Dementia Prevalence Study Research Articles

Estimating the Prevalence of Dementia in New Zealand Using Capture-Recapture Analysis on Routinely Collected Health Data.

Community based dementia prevalence studies are expensive and resource intensive. Aotearoa New Zealand (NZ) has never had a community based dementia prevalence study representing all major ethnic groups. In recent years, dementia prevalence estimates have been derived from routinely collected health data but issues of underdiagnosis and undercoding limit their utility. Capture-recapture techniques can estimate the number of dementia cases missing from health datasets by modelling the ascertained overlaps between linked data sources. Three routinely collected national health data sets-interRAI, Public hospital discharges, and Pharmaceuticals-were linked and all prevalent cases of dementia in NZ for the year 1 January 2021-31 December 2021 were identified. Capture-recapture analysis fitted eight loglinear models to the data, with the best fitting model used to estimate the number of prevalent cases missing from all three datasets. We estimated that almost half (47.8%) of dementia cases are not present in any of the three datasets. Dementia prevalence increased from 3.7% to 7.1% (95% CI 6.9%-7.4%) in the NZ 60+ population and from 4.9% to 9.2% (95% CI 8.9%-9.6%) in the NZ 65+ population when missing cases were included. Estimates of missing cases were significantly higher (p<0.001) in Māori (49.2%), Pacific peoples (50.6%) and Asian (59.6%) compared to Europeans (46.4%). This study provides updated estimates of dementia prevalence in NZ and the proportion of undiagnosed dementia in NZ, highlighting the need for better access to dementia assessment and diagnosis.

Strength together: examining risk and protective factors associated with dementia and cognitive impairment in Aboriginal and Torres Strait Islander peoples through harmonisation of landmark studies

BackgroundRates of dementia for Aboriginal and Torres Strait Islander peoples are three to five times greater compared to non-Indigenous Australians, with earlier age of onset. However, the risk and protective factors that drive these higher rates vary across existing cohort studies, with minimal findings on the role of vascular risk factors beyond stroke. Harmonisation of data across studies may offer greater insights through enhanced diversity and strengthened statistical capabilities. This study aims to combine three landmark cohort studies of Aboriginal and Torres Strait Islander participants to better understand the determinants of cognitive health and dementia.Methods/designThree cohort studies - the Kimberley Healthy Adults Project (KHAP, N = 363), Koori Growing Old Well Study (KGOWS, N = 336) and Torres Strait Dementia Prevalence Study (TSDPS, N = 274) - share a similar research methodology with demographic, medical history, psychosocial factors, cognitive tests and consensus clinical diagnoses of cognitive impairment and dementia. Associations between risk and protective factors of interest and the presence of dementia and/or cognitive impairment diagnoses will be evaluated by univariable and multivariable logistic regression in a harmonised cross-sectional cohort of 898 participants. Factors associated with incident dementia and/or cognitive impairment will be assessed in a subset of KHAP (n = 189) and KGOWS participants (n = 165) who were available in longitudinal follow-up, after exclusion of those with baseline dementia or cognitive impairment. Analyses in relation to outcome measure of death or dementia will be conducted to account for the competing risk of death. Logistic regression will be used to evaluate the association between the individual components of the 16-component Kimberley Indigenous Cognitive Assessment (KICA) tool and the presence of dementia and cognitive impairment determined by independent consensus diagnoses. Multivariable binary logistic regression will be used to adjust for the effect of confounding variables. Results will be reported as odds ratios (OR) with 95% confidence intervals (95% CI).DiscussionGreater understanding of risk and protective factors of dementia and cognitive impairment relevant to Aboriginal and Torres Strait Islander peoples may improve approaches across the life course to delay cognitive decline and reduce dementia risk.

Validation of the Kimberley Cognitive Assessment (KICA-Cog) for Torres Strait Islander Peoples.

