Sains Malaysiana 39(4)(2010): 689–696

Antioxidant Intake and Mild Cognitive Impairment Among  Elderly People in Klang Valley: A Pilot Study

(Kajian Perintis: Pengambilan Antioksidan dan Kegagalan Kognitif Ringan  di Kalangan Warga Tua Lembah Klang)

Sher Hui Wong, Roslee Rajikan*, Suzana Shahar, Noor Aini Mohd Yusoff & Lai Kuan Lee

Department of Nutrition & Dietetics

Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia

Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia

Safiyyah Abdul Aziz

Health Psychology Unit

Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia

Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia

Noor Ibrahim Mohd Sakian

Occupational Therapy Programme

Faculty of Allied Health Sciences, Universiti Kebangsaan Malaysia

Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia

Srijit Das

Department of Anatomy, Faculty of Medicine

Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia

Diserahkan: 22 Jun 2009 / Diterima: 13 Januari 2010

ABSTRACT

Mild cognitive impairment (MCI) is associated with significant morbidity, especially in the development of Alzheimer’s disease and also related to nutritional factors. A pilot study was carried out to determine antioxidant intake and its relation with MCI among elderly people aged between 60 and 74 years in Klang Valley. Subjects were interviewed to obtain socio-demography data and functional status was evaluated using the Instrumental Activities of Daily Living (IADL). Data on food intake was assessed using the diet history questionnaire and food frequency questionnaire, whilst the Geriatric Depression Scale (GDS) was used to assess depression level. A combination of tests was used to assess cognitive decline, which are Mini-mental State Examination (MMSE), Clock Drawing Test (CDT), and Dementia Rating Scale (DRS). Out of 84 elderly recruited, 70 completed all parts of the study (response rate 83.3%). Mean vitamin E intake was less than the Malaysian RNI (50.0% of RNI for men and 43.0% for women). The incidence of amnestic-MCI (aMCI) was 15.7% among the respondents, while 32.8% were depressed. After adjustment for educational background, beta-carotene intake was found to be significantly (β=0.325, p<0.05) correlated to cognitive impairment based on CDT scores. The intake levels of antioxidants among subjects were unsatisfactory and beta-carotene intake was related to poor cognitive status based on CDT.

Keywords: Antioxidants; cognitive impairment; elderly; oxidative stress

ABSTRAK

Kegagalan kognitif ringan sering dikaitkan dengan morbiditi yang signifikan, terutamanya perkembangan penyakit Alzheimer, dan berhubungkait dengan faktor pemakanan. Suatu kajian awal telah dijalankan untuk menentukan pengambilan antioksidan dan hubungkaitnya dengan kegagalan kognitif ringan di kalangan warga tua berumur 60 hingga 74 tahun di Lembah Klang. Subjek ditemuduga untuk memperoleh data sosiodemografi dan status kefungsian diuji dengan menggunakan penilaian Aktiviti Hidup Harian Instrumental (IADL). Data pengambilan diet ditentukan dengan menggunakan soal-selidik sejarah diet dan soal-selidik kekerapan makanan, manakala Skala Kemurungan Geriatrik (GDS) pula digunakan untuk menentukan tahap kemurungan. Satu kombinasi ujian digunakan untuk menentukan kemerosotan kognitif, iaitu Mini-mental State Examination (MMSE), Ujian Pelukisan Jam (CDT), dan Dementia Rating Scale (DRS). Daripada 84 peserta, 70 orang telah melengkapkan kesemua bahagian kajian tersebut (kadar respons 83.3%). Purata pengambilan vitamin E didapati kurang daripada saranan RNI Malaysia (50.0% RNI untuk lelaki dan 43.0% untuk perempuan). Insiden kegagalan kognitif ringan jenis amnestik adalah 15.7% di kalangan responden, manakala 32.8% subjek menghadapi kemurungan. Setelah mengambil kira faktor pendidikan, pengambilan beta-karoten didapati berhubungkait secara signifikan (β=0.325, p<0.05) dengan kegagalan kognitif berdasarkan skor CDT. Tahap pengambilan antioksidan di kalangan subjek adalah tidak memuaskan dan pengambilan beta-karoten didapati berhubungkait dengan status kognitif yang lemah berdasarkan ujian CDT.

