Biomedical subjects

A H Mann

Publications and source records attributed to A H Mann.

At least 37 records · Page 2Linked to original sources

PubMed1998

A prospective population-based cohort study of the effects of disablement and social milieu on the onset and maintenance of late-life depression. The Gospel Oak Project VII.

BACKGROUND: Population-based studies suggest substantial co-morbidity between physical illness and depression in late-life. However, a causal relationship has not been established. If a relationship exists, it is important to establish which aspects of poor health determine risk for depression, and which factors confer vulnerability or resilience in the face of poor health. We investigate the role of disablement, measured as impairment, disability and handicap. METHODS: A prospective population-based cohort study, comprising an index assessment and 1 year follow-up, of all residents aged 65 years or over, of an electoral ward in London, UK (N = 889). RESULTS: The prevalence of SHORT-CARE pervasive depression was 17.7% at index assessment. The 1 year onset rate for pervasive depression was 12.0%, and the 1 year maintenance rate 63.2%. There was a high mortality rate among the depressed. Disablement, particularly handicap was the most important predictor of the onset of depression (population attributable fraction, 0.69). Lack of contact with friends was a direct risk factor but also modified the association between handicap and depression. Marriage was protective for men, but a risk factor for women. Maintenance of depression was predicted by low levels of social support and social participation, rather than by disablement. CONCLUSIONS: It seems likely that disablement, specifically handicap, is the chief cause of onsets of depression in late-life. Genetic predisposition, early adversity and serious life events may play a less prominent role than in earlier life. Effective prevention of late-life depression requires attention at the structural level to the sources of handicap within communities.

Activities of Daily Living↗

PubMed1998

The development of the Short Explanatory Model Interview (SEMI) and its use among primary-care attenders with common mental disorders.

BACKGROUND: Recent anthropological studies have documented the importance of understanding the relation of culture to the experience of mental illness. The use of interviews that elicit explanatory models has facilitated such research, but currently available interviews are lengthy and impractical for epidemiological studies. This paper is a preliminary report on the development of a brief instrument to elicit explanatory models for use in field work. METHOD: The development of the SEMI, a short interview to elicit explanatory models is described. The interview explores the subject's cultural background, nature of presenting problem, help-seeking behaviour, interaction with physician/healer and beliefs related to mental illness. RESULTS: The SEMI was employed to study the explanatory models of subjects with common mental disorders among Whites, African-Caribbean and Asians living in London and was also used in Harare, Zimbabwe. Data from its use in four different ethnic groups is presented with the aim of demonstrating its capacity to show up differences in these varied settings. CONCLUSIONS: The simplicity and brevity of the SEMI allow for its use in field studies in different cultures, data can be used to provide variables for use in quantitative analysis and provide qualitative descriptions.

Africa↗

PubMed1998

The prevalence of diagnoses, impairments, disabilities and handicaps in a population of elderly people living in a defined geographical area: the Gospel Oak project.

OBJECTIVE: to measure the prevalence of impairments, disabilities and handicaps in a geographically-defined elderly population. DESIGN: cross-sectional analysis of an interview survey. SETTING: a single North London electoral ward (district). PARTICIPANTS: 654 residents (74%) over the age of 65 years were interviewed from a register of 889. A random sample of 225 had additional data collected which are reported in this analysis. MAIN OUTCOME MEASURES: point prevalence and distribution of the total number of reported diagnoses, impairments and disabilities, and distributions of the Office of Population Censuses and Surveys (OPCS) disability scale and the London Handicap Scale scores. RESULTS: participants had a median of three reported diagnoses and two impairments. Forty-three percent were in the least disabled OPCS disability category (i.e. below the disability threshold) and 41% were able to undertake all of 12 basic activities of daily living without difficulty. Overall handicap scores were heavily skewed towards no health-related disadvantage, with a median score of 83 out of 100, and 37% having a score of 90 or more. All indicators showed deteriorating health with increasing age, but age-adjusted gender differences were small. CONCLUSIONS: an elderly population's health problems were classified using a comprehensive framework, revealing high prevalences of diagnoses, impairments, disabilities and handicaps. The schema is appropriate for health care needs assessment and is a suitable basis for describing the population's health.

Aged↗

PubMed1998

Common mental disorders, explanatory models and consultation behaviour among Indian women living in the UK.

