Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data

Abstract

Background Nine potentially modifiable risk factors (less childhood education, midlife hearing loss, hypertension, and obesity, and later-life smoking, depression, physical inactivity, social isolation, and diabetes) account for 35% of worldwide dementia, but most data to calculate these risk factors come from high-income countries only. We aimed to calculate population attributable fractions (PAFs) for dementia in selected low-income and middle-income countries (LMICs) to identify potential dementia prevention targets in these countries. MethodsThe study was an analysis of cross-sectional data obtained from the 10/66 Dementia Research surveys of representative populations in India, China, and six Latin America countries (Cuba, Dominican Republic, Mexico, Peru, Puerto Rico, and Venezuela), which used identical risk factor ascertainment methods in each country. Between 2004 and 2006 (and between 2007 and 2010 for Puerto Rico), all residents aged 65 years and older in predefined catchment areas were invited to participate in the survey. We used risk factor prevalence estimates from this 10/66 survey data, and relative risk estimates from previous meta-analyses, to calculate PAFs for each risk factor. To account for individuals having overlapping risk factors, we adjusted PAF for communality between risk factors, and used these values to calculate overall weighted PAFs for India, China, and the Latin American sample.Findings The overall weighted PAF for potentially modifiable risk factors for dementia was 39•5% (95% CI 37•5-41•6) in China (n=2162 participants), 41•2% (39•1-43•4) in India (n=2004), and 55•8% (54•9-56•7) in our Latin American sample (n=12 865). Five dementia risk factors were more prevalent in these LMICs than worldwide estimates, leading to higher PAFs for dementia: less childhood education (weighted PAF of 10•8% in China, 13•6% in India, and 10•9% in Latin America vs 7•5% worldwide),

Longitudinal measurement invariance of neuropsychological tests in a diverse sample from the ELSA-Brasil study

“…13 Although longitudinal studies from developed countries have assessed the association between risk factors and cognitive decline, these risk factors might have distinct profiles and distributions in LMIC. [33][34][35][36] It is important to consider socioeconomic and sociocultural aspects when designing studies to investigate risk factors for cognitive decline to promote more effective local public policy. Our results indicate that the longitudinal ELSA-Brasil findings can contribute reliable results, as shown in other studies from developed countries.…”

Effect of Poor Glycemic Control Incognitive Performance Inthe Elderly With Type 2 Diabetes Mellitus: The Mexican Health and Aging Study

“…As type 2 DM control is one of the strongest modi able comorbidities that affect brain function, hypertension and obesity are equally relevant risk factors to target. Since currently there are no therapies to cure dementia, the treatment of modi able risk factors should be emphasized 2,3 .…”

“…The increasing prevalence of diabetes in the population will lead to a higher number of people with diabetes-related cognitive impairment. For this reason, efforts to control not only type 2 DM, but hypertension, depression and other risk factors are essential for dementia prevention around the world 2,3 .…”

Global Mapping of Interventions to Improve Quality of Life of Patients with Alzheimer’s Disease during 1990–2018

“…As can be seen from the previous literature, the incidence of AD frequently remains unreported, despite the growing number of older adults in these countries. This observation could be due to an underestimation by traditional psychiatric diagnosis based on, e.g., the Diagnostic and Statistical Manual (DSM) [38][39][40][41]. Moreover, most people with severe AD live in low-and middle-income countries where the health facilities for diagnosing and managing AD remain insufficient.…”