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      Identifying risk for dementia across populations: A study on the prevalence of dementia in tribal elderly population of Himalayan region in Northern India

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          Abstract

          Introduction:

          Studies have suggested that dementia is differentially distributed across populations with a lower prevalence in developing regions than the developed ones. A comparison in the prevalence of dementia across populations may provide an insight into its risk factors. Keeping this in view, a study was planned to evaluate the prevalence of dementia in tribal elderly population.

          Materials and Methods:

          A cross-sectional comprehensive two-phase survey of all residents aged 60 years and older was conducted. Phase one involved screening of all individuals aged 60 and above with the help of a cognitive screen specifically developed for the tribal population. Phase two involved clinical examination of individuals who were suspected of dementia as per the developed cognitive screening test.

          Results:

          The results revealed that no individual above 60 years of age in the studied population was diagnosed as a case of dementia. Thereby, pointing out at some unknown factors, which are responsible for prevention of dementia.

          Discussion:

          The differences between the prevalence rate in this study and other studies in India appear to be a function of a valid regional difference. Environmental, phenotypic and genetic factors may contribute to regional and racial variations in dementia. Societies living in isolated hilly and tribal areas seem less predisposed to dementia, particularly age related neurodegenerative and vascular dementia, which are the most common causes for dementia in elderly. This may be because some environmental risk factors are much less prevalent in these settings.

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          Most cited references 20

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          Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey

          Summary Background Studies have suggested that the prevalence of dementia is lower in developing than in developed regions. We investigated the prevalence and severity of dementia in sites in low-income and middle-income countries according to two definitions of dementia diagnosis. Methods We undertook one-phase cross-sectional surveys of all residents aged 65 years and older (n=14 960) in 11 sites in seven low-income and middle-income countries (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Dementia diagnosis was made according to the culturally and educationally sensitive 10/66 dementia diagnostic algorithm, which had been prevalidated in 25 Latin American, Asian, and African centres; and by computerised application of the dementia criterion from the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). We also compared prevalence of DSM-IV dementia in each of the study sites with that from estimates in European studies. Findings The prevalence of DSM-IV dementia varied widely, from 0·3% (95% CI 0·1–0·5) in rural India to 6·3% (5·0–7·7) in Cuba. After standardisation for age and sex, DSM-IV prevalence in urban Latin American sites was four-fifths of that in Europe (standardised morbidity ratio 80 [95% CI 70–91]), but in China the prevalence was only half (56 [32–91] in rural China), and in India and rural Latin America a quarter or less of the European prevalence (18 [5–34] in rural India). 10/66 dementia prevalence was higher than that of DSM-IV dementia, and more consistent across sites, varying between 5·6% (95% CI 4·2–7·0) in rural China and 11·7% (10·3–13·1) in the Dominican Republic. The validity of the 847 of 1345 cases of 10/66 dementia not confirmed by DSM-IV was supported by high levels of associated disability (mean WHO Disability Assessment Schedule II score 33·7 [SD 28·6]). Interpretation As compared with the 10/66 dementia algorithm, the DSM-IV dementia criterion might underestimate dementia prevalence, especially in regions with low awareness of this emerging public-health problem. Funding Wellcome Trust (UK); WHO; the US Alzheimer's Association; and Fondo Nacional De Ciencia Y Tecnologia, Consejo De Desarrollo Cientifico Y Humanistico, and Universidad Central De Venezuela (Venezuela).
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            Canadian study of health and aging: study methods and prevalence of dementia.