Women of Indian origin are said to have a lower rate of recognized common mental disorders and a higher frequency of consultation in primary care than white British. The aim of this study was to evaluate factors, including explanatory models (patient perspectives) of illness, associated with common mental disorders and with frequency of consultation among women of Indian origin in primary care. The investigation was conducted in a general practice in West London with a large Indian population. Consecutive woman attenders of Indian descent were screened with the General Health Questionnaire-12 to identify probable cases of psychiatric morbidity. 100 patients were interviewed with the Revised Clinical Interview Schedule (CIS-R), a specific tool for the diagnosis of common mental disorders, and the Short Explanatory Model Interview, which elicits the individual's conceptualization of his or her illness. Those patients who satisfied CIS-R criteria were classified as 'cases', the others as 'controls'. Common mental disorders were documented in 30% of patients. The general practitioner's diagnosis of common mental disorders had a sensitivity of 17% and a specificity of 91%. Individuals with common mental disorders had a higher frequency of consultation (P = 0.017), were less likely to see depression as an indication for medical intervention and were more likely to withhold some of their concerns from the general practitioner. Incorrect diagnosis by the GP was most likely to occur when patients did not disclose all their complaints. These associations were all statistically significant after adjustment for possible confounders by multiple linear and logistic regression. Women of Indian origin in this sample had rates of common mental disorders similar to those in other UK populations. Differing conceptualizations of common mental disorders may contribute to their underrecognition in women of Indian origin.

Adult↗

PubMed1998

The development of a scale to measure concepts of schizophrenia: experience among Brazilian psychiatrists.

INTRODUCTION: Among psychiatric disorders schizophrenia is often said to be the condition with the most disputed definition. The Bleulerian and Schneiderian approaches have given rise to diagnostic formulations that have varied with time and place. Controversies over the concept of schizophrenia were examined within European/North American settings in the early 1970s but little has since been reported on the views of psychiatrists in developing countries. In Brazil both concepts are referred to in the literature. A scale was developed to measure adherence to Bleulerian and Schneiderian concepts among psychiatrists working in S. Paulo. METHODOLOGY: A self-reported questionnaire comprising seventeen visual analogue-scale statements related to Bleulerian and Schneiderian definitions of Schizophrenia, plus sociodemographic and training characteristics, was distributed to a non-randomised sample of 150 psychiatrists. The two sub-scales were assessed by psychometric methods for internal consistency, sub-scale structure and test-retest reliability. Items selected according to internal consistency were examined by a two-factor model exploratory factor analysis. Intraclass correlation coefficients described the stability of the scale. RESULTS: Replies were received from 117 psychiatrists (mean age 36 (SD 7.9)), 74% of whom were made and 26% female. The Schneiderian scale showed better overall internal consistency than the Bleulerian scale. Intra-class correlation coefficients for test-retest comparisons were between 0.5 and 0.7 for Schneiderian items and 0.2 and 0.7 for Bleulerian items. There was no negative association between Bleulerian and Schneiderian scale scores, suggesting that respondents may hold both concepts. Place of training was significantly associated with the respondent's opinion; disagreement with a Bleulerian standpoint predominated for those trained at the University of S. Paulo. CONCLUSIONS: The less satisfactory reliability for the Bleulerian sub-scale limits confidence in the whole scale but on the other hand this questionnaire contributes to the understanding of the controversy over Bleulerian and Schneiderian models for conceptualisation of schizophrenia, the former requiring more inference and therefore being prone to unreliability.

Adult↗

PubMed1998

An evaluation of practice nurses working with general practitioners to treat people with depression.