The aim of this study was to validate the Kimberley Indigenous Cognitive Assessment-Cognitive Component (KICA-Cog) adapted for dementia screening in Torres Strait Islander Peoples. Data were obtained from a broader dementia prevalence study completed in the Torres Strait and Northern Peninsula Area between 2015 and 2018. Modifications were made to items from the original KICA-Cog to ensure they were culturally appropriate for the Torres Strait. All participants completed a KICA-Cog and had a comprehensive dementia assessment with a geriatrician experienced in cross-cultural assessment. A total of 255 Torres Strait residents aged 45 years and over completed a KICA-Cog and underwent geriatric assessment. The adapted KICA-Cog showed good validity for dementia diagnosis with a cut point of 33/34 associated with a sensitivity of 81% and specificity of 92% with an area under the ROC curve of 0.91. The KICA-Cog, when modified for the Torres Strait, is a valid cognitive screening tool for dementia. Caution is required when interpreting test scores, as the adapted KICA-Cog had slightly lower sensitivity (ability to detect people with dementia) than the original KICA-Cog. As with all short cognitive tests, individuals with a low KICA-Cog scores should undergo further medical investigations before a dementia diagnosis is considered.

P17: What happens if your colleague was the first person who notice that you have early-onset dementia?

Objective:A national prevalence study of early-onset dementia in Japan has provided data on their challenges and support needs, as documented by the individual and their family members. This study examined differences between 1) cases that the onset of early-onset dementia was detected by work colleagues, and 2) other cases.Methods:After identifying medical or long-term care service offices used by people with early-onset dementia in 12 regions in Japan, a questionnaire was distributed to the individuals and their family members. The items surveyed were age at the time of the survey, gender, employment at the onset, age when the initial symptoms were detected, the person who detected the initial symptoms, and consideration received at the workplace. In this report, only those who were working at the onset were included in the analysis. Next, they were divided into two groups according to whether the person who detected the initial symptoms was a colleague or not, and a chi-square test was used to compare the two groups. This study was conducted with the approval of the Ethics Committee of the Tokyo Metropolitan Institute of Gerontology and Geriatric Medicine.Results:Of the 1035 questionnaires collected, 559 were were working at the time of onset of initial symptoms, and 149 (26.7%) of these cases were initially detected by a colleague. Comparison between groups revealed that the cases detected by colleagues 1) were recommended to see an occupational physician (P&lt;0.001), 2) were referred to a specialist (P&lt;0.001), 3) received consideration such as reassignment in the workplace (P&lt;0.001), 4) received consideration regarding transportation (P=0.023), 5) had someone to talk to in the workplace (P&lt;0.001), and 6) were significantly unlikely to receive no consideration at all (P=0.010).Conclusion:Early-onset dementia was noticed by a colleague due to an increase mistake in the workplace but may have received reasonable accommodations that could have been considered by each workplace. The results of this study may help to promote dementia-friendly workplace strategies.

Dementia and mild cognitive impairment in older people in Trøndelag.

The number of people with dementia is expected to triple by 2050. We present figures showing the prevalence of dementia and mild cognitive impairment in Trondheim, and show how weighting for non-response and nursing home residency affects these figures when comparing Trondheim with Nord-Trøndelag. In the fourth data collection in the Trøndelag Health Study (HUNT4) in the Norwegian county of Trøndelag, people aged 70 and over in Trondheim were invited to participate in HUNT4 Trondheim 70+. The participants were interviewed and underwent cognitive testing. A diagnostic team diagnosed dementia and mild cognitive impairment. Weights adjusting for non-response bias were used in the comparison of Trondheim and Nord-Trøndelag. The prevalence of dementia in Trondheim was estimated at 16.2% for the age group 70 years and over, after weighting for non-response bias with regard to age, sex, education and proportion of nursing home residents. Unadjusted dementia prevalence was 21.0% in Trondheim and 15.7% in Nord-Trøndelag. After weighting, the prevalence was almost identical in the two samples. Weighting for non-response is crucial for obtaining representative figures in prevalence studies of dementia.

Living with Dementia in Aotearoa (LiDiA): A Feasibility Study for a Dementia Prevalence Study in Māori and Non-Māori Living in New Zealand.