Kata kunci: Antioksidan; kegagalan kognitif; tekanan oksidatif; warga tua

RUJUKAN

Arokiasamy, J.T. 1997. Malaysia’s Ageing Issues (Editorial). Med. J. Malaysia 52: 197-201.

Crum, R.M., Anthony, J.C., Bassett, S.S. & Folstein, M.F. 1993. Population-based norms for the Mini-mental State Examination by age and educational level. JAMA. 269(18): 2386-2391.

Delanty, N. & Dichter, M.A. 2000. Antioxidant therapy in neurologic disease. Arch. Neurol. 57: 1265-70.

Emerit, J., Edeas, M. & Bricaire, F. 2004. Neurodegenerative diseases and oxidative stress. Biomed. Pharmacother. 58: 39-46.

Folstein, M.F., Folstein, S.E. & McHugh, P.R. 1975. ‘Mini Mental State Examination’. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr. Res. 2(46): 189-198.

Grodstein, F., Chen. J. & Willett, W.C. 2003. High-dose antioxidant supplements and cognitive function in community-dwelling elderly women. Am. J. Clin. Nutr. 77(4): 762-3.

Grodstein, F., Kang, J.H., Glynn, R.J., Cook, N.R. & Gaziano, J.M. 2007. A randomized trial of beta carotene supplementation and cognitive function in men: The Physicians; Health Study II. Arch. Intern. Med. 167(20): 2184-2190.

Hanninen, T., Hallikainen, M., Tuomainen, S., Vanhanen, M. & Soininen, H. 2002. Prevalence of mild cognitive impairment: A population-based study in elderly subjects. Acta. Neurol. Scand. 106(3): 148-54.

Hardy, J.A. & Higgins, G.A. 1992. Alzheimer’s disease: the amyloid cascade hypothesis, Science 256: 184-185.

Hardy, J. & Selkoe, D.J. 2002. The amyloid hypothesis of Alzheimer’s disease: progress and problems on the road to therapeutics. Science 297(5580): 353-356.

Joshi, K., Kumar, R. & Avasthi, A. 2003. Morbidity profile and its relationship with disability and psychological distress among elderly people in Northern India. Inter. J. Epid. 32: 978-987.

Kang, J.H., Cook, N., Manson, J.E., Buring, J.E. & Grodstein, F. 2006. A randomized trial of vitamin E supplementation and cognitive function in women. Arch. Intern. Med. 166(22): 2462-2468.

Karim, H.A. 1997. The elderly in Malaysia demographic trends. Med. J. Malaysia. 52(3): 206-12.

Kšnig, G., Masters, C. & Beyreuther, K. 1990. Retinoic acid induced differentiated neuroblastoma cells show increased expression of the §B4 amyloid gene of Alzheimer‘s disease and an altered splicing pattern. FEBS Lett. 269(2): 305-310.

Lawton, M.P. & Brody, E.M. 1969. Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist 9: 179-186.

Lunenfeld, B. 2002. The ageing male: demographics and challenges. World. J. Urol. 20: 11-16.

Masaki, K.H., Losonczy, K.G., Izmirlian, G., Foley, D.J., Ross, G.W., Petrovitch, H., Havlik, R. & White, L.R. 2000. Association of vitamin E and C supplement use with cognitive function and dementia in elderly men. Neurology. 54: 1265-72.

Mattis, S. 1976. Mental status examination for organic mental syndrome in the elderly patient. In: Bellack L, Karasu TB, eds. Geriatrics Psychiatry: A Handbook for Psychiatrists and Primary Care Physicians. New York, NY: Grune & Stratton.

Mattis, S. 1988. Dementia Rating Scale: Professional Manual. Odessa, Florida: Psychological Assessment Resources Inc.

Mendelsohn, A.B., Belle, S.H., Stoehr, G.P. & Ganguli, M. 1998. Use of antioxidant supplements and its association with cognitive function in a rural elderly cohort. Am. J. Epidemiol. 148: 38-44.

Monsch, A.U., Bondi, M.W., Salmon, D.P., Butters, N., Thal, L.J., Hansen, L.A. Wiederholt, W.C., Cahn, D.A. & Klauber, M.R. 1995. Clinical validity of the Mattis Dementia Rating Scale in detecting Dementia of the Alzheimer type. A double cross-validation and application to a community-dwelling sample. Arch. Neurol. 52(9): 899-904.

