A cross-sectional study to assess prevalence and factors associated with mild cognitive impairment among older adults in an urban area of Kerala, South India

Devi Mohan, Thomas Iype, Sara Varghese, Anuja Usha, Minu Mohan, Devi Mohan, Thomas Iype, Sara Varghese, Anuja Usha, Minu Mohan

Abstract

Objectives: To assess the prevalence and factors associated with mild cognitive impairment (MCI) among older adults in an urban area of South India.

Setting: The study was conducted in the capital city of Thiruvananthapuram in the South Indian state of Kerala.

Participants: The study participants were community-dwelling individuals aged 60 years and above.

Primary outcome measure: MCI was the primary outcome measure and was defined using the criteria by European Alzheimer's Disease Consortium. Cognitive assessment was done using the Malayalam version of Addenbrooke's Cognitive Examination tool. Data were also collected on sociodemographic variables, self-reported comorbidities like hypertension and diabetes, lifestyle factors, depression, anxiety and activities of daily living.

Results: The prevalence of MCI was found to be 26.06% (95% CI of 22.12 to 30.43). History of imbalance on walking (adjusted OR 2.75; 95 % CI of 1.46 to 5.17), presence of depression (adjusted OR 2.17, 95 % CI of 1.21 to 3.89), anxiety (adjusted OR 2.22; 95 % CI of 1.21 to 4.05) and alcohol use (adjusted OR 1.99; 95 % CI of 1.02 to 3.86) were positively associated with MCI while leisure activities at home (adjusted OR 0.33; 95 % CI of 0.11 to 0.95) were negatively associated.

Conclusion: The prevalence of MCI is high in Kerala. It is important that the health system and the government take up urgent measures to tackle this emerging public health issue.

Keywords: dementia; elderly; mild cognitive impairment.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Proportion of study subjects with comorbidities (n=426). HADS, Hospital Anxiety Depression Scale.
Figure 2
Figure 2
Spectrum of cognitive pattern of the study participants (n=426).
Figure 3
Figure 3
Distribution of mild cognitive impairment (MCI) cases (n=111) by age, gender and type of MCI.
Figure 4
Figure 4
Proportion of mild cognitive impairment (MCI) cases showing decline in various sub scores of Malayalam version of Addenbrooke’s Cognitive Examination (m-ACE) (n=111).

