Epidemiology of Alzheimer’s disease and Dementia in Australia

This research investigates the risk of physical and mental inactivity to the development of Alzheimer’s disease and the resultant development of dementia in the Australian aging population. The study aims to contribute to the existing data available on the prevalence of Alzheimer’s disease in Australia, establish the relationship between physical and mental inactivity and the development of Alzheimer’s disease, and find out the changes in diagnosis, onset and progression of Alzheimer’s disease in an individual with remarkable risk factors.

Running head: ALZHEIMER’S DISEASE AND DEMENTIA 1
Epidemiology of Alzheimer’s disease and Dementia in Australia
Name:
Institutional Affiliation

ALZHEIMER’S DISEASE AND DEMENTIA 2
Effects of inactivity on the development Alzheimer’s disease and Dementia in
Australia
Abstract
Aging is a major defining process of human life coming with advantages and
disadvantages such as wisdom and health problems. With the improvement in medical
practice and technology, the life expectancy in many nations has gone up remarkably with
more than 100 nations worldwide reporting an average of more than 2 million citizens aged
60 years and above. This is projected to increase by almost half percentages by the year 2030.
In Australia, in 2016 an approximated 2.1 million citizens were aged older than 65 years with
the number estimated to rise to about 3.3 million people by 2040. The risk factors for the
development of Alzheimer’s disease will be investigated with a focus on the lack of or
reduced inactivity measured by level of education and occupation as a cause of the
neurodegenerative disorder of the human cerebral matter. A systematic review of peer-
reviewed literature will be conducted on the relevant literature to the epidemiology of
Alzheimer’s disease and dementia and a mini-review of the hospital data records in the
country with a cross-sectional case study to investigate the risk factors that predisposed the
participants(with Alzheimer’s disease and dementia) to the disorder. The approximated
timeframe for the research is 135 days. The results will be analysed and the important points
summarized before presentation to the health organizations.

ALZHEIMER’S DISEASE AND DEMENTIA 3
Table of Content
Abstract.....................................................................................................................................2
1.0 Introduction........................................................................................................................3
1.1 Aims and objectives.....................................................................................................................3
1.2 Background and rationale............................................................................................................3
1.3 Significance of the research.........................................................................................................5
2.0 Literature review................................................................................................................6
3.1 Theoretical framework................................................................................................................8
4.0 Methodology.......................................................................................................................9
5.0 Research design and methodology....................................................................................9
5.1 Participants..................................................................................................................................9
6.0 Data collection..................................................................................................................11
7.0 Data analysis.....................................................................................................................12
8.0 Limitations........................................................................................................................12
8.1 Ethics.........................................................................................................................................12
8.1.1 Informed consent...............................................................................................................12
8.1.2 Confidentiality....................................................................................................................13
8.1.3 Risks and benefits...............................................................................................................13
8.2.4 Compensation and incentives.............................................................................................13
9.0 Results presentation.........................................................................................................13
10.0 Timeline and budget......................................................................................................14
11.0 Conclusion.......................................................................................................................16
12.0 References.......................................................................................................................17

ALZHEIMER’S DISEASE AND DEMENTIA 4
1.0 Introduction
Alzheimer’s disease has increasing become a malignant and highly prevalent disorder of the
elderly. The disease results from neurodegeneration of the cerebral cortex and brain matter in
the areas of the hippocampus and the amygdala. The causative agents of Alzheimer’s disease
have not been well understood however a number of research and experiments have
implicated several risk factors responsible for the sporadic but insidious development of the
disease. The risk factors include familial predisposition, chromosomal mutations, inactivity
and cerebrovascular disorders. The incidence of the disorder rises with age steadily from the
ages of 65 years and peaking at the age of 85-89 years. The clinical progression of the disease
is slowly. The clinical picture starts with the steady and slow impairment of higher motor and
sensory functions such as mood and behaviour which are highly interfered with. As the
disease progresses, cortical functions of the individual’s brains are severely affected with
clinical manifestations including disorientation of time, place and person, severe memory loss
in terms of short, intermediate and long-term memories and aphasia with profound disability
in motor functions such as movement.
1.1 Aims and objectives
Aims.
Very little is known concerning the causes of Alzheimer’s disease in the population
with several theories developed to link the disease to familial inheritance of the causal agent
and chromosomal mutations. The aim of this study is to provide and discuss the risk of
physical and mental inactivity to the development of Alzheimer’s disease and the resultant
development of dementia in the Australian aging population. The study aims to:
i. Contribute to the existing data available on the prevalence of Alzheimer’s
disease in Australia.