Recent estimations have projected a threefold increase in dementia prevalence in Aotearoa New Zealand (NZ) by 2050, particularly in Maori and Pacific peoples. However, to date, there are no national data on dementia prevalence, and overseas data are used to estimate the NZ dementia statistics. The aim of this feasibility study was to prepare the groundwork for the first full-scale NZ dementia prevalence study that is representative of Māori, European, Pacific and Asian peoples living in NZ. The main feasibility issues were: (i) Sampling to ensure adequate community representation from the included ethnic groups, (ii) Preparing a workforce to conduct the fieldwork and developing quality control, (iii) Raising awareness of the study in the communities (iv) Maximizing recruitment by door-knocking, (v) Retaining those we have recruited to the study and (vi) Acceptability of study recruitment and assessment using adapted versions of the 10/66 dementia protocol in different ethnic groups living in South Auckland. We found that a probability sampling strategy using NZ Census data was reasonably accurate and all ethnic groups were sampled effectively. We demonstrated that we were able to train up a multi-ethnic workforce consisting of lay interviewers who were able to administer the 10/66 dementia protocol in community settings. The response rate (224/297, 75.5%) at the door-knocking stage was good but attrition at subsequent stages was high and only 75/297 (25.2%) received the full interview. Our study showed that it would be feasible to conduct a population-based dementia prevalence study using the 10/66 dementia protocol in Māori, European and Asian communities living in NZ, utilizing a qualified, skilled research team representative of the families participating in the study. The study has demonstrated that for recruitment and interviewing in Pacific communities a different but culturally appropriate approach is required.

Psychosocial profiles within community-dwelling older adults with Mild Cognitive Impairment: A prevalence and latent profile analysis study.

Mild Cognitive Impairment (MCI) is an at-risk stage for dementia and accurate prevalence studies are lacking in Singapore. From the literature, it is evident that psychosocial factors increase the risk of conversion to dementia. In this study, we sought to establish the prevalence of MCI in Singapore and study the associated psychosocial factors using latent profile analysis. 902 community-dwelling older adults, aged between 60 and 99 years old (Mage = 70.48 years), were recruited as part of the Community Health and Intergenerational Study (CHI). They completed neurocognitive assessments and questionnaires on depression and anxiety symptoms, quality of life, social support, satisfaction with life, and social connectivity. Petersen's criteria was used to diagnose MCI. Within the MCI sample, 166 subjects' psychosocial scores were entered into a latent profile analysis to identify profiles of psychosocial functioning. The prevalence of MCI in our sample was 21.5%. They had significantly lower years of education and perceived social support and higher depressive symptoms than the normal ageing group. Three distinct profiles emerged within the MCI group corresponding to a positive (45.2%), neutral (38.5%), and negative (16.3%) pattern of psychosocial scores. These profiles did not differ significantly in terms of demographic or cognitive variables. The three psychosocial profiles might reflect the differing implications of MCI on a person's well-being and the negative psychosocial profile might likely be most at risk of conversion to dementia. Future longitudinal studies are required to confirm these implications.

Dementia prevalence estimation among the main ethnic groups in New Zealand: a population-based descriptive study of routinely collected health data

ObjectiveEstimates of dementia prevalence in New Zealand (NZ) have previously been extrapolated from limited Australasian studies, which may be neither accurate nor reflect NZ’s unique population and diverse ethnic groups....

Culturally Appropriate Assessment of Depression and Anxiety in Older Torres Strait Islanders: Limitations and Recommendations

ABSTRACT Objectives The aim of the study was to assess the prevalence of anxiety and depression in older Aboriginal and Torres Strait Islander adults. Methods A modified version of the PHQ-9 (KICA-dep) and the Geriatric Anxiety Inventory (GAI) were administered as part of a wider dementia prevalence study conducted in the Torres Strait. Results were compared to diagnoses obtained on Geriatric review to evaluate their applicability in the region. Results A total of 236 participants completed the KICA-dep and 184 completed the GAI short form. Of these, 10.6% were identified with depression and 15.8% with anxiety. Some participants found questions about suicide ideation and self-harm offensive and others had difficulty understanding concepts on the GAI. The KICA-dep performed poorly in comparison to diagnosis on geriatric clinical review, so results are unlikely to reflect the true prevalence of depression in the region. Conclusions Further research is required to explore the underlying dimensions of depression and anxiety and terminology used to express mood symptoms in the Torres Strait. Clinical Implications • Current mental health screening tools are not applicable for the Torres Strait • More work is required to determine how symptoms of depression and anxiety are expressed within Torres Strait communities

