Few studies have examined the associations of various factors with mild cognitive impairment/dementia across different regions in India. This has been summarised in Table 6.4.

Table 6.4.

Associations with MCI/ dementia	City/State Study was conducted	Description
Gender	All states, India	The GBD 2019 study provides a state wise prevalence of dementia across India, demonstrating that the prevalence of dementia is consistently higher in females than males (India State-Level Disease Burden Initiative Neurological Disorders Collaborators, 2021)
Hypertension and diabetes	Kolkata, West Bengal	Community-based study identified risk factors for mild cognitive impairment (MCI) to be hypertension and diabetes mellitus (Das et al., 2007).
	Ernakulam, Kerala	A univariate analysis done as part of another comparative study showed that hypertension had a significant association with dementia (Lalu et al., 2018).
Obesity	New Delhi, Delhi	Most participants (68%) with vascular dementia were obese in a study conducted in memory clinic of a tertiary care hospital. The study concluded that obesity is common in persons with vascular dementia and needs to be addressed as it can independently contribute to vascular dementia (Chandra and Anand, 2015).
	New Delhi, Delhi	A case control study identified higher BMI to be associated with greater risk for dementia (Tripathi et al., 2012).
Hearing Loss	Ernakulam, Kerala	A univariate analysis as part of a comparative study of risk factors in dementia patients and control group found hearing loss to be a risk factor for dementia (Lalu et al., 2018).
Education (association with dementia shows mixed results)	Ernakulam, Kerala	A univariate analysis as part of a comparative study of risk factors for dementia patients and a control population found a significant association between dementia and education (Lalu et al., 2018).
	Hyderabad, Telangana	Examination of cases records of 648 dementia patients showed relationship between dementia and education is context-dependent, influenced by LSES, CVD and bilingualism (Iyer et al., 2014).
	Hassan district, Karnataka	A higher prevalence of dementia was found among illiterates (7.4%) (Sumana et al., 2016).
Depression	Ludhiana, Punjab	Cognitively impaired older adults were found to be 3 times at risk of developing depression and furthermore depression was associated with cognitive impairment (Sengupta and Benjamin, 2015).
Low socioeconomic status	Ludhiana, Punjab	Poverty and illiteracy were reported to be associated with cognitive impairment (Sengupta et al., 2014).
Smoking	Kolkata, West Bengal	Inhaling and chewing of tobacco— was a risk factor among dementia patients when compared to the control population in an epidemiological study of mild cognitive impairment (Das et al., 2007).
	Kerala	Smoking was identified to be associated with vascular dementia in an epidemiological study of dementia prevalence in rural Kerala (Shaji et al., 1996).
Physical inactivity	Ernakulam, Kerala	Univariate analysis has demonstrated poor levels of physical activity have been identified as an independent risk factor for dementia (Lalu et al., 2018).

Source: (Das et al., 2007; India State-Level Disease Burden Initiative Neurological Disorders Collaborators, 2021; Iyer et al., 2014; Lalu et al., 2018; Sengupta et al., 2014; Sengupta and Benjamin, 2015; Shaji et al., 1996; Sumana et al., 2016)

In addition, a cross-sectional study of potentially modifiable risk factors for dementia reported less education, hearing impairment, depression, and physical inactivity, in particular, to be associated with increased odds of dementia in India (Belessiotis-Richards et al., 2021).

The risk factors in Table 6.4 are similar to previously identified potentially modifiable risk factors (low education in early life, mid-life hearing loss, mid-life hypertension, mid-life obesity, later-life smoking, later-life depression, later-life physical inactivity, later-life social isolation and later-life diabetes) for dementia, which, if addressed, may delay up to 41% of dementia in India (Mukadam et al., 2019).

References:

Chandra, M., & Anand, K. S. (2015). Obesity in Indian subjects with vascular dementia. International Journal of Advances in Medicine, 2(2), 147.

Belessiotis-Richards, C., Livingston, G., Marston, L., & Mukadam, N. (2021). A cross-sectional study of potentially modifiable risk factors for dementia and cognitive function in India: A secondary analysis of 10/66, LASI, and SAGE data. International journal of geriatric psychiatry, 37(2), 10.1002/gps.5661. Advance online publication. https://doi.org/10.1002/gps.5661

Das, S. K., Bose, P., Biswas, A., Dutt, A., Banerjee, T. K., Hazra, A. M., …& Roy, T. (2007). An epidemiologic study of mild cognitive impairment in Kolkata, India. Neurology, 68(23), 2019–2026. https://doi.org/10.1212/01.wnl.0000264424.76759.e6

India State-Level Disease Burden Initiative Neurological Disorders Collaborators (2021). The burden of neurological disorders across the states of India: The Global Burden of Disease Study 1990-2019. The Lancet. Global health, 9(8), e1129–e1144.

Iyer, G. K., Alladi, S., Bak, T. H., Shailaja, M., Mamidipudi, A., Rajan, A., … & Kaul, S. (2014). Dementia in developing countries: Does education play the same role in India as in the West? Dementia & Neuropsychologia, 8(2), 132–140. https://doi.org/10.1590/S1980-57642014DN82000008

Lalu, J. S., Vijayakumar, P., George, S., Nair, A. V., & B., A. (2018). Risk factors of dementia: a comparative study among the geriatric age group in Ernakulam, Southern India. International Journal Of Community Medicine And Public Health, 5(2), 544. https://doi.org/10.18203/2394-6040.ijcmph20180117

Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., … & Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413-446.

Mukadam, N., Sommerlad, A., Huntley, J., & Livingston, G. (2019). Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data. The Lancet Global Health, 7(5), e596-e603.

Sengupta, P., & Benjamin, A. I. (2015). Prevalence of depression and associated risk factors among the elderly in urban and rural field practice areas of a tertiary care institution in Ludhiana. Indian journal of public health, 59(1), 3. https://doi.org/10.4103/0019-557X.152845

Sengupta, P., Benjamin, A. I., Singh, Y., & Grover, A. (2014). Prevalence and correlates of cognitive impairment in a north Indian elderly population. WHO South-East Asia journal of public health, 3(2), 135-143. https://doi.org/10.4103/2224-3151.206729

Shaji, S., Promodu, K., Abraham, T., Roy, K. J., & Verghese, A. (1996). An Epidemiological Study of Dementia in a Rural Community in Kerala, India. British Journal of Psychiatry, 168(6), 745–749. https://doi.org/10.1192/bjp.168.6.745.

Sumana, M., Sreelatha, C.Y., Sreeranga, A., Arpitha,B., Akshatha, S., & Anand, H. (2016). Prevalence of dementia and other psychiatric morbidities among geriatric population of Salagame primary health centre in Hassan district, Karnataka, India. International Journal of Community Medicine and Public Health, 3(5), 1315–1317. https://doi.org/10.18203/2394-6040.ijcmph20161404

Tripathi, M., Vibha, D., Gupta, P., Bhatia, R., Srivastava, M.V.P., Vivekanandhan, S., Bhushan Singh, M., Prasad, K., Dergalust, S., Mendez, M.F. (2012). Risk factors of dementia in North India: a case–control study. Aging Ment. Health 16, 228–235. https://doi.org/10.1080/13607863.2011.583632