BACKGROUND: The diagnosis and treatment of depression constitutes a significant component of a general practitioner's workload. A pilot study has suggested that the practice nurse may have an important contribution to make in the care of patients with depression. AIM: To evaluate an extended role for practice nurses in improving the outcome of depression through two specially-designed interviews running in parallel. METHOD: Two naturalistic, random allocation studies took place concurrently over four months. Study 1 evaluated the effectiveness of standardized psychiatric assessment by a practice nurse and feedback of information to the general practitioner (GP). Study 2 evaluated the above assessment and feedback combined with nurse-assisted follow-up care. Twenty general practices participating in the Medical Research Council General Practice Research Framework took part in the study. Subjects included general practice attenders identified as depressed by their GP. The main outcome measures were a change in Beck Depression Inventory (BDI) scores and in the proportion of patients fulfilling DSM-III criteria for major depression. RESULTS: A total of 577 patients were recruited; 516 [89% (95% CI = 86-92%)] were rated as depressed on the BDI and 474 [82% (95% CI = 79-85%)] met criteria for DSM-III major depression. Altogether, 524 (91%) patients completed follow-up at four months. All groups of patients showed improvement, but no difference in the rate of improvement was shown for the nurse intervention groups. BDI mean scores fell from 18.54 (95% CI = 17.53-20.06) to 11.53 (95% CI = 10.02-13.04) in Study 1, and from 21.01 (95% = CI 20.26-21.86) to 10.62 (95% CI = 9.73-11.51) in Study 2. The proportion of patients fulfilling criteria for DSM-III major depression in Study 1 fell from 80% (95% CI = 73-87%) to 30% (95% CI = 22-38%), and in Study 2 from 80% (95% CI = 76-84%) to 27% (95% CI = 23-31%). Prescription rates of antidepressant medication were higher than expected, ranging between 63% and 76% in the two studies. CONCLUSION: There was an increase in the rate of antidepressant prescription, but no additional benefit could be adduced for patients who received a nurse intervention.

Adolescent↗

PubMed1997

Predictors of clinical and social outcomes after hospitalization in schizophrenia.

A prospective cohort study of schizophrenia was carried out in Sao Paulo, Brazil, in order to investigate clinical and social outcomes in schizophrenia and related psychoses after hospitalization. A sample of 124 individuals who were living in a defined catchment area and had been consecutively admitted to psychiatric hospitals in that area with clinical diagnoses of non-affective functional psychoses was followed up for 2 years. Assessments of clinical status and social adjustment at inclusion and at 2-year follow-up were carried out by means of standardized instruments, the PSE and the DAS. At the end of the follow-up period, 120 subjects (96.8%) were traced, and 103 (83.1%) were re-assessed. At the second assessment, the proportion of subjects with a nuclear syndrome of schizophrenia had halved (from 68.3% to 32.7%), 23.8% were symptom free and 60.2% showed at least one psychotic symptom. Presence of psychotic symptoms at follow-up was best predicted by educational level (less than 4 years of formal education) and an initial DSM-III-R diagnosis of schizophrenia. The distribution of global social adjustment levels at 2-year follow-up was similar to that observed at the outset, with approximately one third of subjects showing good, one third showing intermediate and one third showing poor global social adjustment. Social disability was best predicted by longer duration of illness, worse social adjustment levels at inclusion and lower educational level.

Adolescent↗

PubMed1997

The validation of the 12-item General Health Questionnaire among ethnic Indian women living in the United Kingdom.

BACKGROUND: The General Health Questionnaire (GHQ) has been validated in different languages and cultures and in diverse settings. However, the validity of the 12-item version, increasingly used for screening for psychiatric morbidity in primary care, has not been established among ethnic Indians living in the United Kingdom. METHODS: The GHQ-12 was used to screen for psychiatric morbidity in a study of patterns of consultation and explanatory models of mental illness in a general practice in West London. All individuals who scored 2 or more and an equal number of individuals who scored 0 or 1 were interviewed using the Revised Clinical Interview Schedule (CIS-R) to confirm psychiatric morbidity. Hindi versions of the both these instruments were also employed. Thresholds of GHQ were compared against the standard of the CIS-R using the recommended threshold of 12 and above as indicating caseness. A receiver operator characteristic curve was drawn to obtain the best threshold value for screening. RESULTS: The optimal threshold for screening as assessed by receiver operator characteristic analysis was 2/3. This threshold had a sensitivity of 96.7% and a specificity of 90%. CONCLUSIONS: The sensitivity and specificity of the 12-item General Health Questionnaire among women of ethnic Indian origin living in the United Kingdom is high. It can be employed as a screening instrument to identify individuals with psychiatric morbidity in this population.

Adult↗

PubMed1997

Impairment, disability and handicap as risk factors for depression in old age. The Gospel Oak Project V.

