Anaemia: A New Modifiable Risk factor among People Living With Dementia in Uganda

Abstract

Background: Anaemia describes a condition in which there is a reduction of haemoglobin concentration in the blood of an individual to a level below 11g/dl. Anaemia is very common after age 65 years, accounting for 4.2% to 28 when WHO criteria are applied in different gender and age groups. Dementia is a clinical syndrome that affects memory, thinking, behaviour and ability to perform everyday activity. Dementia is a growing public health problem and results in cognitive decline and behavioural problems that lead to impairment in activities of daily living. WHO in 2021 reported that more than 50 million people were living with dementia, and about 10 million new cases are detected every year. There is a paucity of data in the area of dementia research from Sub-Saharan Africa and Uganda. Many patients are undiagnosed clinically due to non-consideration of readily accessible laboratory blood biomarkers. The current study was performed on people lining with dementia attending Hospitals in Kampala, Uganda to assess and compare levels of erythrocytes, leucocytes and platelets with non-demented control group Using Haematological biomarkers may be useful in dementia diagnosis.

Objective of the study: A case-control study was conducted to assess some Haematological profile as possible diagnostic biomarkers of Anaemia among Dementia patients attending five selected referral Hospitals in Uganda.

Methods: A case-control study was conducted among patients presenting consecutively to the Neurology and Psychiatric clinics of Mulago National Referral Hospital (MNRH).Kampala,Uganda  and Kiruddu National Referral Hospital (KNRH) Kampala,Uganda between January to December, 2024. Seventy-eight (78) elderly patients aged fifty years and older diagnosed with dementia by a Specialist or Medical Officer were recruited as case subjects while Seventy-eight (78) cohort subjects age and sex matched with no history of dementia served as control. Social demographics, clinical and laboratory characteristics were assessed for both cases and controls. Questionnaires with close-ended questions and Dementia diagnostic tools (MMSE)and Blessed Dementia Scale (BDS) were distributed to participants to collect data. Ten millilitres (10 ml) of blood samples were collected aseptically from antecubital vein from participants into Sodium EDTA vacutainer bottles for assessment of Haematological parameters using Mindray autoanalyzer for Complete Blood Count (CBC) analysis. Quantitative data was collected and entered into a Microsoft excel spreadsheet and exported into STATA software version 14.0 for analysis. Descriptive statistics including frequencies, percentages, mean and standard deviation were used to describe the Social demographics of the cases and controls. P-values of <0.05 was chosen to be statistically significant.Fisher’s exact test and odd ratios were used to establish association of parameters with dementia. Confounders were ruled out by performing post-diagnostic checks like VIF (Variance Inflation Factors) to ensure that those that are highly collinear are eliminated.Ethical approvals were obtained from Mount Kenya University Ethical Review Committee (MKU/ISERC/3354) and St. Francis Hospital Research Ethics Committee (SFREC-2023-117).

Results: The findings in the present study revealed statistically significant differences (p<0.05) and very low values in the means of Haemoglobin concentration, RBC count, Haematocrit, MCV,MCH, MCHC, and RDW-SD when the case group was compared with the control group.

Conclusion: Based on the result obtained, decreased erythrocytes and RBC indices may be possibly involved in the pathogenesis of dementia.

Keywords: Dementia, Erythrocytes, Haemoglobin, Haematocrit, Mean Cell Volume.