DESK REVIEWS | 06.02.01. What is the estimated prevalence and incidence of dementia and the source of these estimates?

DESK REVIEW | 06.02.01. What is the estimated prevalence and incidence of dementia and the source of these estimates?

According to the Global Burden of Disease Study 2016, the estimated prevalence of dementia in Brazil was approximately 16.9% in 2016 (GBD 2016, 2019). A systematic review conducted between 1990 and 2010 with older people aged 60 years and over found that, among high quality studies, all conducted in urban areas of São Paulo state, the prevalence of dementia ranged from 5.1% to 19.0% (Fagundes et al., 2011). Another study projected the prevalence of dementia among people 65 years and older in Brazil based on Census data (2010). The authors estimated that prevalence in the national territory would be 7.9% in 2020 (Burlá et al., 2013). There are several articles reporting prevalence measures in the literature; all of these were conducted in the south or southeast of Brazil. Therefore, there is lack of updated studies representative of the Brazilian population. The incidence rate of dementia was 13.8 per 1,000 person-years according to a study carried out in the city of Catanduva, São Paulo, with individuals aged 65 years and over (Nitrini et al., 2004). A study conducted in the city of Porto Alegre found the incidence rate of Alzheimer’s disease as 14.8 per 1,000 person-years (Chaves et al., 2009).

References:

Burlá, C., Camarano, A. A., Kanso, S., Fernandes, D., & Nunes, R. (2013). Panorama prospectivo das demências no Brasil: Um enfoque demográfico. Ciência & Saúde Coletiva, 18(10), 2949–2956. https://doi.org/10.1590/S1413-81232013001000019

Chaves, M. L., Camozzato, A. L., Godinho, C., Piazenski, I., & Kaye, J. (2009). Incidence of Mild Cognitive Impairment and Alzheimer Disease in Southern Brazil. Journal of Geriatric Psychiatry and Neurology, 22(3), 181–187. https://doi.org/10.1177/0891988709332942

Fagundes, S. D., Silva, M. T., Thees, M. F. R. S., & Pereira, M. G. (2011). Prevalence of dementia among elderly Brazilians: A systematic review. Sao Paulo Medical Journal, 129(1), 46–50. https://doi.org/10.1590/S1516-31802011000100009

GBD 2016. (2019). Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 18, 88–106. http://dx.doi.org/10.1016/S1474-4422(18)30403-4

Nitrini, R., Caramelli, P., Herrera, E., Bahia, V. S., Caixeta, L. F., Radanovic, M., Anghinah, R., Charchat-Fichman, H., Porto, C. S., Carthery, M. T., Hartmann, A. P. J., Huang, N., Smid, J., Lima, E. P., Takada, L. T., & Takahashi, D. Y. (2004). Incidence of dementia in a community-dwelling Brazilian population. Alzheimer Disease and Associated Disorders, 18(4), 241–246.

Prevalence of dementia has been reported based on several population based epidemiological studies conducted across India over the last two decades. According to the Dementia India Report 2010 (Alzheimer’s and Related Disorders of India [ARDSI], 2010) projections, an estimated 5.29 million Indian people aged over 60 have dementia. The more recent Global Burden of Disease study estimated that 3.69 million people had Alzheimer’s disease or other dementias in India in 2019 (India State-Level Disease Burden Initiative Neurological Disorders Collaborators, 2021). There is variability in reported prevalence rates ranging from 0.3% (Rodriguez et al., 2008) to 14.9% (Seby et al., 2011) among older adults, depending on the sample size, age of the cohort, geographical area considered (rural vs. urban population) and the year of the study (Table 6.1). Meta-analysis of individual studies have reported pooled prevalence estimates for dementia to range from 3.4% (95% CI = 2.0 to 5.0) to 4.4% (2.2-7.2) in India (Dhiman et al., 2021; Farina et al, 2020).

