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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.
The current study was performed on people living with dementia attending Hospitals in Kampala, Uganda to assess and compare levels of erythrocytes and red cells indices of dementia subjects with non-demented control group.
Anaemia is defined by World Health Organization as a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal (WHO,2025) There is a reduction of haemoglobin (Hb) concentration in the blood of an individual to a level below 11g/dl. Anaemia is a public health concern that affect majorly young children and pregnant women in resource-poor countries (WHO,2001). Anaemia is very common in after age 65 years, accounting for 4.2% (Nilsson -Ehla et al.,2000) to 28% (Atti et al.,2006) when WHO criteria are applied in different gender and age group. Anaemia has consequences for human health as well as social and economic development.
For older persons the criteria for anaemia may not be as widely accepted as for younger people. The haemoglobin concentration is lower on average in people of older age and could therefore necessitate an adjustment of the criteria set by WHO. On the other hand, the decline in haemoglobin concentration during aging is small and may not require unique criteria. (Nilsson -Ehla et al.,2000). Although cross-sectional studies found an association between anaemia and dementia longitudinal studies provided contradictory results(Atti et al.,2006) Anaemia is one of the most common nutritional deficiency diseases observed globally and affects more than a quarter of the world’s population (WHO/CDC, 2018). Anaemia affects 1.62 billion people (25%) globally, whereby 56 million are elderly (Atti et al.,2006) Currently, there is limited local data on laboratory specific studies and factors associated with anaemia in dementia in Uganda.
The hemoglobin test results were categorized into mild, moderate, and severe anaemia based on WHO guidelines: Mild anaemia: Hemoglobin levels between 10.0–10.9 g/dL Moderate anemia: Hemoglobin levels between 7.0–9.9 g/dL and Severe anemia: Hemoglobin levels below 7.0 g/dL. WHO defined Dementia as a group of disorders characterized by a decline from a previously attained cognitive level that affects activities of daily living and social functioning (WHO,2023)
Dementia is a clinical syndrome that affects memory, thinking, behaviour and ability to perform everyday activity. (Alzheimer’s Association,2023;WHO,2023) 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.
WHO defined Dementia as a group of disorders characterized by a decline from a previously attained cognitive level that affects activities of daily living and social functioning (WHO,2023). Among many causes of dementia are hypothyroidism, chronic alcohol abuse, brain tumours,subdural hematomas, psychiatric depression, traumatic brain injury, infections (HIV and Syphilis), vitamin deficiencies, cardiovascular diseases and chemotherapy related cognitive dysfunction(Khalil et al,2021)
Various disorders impact memory, cognition, behaviour, and daily activities; they are together known as dementia (WHO,, 2023). Memory and language are two of the cognitive areas that suffer reductions, leading to diminished functioning; nonetheless, awareness, alertness, and attention is unaffected. (Oh and Rabins, 2019).Very elderly people may show dementia symptoms which include losing tract of time, forgetting recent events, difficulty in solving problems or making decision, it is not part of normal ageing (Fynat,2018). Llibre-Rodríguezes et al. 2017, reported that disability, dependency and other abnormalities seen among older people in Latin America, are majorly caused by dementia.
Dementia affects an estimated 55 million individuals globally, with the World Health Organization reports that around 10 million new cases are diagnosed annually. (WHO, 2023) projections. The increasing incidence of chronic illnesses and the aging population are projected to cause a substantial rise in the burden of dementia in Low-Middle income countries.(LMICs) across the African, Asian, and Latin American continents (UNDESA, 2015)
Approximately 5-8 percent of the global population aged 60 and up is affected by dementia. An estimated 2.13 million individuals in Sub-Saharan Africa were impacted by dementia in 2015, according to 2019 research by Kehoua et al. (2019) With the greatest expected growth in Eastern and Central Sub-Saharan Africa, the research predicted that the number would reach 3.38 million as of 2030 and 7.26 million as of 2050 (Kehoua et al., 2019). After cancer (2.0%), musculoskeletal illnesses (8.9%), cardiovascular diseases (5.0%), and cerebrovascular diseases (5.0%), dementia takes up the lion's share percentage of disability-adjusted life years (DALYs) for those aged 60 and above (9.5%) (Fymat, 2019).
With the rapid rise in population growth and increase in the population, dementia is on the rise among the elderly and together with other non-communicable diseases, this portends a great economic burden. Dementia is perceived as part of normal aging in Africa, therefore many people living with dementia are suffering undiagnosed or diagnosed very late due to lack of awareness. Many cardiovascular risk factors and oxidative stress have been attributed to causing Dementia. (Butterfield and Halliwell, 2019; He et al., 2020). Clinical utility have been found in Haematology parameters in patient living with demmtia in studies conducted by Akingbade et al.,2018; Khalil et al,2021 and Schrolder et al,2022,
Using the clinical practice management guideline for dementia, Shaji et al., 2018, gave the following tests used in clinical practice management to assess or exclude dementia: Complete/ Full Blood Count (CBC/FBC), Lipid Profile tests, Erythrocyte Sedimentation Rates (ESR) , liver, renal and thyroid function Tests, hormonal assay, serum level of urea, electrolytes, urine analysis, VDRL / TPHA, HIV, Calcium, Vitamin B12, phosphate and folic acid assay (Shaji et al., 2018).