BACKGROUND: An association between disablement and late-life depression is often reported in cross-sectional studies. However, many lack effect sizes, and do not control for confounding. Therefore, it is difficult both to quantify the overall impact of poor health on depression and to understand which aspects are most salient. METHODS: A catchment area survey of all over 65-year-old residents of an electoral district in London, UK, using a population register derived from a door-to-door census was undertaken. Depression was measured using SHORT-CARE, and the consequences of disease classified according to the WHO International Classification of Impairments, Disabilities and Handicaps. RESULTS: Six hundred and fifty-four subjects were interviewed out of an older population of 889. The prevalence of SHORT-CARE pervasive depression was 17%. Impairment, disability and, particularly, handicap were strongly associated with depression. The adjusted odds ratio for depression in the most handicapped quartile compared with the least was 24.2 (8.8-66.6). The population attributable fraction (PAF) for depression attributable to handicap was 0.78. The PAFs for recent life events and female gender were much lower. Handicap explained most of the depression associated with individual impairments and disabilities. Adjusting for handicap abolished or weakened the associations between depression and social support, income, older age, female gender and living alone. CONCLUSIONS: Even given some uncertainty in distinguishing handicap and depression as constructs, and the impossibility of deciding direction of causality, it seems likely that handicap is of central significance to late-life depression. Handicap may be more amenable to intervention than either impairment or disability.

Activities of Daily Living↗

PubMed1997

Social support deficits, loneliness and life events as risk factors for depression in old age. The Gospel Oak Project VI.

BACKGROUND: A companion paper reported a very strong cross-sectional association between handicap and late-life depression. Adjusting for handicap weakened associations between sociodemographic variables and depression. It was unclear whether handicap was a confounder, or a useful summary variable, mediating the effect of a range of sociodemographic disadvantages. This paper focuses on the cross-sectional relationship between depression and demographic variables, social support, and life events. METHOD: A community survey of all residents over the age of 65 years of an electoral district in London, UK. RESULTS: There was a moderate association between SHORT-CARE pervasive depression and the number of life events experienced over the previous year. Personal illness, bereavement and theft were the most salient events. There was a stronger, graded, relationship between the number of social support deficits (SSDs) and depression. Number of SSDs also related to age, handicap, loneliness and use of homecare services. Loneliness was itself strongly associated with depression; odds ratio 12.4 (7.6-20.0). CONCLUSIONS: Problems of collinearity, and the cross-sectional design of the study limited interpretation of the exact nature of the relationship between social support, loneliness, handicap and depression. However, the clustering of these four factors can be used to define a large part of the elderly population with a poor quality of life. An important avenue for future research will be the development and implementation of population intervention strategies designed to address some or all of these problems among older people in general.

Aged↗

PubMed1997

Is there any evidence for a protective effect of antithrombotic medication on cognitive function in men at risk of cardiovascular disease? Some preliminary findings.

To explore whether antithrombotic medication may protect against cognitive decline, tests of verbal memory, attention, abstract reasoning, verbal fluency, and mental flexibility were administered to 405 men at risk of cardiovascular disease. These subjects were a subgroup of those who had been participating in a randomised double blind factorial trial of low dose aspirin (75 mg daily) and low intensity oral anticoagulation with warfarin (international normalised ratio of 1.5) at 35 general practices across the United Kingdom for at least five years, were at least 55 years old at trial entry, and had been randomly allocated to one of four groups: active warfarin and active aspirin, active warfarin and placebo aspirin, placebo warfarin and active aspirin, and double placebo. Verbal fluency and mental flexibility were significantly better in subjects taking antithrombotic medication than in subjects taking placebo. Aspirin may have contributed more than warfarin to any beneficial effect. These results provide tentative evidence that antithrombotic medication may protect cognitive function in men at risk of cardiovascular disease.

Aged↗

PubMed1997

Personality disorder and suicide. A case-control study.

BACKGROUND: The relationships between personality disorders and suicide were investigated among two aboriginal groups and the Han Chinese in East Taiwan. METHOD: Biographical reconstructive interviews were conducted for consecutive suicides from each of the three ethnic groups (116 suicides in total), 113 of whom were matched with two controls for age, gender, and area of residence. RESULTS: In all three groups, a high proportion of suicides suffered from ICD-10 personality disorder before suicide (46.7-76.7%), and the most prevalent category was emotionally unstable personality disorder (F60.3) (26.7-56.7%). The risk for suicide was mainly significantly associated with F60.3, comorbidity among personality disorders, and comorbidity of personality disorder with other psychiatric disorders, particularly severe depression. CONCLUSION: The main category of personality disorder significantly associated with the risk of suicide is F60.3 in ICD-10. The risk is highest for a comorbidity of this category and severe depression.