References

    1. Christensen H. What cognitive changes can be expected with normal ageing? Aust N Z J Psychiatry 2001;35:768–75. 10.1046/j.1440-1614.2001.00966.x
    1. World Health Organistaion and Alzheimer’s Disease International. Dementia: A public health priority. Geneva, 2012.
    1. World Health Organisation. Global action plan on the public health response to dementia 2017–2025. Geneva, 2017.
    1. Rao GN, Bharath S. Cost of dementia care in India: delusion or reality? Indian J Public Health 2013;57:71–7. 10.4103/0019-557X.114986
    1. Ferri CP, Prince M, Brayne C, et al. . Alzheimer’s Disease International. Global prevalence of dementia: a Delphi consensus study. Lancet 2005;366:2112–7. 10.1016/S0140-6736(05)67889-0
    1. Ministry of Home Affairs GoI. SRS Statistical Report 2016, 2016.
    1. Commission P. Kerala Development Report. New Delhi: Academic Foundation, 2008.
    1. Petersen RC, Smith GE, Waring SC, et al. . Aging, memory, and mild cognitive impairment. Int Psychogeriatr 1997;9 Suppl 1:65–9. 10.1017/S1041610297004717
    1. Petersen RC, Doody R, Kurz A, et al. . Current concepts in mild cognitive impairment. Arch Neurol 2001;58:1985–92. 10.1001/archneur.58.12.1985
    1. Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183–94. 10.1111/j.1365-2796.2004.01388.x
    1. Gauthier S, Reisberg B, Zaudig M, et al. . Mild cognitive impairment. The Lancet 2006;367:1262–70. 10.1016/S0140-6736(06)68542-5
    1. Rubin EH, Storandt M, Miller JP, et al. . A prospective study of cognitive function and onset of dementia in cognitively healthy elders. Arch Neurol 1998;55:395–401. 10.1001/archneur.55.3.395
    1. Katz MJ, Wang C, Hall C, et al. . Mortality associated with amnestic Mild Cognitive Impairment in a community based population: Results from the Einstein Aging Study (EAS). Alzheimer’s & Dementia 2010;6:S454–S455. 10.1016/j.jalz.2010.05.1515
    1. Ward A, Arrighi HM, Michels S, et al. . Mild cognitive impairment: disparity of incidence and prevalence estimates. Alzheimers Dement 2012;8:14–21. 10.1016/j.jalz.2011.01.002
    1. Das SK, Bose P, Biswas A, et al. . An epidemiologic study of mild cognitive impairment in Kolkata, India. Neurology 2007;68:2019–26. 10.1212/01.wnl.0000264424.76759.e6
    1. Sosa AL, Albanese E, Stephan BC, et al. . Prevalence, distribution, and impact of mild cognitive impairment in Latin America, China, and India: a 10/66 population-based study. PLoS Med 2012;9:e1001170 10.1371/journal.pmed.1001170
    1. Swarnalatha N. Cognitive status among rural elderly women. Journal of the Indian Academy of Geriatrics 2007;3:15–19.
    1. Afgin AE, Massarwa M, Schechtman E, et al. . High prevalence of mild cognitive impairment and Alzheimer’s disease in arabic villages in northern Israel: impact of gender and education. J Alzheimers Dis 2012;29:431–9. 10.3233/JAD-2011-111667
    1. Marengoni A, Fratiglioni L, Bandinelli S, et al. . Socioeconomic status during lifetime and cognitive impairment no-dementia in late life: the population-based aging in the Chianti Area (InCHIANTI) Study. J Alzheimers Dis 2011;24:559–68. 10.3233/JAD-2011-101863
    1. Luchsinger JA, Reitz C, Patel B, et al. . Relation of diabetes to mild cognitive impairment. Arch Neurol 2007;64:570–5. 10.1001/archneur.64.4.570
    1. Reitz C, Tang MX, Manly J, et al. . Hypertension and the risk of mild cognitive impairment. Arch Neurol 2007;64:1734–40. 10.1001/archneur.64.12.1734
    1. Geda YE, Roberts RO, Mielke MM, et al. . Baseline neuropsychiatric symptoms and the risk of incident mild cognitive impairment: a population-based study. Am J Psychiatry 2014;171:572–81. 10.1176/appi.ajp.2014.13060821
    1. Anderson ND, Murphy KJ, Troyer AK. Living with mild cognitive impairment: A guide to maximizing brain health and reducing risk of dementia: Oxford University Press, 2012.
    1. Vancampfort D, Stubbs B, Lara E, et al. . Mild cognitive impairment and physical activity in the general population: Findings from six low- and middle-income countries. Exp Gerontol 2017;100:100–5. 10.1016/j.exger.2017.10.028