            To estimate the prevalence of dementia and its subtypes by sex and age group for five regions of Canada. Prevalence survey. Community and institutional settings in Canada, excluding those in the two territories, Indian reserves and military units. Representative sample of people aged 65 and over interviewed between February 1991 and May 1992. Those in the community (9008 subjects) were chosen randomly from medicare lists in nine provinces or from the Enumeration Composite Record in Ontario. People in institutions (1255) were randomly selected from residents in stratified random samples of institutions in each region. Screening with the Modified Mini-Mental State (3MS) Examination to identify cognitive impairment. Clinical examination of all those in institutions, those in the community with a 3MS score of less than 78 and a sample of those in the community with a 3MS score of 78 or more to diagnose dementia. Dementia and Alzheimer's disease were defined according to established criteria. Prevalence of dementia of all types, by region, sex and age group, the estimated number of cases in the population by type of dementia and the age-standardized rate per 1000 population. The prevalence estimates suggested that 252,600 (8.0%) of all Canadians aged 65 and over met the criteria for dementia (95% confidence interval [CI] 236,800 to 268,400). These were divided roughly equally between the community and institutional samples; the female:male ratio was 2:1. The age-standardized rate ranged from 2.4%, among those aged 65 to 74 years, to 34.5%, among those aged 85 and over. The corresponding figures for Alzheimer's disease were 5.1% overall (161,000 cases; 95% CI 148,100 to 173,900), ranging from 1.0% to 26.0%; for vascular dementia it was 1.5% overall, ranging from 0.6% to 4.8%. If the prevalence estimates remain constant, the number of Canadians with dementia will rise to 592,000 by 2021. These Canadian estimates of the prevalence of dementia fall toward the upper end of the ranges in other studies, whereas the estimates for Alzheimer's disease fall in the middle of the ranges. This may suggest an unusual balance between Alzheimer's and other forms of dementia in the Canadian population.
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              Prevalence of Alzheimer's disease and dementia in two communities: Nigerian Africans and African Americans.

              This article reports on a prevalence study of dementia and Alzheimer's disease among two groups of subjects with the same ethnic background but widely differing environments. The study was conducted among residents aged 65 years and older in two communities: Yorubas (N = 2,494) living in Ibadan, Nigeria, and African Americans (N = 2,212 in the community and N = 106 in nursing homes) living in Indianapolis, Indiana. The study design consisted of a screening stage followed by a clinical assessment stage for selected subjects on the basis of their performance on the screening tests. The age-adjusted prevalence rates of dementia (2.29%) and Alzheimer's disease (1.41%) in the Ibadan sample were significantly lower than those in the Indianapolis sample, both in the community-dwelling subjects alone (4.82% and 3.69%, respectively) and in the combined nursing home and community samples (8.24% and 6.24%, respectively). The prevalence rates of dementia and Alzheimer's disease increased consistently with advancing age in both study groups. To the authors' knowledge, this is the first study, using the same research method at the two sites, to report significant differences in rates of dementia and Alzheimer's disease in two different communities with similar ethnic origins.
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                Author and article information

                Journal
                Ann Indian Acad Neurol
                Ann Indian Acad Neurol
                AIAN
                Annals of Indian Academy of Neurology
                Medknow Publications & Media Pvt Ltd (India )
                0972-2327
                1998-3549
                Oct-Dec 2013
                : 16
                : 4
                : 640-644
                Affiliations
                Department of Community Medicine, Dr. R. P. Government Medical College, Tanda, Himachal Pradesh, India
                [1 ]Department of Medicine, Dr. R. P. Government Medical College, Tanda, Himachal Pradesh, India
                [2 ]NCD Division, Indian Council of Medical Research, New Delhi, India
                [3 ]Department of Psychiatry, Dr. R. P. Government Medical College, Tanda, Himachal Pradesh, India
                Author notes
                For correspondence: Dr. Sunil Kumar Raina, Department of Community Medicine, Dr. R. P. Government Medical College, Tanda, Himachal Pradesh, India. E-mail: ojasrainasunil@ 123456yahoo.co.in
                Article
                AIAN-16-640
                10.4103/0972-2327.120494
                3841618
                Copyright: © Annals of Indian Academy of Neurology

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Original Article

                Neurology

                risk, tribal, populations, dementia

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