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.
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.
Prince
Martin
M
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
Acosta
Daisy
D
Ferri
Cleusa P
CP
Guerra
Mariella
M
Huang
Yueqin
Y
Jacob
K S
KS
Jotheeswaran
A T
AT
Liu
Zhaorui
Z
Rodriguez
Juan J Llibre
JJ
Salas
Aquiles
A
Sosa
Ana Luisa
AL
Williams
Joseph D
JD
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