OF DEMENTIA AMONG URBAN INHABITANTS OF VARANASI DISTRICT, U.P., INDIA
Poddar K. 1, Singh A. 1,
Kant1S., Singh T.B. 2, Srivastava N.K. 3
Neurology Centre, Varanasi, U.P., India.
Professor, Division of Biostatistics, Department of Community Medicine, IMS,
BHU, Varanasi, U.P., India.
3. Research scholar, Division of Biostatistics, Department of Community
Medicine, IMS, BHU, Varanasi, U.P., India.
Dementia is a major health problem among
elderly. Dementia is an umbrella term for a variety
of brain disorders. Symptoms include loss of memory, confusion in taking
judgment and making sequencing of reasoning, and changes in mood and behaviour.
Several studies showed the prevalence of Dementia which varies between 3
to 8% in urban areas.
The objective of this paper is to
find out the significant risk factors for dementia and its distribution among
urban inhabitants in Varanasi.
The study area was neurological
centre add and its catch up areas. It is a cross-sectional study. Data is
collected with pre-designed, pre-tested and structured schedule method. Complete
enumeration was done for elderly ≥50 years from the study area. To screen the
dementia Hindi Mental State Examination (HMSE) was used as the instrumental tool
to find out the score of the individual and a cut off score of ≤ 23 was consider
as presence of dementia among the study subject. χ2 test was used to find
significant positive association of risk factors with dementia.
This study is based on 816 urban
inhabitants in the age of ≥50 years. The overall prevalence of dementia was
observed 3.7% ranging from 2.4% to 14.3% in the age groups of 50 – 59 and ≥
80years respectively. This shows that the prevalence of dementia increases as
age increases. The dementia prevalence in urban female was observed 4.6% as
compared to male 3.1%. The findings also support that as the educational level
increases the dementia percentage decreases. Thus, it is showed that the
educational level is highly negatively associated with disease prevalence. The
presence of personal habitual variables such as tobacco chewing, smoking, liquor
had no significant association (p> 0.05) with this morbidity. The associated
co-morbidities, e.g., hypertension, diabetes and IHD has no significant
association for dementia (P>0.05). The results of binary logistic regression
analysis showed that age, marital status and education were found significant
independent variables with odds ratio were 2.81 (95% C.I. 1.01-4.72), 2.67 (95%
C.I. 1.22-5.84) and 5.10 (95% C.I. 2.43-10.68) respectively. The stepwise binary
logistic regression analysis depicts that education was found most significant
variable followed by marital status. The value of LR test used at stepwise also
showed the significant effect of these variables.
the size of the elderly population is fast growing although it constituted only
7.4% of total population at the turn of the new millennium, i.e. census 2011.
For a developing country like
India, this may pose mounting pressures on
various socio economic fronts including old age pension outlays, health care
expenditures, social discipline, savings levels preparing the programmes etc.
This segment of population faces multiple medical and psychosocial problems.
There is an emerging need to pay greater attention to ageing-related issues and
to promote holistic policies and programmes for well being dealing with the
Dementia, Hindi Mental State
Examination (HMSE), Prevalence.
Dementia from the Latin word means ‘madness’ is
a serious loss of global cognitive ability in a unimpaired person, from beyond
of normal aging. It may be the result of brain injury or progressive, resulting
in long-term decline due to damage/disease in the body. Although dementia is
more common in the geriatric population
but it occur before the age of 65 that call early onset dementia.
The prevalence of dementia among
urban habitants of age 60 years and above was 2.7%. and prevalence of dementia
was reported to be 3.6% in the urban population of madras1,
have reported this figure as 3.4% in the rural community of Kerala.3
Among the population of age 55 years and above of a rural community in
Northern India, the prevalence rate of 8.4 per 1000 was reported.4
Considering the magnitude of this problem, it is essential to focus our
attention on the burden of this disease in the elderly population, which can
make a significant impact on our society.
1 To determine the burden of dementia among
various socio demographic & personal variables.
