Paddick Stella-Maria, Longdon Anna, Gray William K, Dotchin Catherine, Kisoli Aloyce, Chaote Paul, Walker Richard
Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK.
Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
Dement Neuropsychol. 2014 Apr-Jun;8(2):117-125. doi: 10.1590/S1980-57642014DN82000006.
The majority of people with dementia worldwide live in developing countries. Studies from the developed world have reported an association between lower educational attainment and dementia, but there are few data from the developing world where literacy and educational levels are frequently much lower. In this study we assessed the association between education and dementia prevalence in a rural Tanzanian setting.
In phase I, 1198 individuals aged 70 and over were assessed using the Community Screening Instrument for Dementia (CSI-D). In phase Ii a stratified sample of those seen in phase I were fully assessed and a clinical diagnosis based on DSM-IV criteria was made where appropriate. Information regarding literacy, highest attained educational level and occupation were also collected.
The median subject cognitive score on the CSI-D was 25.7 (IQR 22.7 to 28.0) for females and 27.7 (IQR 25.7 to 29.4) for males. This difference was significant (U=117770.0, z= -9.880, p<0.001). In both males and females a lower CSI-D subject cognitive score was significantly associated with having had no formal education (U=34866.5, z= -6.688, p<0.001, for females; U=20757.0, z= -6.278, p<0.001, for males). After adjusting for the effect of age, having no formal education was significantly associated with greater odds of having 'probable dementia' by CSI-D, as was illiteracy. Amongst those interviewed in phase II, there was no significant difference in literacy or education between those with diagnosed DSM-IV dementia and those without.
In this rural Tanzanian population, we found a significant association between low levels of education and dementia by CSI-D. This relationship was not significant in cases meeting DSM-IV criteria for dementia.
全球大多数痴呆症患者生活在发展中国家。发达国家的研究报告了较低的教育程度与痴呆症之间的关联，但在识字率和教育水平通常低得多的发展中国家，相关数据很少。在本研究中，我们评估了坦桑尼亚农村地区教育与痴呆症患病率之间的关联。
在第一阶段，使用社区痴呆症筛查工具（CSI-D）对1198名70岁及以上的个体进行评估。在第二阶段，对第一阶段中看到的个体进行分层抽样并进行全面评估，并在适当情况下根据DSM-IV标准做出临床诊断。还收集了有关识字率、最高教育水平和职业的信息。
女性在CSI-D上的受试者认知得分中位数为25.7（四分位距22.7至28.0），男性为27.7（四分位距25.7至29.4）。这种差异具有统计学意义（U = 117770.0，z = -9.880，p < 0.001）。在男性和女性中，较低的CSI-D受试者认知得分都与未接受过正规教育显著相关（女性：U = 34866.5，z = -6.688，p < 0.001；男性：U = 20757.0，z = -6.278，p < 0.001）。在调整年龄影响后，未接受过正规教育以及文盲与根据CSI-D诊断为“可能患有痴呆症”的较高几率显著相关。在第二阶段接受访谈的人群中，被诊断患有DSM-IV痴呆症的人与未患痴呆症的人在识字率或教育程度上没有显著差异。
在这个坦桑尼亚农村人群中，我们发现教育水平低与通过CSI-D诊断的痴呆症之间存在显著关联。在符合DSM-IV痴呆症标准的病例中，这种关系并不显著。
