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Prevalence of dementia in an urban population in Kerala, India

  • S. Shaji (a1), Srija Bose (a2) and Abraham Verghese (a3)
Abstract
Background

Dementia is emerging as an important health problem of elderly people in India.

Aims

To investigate the prevalence, psychosocial correlates and risk factors of various dementing disorders in an urban population in Kerala, southern India.

Method

A door-to-door survey was conducted in the city of Kochi (Cochin) to identify residents aged ?65 years using cluster sampling. Of 1934 people screened with a vernacular adaptation of the Mini-Mental State Examination, all those scoring at or below the cut-off of 23 were evaluated further and those with confirmed cognitive and functional impairment were assigned diagnoses according to DSM–IV criteria. Identified cases were categorised by ICD–10 criteria. Ten percent of those screened as negative were evaluated at each stage.

Results

Prevalence of dementia was 33. 6 per 1000 (95% Cl 27.3–40.7). Alzheimer's disease was the most common type (54%) followed by vascular dementia (39%), and 7% of cases were due to causes such as infection, tumour and trauma. Family history of dementia was a risk factor for Alzheimer's disease and history of hypertension was a risk factor for vascular dementia.

Conclusions

Dementia is an important health problem of the elderly population. Identification of risk factors points towards the possibility of prevention.

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Copyright
Corresponding author
Dr S. Shaji, Bethsada Hospital, Vengola PO, PIN 683 554, Ernakulam District, Kerala, India
Footnotes
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Declaration of interest

None. Funding detailed in Acknowledgements.

Footnotes
References
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Prevalence of dementia in an urban population in Kerala, India

  • S. Shaji (a1), Srija Bose (a2) and Abraham Verghese (a3)
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eLetters

Prevalence of dementia in an urban population in Kerala, India

Sunny T Varghese, Resident
25 February 2005

Shaji et al (2005) have estimated the prevalence of dementia in an urban population of Kerala, India and have provided a glimpse into the various factors associated with dementia in their study. A few methodological issues of the study would need further clarification.

Although a cut off score of 23 was taken in the MMSE for all the subjects, a different cut off score would have been appropriate among the illiterates (11.2%) as educational status has been shown to affect the MMSE scores .

Although one case of dementia was missed in the 10 % of negatively screened population, the addition of 10 more cases to the final number of 56 cases seems to have inordinately escalated the final figures. In that case, the final number of dementia cases should have been 66 instead of 65as described in the study.

With no objective evidence to suggest hypertension in the patients other than the verbal account of the caregivers, the very high odds ratio for hypertension is misleading. Further more with such a small number of subjects, the selection of the controls should have been more stringent. It would be advisable to take more number of controls for such a small sample size of patients with vascular dementia (n=22).

Although age has been shown to be a risk factor for dementia in many studies, how this conclusion was reached in this study is not clear.

Another issue of how the number of patients on treatment for Alzheimers dementia (21 out of 31) is more than the total number of alzheimers dementia detected in the study (n=30) also needs to be addressed.

Despite a few limitations the study adds to the growing literature ofthe epidemiology of dementia in developing countries and would be helpful for health care planners for adequate resource allocation for preventive and curative services.
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Conflict of interest: None Declared

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