ALZHEIMER’S DISEASE AND DEMENTIA 5
ii. Establish the relationship between physical and mental inactivity and the
development of Alzheimer’s disease.
iii. Establish how changing in the levels of inactivity will reduce the progress or
delay the sporadic onset of Alzheimer’s disease in the population with the
disorder or additional risk factors such as a positive family history of the
disease.
The specific objectives of the study are:
1) To determine the prevalence of Alzheimer’s disease in the Australian population.
2) To investigate the association between mental and physical inactivity to the sporadic
development of AD in an individual with a positive family history of the disorder or
Down’s syndrome.
3) To find out the changes in diagnosis, onset and progression of Alzheimer’s disease in
an individual with remarkable risk factors.
Hypothesis.
Hypothetically, this case study is to define and discuss the association between physical and
mental inactivity to the development of Alzheimer’s disease.
Hypothesis 1. Lower levels of activity and immobility is associated with an earlier age of
onset for Alzheimer’s disease.
Hypothesis 2. Lower levels of mental activity such as educational achievements positively
relate to the early diagnosis, development and progression of Alzheimer’s disease.
Hypothesis 3. Higher levels of mental and physical activity does not alter the age of onset of
Alzheimer’s disease but only delay the diagnosis.

ALZHEIMER’S DISEASE AND DEMENTIA 6
1.2 Background and rationale
Alzheimer’s disease is a disorder of the human brain that is characterized by
neurodegeneration of the brain matter resulting in impaired cognitive and behavioural
functions that was first described by Alois Alzheimer, 1906. The impairment therefore
severely interferes with the social, economic and occupational life of the affected individuals
resulting in a high cost of management and patient care. Alzheimer’s disease is a chronic
condition that is not transmissible from person to person. The curative mechanisms of the
disease are not yet developed and therefore Alzheimer’s disease is incurable. As chronic as
AD is, it takes a long preclinical duration of time and progresses over time until death
ensures.
There is no well understood d causative agents of Alzheimer’s disease. However,
genetic composition of the affected individuals has been implicated to try and explain the
pathogenesis of the disorder. In the elderly, Alzheimer’s disease is the primarily the cause of
dementia. Dementia is defined as a broad category of brain disorders that result in the
reduction in the ability to think and remember information hence a poor quality of life with
affected functioning of routine activities. In this instance therefore, Alzheimer’s disease and
dementia will be investigated together as a single entity in this research proposal.
Clinical studies such as medical imaging using magnetic resonance images, the
affected brain is found to have atrophied in the cortical regions with very wide sulci and
enlargement of the ventricles. Structures in the midbrain such as the hippocampus and
amygdala arte involved in the neurodegeneration early in the disease and thus are severely
affected as the disease progresses. Histologically, neuritic plaques of amyloid peptides are
deposited in the cortical matter of the brain resulting in diffuse neurofibrillary tangles that