Available findings from multiple studies show that there is a need to further study blood biomarkers of relevance to dementia in Ugandan hospital setting (Ahmed et al., 2014., Kamoga et al., 2019; Lekoubou et al., 2014).
Musisi et al.,2008) Nakasujja et al., 2007 and Namuli,2015) reported that data on studies conducted on dementia in Uganda were limited and there were needs to carry out more research in this area. This present study therefore assessed some haematological parameters of potential relevance to people living with dementia in Uganda.
This study was conducted to determine association of anaemia with dementia using haematological profile of patients attending elected referral Hospitals in Kampala,Uganda Hypotheses Objectives - H1: Alternative /Research Hypothesis There is a significant (positive or negative) association between anaemia and dementia. H0: Null Hypothesis There is no association between anaemia and dementia
Materials and Equipment
Mindray Haematology Autoanalyzer, Table top high-speed haematocrit centrifuge (Max Speed = 16000 rev/min); Refrigerator, Freezer, Syringes and needles, cotton wool, gloves, blood vacutainer bottles, test tubes, Potassium EDTA anticoagulant bottles, Haematology auto-analyser reagents, 70% alcohol swab.
Study Design, Setting and Population
A case-control study was conducted to assess some Haematological parameters as possible diagnostic biomarkers of anaemia among Dementia patients attending Mulago and Kiruddu National Referral Hospitals, Kampala between January and December.2024. Dementia cases were selected from the population of people living with dementia undergoing treatment at the Psychiatric and Neurology clinics of Mulago and Kiruddu National Referral Hospitals. Participants for the control group were selected from three different hospitals in Kampala, Uganda. These are Lubaga, Mengo, and Nsambya Hospitals.
Figure 1: Showing Map of Study area where the research was conducted in Kampala, Uganda.
Figure 2: Flow diagram for participant’s selection
Participants were people living with dementia who visited the research locations (Mulago, Kiruddu, Lubaga, Mengo and Nsambya Hospitals) during the study period (January,2024-December,2024) and who fulfilled all inclusion criteria.
Study Population
All Ugandans afflicted with dementia who visited the research locations (Mulago, Kiruddu, Lubaga, Mengo and Nsambya Hospitals) during the study period January, 2024-December, 2024) and who fulfilled all inclusion criteria.
Eligibility Criteria
Inclusion Criteria
Clinical diagnostic and cognitive testing for dementia measured by Mini Menta State Examination (MMSE) and screened by Blessed Dementia Scale (BDS)
Exclusion Criteria
The research excluded: participants, hospital based, 50 years and above who declined to participate.
Armitage, Berry, and Mathew (2008) presented a method for determining the sample size of comparison groups. In particular, the researcher determined dementia patient sample size using this formula:
n = Z² pq
d²
Sample size = n
Z= standard normal deviation, generally 1.96 (95% confidence level).
Value at 95% confidence interval (1.96)
p=Local prevalence of condition (5% or 0.05) (WHO,2019)
q=1-p, the desired confidence level
d=Error margin (5% or 0.05) or Level of accuracy
Therefore, n = 1.96² x 0.05 x 0.95
0.0025
n = 3.84x 0.05x0.95
0.0025
n = 0.182476
0.0025
n = 72.99 =73
78 participants were selected as cases to cater for attrition and loss to follow up and 78 age and sex matched control group was also selected.
Type of test: two-sided test
Experimental and Techniques
Sampling Procedure and testing
Blood samples of dementia patients were collected from Mulago and Kiruddu Hospitals. Venous blood samples of the dementia and control group were collected aseptically by the researcher using graduated syringes of 10ml. This blood was distributed into Sodium EDTA anticoagulant vacutainer bottles; which was analyzed for levels of erythrocytes, leucocytes and platelets through the Complete Blood Count (CBC) test. The EDTA samples which had whole blood were analyzed immediately. The analysis was carried out at Makerere University Biochemistry Laboratories, Kampala,Uganda and Islamic University Medical Centre Laboratory using Mindray Haematology Analyzer.The parameters in included in Complete Blood Count (CBC) are: Haematocrit,Red Blood Cells(RBC) Count, White Blood Cells(WBC) MCV,MCH,MCHC, Platelets, Mean Platelet Volume, Platelet Distribution Width, Haemoglobin, Absolute and differential Neutrophil count Absolute and differential MID (Eosinophil Basophil and Monocytes) and Absolute and differentia Lymphocytes .The tests with outrageous values or outliers were repeated for the reliability of results and quality control.
Data Collection and Analysis
Social demographic data was collected for information on age, sex, marital status , residence, religion affiliation .The descriptive statistics including frequencies, mean values, minimum and maximum values were analyzed using STATA version 14.0.Each parameter of CBC in the cases and control groups were compared with normal range.Fishers Exact test and Odd ratios were carried out to establish association of social demographic characteristics and biomarkers with dementia.
Statistical Analysis
A t-test was applied to see the significance of difference between dementia patient group with the control group. For each CBC parameter, p-value of less than 0.05(p<0.005) was considered the significant.
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