Belessiotis-Richards Clara, Livingston Gill, Marston Louise, Mukadam Naaheed
Department of Psychiatry, University College London, London, UK.
Department of Primary Care and Population Health, University College London, London, UK.
Int J Geriatr Psychiatry. 2021 Nov 22;37(2). doi: 10.1002/gps.5661.
Dementia is rising globally, particularly in low-and-middle-income countries. India has almost four million people living with dementia, set to double by 2050. Targeting nine potentially modifiable risk factors (less education, hearing impairment, depression, physical inactivity, hypertension, obesity, smoking, diabetes, and social isolation) could possibly prevent or delay many dementias. We aimed for the first time to examine risk factors for dementia in India and their link with cognitive status and dementia, to inform prioritisation of public health interventions that could prevent or delay dementia.
We conducted a cross-sectional analysis using three studies: 10/66 Dementia Study (n = 2004), Longitudinal Aging Study of India (n = 386), and Study of Global Ageing (n = 2441). Our exposures were the nine risk factors above. We calculated a cognitive z-score within each study and used dementia diagnosis in 10/66. We adjusted for socioeconomic factors, age, and sex using multivariable linear for cognition and logistic regression for dementia.
Less education, hearing impairment, depression, and physical inactivity were associated with lower z-scores and increased odds of dementia. Obesity was associated with higher z-score and lower odds of dementia. Social isolation was associated with lower z-scores and decreased odds of dementia. Results for smoking, diabetes, and hypertension were inconsistent.
Our risk estimates were larger for less education, hearing impairment and physical inactivity compared to global estimates and should be intervention priorities. This study highlights the need for longitudinal studies to clarify the relationship between these potentially modifiable risk factors and dementia in India.
痴呆症在全球范围内呈上升趋势，尤其是在低收入和中等收入国家。印度有近400万人患有痴呆症，预计到2050年将增加一倍。针对九个可能可改变的风险因素（教育程度低、听力障碍、抑郁症、身体活动不足、高血压、肥胖、吸烟、糖尿病和社会隔离）可能会预防或延缓许多痴呆症的发生。我们首次旨在研究印度痴呆症的风险因素及其与认知状态和痴呆症的联系，以为可预防或延缓痴呆症的公共卫生干预措施的优先排序提供依据。
我们使用三项研究进行了横断面分析：10/66痴呆症研究（n = 2004）、印度纵向衰老研究（n = 386）和全球老龄化研究（n = 2441）。我们的暴露因素是上述九个风险因素。我们在每项研究中计算了认知z分数，并在10/66研究中使用了痴呆症诊断。我们使用多变量线性回归分析认知情况，并使用逻辑回归分析痴呆症情况，对社会经济因素、年龄和性别进行了调整。
教育程度低、听力障碍、抑郁症和身体活动不足与较低的z分数以及痴呆症几率增加有关。肥胖与较高的z分数和较低的痴呆症几率有关。社会隔离与较低的z分数和较低的痴呆症几率有关。吸烟、糖尿病和高血压的结果不一致。
与全球估计相比，我们对教育程度低、听力障碍和身体活动不足的风险估计更大，应将其作为干预重点。这项研究强调需要进行纵向研究，以阐明印度这些可能可改变的风险因素与痴呆症之间的关系。
