Abstract
The majority of people with dementia worldwide live in developing countries. Studies from the developed world have reported an association between lower educational attainment and dementia, but there are few data from the developing world where literacy and educational levels are frequently much lower. In this study we assessed the association between education and dementia prevalence in a rural Tanzanian setting.MethodsIn phase I, 1198 individuals aged 70 and over were assessed using the Community Screening Instrument for Dementia (CSI-D). In phase Ii a stratified sample of those seen in phase I were fully assessed and a clinical diagnosis based on DSM-IV criteria was made where appropriate. Information regarding literacy, highest attained educational level and occupation were also collected.ResultsThe median subject cognitive score on the CSI-D was 25.7 (IQR 22.7 to 28.0) for females and 27.7 (IQR 25.7 to 29.4) for males. This difference was significant (U=117770.0, z= –9.880, p<0.001). In both males and females a lower CSI-D subject cognitive score was significantly associated with having had no formal education (U=34866.5, z= –6.688, p<0.001, for females; U=20757.0, z= –6.278, p<0.001, for males). After adjusting for the effect of age, having no formal education was significantly associated with greater odds of having 'probable dementia' by CSI-D, as was illiteracy. Amongst those interviewed in phase II, there was no significant difference in literacy or education between those with diagnosed DSM-IV dementia and those without.ConclusionIn this rural Tanzanian population, we found a significant association between low levels of education and dementia by CSI-D. This relationship was not significant in cases meeting DSM-IV criteria for dementia.
Highlights
Dementia is becoming a worldwide public health issue, with 44.35 million people currently estimated to have the condition.[1]
Females were 3.56 times more likely to have had no education than males
As reported from other studies in sub-Saharan Africa (SSA), we did not find an independent association between dementia on DSM-IV criteria and educational level
Summary
Dementia is becoming a worldwide public health issue, with 44.35 million people currently estimated to have the condition.[1] The resultant disease burden is considerable in terms of disability and health resource utilisation. Since curative treatment is not currently available, preventive strategies and identification of potentially modifiable risk factors are the priority. In sub-Saharan Africa (SSA), it is estimated that there are currently 2.1 million people with dementia.[2] Recent data suggest that prevalence of dementia in the elderly is currently similar to that reported in high income countries[3,4,5,6] and will continue to rise as demographic transition continues. 71% of people with dementia will live in low and middle income countries (LMIC) by 2050.1 Identification of potentially modifiable risk factors relevant to these settings is even more pressing
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