Prevalence study of dementia with Lewy bodies in a Parkinson's disease reference center: Clinical and laboratory analysis of a Rio de Janeiro/Brazil cohort

Aims: To apply the diagnostic criteria for Dementia with Lewy Bodies (DLB) in a cohort of patients with parkinsonian syndromes in Rio de Janeiro; to estimate the prevalence of this syndrome; to analyze the clinical profile, pharmacological treatment and neuroimaging of this group of patients.

Factors associated with the increased risk of dementia found in the Torres Strait

To identify the specific risk factors for dementia in the Torres Strait. This research was conducted as part of a cross-sectional dementia prevalence study conducted in the Torres Strait. Participants underwent a comprehensive health assessment, where data on risk factors were collected, and a Geriatrician assessment, which was used to establish dementia diagnoses. A total of 276 Torres Strait residents aged between 45 and 93 participated in the study. Cerebrovascular disease, chronic kidney disease and older age were the most significant risk factors in this population. Once adjusted for age, cerebrovascular disease, chronic kidney disease, diabetes, low education and problems with mobility and incontinence were significantly associated with dementia. Reducing dementia risk in the Torres Strait requires multifactorial interventions to address potentially modifiable risk factors with a particular focus on addressing the development of chronic midlife diseases.

Community involvement to maximise research success in Torres Strait Islander populations: more than just ticking the boxes.

Health research is important to effectively address the health disparities between Indigenous and non-Indigenous Australians. However, research within Aboriginal and Torres Strait Islander communities has not always been conducted ethically or with tangible benefits to those involved. Justifiably then, people may be reticent to welcome researchers into their communities. Genuine commitment to community consultation, the fostering of partnerships and collaborative approaches maximise successful outcomes and research translation in these communities. Despite guidelines existing to try to ensure the needs of Aboriginal and Torres Strait Islanders are met through any research involving them, non-Indigenous researchers may not be fully aware of the complexities involved in applying these guidelines. This article explores how a team of Indigenous and non-Indigenous researchers understood and applied the guidelines during a 3-year dementia prevalence study in the Torres Strait. Their reflections on the practicalities involved in conducting ethically sound and culturally appropriate research are discussed. Having a deep understanding of the ethical principles of research with Torres Strait communities is more than just 'ticking the boxes' on ethics approvals. Genuine community involvement is paramount in conducting research with the communities and only then will research be relevant to community needs, culturally appropriate and facilitate the translation of knowledge into practice.

426 PREVALENCE OF, AND RISK FACTORS FOR, DEMENTIA IN ADULT OUTPATIENT REFERRALS TO A REGIONAL REFERRAL HOSPITAL IN ARUSHA, TANZANIA

Abstract Introduction The global burden of dementia is increasing, with the greatest increase predicted to occur in sub-Saharan Africa (SSA). Despite this there are limited previous data on the prevalence of, and risk factors for, dementia in SSA. This study aimed to estimate the prevalence of dementia, and investigate its associations, in those aged 60 years and older attending the outpatient department of Mount Meru Hospital in northern Tanzania. This is the first hospital-based outpatient dementia prevalence and risk factors study to be conducted in an east African population. Methods This was a one-phase cross-sectional study. Adults aged 60 years and over attending medical outpatients were screened for dementia using The Identification and Intervention for Dementia in Elderly Africans cognitive screening tool. Those who scored ≤9 were clinically assessed using the DSM-IV criteria. Demographic, medical comorbidity and lifestyle information were collected during a clinical assessment. Results Prevalence of dementia was 5.0% (95% confidence interval: 3.7–6.3). Binary logistic regression found female sex (odds ratio (OR) = 2.778), having no formal education (OR = 6.088), quantity of alcohol consumption (units/week) (OR = 1.080), uncorrected visual impairment (OR = 4.260), body mass index &amp;lt;18.5 kg/m2 (OR = 6.588) and stroke (OR = 15.790 with wide 95% confidence interval (3.48–74.475)) to be significantly, independently associated with dementia. Conclusions The prevalence of dementia in this population is lower than previously reported community-based rates in Tanzania, and similar to those in high-income countries. This is the first time the association between uncorrected visual impairment and dementia has been reported in SSA. Other associations identified are in keeping with previous literature. Further research on the management of dementia and its risk factors, and the support and education of carers and patients in east African populations is required.

Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009-2010 and 2018-2019: is there evidence of changing prevalence?

Although limited, existing epidemiological data on dementia in sub-Saharan Africa indicate that prevalence may be increasing; contrasting with recent decreases observed in high-income countries. We have previously reported the age-adjusted prevalence of dementia in rural Tanzania in 2009-2010 as 6.4% (95% confidence interval [CI] 4.9-7.9) in individuals aged ≥70 years. We aimed to repeat a community-based dementia prevalence study in the same setting to assess whether prevalence has changed. This was a two-phase door-to-door community-based cross-sectional survey in Kilimanjaro, Tanzania. In Phase I, trained primary health workers screened all consenting individuals aged ≥60 years from 12 villages using previously validated, locally developed, tools (IDEA cognitive screen and IDEA-Instrumental Activities of Daily Living questionnaire). Screening was conducted using a mobile digital application (app) on a hand-held tablet. In Phase II, a stratified sample of those identified in Phase I were clinically assessed using the DSM-5 criteria and diagnoses subsequently confirmed by consensus panel. Of 3011 people who consented, 424 screened positive for probable dementia and 227 for possible dementia. During clinical assessment in Phase II, 105 individuals met DSM-5 dementia criteria. The age-adjusted prevalence of dementia was 4.6% (95% CI 2.9-6.4) in those aged ≥60 years and 8.9% (95% CI 6.1-11.8) in those aged ≥70 years. Prevalence rates increased significantly with age. The prevalence of dementia in this rural Tanzanian population appears to have increased since 2010, although not significantly. Dementia is likely to become a significant health burden in this population as demographic transition continues.

Using Big Data to Estimate Dementia Prevalence in New Zealand: Protocol for an Observational Study.

BackgroundDementia describes a cluster of symptoms that includes memory loss; difficulties with thinking, problem solving, or language; and functional impairment. Dementia can be caused by a number of neurodegenerative diseases, such as Alzheimer disease and cerebrovascular disease. Currently in New Zealand, most of the systematically collected and detailed information on dementia is obtained through a suite of International Residential Assessment Instrument (interRAI) assessments, including the home care, contact assessment, and long-term care facility versions. These versions of interRAI are standardized comprehensive geriatric assessments. Patients are referred to have an interRAI assessment by the Needs Assessment and Service Coordination (NASC) services after a series of screening processes. Previous estimates of the prevalence and costs of dementia in New Zealand have been based on international studies with different populations and health and social care systems. This new local knowledge will have implications for estimating the demographic distribution and socioeconomic impact of dementia in New Zealand.ObjectiveThis study investigates the prevalence of dementia, risk factors for dementia, and drivers of the informal cost of dementia among people registered in the NASC database in New Zealand.MethodsThis study aims to analyze secondary data routinely collected by the NASC and interRAI (home care and contact assessment versions) databases between July 1, 2014, and July 1, 2019, in New Zealand. The databases will be linked to produce an integrated data set, which will be used to (1) investigate the sociodemographic and clinical risk factors associated with dementia and other neurological conditions, (2) estimate the prevalence of dementia using weighting methods for complex samples, and (3) identify the cost of informal care per client (in number of hours of care provided by unpaid carers) and the drivers of such costs. We will use design-based survey methods for the estimation of prevalence and generalized estimating equations for regression models and correlated and longitudinal data.ResultsThe results will provide much needed statistics regarding dementia prevalence and risk factors and the cost of informal care for people living with dementia in New Zealand. Potential health inequities for different ethnic groups will be highlighted, which can then be used by decision makers to inform the development of policy and practice.ConclusionsAs of November 2020, there were no dementia prevalence studies or studies on informal care costs of dementia using national data from New Zealand. All existing studies have used data from other populations with substantially different demographic distributions. This study will give insight into the actual prevalence, risk factors, and informal care costs of dementia for the population with support needs in New Zealand. It will provide valuable information to improve health outcomes and better inform policy and planning.International Registered Report Identifier (IRRID)DERR1-10.2196/20225

