title: The association between common physical impairments and dementia in low and middle income countries, and, among people with dementia, their association with cognitive function and disability. A 10/66 Dementia Research Group population-based study.
abstract: OBJECTIVE
  Chronic physical comorbidity is common in dementia. However, there is an absence of evidence to support good practice guidelines for attention to these problems. We aimed to study the extent of this comorbidity and its impact on cognitive function and disability in population-based studies in low and middle income countries, where chronic diseases and impairments are likely to be both common and undertreated.
  
  
  METHODS
  A multicentre cross-sectional survey of all over 65 year old residents (n = 15 022) in 11 catchment areas in China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru. We estimated the prevalence of pain, incontinence, hearing and visual impairments, mobility impairment and undernutrition according to the presence of dementia and its severity, and, among those with dementia, the independent contribution of these impairments to cognitive function and disability, adjusting for age, gender, education and dementia severity.
  
  
  RESULTS
  Incontinence, hearing impairment, mobility impairment and undernutrition were consistently linearly associated with the presence of dementia and its severity across regions. Among people with dementia, incontinence, hearing impairment and mobility impairment were independently associated with disability in all regions while the contributions of pain, visual impairment and undernutrition were inconsistent. Only hearing impairment made a notable independent contribution to cognitive impairment.
  
  
  CONCLUSIONS
  There is an urgent need for clinical trials of the feasibility, efficacy and cost-effectiveness of regular physical health checks and remediation of identified pathologies, given the considerable comorbidity identified in our population based studies, and the strong evidence for independent impact upon functioning.
authors.affiliation: King's College London, Institute of Psychiatry, Centre for Global Mental Health, Health Service and Population Research Department, London, UK. m.prince@iop.kcl.ac.uk
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
authors.forename: Daisy
authors.initials: D
authors.lastname: Acosta
authors.forename: Cleusa P
authors.initials: CP
authors.lastname: Ferri
authors.forename: Mariella
authors.initials: M
authors.lastname: Guerra
authors.forename: Yueqin
authors.initials: Y
authors.lastname: Huang
authors.forename: K S
authors.initials: KS
authors.lastname: Jacob
authors.forename: A T
authors.initials: AT
authors.lastname: Jotheeswaran
authors.forename: Zhaorui
authors.initials: Z
authors.lastname: Liu
authors.forename: Juan J Llibre
authors.initials: JJ
authors.lastname: Rodriguez
authors.forename: Aquiles
authors.initials: A
authors.lastname: Salas
authors.forename: Ana Luisa
authors.initials: AL
authors.lastname: Sosa
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Williams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000502:physiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology* / Q000503:physiopathology; D003906:Developing Countries / Q000706:statistics & numerical data; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D012044:Regression Analysis; D012959:Socioeconomic Factors