Adult↗

PubMed1997

A controlled comparison of the ability of practice nurses to detect psychological distress in patients who attend their clinics.

This study aimed to compare the ability of practice nurses in two groups of general practices to detect psychological distress in patients attending their clinics. Practice nurses in Britain are employed directly by general practitioners (GPs) and carry out their duties mainly in treatment rooms in GP's practices. The number of practice nurses has increased rapidly since the mid-1970s; recent estimates put the total between about 15000 and 18000. Most psychiatric disorders that come to medical attention do so initially within a primary care setting. In Britain, 98% of the population is registered with a GP and 70% of these people will consult their doctor in a given year. In the early 1990s the WHO found a 24% prevalence of current mental disorder in users of general health care. A further 9% of patients had significant and/or disabling symptoms but did not reach the threshold criteria for a confirmed diagnosis of mental disorder. Although published reports of surveys of practice nurses have shown varying degrees of involvement in mental health care, it is thought to be important that they become agents of detection of mental health problems because these nurses are in contact with a wide range of vulnerable people. Armstrong (1994) found that informants in a survey thought that practice nurses needed additional training in three main areas of mental health care: recognition followed by appropriate referral and on-going care of people with depression and anxiety; primary prevention of depression; and care in the community for people with serious long-term mental illness. The study briefly reported here measured practice nurses' detection of mental health problems. Results showed that practice nurses detect about 23% of those identified as cases using the General Health Questionnaire (GHQ). Testing of agreement between nurses and patients using Cohen's (1960) kappa showed a low level of agreement between nurses and patients concerning psychological distress.

Attitude of Health Personnel↗

PubMed1996

Randomised controlled trial of effect of intervention by psychogeriatric team on depression in frail elderly people at home.

OBJECTIVE: To investigate the efficacy of intervention by a psychogeriatric team in the treatment of depression in elderly disabled people receiving home care from their local authority. DESIGN: Randomised controlled trial with blind follow up six months after recruitment. SETTING: Community of south east London. SUBJECTS: 69 people aged 65 or over who received home care and were depressed according to criteria of the standardised automatic geriatric examination for computer assisted taxonomy (AGECAT). 33 were randomly allocated to an intervention group and 36 to a control group. INTERVENTION: Members of the intervention group received an individual package of care that was formulated by the community psychogeriatric team in their catchment area and implemented by a researcher working as a member of that team. The control group received normal general practitioner care. MAIN OUTCOME MEASURES: Recovery from depression (AGECAT case at recruitment but non-case at follow up). RESULTS: Data were analysed on an intention to treat basis. 19 (58%) of the intervention group recovered compared with only nine (25%) of the control group, a difference of 33% (95% confidence interval 10% to 55%). This powerful treatment effect persisted after controlling for possible confounders in logistic regression analysis, with members of the intervention group more likely than members of the control group to have recovered at follow up (odds ratio 9.0 (2.0 to 41.5)). This did not seem to be a simple effect of antidepressant prescription: use of antidepressants at follow up did not have a significant effect (multiply adjusted odds ratio 0.3 (0.0 to 1.9)). CONCLUSIONS: Depression is treatable in elderly people receiving home care. Therapeutic nihilism based on an assumed poor response to treatment in these socially isolated, disabled elderly people in the community is not supported.

Aged↗

PubMed1996

Is the cognitive function of older patients affected by antihypertensive treatment? Results from 54 months of the Medical Research Council's trial of hypertension in older adults.