Differences in estimates may be related to the adoption of different methods and defining criteria, but differences in environmental and genetic risk factors may also contribute. Recognising the need to study dementia prevalence using a uniform method, the Government of India’s scientific research funding agency, specifically the Department of Biotechnology, has initiated a multi-centric study across rural, urban, and tribal areas to observe dementia prevalence (Bhatt, 2020).

Table 6.1 shows dementia prevalence across the country

S.No Publication Location Age of population surveyed Number

screened

Screening tool Confirmation tool Prevalence of dementia
1 Razdan et al., (1994)

Neuroepidemiology

Rural Kashmir All 63,645   Neurological examination No dementia was found
2 Shaji et al., (1996)

The British Journal of Psychiatry

Rural Kerala ≥60 years 2067 Vernacular adaptation of the Mini Mental State Examination.

 

Score of 23 and below -a detailed neuropsychological evaluation by CAMDEX-Section B.

DSM-III-R criteria for dementia

 

Subcategorisation of dementia was done based on ICD-10 diagnostic criteria

 33.9 per 1000

 

 

3 Rajkumar, Kumar and Thara (1997)

International Journal of Geriatric Psychiatry

Rural

Tamil Nadu

≥60 years 750 Geriatric Mental State schedule (GMS).   3.5%
4 Chandra et al., (1998)

Neurology

Rural

Haryana

≥55 years 5126 Hindi cognitive and functional screening instruments, developed for and validated in this population. DSM- IV

diagnostic criteria,

Clinical Dementia Rating Scale (CDR),

National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer’s Disease and Related Disorders Association (NINCDS-ADRDA) criteria.

≥55 years: 0.84%

≥65 years: 1.36%

5 Vas et al., (2001)

International Psychogeriatrics

Urban

Maharashtra

≥40 years 24,488 Self-report or interviewer-rated protocols based on the Sandoz Clinical Assessment Geriatric Scale.

 

“A score +2 SD above the mean were screened for cognitive functioning using a modified and translated version of the Mini Mental State Examination”

Detailed neurological, psychiatric, and neuropsychological evaluation as well as  laboratory investigations and other tests etc.

 

DSM-IV diagnostic criteria.

≥40 years: 0.43%

 

≥65 years: 2.44%

6 Shaji, Bose and Verghese (2005)

The British Journal of Psychiatry

 

Urban

Kerala

≥65 years 1934 Vernacular adaptation of the Mini-Mental State Examination Diagnoses according to DSM-IV criteria. Identified cases were categorised by ICD-10 criteria. 33.6 per 1000
7 Das et al., (2006)

The Indian Journal of Medical Research

Urban

West Bengal

≥50 years 52,377 National Institute of Mental Health and Neurosciences (NIMHANS) used questionnaire.

 

A modified version of

“Cognitive Battery”

used by Ganguli et al.

DSM-IV

criteria

87.82 per 100,000 population
8 Rodriguez et al.,

(2008)

Lancet

Urban/Rural

Tamil Nadu

≥65 years Urban: 1005

 

Rural: 999

10/66 dementia diagnostic algorithm and by computerised application of dementia criterion from the DSM-IV.   10/66 standardized prevalence:

 

Urban: 8.2%

 

Rural: 8.7%

 

DSM-IV dementia standardized prevalence:

 

Urban: 0.9%

 

Rural: 0.3%

9 Das et al., (2008)

The Journal of the Association of Physicians of India

Urban

West Bengal

≥60 years 5430 National Institute of Mental Health and Neurosciences (NIMHANS) developed questionnaire.

 

A modified version of

“Cognitive Battery”

developed by Ganguli et al.

DSM-IV

criteria and for “individual subtypes the standard

Definitions of NINDS-ADRDA” were used.

 

≥60 years: 7.89 per 1000 elderly

 

 

10 Banerjee et al., (2008)

Neuroepidemiology

Urban

West Bengal

≥50 years 6129 Screening questionnaire

 

Kolkata Cognitive Test Battery

DSM-IV criteria ≥50 years: 0.62%

≥60 years: 1.25%

11 Raina et al., (2008)

Annals of Indian Academy of Neurology

Migrant community cluster of Jammu city Kashmir

 

≥60 years 200 Kashmiri version of the Mini-Mental State Examination

 

A functional ability questionnaire- Everyday Abilities Scale for India (EASI)

Clinical evaluation was carried out by a neurologist.

