State of the Places of Senile Dementia in the Old Hospice of the City of Lubumbashi

The objective of this study was to describe the state of the scene of senile dementia in an intra-institutional environment in the city of Lubumbashi. We conducted a descriptive cross-sectional study, over a period of three months, from February 20 to May 20, 2016. The study population is made up of the residents of the 9 retirement institutions for senior citizens (old people’s home) which counts the city of Lubumbashi. Participation was voluntary with informed consent duly signed by the patient. The probable cases of dementia were detected through the CSI-D and the 5-word test. A predominance of Alzheimer’s was noted (76.92%) and most of them were widowed (69.23%). The mean age of the dementia population was 76.46 ± 9.87 years, while (69.23%) of the patients were out of school. In (23.08%) cases demented patients were male, with a sex ratio of 0.3. Nearly (46.15%) of the demented were drinking. It appears that (69.23%) of the dementias were hypertensive. There are associations between different risk factors and the presence of dementias. Alcohol with an OR (Odd Ratio) = 0.08 (95% CI [0.01 - 0.72], p < 0.05). In our environment, our results indicate a different situation with a much higher prevalence.

of at least one of the following functions: language, calculation, judgment, abstract thinking, praxies, gnosies, or modifications of the personality [1]. APA, for its part, characterizes dementia as an insidious and progressive syndrome characterized by multiple deficits, at the head of which necessarily include memory disorders. Memory problems must be accompanied by at least one other type of deficit (language, praxis, gnosis or executive function). These cognitive deficits must be a decline compared to previous abilities and they must compromise the professional or social activities of the person. Finally, they must not be linked to delirium or psychiatric illness [2] [3] [4]. Dementias can be classified according to two degenerative types (Alzheimer's disease, frontotemporal dementia, Lewy body dementia) or nondegenerative (vascular, traumatic, infectious, toxic and metabolic). The dementia of old people is for the most part represented by Alzheimer's disease and vascular dementia. AD is the most common neurodegenerative dementia, it is predominantly cortical. It is the leading cause of dementia in the elderly. It can be defined as a progressive, global and homogenous alteration of cognitive functions, vegetative functions and motor functions, in a picture of loss of autonomy and social "disintegration" of the subject of slow but inexorable evolution. The diagnostic criteria established for AD are those of NINCDS-ADRDA. These criteria have recently been revised by Dubois et al. [5].
Vascular dementia is the second most common type of dementia in the elderly.
The diagnosis can be based on the patient's history, on the modified Hachinski score and also on the NINCDS-AIREN criteria. The objective of this study was to describe an inventory of senile dementia in an institutional setting in the city of Lubumbashi.

Patients
The study population is made up of the residents of the 9 pension institutions for senior citizens (old people's home) that the city of Lubumbashi has. Participation was voluntary with informed consent duly signed by the patient.

Methods
We conducted a descriptive cross-sectional study over a period of three months, from February 20 to May 20, 2016. Our study parameters were socio-demographic and medical history (including a history of cardiovascular disease and head trauma), psychiatric and family, as well as current medical treatment if available; the probable cases of dementia were detected through the CSI-D [4] and the 5-word test [5]. During screening, a medical examination was performed to collect certain variables such as: Blood pressure with measurement of systolic and diastolic pressures (mmHg) to detect possible hypertension (hypertension); the weight (kg) and the height (cm), which will make it possible to calculate the Body Mass Index (weight/height 2 ), classified in the following way: BMI < 18.5 kg/m 2 (under-weight), 18.5 ≤ BMI ≤ 24.9 kg/m 2 (normal weight), 25.0 ≤ BMI ≤

Results
We had a general population of 83 inmates, 62 (74.70%) of whom signed their agreements for participation in the study. After a medical examination, the CSID test, the 5-word test, the application of the diagnostic criteria DSM IV and NINCDS-ADRDA, we selected 13 demented subjects, i.e. (20.97%) of the surveyed population.
After applying the NINCDS-ADRDA diagnostic criteria and the Hachinski score, we noticed a probable predominance of Alzheimer's with 10 out of the 13 cases, a relative frequency of (76,9%) and the most of them were widowed (69.2%) ( Table 1).

