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Prevalence of Alzheimer's disease and other dementias in rural India

The Indo-US study

From the Department of Epidemiology, Graduate School of Public Health (Drs. Chandra, Ganguli, and Belle, and J. Johnston), and the Division of Geriatrics and Neuropsychiatry, Department of Psychiatry, School of Medicine (Drs. Ganguli and DeKosky), University of Pittsburgh, PA; and the Centre for Ageing Research (Drs. Chandra and Pandav), New Delhi, India.

Address correspondence and reprint requests to Dr. Mary Ganguli, Western Psychiatric Institute and Clinic, 3811 O'Hara Street, Pittsburgh, PA 15213-3593.

Objective: To determine the prevalence of AD and other dementias in a rural elderly Hindi-speaking population in Ballabgarh in northern India.

Design: The authors performed a community survey of a cohort of 5,126 individuals aged 55 years and older, 73.3% of whom were illiterate. Hindi cognitive and functional screening instruments, developed for and validated in this population, were used to screen the cohort. A total of 536 subjects (10.5%) who met operational criteria for cognitive and functional impairment and a random sample of 270 unimpaired control subjects (5.3%) underwent standardized clinical assessment for dementia using the Diagnostic and Statistical Manual of Mental Disorders-fourth edition diagnostic criteria, the Clinical Dementia Rating Scale (CDR), and National Institute of Neurological and Communicative Disorders and Stroke-Alzheimer's Disease and Related Disorders Association (NINCDS-ADRDA) criteria for probable and possible AD.

Results: We found an overall prevalence rate of 0.84% (95% CI, 0.61 to 1.13) for all dementias with a CDR score of at least 0.5 in the population aged 55 years and older, and an overall prevalence rate of 1.36% (95% CI, 0.96 to 1.88) in the population aged 65 years and older. The overall prevalence rate for AD was 0.62% (95% CI, 0.43 to 0.88) in the population aged 55+ and 1.07% (95% CI, 0.72 to 1.53) in the population aged 65+. Greater age was associated significantly with higher prevalence of both AD and all dementias, but neither gender nor literacy was associated with prevalence.

Conclusions: In this population, the prevalence of AD and other dementias was low, increased with age, and was not associated with gender or literacy. Possible explanations include low overall life expectancy, short survival with the disease, and low age-specific incidence potentially due to differences in the underlying distribution of risk and protective factors compared with populations with higher prevalence.

Supported by grants AG09202, AG07562, and AG05133 from the National Institute on Aging (National Institutes of Health, US Department of Health and Human Services).

Received April 23, 1998. Accepted in final form June 6, 1998.