 

Patients diagnosed with dementia  further underwent detailed laboratory investigations and MRI scan.

6.5%
12 Mathuranath et al., (2010)

International Journal of Geriatric Psychiatry

Urban

Kerala

≥55 2466 Addenbrooke’s cognition examination (ACE) (Mathuranath et al., 2000), a cognition screening battery like the CERAD screening battery.

 

An instrumental activities of daily living scale for the elderly (IADL-E)

A semi-structured family interview with family members.

 

The evaluations included:

 

a) Cognition and behavioural symptoms (over past month).

 

b) Clinical evaluation.

 

c) Neuropsychological evaluation.

 

d) Further evaluation – screening blood investigations and/or neuroimaging tests.

 

DSM-IV criteria used to diagnose dementia.

 

≥65 years: 4.86%

 

13 Saldanha et al., (2010)

Indian Journal of Psychiatry

Urban

Maharastra

≥65 2119 Mini Mental State Examination (MMSE

 

‘Cognitive test component’ of the 10/66 research groups instrument – community screening instrument for Dementia (CSI-D),

ICD-10 Diagnostic Research Criteria. ≥65 years: 4.1%
14 Seby, et al., (2011)

Indian Journal of Psychiatry

Urban Pune – Maharashtra >65 202 Hindi version Mini-Mental State Examination (MMSE)   14.9%
15 Poddar et al., (2011)

Annals of Indian Academy of Neurology

Urban and Rural

Uttar Pradesh

≥50 years 2890 Hindi version of the Mini Mental State Examination (MMSE)   5.1%
16 Raina et al., (2014)

North American Journal of Medical Sciences

Urban, Rural, Tribal Himalaya ≥60 years 2000 Hindi Mental State Examination (HMSE) Detailed clinical history.

 

Subjects examined for

cognitive or intellectual, functional, and  psychiatric or behavioural symptoms.

1.6%

 

17 Raina, Chander and Bhardwaj (2016)

Journal of Neurosciences in rural practice

Tribal Himachal Pradesh ≥60 years 481 Bharmouri Mental State Examination [BMSE] The clinical evaluation was carried out by a neurologist. No dementia
18 Banerjee et al., (2017)

International Journal of Geriatric Psychiatry

Urban Bengal ≥60 years 100,802 Two dementia pertinent questions to family members

 

Detailed clinical history

 

Kolkata Cognitive Screening Battery

DSM-IV criteria for dementia

 

 

1.53%

Table Source: (Razdan et al., 1994;  Shaji et al., 1996; Rajkumar, Kumar and Thara, 1997; Chandra et al., 1998; Vas et al., 2001; Shaji, Bose and Verghese, 2005; Rodriguez et al., 2008; Das et al., 2006; Das et al., 2007; Das et al., 2008; Raina et al., 2008; Mathuranath et al., 2010 ; Saldanha et al., 2010; Seby, Chaudhary and Chakraborty, 2011, Poddar et al., 2011; Raina et al., 2014; Raina, Chander and Bhardwaj, 2016; Banerjee et al., 2017).

Moreover, there are few studies reporting incidence of dementia in India and results are varied (Table 6.2).

Table 6.2 shows studies reporting incidence rates for dementia in India

S.No. Publication Method Screening tool Confirmation tool Incidence
1. Chandra et al., 2001, Neurology 28 villages in Haryana (North India)

2 years.

Hindi cognitive screening battery based on the Consortium

to Establish a Registry for AD (CERAD) neuropsychological

panel.

DSM-IV criteria and

the Clinical Dementia Rating scale CDR

Incidence rates per 1000 persons-years for AD: 3.24 (95% CI: 1.48-6.14) for those aged ≥ 65 years.