Disclosure of individual‐specific results to participants of a dementia prevalence study: A qualitative study

AbstractBackgroundDementia research and innovation is action area 7 of the WHO Global action plan on the public health response to dementia. Effective progress in this area depends on the promotion of participation in research both for people with and for those without dementia. However, evidence suggests that current research ethics policies and norms take participants’ preferences in little account, and may hinder equitable opportunities to take part in epidemiological research. Before conducting an epidemiological study into dementia and its impact, whose primary outcome is prevalence of dementia based on a probabilistic dementia diagnosis, we conducted a qualitative study to explore participants’ understanding of the meaning of individual‐specific results and on their preferences regarding their return.MethodBetween July 2019 and January 2020, we conducted interviews with individuals who participated in the validation phase of an epidemiological study (N = 22). Participants were 65 years old or older and resident in the Italian‐speaking part of Switzerland. We elicited information on their participation experience in the validation study, their reasons for participation (including expectations and potential barriers), their opinion on the return of research results, their understanding of these results. We also explored the communication preferences and the personal justification in favor or against the and the anticipated feelings with respect to the return of results. Finally, we discussed their preferences regarding the provision of informed consent for the return of study results. All interviews were recorded, transcribed and analyzed using thematic analysis techniques.ResultMost participants reported that researchers have a duty to share individual‐specific results with participants if requested to, and that these results must meet certain validity and reliability criteria. The main reasons in support for the return include the desire to know/ exclude oneself dementia diagnosis, and the need to establish a relationship of mutual trust between researchers and participants.ConclusionIn the context of an epidemiological study on dementia, researchers should demonstrate the validity of individual results (including dementia diagnosis) and offer in advance to participants the opportunity to receive this information accounting for their preferences and values.

For the sake of informed participation: Development of two audio‐visual aids for informed consent to a dementia prevalence study through participatory action research

AbstractBackgroundThe limits of traditional informed consent are well known. Its goal should be to support individual autonomy and provide assurance that potential research participants are neither deceived nor coerced. For these reasons, they should be designed to give potential research participants control over the amount of information they receive and the opportunity to rescind consent already given. However, most informed consent forms are excessively long and use a technical jargon that is hard to understand for lay people. As part of an epidemiological study on dementia and its impact, we set out to develop two visual aids for informed consent (a video and a printed infographic) through participatory action research.MethodWe conducted four focus groups with people aged 65 or older and resident in the Italian‐speaking Canton of Switzerland (N=30). Participants were shown a preliminary version of the visual aids and were asked to provide feedback on information quality and appeal (speed, duration, color, font etc.). Focus groups were tape‐recorded, transcribed and analyzed to inform refinement of the visual aids before each subsequent focus group.ResultThe two visual aids complied with good clinical practice (GCP) guidelines of informed consent. We adapted the videos to the participants’ demand for lower speed and longer duration. We re‐arranged information according to a question‐and‐answer format displayed within the same graphical sequence. Information deemed too complex by participants was simplified using an advanced readability assessment tool (READ–IT), which combines traditional raw text features with lexical, morpho‐syntactic and syntactic information.ConclusionParticipatory action research is crucial for the development of tailored tools to support informed consent in epidemiological research. Further research is warranted to test if compared to traditional informed consents, the use of audio‐visual aids developed with potential participants to epidemiological research promotes research participation, and in a better informed fashion.

