographic areas with different
socioeconomic level – Tirana (central Albania) and Saranda (south
Albania) – found besides other neurological disorders, a prevalence for
dementia of 9.6 % (7.7-11.5), similar between the two areas.17 None of the two previous studies evaluated mild
cognitive impairment, neither did they include patients from northern
regions of Albania.
Studies on MCI reported in various European studies since 1995 presented
substantial heterogeneity, as reported by Alexander et al , which
pointed out that the majority of studies reported an increase of
dementia prevalence with patients 75 years or older. Furthermore,
pooled prevalence of dementia increased constantly from 55 years old,
ending up at 44.7 % in patients older than 95 years.(18) The factors clearly associated with higher
prevalence of dementia and MCI in our study were gender, age and level
of education, as observed in many studies. (19,20,21)We also found a higher prevalence of MCI among patients in the city of
Shkoder compared to Tirana, which may be partly explained by the higher
socioeconomic and educational level of the latter.
According to a recent report by the Alzheimer Society of Canada, there
is great variability regarding the prevalence of dementia depending on
the different methodology and definitions used, as well as data source.
Another weak point of the majority of studies for dementia prevalence
estimation is not including MCI in the projections.(22) In our study, there is very poor agreement
between the two types of tools employed for the detection of MCI, namely
MoCA / MoCA B and mini-cog. The Kappa Index of 2,38 % highlights the
differences between the tools used. The majority of published studies
have compared the screening tool MoCA with MMSE, showing its superiority
in the detection of individuals with MCI. (23)Nevertheless, there is a lack of studies comparing MoCA to mini-cog, as
well as a restricted number of studies that evaluate diagnostic accuracy
of mini-cog for dementia in primary healthcare. (24)
Dementia is often going under-detected until the late stage, having a
deep impact in patients’ and caregivers´ quality of life, delaying
potentially beneficial nonpharmacological and pharmacological
treatments. A systematic review by Lang et al including 23
studies calculated a pooled rate of undiscovered dementia of 61.7 %,
with higher rates in China, India compared to Europe and North America,
more common in community settings than assisted living facilities, and
men younger than 70 years old. Focused attempts to tackle the growing
problem of undiagnosed dementia, especially among low socioeconomic
background countries, are necessary to mitigate inequality; early
detection of MCI might be the key to early detection and management of
this syndrome. (25,26)