1.74 (95% CI: 0.84-3.20) for those aged ≥55 years.

Standardised against the age distribution of the 1990 US Census, the overall incidence rate in those aged 65 years was 4.7 per 1000 person-years.

2. Mathuranath et al., 2012, Neurology India 4 urban and semi-urban regions of Trivandrum city in Kerala. Malayalam Addenbrooke’s cognitive examination (mACE). Clinical evaluation by neurologist based on the DSM-IV criteria. Incidence rates per 1000 person-years for AD:

11.67 (95% CI: 10.9-12.4) for those aged ≥55 years.

15.54 (95% CI: 14.6-16.5) for those aged ≥65 years.

Standardised against the year 2000 U.S. Census, the age-adjusted incidence rate was 9.19 (95% CI: 9.03-9.35) per 1000 person-years.

3. Banerjee et al., 2017, Int Journal of GerPsychiatry Kolkata, West Bengal Two dementia pertinent questions to family members.

 

Detailed clinical history

 

Kolkata Cognitive Screening Battery

DSM-IV criteria Average annual incidence rate of dementia was 72.57 per 100,000 ≥ 55 years age.

 

Source: (Chandra et al., 2001; Mathuranath et al., 2012; Banerjee et al., 2017)

References:

Alzheimer’s and Related Disorders Society of India. (2010). THE DEMENTIA INDIA REPORT 2010: Prevalence, impact, cost and services for dementia. New Delhi. Available from:  https://ardsi.org/pdf/annual%20report.pdf

Banerjee, T. K., Dutta, S., Das, S., Ghosal, M., Ray, B. K., Biswas, A.,… & Das, S. K. (2017). Epidemiology of dementia and its burden in the city of Kolkata, India. International Journal of Geriatric Psychiatry, 32(6), 605–614. https://doi.org/10.1002/gps.4499

Banerjee, T. K., Mukherjee, C. S., Dutt, A., Shekhar, A., & Hazra, A. (2008). Cognitive dysfunction in an urban Indian population: some observations. Neuroepidemiology, 31(2), 109–114. https://doi.org/10.1159/000146252

Bhatt, B. (2020). DBT’s multi-centric Dementia Science Programme. Vigyan Samachar. Available from: https://vigyanprasar.gov.in/wp-content/uploads/DBT%E2%80%99s-multi-centric-Dementia-Science-Programme-10apr20.pdf

Chandra, V., Ganguli, M., Pandav, R., Johnston, J., Belle, S., & DeKosky, S. T. (1998). Prevalence of Alzheimer’s disease and other dementias in rural India: the Indo-US study. Neurology, 51(4),1000–1008. https://doi.org/10.1212/wnl.51.4.1000

Chandra, V., Pandav, R., Dodge, H. H., Johnston, J. M., Belle, S. H., DeKosky, S. T., & Ganguli, M. (2001). Incidence of Alzheimer’s disease in a rural community in India: the Indo-US study. Neurology, 57(6), 985–989. https://doi.org/10.1212/wnl.57.6.985

Das, S. K., Biswas, A., Roy, J., Bose, P., Roy, T., Banerjee, T. K., … & Hazra, A. (2008). Prevalence of major neurological disorders among geriatric population in the metropolitan city of Kolkata. The Journal of the Association of Physicians of India, 56, 175–181. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/18697633

Das, S. K., Biswas, A., Roy, T., Banerjee, T. K., Mukherjee, C. S., Raut, D. K., & Chaudhuri, A. (2006). A random sample survey for prevalence of major neurological disorders in Kolkata. Indian Journal of Medical Research, 124(2), 163.