2 To find out the significant risk factors for
Material and methods
This Study was based on 816 subjects of aged 50
years and above residing in the urban area of Varanasi District of Uttar
Pradesh. The data was collected in two phases on the same day. In first phase, a
door to door survey was conducted to identify aged ≥50 years and to collect the
information regarding socio demographic personal variables using cluster
sampling on pre-designed and pre-tested schedule. In second phase, Hindi version
of Mini Mental State Examination was administered to know the cognitive decline
(Ganguli et al., 1995).Chi-square and student t- test were used at 5% level of
significance at two tailed test as per their suitability.
The study area is Hindi speaking
belt and the mostly used common language among the subjects was Hindi and,
therefore, the Hindi version of the Mini Mental State Examination (MMSE)
developed by the Ganguli et al 19955 was used and their standard was
maintained. This Hindi Mental State Examination (HMSE) consists of 22 items
which includes different components of intellectual capability. The examination
covers several areas of cognitive functioning, such as orientation to time and
space, attention and concentration, recognition of objects, language, function,
both comprehensive and expressive speech, motor functioning and praxis. It is
relatively simple to administer and provides a quick, brief index of the
subject's current level of mental functioning. It is a modified version of the
cut-off score of ≤23 was taken to screen the dementia cases, with a sensitivity
of 88%, specificity of 82% and with an interrater reliability coefficient of 0.9
as per reported.3
By applying the cross-sectional/
design, the data were collected in two phases on the same day. During the first
phase, all the subjects were thoroughly interviewed by a psychologist and the
background information like age, gender, education, and marital status, dietary
habits, number of family members, number of earning family members, addiction
(tobacco and alcohol) and associated co-morbidities were noted. In the second
phase, the HMSE was administered to determine the cognitive decline.
The data were entered in the MS
Excel software after completion of data collection and scrutiny. The qualitative
data was presented in the form of number and percentage. The significant
association of dementia with socio-demographic, behavioral and co-morbidity
variables was tested by the X2 test at a 5% level of significance and
at the two-tailed test. The relative risk (RR) and 95% CI were calculated for
each study variable. The statistical calculation was performed using the
Statistical Package of Social Sciences (SPSS), version 16.0.
The result of this study was based
on 816 subjects. The overall prevalence of dementia was observed to be 3.68%.
Further analysis has been performed on all subjects. The distribution of the
subjects in the age group 50-59, 60-69, 70-79 and 80 years and above was 51.5,
31.4, 14.6 and 2.5%, with a prevalence of dementia of 2.4, 3.9, 5.9 and 14.3%,
respectively, which shows that the prevalence increases with age (P<0.05, Table
1). The percentage gender distribution was 60.2 for males and 39.8 for females,
and the prevalence of dementia in males and females was 3.1% and 4.6%,
respectively, and there was a significant association between dementia and
gender(P<0.05, Table 1). 16.4% of the subjects were widows/widower and, among
them, 7.5% were suffering from dementia as compared with 2.9% among the married
subjects, i.e. more than double in widows/ widower (P<0.05, Table 1). This
result highlights that persons living without life partner had three times
higher prevalence than the married life, thus living with spouse was an
preventive measure of dementia.
Table.1. Association of Socio-demographic
variables with Dementia
HMSE SCORE ≤23
HMSE SCORE>23 No (%)
A continuous pattern of decrease
in the prevalence of dementia was observed with increase in the educational
level. The prevalence of dementia in the uneducated was 10.0%, which decreased
to a significant level of 2.4% for subjects educated up to class 5th,
then further reduced to 0.9% for high school and onwards [P<0.05, Table 2]. The
prevalence of dementia in the unemployed subjects was 4.4% as compared with 4.9%
in the self-employed, 1.5% in employed and 2.5% in retired subjects [P>0.05,
Table 2]. The total number of members in the family had not significant
association with the prevalence of the disease (P>0.05, Tbale2), subjects living
with family members less than 5, 6-7, 8-10, 11-15 and 16 and more had a
prevalence of dementia 3.1, 2.5, 4.0, 6.5 and 6.1%, respectively. The total
number of earning members in the family had no significant association with the
prevalence (p>0.05, Table2).
