Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-0116cDementia in the Indian SubcontinentS. Rajkumar 1 , M. Ganguli 2 and D. V. Jeste 31 University of Newcastle, NSW, Australia, 2 University of Pittsburgh, PA, USA, and3University of San Diego, and VA San Diego Healthcare System, CA, USAOf India’s population of nearly one billion, 50 million are aged 65years or older and constitute a major potential high-risk group fordementia, yet pathological studies of dementia in India suggestthat Alzheimer’s disease (AD) is rare or unrecognized in mostclinic populations. The few published epidemiological studies ofdementia from India suggest potential regional differences inprevalence, which may be partly attributable to literacy or urban/rural residence. Differences across studies may also reflectmethodological difficulties and differences. Psychometric andother screening instruments must be standardized in differentIndian languages for elderly populations with widely varyinglevels of literacy, education and urbanization. Older individualsfrequently have inadequately corrected sensory impairments,which can interfere with testing. They may have little interest incurrent national or world events, and thus appear to be impaired,and may not know their dates of birth. Cognitive deficits may beunder-recognized and under-reported by family members, out ofrespect for, as well as reflecting low expectations of, the elderly.Prevalence rates of dementia from different studies in India 1–5have ranged from a low of 1.36% to a high of 3.5% among thoseaged 65+. These low rates were found despite the use of highlystandardized instruments for case detection, e.g. the GMS–AGECAT program and the community version of the GMS atthe Madras site of a WHO multicenter study 4 .Lower prevalence may be due to shorter life expectancy, withselective survival of those not at risk for dementia, and also toshorter duration or survival with the disease. Survival may beunderestimated if the manifestations of dementia are detected lateor attributed in their earlier stages to normal aging. Plausible riskfactors yet to be explored in Indian populations include headtrauma, thyroid disease and illiteracy. Potential protective factorsmight range from family caregiving to low-fat diets. Tolerance ofmemory loss in old age, as well as lack of financial resources, maydelay acceptance of treatment across the majority of Indiancommunities. Although prevalence is low, dementia may still posea major public health challenge given the vastly growingpopulation, the minimal existing infrastructure and the transitionsin family structure in these regions.REFERENCES1. Rajkumar S, Kumar S. Prevalence of dementia in the community: arural–urban comparison from Madras, India. Aust J Ageing 1996; 15:9–13.2. Rajkumar S, Kumar S, Thara R. Prevalence of dementia in a ruralsetting: a report from India. Int J Geriat Psychiat 1997; 12: 702–7.3. Shaji S, Promodu K, Abraham T et al. An epidemiological study ofdementia in a rural community in Kerala, India. Br J Psychiat 1996;168: 745–9.4. Copeland JRM, Dewey ME. The computer assisted systems. InHoveguimian S et al., eds, Classification and Diagnosis of Alzheimer’sDisease. An International Perspective. Hogrefe and Huber, 1989: 87–94.5. Chandra V, Ganguli M, Pandav R et al. Prevalence of Alzheimer’sdisease and other dementias in rural India: the Indo-US Study.Neurology 1998; 51: 1000–8.Principles and Practice of Geriatric Psychiatry, 2nd edn. Edited by J. R. M. Copeland, M. T. Abou-Saleh and D. G. Blazer&2002 John Wiley & Sons, Ltd