ALZHEIMER’S DISEASE AND DEMENTIA 7
progresses severely resulting with reactive gliosis and neuronal loss as the ultimate
complications hence dementia.
Alzheimer’s disease and dementia rarely presents in individuals younger than 50
years of age. The incidence of the disorder rises with age steadily from the ages of 65 years
and peaking at the age of 85-89 years. The clinical progression of the disease is slowly. The
clinical picture starts with the steady and slow impairment of higher motor and sensory
functions such as mood and behaviour which are highly interfered with. As the disease
progresses, cortical functions of the individual’s brains are severely affected with clinical
manifestations including disorientation of time, place and person, severe memory loss in
terms of short, intermediate and long-term memories and aphasia with profound disability in
motor functions such as movement. Ultimately, as the disease progression severely affects the
patient with peak neurodegeneration and accumulation of the amyloid peptides, the individual
becomes totally disabled, dyskinesia sets in and mute depending 100% on their caregivers for
thus increasing the socioeconomic, medical and financial problems on the family, friends and
the nation.
Alzheimer’s disease is majorly sporadic with a smaller fraction of the affected
individuals showing a positive familial inheritance model. No treatments modality and
regimes has been developed to cure, prevent or reverse the progression of Alzheimer’s
disease and dementia. However, some drugs are used to relieve the symptoms by increasing
the quantity of neuropeptide transmitters in the brain. As of 2015, there were 29.8 million
reported and documented cases of Alzheimer’s disease with a mortality number recorded at
1.9 million (Lancet, 2016).
1.3 Significance of the research
This research will provide great impact to the department of health, hospitals and medical
schools with the latest information on the epidemiology of Alzheimer’s disease and its

ALZHEIMER’S DISEASE AND DEMENTIA 8
complication of dementia. From the report, the Australian population will understand the
disease burden provided by the AD and dementia. Thus, will be able to develop strategies and
interventions that would be effective in the prevention of the Alzheimer’s disease and reduce
the disease effects in the society. Finally, the research will create a foundation for the future
researcher to conduct research in the Australian population by providing the basic
information as a literature publication.
2.0 Literature review
Alzheimer’s disease and dementia rarely presents in individuals younger than 50 years of age.
The incidence of the disorder rises with age steadily from the ages of 65 years and peaking at
the age of 85-89 years. The clinical progression of the disease is slowly. The clinical picture
starts with the steady and slow impairment of higher motor and sensory functions such as
mood and behaviour which are highly interfered with. As the disease progresses, cortical
functions of the individual’s brains are severely affected with clinical manifestations
including disorientation of time, place and person, severe memory loss in terms of short,
intermediate and long-term memories and aphasia with profound disability in motor functions
such as movement. Ultimately, as the disease progression severely affects the patient with
peak neurodegeneration and accumulation of the amyloid peptides, the individual becomes
totally disabled, dyskinesia sets in and mute depending 100% on their caregivers for thus
increasing the socioeconomic, medical and financial problems on the family, friends and the
nation (Robin &Cotlan 2001.)
In the study by Ana Luisa, 2012, a mini-systematic review concluded that the
epidemiological data on Alzheimer’s disease and dementia is so large to warrant the
intervention of dementia as a national and worldwide health problem. Since the recent
researches, meta-analyses and peer-reviewed literatures have failed to identify the cause or
strategies and interventions for the prevention of AD, the age-related heterogeneous disorder

ALZHEIMER’S DISEASE AND DEMENTIA 9
should be considered a public health priority to reduce the projected large incidence rate by
the year 2030.
Focusing on the developing world, Kalaria et al, 2008 conducted studies to determine
the disease burden of Alzheimer’s disease and dementia in Latin America, Asia and Africa.
In the research, the authors identified the risk factors to development of AD and determined
the mortality incidences due to Alzheimer’s disease and dementia within the population.
Despite a high mortality and morbidity rate due to infective diseases, poverty and conflicts,
the article discusses the remarkable impacts of AD on the mortality rates in the developing
countries and how the values are projected to increase globally affecting both developed and
developing countries due to either sporadic or familial Alzheimer’s disease and dementia.
A systemic review and metaanalysis on the on the prevalence of Alzheimer’s disease
and dementia with a peer review of global literatures on dementia focusing on publications
from the year 1980 to 2009. The prevalence of dementia, primarily depended on the diagnosis
of Alzheimer’s disease is substantially similar across the globe with a convergence on the
ages above 65 years, Prince et al, 2012. With the better healthcare provided globally, the
prevalence was estimated to rise by a double figure by the year 2020 which will require the
different countries structure an Alzheimer’s survey regularly with research on progression
prevention and cure.
With a looming epidemic of Alzheimer’s disease and dementia on the globe due to the
aging of the world population, therapeutic and preventive measures effective for the delay
and progression of the disorder should be addressed. This is because the disease burden of
AD is estimated to grow rapidly by the year 2050 to an estimated 84 million affected elderly
patients (Brookmeyer et al, 2007)