OBJECTIVE: To establish whether initiation of treatment with diuretic or beta blocker is associated over 54 months with change in cognitive function. DESIGN: A cognitive substudy, nested within a randomised, placebo controlled, single blind trial. SETTING: 226 general practices from the Medical Research Council's general practice research framework. SUBJECTS: A subset of 2584 subjects sequentially recruited from among the 4396 participants aged 65-74 in the trial of treatment of hypertension in older adults. The 4396 subjects were randomised to receive diuretic, beta blocker, or placebo. Subjects had mean systolic pressures of 160-209 mm Hg and mean diastolic pressures <115 mm Hg during an eight week run in. OUTCOME MEASURES: The rate of change in paired associate learning test (PALT) and trail making test part A (TMT) scores (administered at entry and at 1, 9, 21, and 54 months) over time. RESULTS: There was no difference in the mean learning test coefficients (rate of change of score over time) between the three treatments: diuretic -0.31 (95% confidence interval -0.23 to -0.39), beta blocker -0.33 (-0.25 to -0.41), placebo -0.30, (-0.24 to -0.36). There was also no difference in the mean trail making coefficients (rate of change in time taken to complete over time) between the three groups: diuretic -2.73 (95% confidence interval -3.57 to -1.88), beta blocker -2.08 (-3.29 to -0.87), placebo -3.01, (-3.69 to -2.32). A less conservative protocol analysis confirmed this negative finding. CONCLUSION: Treating moderate hypertension in older people is unlikely to influence, for better or for worse, subsequent cognitive function.

Adrenergic beta-Antagonists↗

PubMed1996

Mortality among patients with non-affective functional psychoses in a metropolitan area of south-eastern Brazil.

High mortality rates among those suffering from schizophrenia and related psychoses have been consistently described in developed societies. However, to date there is a lack of data on this matter in Brazil. In order to examine this issue, a prospective 2-year follow-up study was carried out in S. Paulo. The sample consisted of 120 consecutive admissions to psychiatric hospitals in a defined catchment area, aged 18 to 44 years old, with clinical diagnoses of non-affective functional psychoses according to the ICD-9. After 2 years, 116 (96.7%) subjects were traced. During the study period there were 7 deaths (6.0% of those traced), 5 (4.3%) due to suicide. All but one of the suicides occurred in the first year after discharge from hospital. Age and sex Standardised Mortality Ratios (relative to rates for the population of the city of Sao Paulo) were 8.4 for overall mortality (95% confidence interval: 4.0-15.9) and 317.9 for deaths due to suicide (95% confidence interval: 125.2-668.3). These results are in agreement with previous studies, and show that in Brazil non-affective functional psychoses are life-threatening illnesses, which need adequate care, particularly when patients go back to live in the community after hospital discharge.

Adolescent↗

PubMed1995

Prevalence and course of depression among elderly residential home admissions in Mannheim and Camden, London.

A longitudinal study based on consecutive admissions to all residential homes for the elderly was conducted in the industrial city of Mannheim (Germany) and in the London borough of Camden (England). Inclusion criteria were that the elderly persons (65 years old and older) came directly from their own home or, if transferred from a hospital, had been there for less than 3 months. At each site, 60 home residents were interviewed at admission and 3 months and 8 months later. Depression and dementia were assessed with the aid of the Brief Assessment Scale. The prevalence of depression (Mannheim: 34.6%; Camden: 47.9%) was already high at admission and did not change significantly over time. Residents in Camden were more demented and more impaired in their activities of daily living at the time of admission, and the percentage of those who died or were transferred to a hospital or nursing home within 8 months thereafter was higher in Camden (30%) than in Mannheim (5%). Multiple regression analysis revealed that, in both study areas, depression at baseline was the best predictor for depression 3 months and 8 months later. This relationship was particularly strong in Camden, where a high percentage of the depressed at admission showed a chronic course of illness. Sex, age, home visits, social isolation, activities of daily living, cognitive impairment, and somatic symptoms at the time of admission were not significantly associated with depression 3 months later. Eight months after admission, a similar pattern was found in Mannheim. In Camden, however, in addition to depression, a lack of home visits by relatives and friends, and somatic symptoms at baseline, were significant predictors of depression 8 months after admission.

Aged↗

PubMed1994

The Gospel Oak Study stage III: the incidence of dementia.

Of an original sample of 705 elderly (aged over 65) community residents 71% were rescreened after two years and four months using Short CARE. Thirty-one (6.7%) subjects were identified as possible new cases of dementia, implying a mean annual inception rate among the survivors of 26 per 1000. These were subjected to full clinical assessment, which yielded 10 cases of Alzheimer's disease (8 per 1000) and 5 multi-infarct dementia (4 per 1000). The remainder of the cases consisted of 6 with a dementia secondary to other causes, 1 case of mixed dementia and there was insufficient information to classify the remaining 3. Six were found not to be suffering from dementia. This yields an overall annual incidence rate for dementia among the survivors of 20 per 1000.

Aged↗