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Neuroepidemiology. 2019;52(1-2):32-40. doi: 10.1159/000493483. Epub 2018 Nov 26.

Cognitive Function and Impairment in Older, Rural South African Adults: Evidence from "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in Rural South Africa".

Author information

1
Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA.
2
Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA.
3
Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.
4
Harvard Medical School, Boston, Massachusetts, USA.
5
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
6
Centre for Global Health Research, Umeå University, Umeå, Sweden.
7
INDEPTH Network, Accra, Ghana.
8
Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USAlberkman@hsph.harvard.edu.
9
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africalberkman@hsph.harvard.edu.

Abstract

BACKGROUND/AIMS:

We aimed to estimate the prevalence of cognitive impairment, and the sociodemographic and comorbid predictors of cognitive function among older, rural South African adults.

METHODS:

Data were from a population-based study of 5,059 adults aged ≥40 years in rural South Africa in 2015. Cognitive impairment was defined as scoring ≤1.5 SDs below the mean composite time orientation and memory score, or requiring a proxy interview with "fair" or "poor" proxy-reported memory. Multiple linear regression estimated the sociodemographic and comorbid predictors of cognitive score, with multiplicative statistical interactions between each of age and sex with education.

RESULTS:

Cognitive impairment increased with age, from 2% of those aged 40-44 (11/516) to 24% of those aged ≥75 years (214/899). The independent predictors of lower cognitive score were being older, female, unmarried, not working, having low education, low household wealth, and a history of cardiovascular conditions. Education modified the negative associations between female sex, older age, and cognitive function score.

CONCLUSIONS:

The prevalence of cognitive impairment increased with age and is comparable to rates of dementia reported in other sub-Saharan African countries. Age and sex differences in cognitive function scores were minimized as education increased, potentially reflecting the power of even poor-quality education to improve cognitive reserve.

KEYWORDS:

Epidemiology; Africa; Age factors; Cognitive function; Cognitive impairment; Cross-sectional studies ; Education; Prevalence; Sex; Sociodemographic characteristics

PMID:
30476911
DOI:
10.1159/000493483

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