ALZHEIMER’S DISEASE AND DEMENTIA 10
In the Australian population, studies conducted using the case control methodology,
clinically diagnosed and reported cases of Alzheimer’s disease and dementia between the
ages of 52-96 were interviewed to determine the risk factors associated with the development
of the disorder. The article discusses four risk factors involved in the development of AD as a
previous history of dementia, previous diagnosis of AD, chromosomal mutations resulting in
Down’s syndrome in the family and a previous history of underactivity in academic and
occupational life (Broe et al, 1990).
This study therefore seeks to determine and estimate the prevalence and epidemiology
data on Alzheimer’s disease and dementia in Australia. Defined as a public health priority
and one of the non-communicable disease burdens globally, the research focuses will focus
on the link between the levels of activity and the development, progression and diagnosis of
Alzheimer’s disease. As a public health benefit, this study will help address design the
structure and interventions effective in the prevention of the effects of AD while also give
room and foundation for more researches on the prevention and cure Alzheimer’s disease
before progression to dementia and death.
3.1 Theoretical framework
Australia being a developed country with a large elderly population, the prevalence and
incidence rates of Alzheimer’s disease and dementia are high and therefore pose a huge
burden on the Australian public health agency to prevent and reduce the impacts on the
economy and social aspects of the nation. Drawing insights from previous literature, the risks
factors for developing AD are majorly the age factor, occupational and academic inactivity,
familial inheritance and chromosomal mutations associated with Down’s syndrome (Broe et
al, 1990).
4.0 RESEARCH PLAN.
Considering previous literature, this study will be conducted in two phases:

ALZHEIMER’S DISEASE AND DEMENTIA 11
Phase one of the field study to determine and estimate the prevalence and incidence
rates of Alzheimer’s disease and dementia in the Australian population. Additionally, to
define the distribution and prognosis of AD in the population. The following methods of data
collection will be utilized in this phase, interviews, hospital records access, questionnaires
and participatory observation in obtaining data from eight public Australian hospitals in the
states.
Phase two of the study will focus on the selected participants in the study identified
randomly from the patients diagnosed with Alzheimer’s disease and under management to
identify the risk factors in their past medical and social history and the effects of the disease
on the family social and financial aspects.
5.0 STUDY DESIGN AND METHODOLOGY
5.1 Participants
The study will be conducted in Australia. The research participants will be selected to fulfil
the methodology criteria in two phases.
In phase 1, a stratified random sampling method will be used to determine the
hospitals to be used in the data collection and analysis process. The characters of the hospitals
to be identified are;
 A hospital from either one of the eight states.
 A public hospital.
 Hospital is a teaching and referral hospital.
From the sampling, the following hospitals were identified:
 Austin hospital
 St. George hospital

ALZHEIMER’S DISEASE AND DEMENTIA 12
 Queen Elizabeth hospital.
 Calvary John James hospital
 Frankston hospital
 Launceston hospital
 Fiona Stanley hospital
 Gold Coast University Hospital.
In phase 2, a Quota sampling methods will be used to identify the patients to
participate in the research. The sample population is characterized basing on:
 At least 2 years of medication after a diagnosis of AD was made.
 Either male or female.
 Married with a family, for follow up on development of AD, a clinical
trial.
 On medication, at least for 6 months.
 With a positive family history of Alzheimer’s disease or Down’s
syndrome.
A sample size of 144 patients will be used in the research. The patient’s family will be
interviewed in the research, especially the caregivers.
6.0 Data collection
The process of data collection will be carried using the following methods:
In-depth interviews: the participants will be asked questions and allowed to freely air
their views about the structured subtopics relating to Alzheimer’s disease and dementia.
Those interviewed will be medical professionals, patients still well oriented, patients’
caregivers and other family members.

