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Cognitive Function and Impairment in Older, Rural South African Adults: Evidence from “Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in Rural South Africa”
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Abstract
Background/Aims: We aimed to estimate the prevalence of cognitive impairment, and
the sociodemographic and comorbid predictors of cognitive function among older, rural
South African adults. Methods: Data were from a population-based study of 5,059
adults aged ≥40 years in rural South Africa in 2015. Cognitive impairment was defined
as scoring ≤1.5 SDs below the mean composite time orientation and memory score, or
requiring a proxy interview with “fair” or “poor” proxy-reported memory. Multiple
linear regression estimated the sociodemographic and comorbid predictors of cognitive
score, with multiplicative statistical interactions between each of age and sex with
education. Results: Cognitive impairment increased with age, from 2% of those aged
40–44 (11/516) to 24% of those aged ≥75 years (214/899). The independent predictors
of lower cognitive score were being older, female, unmarried, not working, having
low education, low household wealth, and a history of cardiovascular conditions. Education
modified the negative associations between female sex, older age, and cognitive function
score. Conclusions: The prevalence of cognitive impairment increased with age and
is comparable to rates of dementia reported in other sub-Saharan African countries.
Age and sex differences in cognitive function scores were minimized as education increased,
potentially reflecting the power of even poor-quality education to improve cognitive
reserve.