Returning individual-specific results of a dementia prevalence study: insights from prospective participants living in Switzerland.

ObjectivesTo explore prospective participants' preferences regarding the return of their individual‐specific results from a dementia prevalence study (a probabilistic diagnosis of dementia).Methods/DesignWe conducted a qualitative study with 22 individuals aged 45 to 86 and resident in the Canton of Ticino (Switzerland). Participants had previously joined the validation phase of an epidemiological study into dementia and its impact.ResultsWe found that individuals welcome the return of their individual‐specific results, provided these meet a number of validity, clinical, and personal utility criteria. They justify researchers' duty to return study findings with the principles of beneficence (eg, providing information that can help participants' medical decision‐making) and justice (eg, acknowledging participants' efforts to help research by sharing their personal information). Furthermore, individuals anticipate societal benefits of the return of individual specific study findings, including improved interpersonal relationships among individuals and decreased dementia‐related stigma.ConclusionsOur findings suggest that researchers should address the return of individual‐specific study results early on during study design and involve prospective participants in identifying both the conditions under which results should be offered and the perceived individual and societal benefits returning can have.

Dementia Prevalence in a Rural Region ofSouth Africa: A Cross-Sectional Community Study.

Background:Dementia is a growing concern for low- and middle-income countries where longevity is increasing and service provision is poor. Global prevalence estimates vary from 2% to 8.5% for those aged 60 years and older. There have been few dementia studies in sub-Saharan Africa, and prevalence data are lacking for South Africa.Objective:To conduct a large dementia prevalence study in a low income rural population in South Africa.Methods:1,394 Xhosa-speaking community dwellers, aged ≥60 y (mean age±sd 71.3±8.3 y), in three clinic catchment areas, were screened at home. Trained community health workers administered the brief Community Screening Instrument for Dementia (CSID) to participants and informants to assess cognitive and functional capacity. Depressive symptoms were assessed with three questions from the EURO-D.Results:The prevalence estimate using published CSID sensitivity/specificity values was 0.8 (95% CI: 0.06–0.09). Using CSID cut-off scores the estimated prevalence was 0.12 (95% CI: 0.10–0.13), with 161 screen-positives. Both methods gave a rate of 0.11 (95% CI: 0.09–0.13) for those over 65 years (n = 1051). 68.6% of participants were female and 69.8% had less than 7 years of education. Dementia risk was associated with older age and symptoms of depression, but not with sex. The association with education was not significant when controlled for by age.Conclusions:Dementia prevalence estimates were higher than expected for this low-income rural community. There is a need for increased dementia awareness and feasible support interventions. We also need further studies of regional prevalences, dementia subtypes, and modifiable risk factors in South Africa.

Mortality rates in community-dwelling Tanzanians with dementia and mild cognitive impairment: a 4-year follow-up study.

we have previously conducted a community-based prevalence study of dementia in older adults living in the rural Hai district of Tanzania. The aim of this study was to record mortality rates at 4 years post-diagnosis, of those with dementia, mild cognitive impairment (MCI) and no cognitive impairment. during Phase I of the prevalence study, 1,198 people aged 70 years and over were screened, and a stratified sample of 296 was assessed for the presence of dementia or MCI in Phase II. Seventy-eight people had dementia and 46 had MCI. Four years after diagnosis, we attempted to follow-up all those seen in Phase II and record all deaths. of the 296, follow-up data were available for 287 (97.0%), including 77 with dementia and 45 with MCI. Of the 172 with no cognitive impairment, 165 (95.9%) were followed up and a sample of 89 people selected as representative of the background population. Forty-eight people with dementia (62.3%), 19 with MCI (42.2%) and 11 with no cognitive impairment (12.4%) had died at 4-year follow-up. After adjusting for the effects of age, gender and education, the hazard ratio was 6.33 (95% CI 3.19-12.58) for dementia and 3.57 (95% CI 1.64-7.79) for MCI relative to people with no cognitive impairment. Mortality rates were highest in those with vascular dementia. dementia and MCI were associated with excess mortality relative to those with no cognitive impairment.