ALZHEIMER’S DISEASE AND DEMENTIA 13
Participatory observation: as the researcher, I will engage in the daily activities of the
participants observing their routine, taking notes and asking questions while recording the
images and voices of the participants in the field.
Extraction of data: the hospital records will be audited and analysed for the data on
the number of cases diagnosed and recorded to calculate the prevalence, incidence rates and
other records relevant to mortality. The data sources to be analysed will include electronic
health records, outpatient records, pathology and imaging records, mortality records and
survey reports.
Requirements
 Transport.
 Stationery.
 Video recorder.
 Computers.
 ELKI program.
 Audio recorder.
7.0 Data analysis
Being a cross-sectional study, the data collected will be analysed using the following
measures.
Calculation of incidence rate. The rate will be calculated through recording the
number of new cases in the year, determination of the person years.
Analysis of the causal relationship between levels of inactivity and the disease to
provide a discussion according to the objectives and hypothesis regarding the:
Prevalence rates.

ALZHEIMER’S DISEASE AND DEMENTIA 14
Incidence rates.
Risks ratio.
The following models and tools will be used I the data analysis:
A general linear model.
ELKI, for data mining with visualization features.
8.0 Limitations
Primarily the limitation to the methodology is the traveling during data collection.
Therefore, internet based systems such as video teleconferencing and calls will be used where
possible to reduce travelling.
8.1 Ethics
8.1.1 Informed consent
The study will be conducted basing on the guiding principles of protection of the human
subjects who voluntarily chose to participate in the study. Informed consent will be obtained
from the participants within the standard international operations and protocols of the
Australian Ethics Review Committee. The participants will be explained to the consent form
and made to understand before choosing to participate in the study or not. Consent will be
indicated by the participant’s signature or finger print. The participants will be allowed to
pull out of the study at their own will.
8.1.2 Confidentiality
The participants will not be identified by their names during the research, in the data or
during presentation of the information. All the personal identifiers will be removed and the
data collected will be on good clinical practice compliant forms and methods. The data will
be protected to be accessed by only privileged individuals and the after the project, the data
entry forms with identifiers will be destroyed to remove traces of the participants.

ALZHEIMER’S DISEASE AND DEMENTIA 15
8.1.3 Risks and benefits
The only resolve is inconvenience in time during the study. The benefits include education
about Alzheimer’s disease and dementia and the best care practices available.
8.2.4 Compensation and incentives
As the researcher, I do not anticipate any risks to the participants, however I case of breaks in
data privacy, fines will be paid to protect the face of the affected individual or organization.
Additionally, incentives will be given as gifts to the participants in form of food and drugs.
9.0 Results presentation
The results generated and analysed from the study will be represented in charts, tables
and graphs. The qualitative data will be represented in text formats.
The report will be presented and communicated to all the medical training hospitals
that participated in the study, the Department of Health of Australia and my university
supervisors and tutors. Furthermore, the research report will be shared with the broader
audience of research community in online platforms such as Researchgate and the IEEE. To
the university, the report will be presented through pamphlets, conference presentations and
media articles.
10.0 Timeline and budget
The research will take an estimated 135-day period from the day the funds of the
budget are received. The following is the project plan of the research.
Task June July August September October
1st to 15th
Epidemiological
cross-sectional
From beginning to completion.

ALZHEIMER’S DISEASE AND DEMENTIA 16
study in Australia
Review of previous
literature and
conducting a
metaanalysis.
1.1 literature
review
1.2.
systematic review
1.3.
metaanalysis
Study design and
methodology
2.1. Study design
and calculation of
sample size.
2.2. Identification of
sample population.
2.3. Collection of
required tools and
equipment.
Data collection in
the field study.
Data collection.