Age and Schooling of Patients
The prevalence of dementia decreases with age, 7 demented subjects, i.e.
(53.85%), was between 64 and 72 years old. The mean age of the demented population is 76.5 ± 9.8 years and of the 13 demented subjects, 9 (69.2%) were out of school.

Anamnestic Data of Patients
In (23.08%) cases demented patients were male, with a sex ratio of 0.3. Nearly

Intra-Institutional Prevalence of Dementia
The frequency of institutional dementia (in old people's homes) was 13 out of a total of 62. This is a relative frequency of (20.97%). Molero, on the Caribbean coast of Venezuela found that the prevalence of dementia of all types was 10.3% in the over-65s [6]. In India, the prevalence is even lower in the city of Chennai, lower at 1% [7] and in Egypt, the gross prevalence of dementia of all types was 6.0% [8]. In our study, the figures are higher than the other studies. This difference is probably due to the methodology used.

Typing of Dementia
Alzheimer was predominant in our study with 10 out of 13 cases, a relative frequency of (76.92%); followed by vascular dementia with (

Age, Sex and Schooling
The prevalence of dementia decreases with age, 7 demented subjects (53.85%), is between 64 and 72 years old. The mean age of the demented population is 76.46 ± 9.87 years, the median age is 76 years, and the extreme ages are 65 and 96 years. This corroborates the observations of etGuerchet who found that 59% of the total population of his 4 studies was 65 to 74 years old, the overall average age was 73.9 ± 7.4 years [9]. Decrease cases of advanced dementia could be explained by Anne-Claire Samba's study which shows that demented subjects have a higher risk of death. This risk is 2.5 times higher compared to normal subjects (HR = 2.53, 95% CI: 1.42 -4.49, p = 0.001) and increased with age and severity of the disease [10]. In contrast, Farrag notes that the prevalence of dementia and AD increased with age, however, the doubling of dementia prevalence by 5-year-olds was only observed after 75 years [8].  [13] and 0.70 according to Guerchet [9]. In contrast, Farrag et al., in 1998, in Egypt found a sex ratio M/F of 1.05 [8]. In our study population, illiteracy is predominant in 9 subjects against 13 who studied. That is a frequency of 69.23%, of individuals who have never been to school. Guerchet found a lower rate than us 57% of those older subjects had never been to school [9] and Farrag finds that in Egypt, prevalence was affected by the subjects' level of education [8].
In South America, illiteracy or a low level of education is correlated with the cases of dementia encountered according to Llibre Rodriguez et al., 2008 [7].

Multivariate Analyzes
In our cohort, alcohol appears to be a protective factor. Subjects who regularly In Senegal, the prevalence of dementia in the population was 6.6%, it increased with age and was not influenced by sex or marital status. The risk factors identified were age, poor weekly contact with loved ones, stroke, epilepsy, and family history of dementia. Among the Yorubas, the risk factors for AD were age and female sex, while reporting a medical history of hypertension seemed protective.
Age was also an associated risk factor for AD in African Americans and life in rural areas before age 19, but regular alcohol consumption appeared to be protective [13] [16]. Finally, Guerchet in a study conducted in Central Africa, Benin and the Republic of Congo, shows that the variables significantly and independently associated with dementia were age, sex, a body mass index of less than 18.5 kg/m 2 , the existence of anxiety disorders and depressive symptoms at the time of the study [8].

Conclusions
In our environment, our results indicate a different situation with a much higher prevalence. Also, some factors studied, such as: history of alcoholism, hypertension, moving to a home and change of financial status are associated with dementia, reflecting the multifactorial origin of these neurodegenerative disorders. The identification of modifiable risk factors such as social inclusion here opens the door to opportunities for preventive strategies that focus on the creation of recreational facilities for older people.
It is therefore clear that senile dementia is a public health problem, and further studies in the general population could broaden knowledge about the epidemiology of dementias in our environment.