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

Dhiman, V., Menon, G. R., Kaur, S., Mishra, A., John, D., Rao Vishnu, M. V., Tiwari, R. R., & Dhaliwal, R. S. (2021). A Systematic Review and Meta-analysis of Prevalence of Epilepsy, Dementia, Headache, and Parkinson Disease in India. Neurology India, 69(2), 294–301. https://doi.org/10.4103/0028-3886.314588

Farina, N., Ibnidris, A., Alladi, S., Comas-Herrera, A., Albanese, E., Docrat, S., Ferri, C. P., Freeman, E., Govia, I., Jacobs, R., Astudillo-Garcia, C. I., Musyimi, C., Sani, T. P., Schneider, M., Theresia, I., Turana, Y., Knapp, M., & and, S. B. (2020). A systematic review and meta-analysis of dementia prevalence in seven developing countries: A STRiDE project. Global Public Health, 1–16. https://doi.org/10.1080/17441692.2020.1792527

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.

Mathuranath, P. S., Cherian, P. J., Mathew, R., Kumar, S., George, A., Alexander, A.,  Sarma, P. S. (2010). Dementia in Kerala, South India: prevalence and influence of age, education and gender.International Journal of Geriatric Psychiatry, 25(3), 290–297. https://doi.org/10.1002/gps.2338

Mathuranath, P., Menon, R., Ranjith, N., Sarma, Ps., Verghese, J., George, A., …& Kumar, Ms. (2012). Incidence of Alzheimer′s disease in India: A 10 years follow-up study. Neurology India, 60(6), 625. https://doi.org/10.4103/0028-3886.105198

Poddar, K., Kant, S., Singh, A., & Singh, T. B. (2011). An epidemiological study of dementia among the habitants of eastern Uttar Pradesh, India. Annals of Indian Academy of Neurology, 14(3), 164–168. https://doi.org/10.4103/0972-2327.85874

Raina, S. K., Chander, V., & Bhardwaj, A. (2016). Dementia in a tribal landlocked elderly population at high altitude: What explains the lower prevalence?. Journal of neurosciences in rural practice, 7(3), 419–422. https://doi.org/10.4103/0976-3147.182775

Raina, S. K., Raina, S., Chander, V., Grover, A., Singh, S., & Bhardwaj, A. (2014). Is dementia differentially distributed? A study on the prevalence of dementia in migrant, urban, rural, and tribal elderly population of himalayan region in northern India. North American Journal of Medical Sciences, 6(4), 172–177. https://doi.org/10.4103/1947-2714.131243

Raina, S., Raina, S., Razdan, S., & Pandita, K. (2008). Prevalence of dementia among Kashmiri migrants. Annals of Indian Academy of Neurology, 11(2), 106. https://doi.org/10.4103/0972-2327.41878

Rajkumar, S., Kumar, S., & Thara, R. (1997). PREVALENCE OF DEMENTIA IN A RURAL SETTING: A REPORT FROM INDIA. International Journal of Geriatric Psychiatry, 12(7), 702–707. https://doi.org/10.1002/(SICI)1099-1166(199707)12:7<702::AID-GPS489>3.0.CO;2-H

Razdan, S., Kaul, R. L., Motta, A., Kaul, S., & Bhatt, R. K. (1994). Prevalence and Pattern of Major Neurological Disorders in Rural Kashmir (India) in 1986. Neuroepidemiology, 13(3), 113–119. https://doi.org/10.1159/000110368

Rodriguez, J. J. L., Ferri, C. P., Acosta, D., Guerra, M., Huang, Y., Jacob, K., … &10/66 Dementia  Research Group. (2008). Prevalence of dementia in Latin America, India, and China: A population-based cross-sectional survey. The Lancet, 372(9637), 464–474. https://doi.org/10.1016/S0140-6736(08)61002-8

Saldanha, D., Mani, M. R., Srivastava, K., Goyal, S., & Bhattacharya, D. (2010). An epidemiological study of dementia under the aegis of mental health program, Maharashtra, Pune chapter. Indian Journal of Psychiatry, 52(2), 131–139. https://doi.org/10.4103/0019-5545.64588

Seby, K., Chaudhury, S., & Chakraborty, R. (2011). Prevalence of psychiatric and physical morbidity in an urban geriatric population. Indian journal of psychiatry, 53(2), 121. https://doi.org/10.4103/0019-5545.82535

Shaji, S., Bose, S., & Verghese, A. (2005). Prevalence of dementia in an urban population in Kerala, India. British Journal of Psychiatry, 186(2), 136–140. https://doi.org/10.1192/bjp.186.2.136

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.