ALZHEIMER’S DISEASE AND DEMENTIA 17
Data analysis.
Report presentation
and communication
including
conference
presentation and
sharing with online
community of
researchers.
The calculated cost of the research is 3400USD. The following is the breakdown of
the budget allocations.
Budgetary requirement Cost in US dollars.
Survey design. 90
Literature 55
Printing. 250
ELKI program. 50
Stationery. 200
Stuff. 900
Incentives. 500
Transport 300
Bills 150

ALZHEIMER’S DISEASE AND DEMENTIA 18
2495
11.0 Conclusion and Significance.
This paper seeks to determine the disease burden of dementia and therefore project the
prevalence of the disease in the coming years to enable the national and state governments
prepare and strategize the effective prevention interventions for Alzheimer’s disease in the
Australian population. This study will therefore determine the impacts of Alzheimer’s disease
on the social, economic and occupational goals and objectives of the affected individual,
family, society and nation since the disorder disables the individual and require full caregiver
support to perform basic activities such as eating, dressing and cleaning after emptying their
bladder or bowels. Based on the previous studies and datasets, the prevalence, incidence
rates and disease burdens of Alzheimer’s and dementia have been underestimated. However,
due to the increasing burden, the report of this research would be used to explain and discuss
the need for prioritizing Alzheimer’s disease and dementia as a public health problem in
Australia and globally.
12.0 References
Broe, G. A., Henderson, A. S., Creasey, H., McCusker, E., Korten, A. E., Jorm, A. F., &
Anthony, J. C. (1990). A case‐control study of Alzheimer's disease in Australia.
Neurology, 40(11), 1698-1698.
Sosa-Ortiz, A. L., Acosta-Castillo, I., & Prince, M. J. (2012). Epidemiology of dementias and
Alzheimer’s disease. Archives of medical research, 43(8), 600-608.

ALZHEIMER’S DISEASE AND DEMENTIA 19
Prince, M., Bryce, R., Albanese, E., Wimo, A., Ribeiro, W., & Ferri, C. P. (2013). The global
prevalence of dementia: a systematic review and metaanalysis. Alzheimer's &
dementia: the journal of the Alzheimer's Association, 9(1), 63-75.
Kalaria, R. N., Maestre, G. E., Arizaga, R., Friedland, R. P., Galasko, D., Hall, K., ... &
Prince, M. (2008). Alzheimer's disease and vascular dementia in developing
countries: prevalence, management, and risk factors. The Lancet Neurology, 7(9),
812-826.
Brookmeyer, R., Johnson, E., Ziegler-Graham, K., & Arrighi, H. M. (2007). Forecasting the
global burden of Alzheimer’s disease. Alzheimer's & dementia: the journal of the
Alzheimer's Association, 3(3), 186-191.
Hendrie, H. C. (1998). Epidemiology of dementia and Alzheimer's disease. The American
Journal of Geriatric Psychiatry, 6(2), S3-S18.
Stern, Y., Gurland, B., Tatemichi, T. K., Tang, M. X., Wilder, D., & Mayeux, R. (1994).
Influence of education and occupation on the incidence of Alzheimer's disease. Jama,
271(13), 1004-1010.
Rosen, W. G., Mohs, R. C., & Davis, K. L. (1984). A new rating scale for Alzheimer's
disease. The American journal of psychiatry.
Kumar, V., Abbas, A. K., Fausto, N., & Aster, J. C. (2005). Robbins and Cotran pathologic
basis of disease.
Hoda, S. A., & Ginter, P. S. (2015). Robbins and Cotran Pathologic Basis of Disease.
American Journal of Clinical Pathology, 144(1), 172.

ALZHEIMER’S DISEASE AND DEMENTIA 20
Nay, R., Bauer, M., Fetherstonhaugh, D., Moyle, W., Tarzia, L., & McAuliffe, L. (2015).
Social participation and family carers of people living with dementia in Australia.
Health & social care in the community, 23(5), 550-558.
Carling-Jenkins, R., Bigby, C., & Iacono, T. (2014). Family experiences of supporting a
person with Down syndrome and dementia in Australia. Intellectual disability and
dementia: Research into practice, 145-160.
Li, S. Q., Guthridge, S. L., Aratchige, P. E., Lowe, M. P., Wang, Z., Zhao, Y., & Krause, V.
(2014). Dementia prevalence and incidence among the Indigenous and non-
Indigenous populations of the Northern Territory. Med J Aust, 200(8), 465-9.
Jorm, A. F., Dear, K. B., & Burgess, N. M. (2005). Projections of future numbers of dementia
cases in Australia with and without prevention. Australian and New Zealand Journal
of Psychiatry, 39(11‐12), 959-963.