NCCFN. 2005. Recommended Nutrient Intake for Malaysia: A report of the Technical Working Group on Nutritional Guidelines. Ministry of Health Malaysia, Kuala Lumpur.

Perkins, A.J., Hendrie, H.C., Callahan, C.M., Gao, S., Unverzagt, F.W., Xu, Y., Hall, K.S. & Hui, S.L. 1999. Association of antioxidants with memory in a multiethnic elderly sample using the Third National Health and Nutrition Examination Survey. Am. J. Epidemiol. 150: 37-44.

Perry, G., Castellani, R.J., Hirai, K. & Smith, M.A. 1998. Reactive oxygen spesis mediate cellular damage in Alzheimer’s disease. J. Alzheimer’s Disease 1: 45-55.

Petersen, R.C. 2000. Mild cognitive impairment: Transition between aging and Alzheimer’s disease. Neurologia 15: 93-101.

Petersen, R.C., Doody, R. & Kurz, A. 2001. Current concepts in mild cognitive impairment. Arch. Neurol. 58: 1985-92.

Petersen, R.C., Thomas, R.G., Grundman, M., Bennett, D., Doody, R., Ferris, S., Galasko, D., Jin, S., Kaye, J., Levey A., Pfeiffer, E., Sano, M., van Dyck, C.H. & Thal, L.J. for the Alzheimer’s Disease Cooperative Study Group. 2005. Vitamin E and Donepezil for the Treatment of Mild Cognitive Impairment. N. Engl. J. Med. 352: 2379-2388.

Petersen, R.C., Smith, G.E., Waring, S.C., Ivnik, R.J., Tangalos, E.G. & Kokmen, E. 1999. Mild cognitive impairment: clinical characterization and outcome. Arch. Neurol. 56: 303-308.

Roberts, R.O., Geda, Y.E., Knopman, D.S., Christianson, T.J., Pankratz, V.S., Boeve, B.F., Vella, A., Rocca, W.A. & Petersen, R.C. 2008. Duration and Severity of Diabetes Are Associated with Mild Cognitive Impairment. Arch. Neurol. 2008 August; 65(8): 1066-1073.

Sheikh, J.A. & Yesavage, J.A. 1986. Geriatric Depression Scale (GDS): recent findings and development of a shorter version. In: Clinical Gerontology: A guide to assessment and intervention, edited by Brink, T.L. New York: Howarth Press.

Smith, G.E., Petersen, R.C., Parisi, J.E. & Ivnik, R.J. 1996. Definition, course, and outcome of mild cognitive impairment. Aging Neuropsychol Cogn. 3: 141-147.

Sunderland, T., Hill, J.L. & Mellow, A.M. 1989. Clock drawing in Alzheimer’s disease: A novel measure of dementia severity. J. Am. Geriatr. Soc. 37: 725-729.

Suzana, S., Jane, E. & Suriah, A.R. 2000. Validation of a Dietary History Questionnaire against a 7-D Weighed Record for Estimating Nutrient Intake among Rural Elderly Malays. Mal. J. Nutr. 6: 33-44.

Tee, E.S., Ismail, M.N., Nasir, M.A. & Khatijah, I. 1997. Nutrient Composition of Malaysian Foods. 4th Edition. Kuala Lumpur: Institute of Medical Research.

United Nations 1994. The Aging of Asian Population Department for Economic and Social Info and Policy Analysis. (ST/ESA/SER.R/125). New York: United Nations.

USDA Nutrient Data Laboratory 2000. Food and Nutrition Board, Institute of Medicine, National Academy of Science, United States.

Visser, P.J. 2000. Predictors of Alzheimer Type Dementia in Subjects with Mild Cognitive Impairments. Maastricht: Neuropsych Publishers.

WHO Expert Consultation 2004. Appropriate BMI for Asian population for policy and intervention. Geneva: World Health Organization.

Woo, E.K., Han, C., Jo, SA., Park, M.K., Kim, S., Kim, E., Park, M.H., Lee, J., & Jo, I. 2007. Morbidity and related factors among elderly people in South Korea: results from the Ansan Geriatric (AGE) cohort study. BMC Public Health. Jan 22: 7-10.

Zarina, Z.A., Zahiruddin, O. & Che Wan, A.H. 2007. Validation of Malay Mini- mental State Examination. Malaysian J. of Psychiatry 16(1): 16-19.

*Pengarang untuk surat-menyurat; email: roslee@medic.ukm.my