Vas, C. J., Pinto, C., Panikker, D., Noronha, S., Deshpande, N., Kulkarni, L., …& Sachdeva, S. (2001). Prevalence of Dementia in an Urban Indian Population. International Psychogeriatrics,13(4), 439–450. https://doi.org/10.1017/S1041610201007852

The earliest report estimated that the dementia prevalence in Indonesia comes from a joint report of ADI Asia-Pacific members in 2005. The report stated a prevalence of 606,100. The same source reported an incidence of 191,400, which was predicted to increase to 314,100 by 2020 and to 932,000 by 2050 (Access Economics, 2006).

 The most recent estimates based on regional prediction published in the revised World Alzheimer Report 2015 stated that in 2015, approximately 1.2 million people in Indonesia were living with dementia and this number was expected to increase up to almost 4 million by 2050 (Prince et al., 2015).

Other studies identified reported regional dementia prevalence rates.

Yesufu (2009, p.12) reported a dementia prevalence of 4.1% among those aged 60 and older. The research further found that the prevalence of people living with Alzheimer’s Disease was 3.1% in the same age group, while that of all other dementias (‘including Vascular Dementia, possible secondary dementia, and other non-assessed sub-types) was estimated to be 5.4% (age range 52-98 years)’. This research had been conducted in Sumedang (West Java) and Borobodu (Central Java) as well as urban sites in Central and South Jakarta (Northwest Java).

Hogervorst (2011, p.8), studying similar areas to Yesufu (the study was conducted in West and Central Java as well as at an urban site in Jakarta) and who aimed to validate two short dementia screening tests in Indonesia reported a ‘suspected dementia prevalence’ of 8% among those aged 60 and 65 years. The author reports that they found a very high rate (16-21%) possible dementia cases in Borobudur, Central Java, which raised the overall estimated prevalence rate.

Surveymeter, an independent research institution, investigated the prevalence of dementia in the province of Yogyakarta (Suriastini et al., 2016) and Bali (Suriastini et al., 2018). Yogyakarta is located in Java, which is the most densely-populated island in Indonesia (The Editors of Encyclopaedia Britannica, 2017), and currently is the province with the highest percentage of older people among all provinces in Indonesia  (Pusat Data dan Informasi Kementerian Kesehatan RI, 2017). Surveymeter’s data from Yogyakarta showed a dementia prevalence of 20.1% (Suriastini et al., 2016). No data regarding incidence in Yogyakarta were found.

A similar study conducted in 2018 in the province of Bali showed a higher prevalence of dementia at 32.16% (Suriastini et al., 2018). This high prevalence might be related to the proportion of older population in this province. Among provinces outside of Java Island, Bali has the highest number of older people outside of Java (Pusat Data dan Informasi Kementerian Kesehatan RI, 2017). There were no data found regarding incidence in this province either. Surveymeter’s data is based on household surveys in the province of Yogyakarta (Suriastini et al., 2016) and Bali (Suriastini et al., 2018). Both studies were conducted using structured questionnaire and instruments of cognitive screening and functional status assessment such as MMSE, ADL and IADL for both the patients and caregivers in villages or sub-districts.

References:

Access Economics. (2006). Demensia Di Kawasan Asia Pasifik: Sudah Ada Wabah. https://www.alz.co.uk/research/files/apreportindonesian.pdf

Hogervorst, E. (2011). Validation of two short dementia screening tests in Indonesia. IN: Jacobsen, S.R. (ed.) Vascular Dementia: Risk Factors, Diagnosis and Treatment, New York: Nova Science, pp. 235-256.