Table.2. Association of Socio-economic variables
HMSE SCORE <=23
The type of diet had no significant association
(P>0.05), as Table 3 shows that the prevalence of dementia among vegetarians was
4.2% as compared with 2.8% among non-vegetarians. Tobacco chewing and smoking
had no significant association (p>0.05, Table3). The proportion of subjects with
co-morbidities of hypertension and diabetes was 34.6 and 17.4, with prevalence
of dementia of 4.3 and 3.5, respectively. These disease had no significant
association (P>0.05) [Table3].
Table.3. Association of Personal habit and co-
morbidity with Dementia
PERSONAL HABITS AND CO- MORBIDITIES
HMSE SCORE ≤23
The findings of multiple binary logistic
regression analysis have been shown in Table 4 in which only those variables
were included which was found statistically significant at univariate analysis.
The above table depicts that age, marital status and education were found
significant independent variables for dementia with odds ratio 2.81, 2.67 and
5.10, respectively. Among these variables education status and marital status
were observed statistically significant
Table.4. Multiple binary logistic
95% C.I. for odds
The results of stepwise binary
logistic regression analysis are shown in Table 5. The most significant variable
was observed as education status of the subjects with odds ratio 5.10 and 95%
C.I. (2.43-10.68). In the next step marital status was found significant
variable. The values of LR tests used at stepwise also showed the significant
effect of these variables.
Table.5. Stepwise binary logistic
95% C.I. for odds
The extensive studies from developed countries
have provided a range of prevalence between 3.8 to 10% in the age- group of
above 65 years of age.7,8Very few studies are available from
developing countries. Several community based urban and rural studies have been
reported on dementia from different part of India, with a varying range of
prevalence from 1.02% to 4.86% in the age-group 55-65 years and above.1-4,9-12The
findings of our study show that the prevalence of dementia was 3.68%, which was
higher in comparison with other Indian studies, but is consistent with other
studies of Asian and western countries. In a study found that higher prevalence
of dementia of 6.5% among the Kashmiri migrants of age groups 65 years and
above. .13 It was ranging between 8 and 15% in the age-group of 70
years and above. In our study, the prevalence of dementia in female was 4.6 and
in male it was 3.1, i.e. prevalence was more in female than that of male, which
is comparable with other studies.13 This may be due to better care
given to males as compared with females, as the study area was predominantly a
male-dominant society. The marital status also had a significant impact on the
prevalence of dementia. Widows/Widower/Unmarried showed more than double
prevalence as compared with married life living subjects. This may be due to a
better social life in married subjects, although this has not been reported in
other studies and needs more evaluation. The prevalence rates among uneducated
and educated up to class 5th were 10.0 and 2.4%, respectively in our
study. This shows that education, even of primary level, may reduce the
prevalence of dementia at a later age. In a pilot study
with a Malayalam adaptation of the MMSE, there was no
significant difference in the total MMSE scores between the literate and the
illiterate.10 also reported
association of low education with dementia.12 In our study, we also
tried to find out an association between dementia and occupation. The prevalence
of dementia in unemployed subjects was 4.4% in comparison of 1.5% in the
employed. This needs further evaluation. Similarly, an association between types
of family and status of dementia showed a lower prevalence in joint families.
This is possibly because of a healthier atmosphere and number of helping members
in the family, which strengthens the relevance of Indian culture in the study.
This has not been reported in any other study from developing or developed
nations. Diet, tobacco chewing, smoking and concomitant diseases had no
significant association with dementia.
In joint family, the carrying of each member
specially seniors in the family was better as compared to nuclear family because
work sharing concept was present among family members, thus they had time to
spent leisure time with other family members. In
the size of the elderly population is fast growing. In 2010, there are 3.7
million Indians with dementia and this is expected to double by 2030.15
for a developing country like
India, this may pose mounting pressures on
various socio economic fronts including old age pension outlays, health care
expenditures, social discipline, saving levels etc. Again this segment of
population faces multiple medical and psychological problems. There is an
emerging need to pay greater attention to ageing related issues and to promote
holistic policies and programs for well basing dealing with the ageing society.
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