    1. Shaji S, Bose S, Verghese A. Prevalence of dementia in an urban population in Kerala, India. Br J Psychiatry 2005;186:136–40. 10.1192/bjp.186.2.136
    1. Shaji S, Promodu K, Abraham T, et al. . An epidemiological study of dementia in a rural community in Kerala, India. Br J Psychiatry 1996;168:745–9. 10.1192/bjp.168.6.745
    1. Bjelland I, Dahl AA, Haug TT, et al. . The validity of the hospital anxiety and depression scale. an updated literature review. J Psychosom Res 2002;52:69–77.
    1. Portet F, Ousset PJ, Visser PJ, et al. . Mild cognitive impairment (MCI) in medical practice: a critical review of the concept and new diagnostic procedure. Report of the MCI Working Group of the European Consortium on Alzheimer’s Disease. J Neurol Neurosurg Psychiatry 2006;77:714–8. 10.1136/jnnp.2005.085332
    1. Association AP. Diagnostic and statistical manual of mental disorders-IV-TR. Washington, DC: American Psychiatric Association, 2000.
    1. SPSS Inc. IBM SPSS statistics base 20. Chicago, IL: SPSS Inc, 2011.
    1. Bursac Z, Gauss CH, Williams DK, et al. . Purposeful selection of variables in logistic regression. Source Code Biol Med 2008;3:17 10.1186/1751-0473-3-17
    1. Hänninen T, Hallikainen M, Tuomainen S, et al. . Prevalence of mild cognitive impairment: a population-based study in elderly subjects. Acta Neurol Scand 2002;106:148–54. 10.1034/j.1600-0404.2002.01225.x
    1. Unverzagt FW, Gao S, Baiyewu O, et al. . Prevalence of cognitive impairment: data from the Indianapolis Study of Health and Aging. Neurology 2001;57:1655–62. 10.1212/WNL.57.9.1655
    1. Manly JJ, Tang MX, Schupf N, et al. . Frequency and course of mild cognitive impairment in a multiethnic community. Ann Neurol 2008;63:494–506. 10.1002/ana.21326
    1. Singh VB. Prevalence of mild cognitive impairment in elderly population of North India. (accessed 02 Nov 2018).
    1. Kerala Go. Palliative Care 2017. (accessed 9 Feb 2018).
    1. Li X, Ma C, Zhang J, et al. . Prevalence of and potential risk factors for mild cognitive impairment in community-dwelling residents of Beijing. J Am Geriatr Soc 2013;61:2111–9. 10.1111/jgs.12552
    1. Nair V, Ayers E, Noone M, et al. . Depressive symptoms and mild cognitive impairment: results from the Kerala-Einstein study. J Am Geriatr Soc 2014;62:197–9. 10.1111/jgs.12628
    1. Perrochon A, Kemoun G. The Walking Trail-Making Test is an early detection tool for mild cognitive impairment. Clin Interv Aging 2014;9:111 10.2147/CIA.S53645
    1. Montero-Odasso M, Casas A, Hansen KT, et al. . Quantitative gait analysis under dual-task in older people with mild cognitive impairment: a reliability study. J Neuroeng Rehabil 2009;6:35 10.1186/1743-0003-6-35
    1. Steenland K, Karnes C, Seals R, et al. . Late-life depression as a risk factor for mild cognitive impairment or Alzheimer’s disease in 30 US Alzheimer’s disease centers. J Alzheimers Dis 2012;31:265–75. 10.3233/JAD-2012-111922
    1. Verghese J, Lipton RB, Katz MJ, et al. . Leisure activities and the risk of dementia in the elderly. N Engl J Med 2003;348:2508–16. 10.1056/NEJMoa022252
    1. Xu G, Liu X, Yin Q, et al. . Alcohol consumption and transition of mild cognitive impairment to dementia. Psychiatry Clin Neurosci 2009;63:43–9. 10.1111/j.1440-1819.2008.01904.x
    1. Ngandu T. Lifestyle-related risk factors in dementia and mild cognitive impairment: A population-based study: Inst för neurobiologi. vårdvetenskap och samhälle/Dept of Neurobiology, Care Sciences and Society 2006.
    1. Sciences IIfP. India National Family Health Survey (NFHS-3), 2005-06: International Institute for Population Sciences, 2007.
    1. Mathuranath PS, Cherian PJ, Mathew R, et al. . Dementia in Kerala, South India: prevalence and influence of age, education and gender. Int J Geriatr Psychiatry 2010;25:290–7. 10.1002/gps.2338
    1. Mathuranath PS, Cherian JP, Mathew R, et al. . Mini mental state examination and the Addenbrooke’s cognitive examination: effect of education and norms for a multicultural population. Neurol India 2007;55:106 10.4103/0028-3886.32779

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