Prince, M., Wimo, A., Guerchet, M., Ali, G.-C., Wu, Y.-T., Prina, M., & Alzheimer’s Disease International. (2015). World Alzheimer Report 2015 The Global Impact of Dementia: An analysis of prevalence, incidence, cost and trends. https://www.alz.co.uk/research/WorldAlzheimerReport2015.pdf

Pusat Data dan Informasi Kementerian Kesehatan RI. (2017). Analisis Lansia di Indonesia.

Suriastini, Turana, Y., Sukadana, W., Sikoki, B., Witoelar, F., Lesmana, C. B. J., Mulyanto, E. D., Hermoko, R., & Anandari, G. A. A. A. (2018). Menggugah Lahirnya Kebijakan Kelanjutusiaan Menggugah Lahirnya Kebijakan Kelanjutusiaan.

Suriastini, Turana, Y., Witoelar, F., Supraptilah, B., Wicaksono, T., & Dwi, E. (2016). Policy Brief Angka Prevalensi Demensia: Perlu Perhatian Kita Semua. SurveyMETER, Maret, 1–4.

The Editors of Encyclopaedia Britannica. (2017). Java. Encyclopædia Britannica. https://www.britannica.com/place/Java-island-Indonesia

Yesufu, A. O. (2009). Demographic and modifiable risk factors for age related cognitive impairment and possible dementia. Loughborough: Loughborough University

In 2016, the number of prevalent cases for dementia in Kenya was 61,120 and revealed a minor reduction of –2.1% (95% uncertainty Interval [UI] –2.8 to –1.5) from 1990 to 2016 (Nichols et al., 2019).

References:

Nichols, E., Szoeke, C. E. I., Vollset, S. E., Abbasi, N., Abd-Allah, F., Abdela, J., … Murray, C. J. L. (2019). Global, regional, and national burden of Alzheimer’s disease and other dementias, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet Neurology, 18(1), 88–106. http://doi.org/10.1016/S1474-4422(18)30403-4

Since 2003, two national health surveys and two dementia specific surveys have documented the prevalence of dementia and cognitive impairment in Mexico.

1. Mexican Health and Aging Study, MHAS (Encuesta Nacional de Salud y Envejecimiento en México, ENASEM, mhasweb.org).

The initiative is funded by the National Institute of Health and the National Institute of Aging of the United States. This is the first large scale longitudinal study in Mexico with data collected in 2001 (baseline study) with follow-up interviews in 2003, 2012, 2015 and 2018 (Wong et al., 2015). The objective of this longitudinal study is to prospectively evaluate the impact of diseases, functioning and mortality of adults 50 years of age and older (or adults born in 1951 or earlier at the time of the baseline survey), in more and less urban areas of Mexico. In MHAS, the identification of cases of dementia was made using an algorithm based on a cognitive evaluation (performed with a battery of instruments) and another on functional ability. The prevalence of dementia estimated in a report of 2011 was 5.2%, adjusted for age and schooling (Mejía-Arango et al., 2011).

2. National Health and Nutrition Survey ENSANUT 2012 (Encuesta Nacional de Salud y Nutrición, https://ensanut.insp.mx/).

The National Survey of Health and Nutrition (ENSANUT) is a probabilistic, multi-phase survey designed to estimate the prevalence of health conditions, nutrition, and its determinants, in nationally representative samples of children 0 to 11 years of age, adolescents 12 to 19 years old, adults 20 to 59, and older adults (60+ years). It has a representative sample design at the national, state, urban and rural stratum (Romero-Martinez et al., 2013). The module for the evaluation of older adults was first added in 2012 and included a sample of 8,874 adults aged 60 or older. Two instruments were used for dementia diagnosis: a battery to assess cognitive functioning (semantic verbal fluency the Mini-cog) and the evaluation of functional ability. These were used to construct a diagnostic algorithm. People who presented alteration in both cognitive ability and functional ability were considered to have dementia. This resulted in an estimated dementia prevalence of 7.9% for the total of older adults’ sample (Manrique Espinoza et al., 2013). In relation to distribution of dementia across the country, Acosta-Castillo et al., (2017) report the prevalence of dementia by state and level of deprivation, and report adjusted prevalence of dementia (by sex, age and education) of 8.0% at national level, ranging from 3.3% in Querétaro to 12.5% in Jalisco, and from 3.9% in people between 60-69 years and 20.6% in the group aged 80 years or more. The prevalence is similar in some levels of deprivation (around 8.0%), except in those areas with high and very high deprivation (11.1%). They report that of the almost 900,000 people living with dementia in Mexico, more than half have experienced food insecurity and about 200 thousand live in localities with high and very high levels of deprivation. This demonstrates great variability in the prevalence of dementia by state and suggests that many people affected by dementia experience high levels of vulnerability.

3. Dementia Research Group 10/66 study (https://www.alz.co.uk/1066/).

The 10/66 Dementia Research Group research programme was developed to address the dementia prevalence, incidence, and impact across Latin American countries, China and India, using a validated and common methodology in a multi-centric population of adults aged 65 years and over (Prina et al., 2017). Data have been obtained on the prevalence and impact of dementia, and on incidence (phase 2007-2010), which evaluated the incidence of dementia and some associated risk factors, as well as mortality, with a median follow-up of 3 years (Prince et al., 2012). The case identification of dementia is carried out using two algorithms, one that operationalizes the criteria for dementia of the DSM-IV, and another that is developed by the 10/66 group (Prince et al., 2003). A case is considered positive for dementia if either of the two criteria is positive. The prevalence of dementia is of 8.6% in the urban area, compared to 7.4 in the rural area. However, the standardised prevalence (95% CI) using the 10/66 algorithm is 7.4% (5.9-8.9) in Mexico in urban areas, and 7.3% (5.7-8.9) in rural areas. The standardised prevalence according to DSM-IV criteria is 3.2% (2.2-4.2) in Mexico urban, and 2.4% (1.2-3.6) (Llibre et al., 2008).

4. Survey of the Metropolitan Area of Guadalajara.

In 2014, a cross-sectional study was conducted on a population aged 60 years or above, living in the state of Jalisco (in the Western region of the country). A total of 1,142 people participated. Participants were selected through multiple probability random sampling and door-to-door interviewing. All participants were evaluated for their cognitive function, emotional state, and physical performance. Cognitive function, depression and functional disability were assessed using the Mini-Mental State Examination (Folstein et al., 1975), the geriatric depression scale and the Katz index, respectively. The diagnosis of dementia was made according to the DSM-IV criteria. The prevalence of dementia was 9.5% (63.35% of women and 36.7% of men) (Velázquez-Brizuela et al., 2014).

Table 11 shows prevalence data of dementia. Variations may be due to the use of different classifications, forms and extensions of cognitive assessments and assessment of limitations in functionality. For example, while ENSANUT and MHAS/ENASEM only assess dementia with cognition and loss of function (assessed through altered activities of daily living); in 1066 DSM-IV criteria are operationalised and the algorithm is tested against these criteria, not only against the sum of cognitive impairment and loss of functionality. 

Table 11. Population studies, prevalence data of dementia.

Study Evaluation criteria Sample size Adjusted prevalence, total or subgroups
MHAS/ENASEM

(Mejía- Arango et al., 2011)

Cognitive evaluation and functional limitations (CCCE, difficulty in performing daily activities 7,166 community-dwelling adults, 60 years and older 6.1
Dementia Research Group 10/66

(Llibre et al., 2008)

10/66 Algorithm and DSM IV Criteria 1,003 urban and 1,000 rural community-dwelling adults, 65 years and older Urban 8.6

Rural 8.5

Survey of the Metropolitan Area of Guadalajara (Encuesta del Área Metropolitana de Guadalajara)

(Velázquez-Brizuela et al., 2014)

DSM-IV 1,142 older adults, 60 years and older 9.5
National Health and Nutrition Survey ENSANUT 2012

(Manrique Espinoza et al., 2013)

Cognitive evaluation and functional limitations 8,874 older adults, 60 years and older 7.9
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