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PAPERS:
S. SHAJI, SRIJA BOSE, and ABRAHAM VERGHESE
Prevalence of dementia in an urban population in Kerala, India
The British Journal of Psychiatry 2005; 186: 136-140 [Abstract] [Full text] [PDF]
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[Read eLetter] Prevalence of dementia in an urban population in Kerala, India
Sunny T Varghese   (25 February 2005)

Prevalence of dementia in an urban population in Kerala, India 25 February 2005
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Sunny T Varghese,
Resident
All India Institute of Medical Sciences,New Delhi India

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Re: Prevalence of dementia in an urban population in Kerala, India

sunny_tv{at}rediffmail.com Sunny T Varghese

Shaji et al (2005) have estimated the prevalence of dementia in an urban population of Kerala, India and have provided a glimpse into the various factors associated with dementia in their study. A few methodological issues of the study would need further clarification.

Although a cut off score of 23 was taken in the MMSE for all the subjects, a different cut off score would have been appropriate among the illiterates (11.2%) as educational status has been shown to affect the MMSE scores .

Although one case of dementia was missed in the 10 % of negatively screened population, the addition of 10 more cases to the final number of 56 cases seems to have inordinately escalated the final figures. In that case, the final number of dementia cases should have been 66 instead of 65 as described in the study.

With no objective evidence to suggest hypertension in the patients other than the verbal account of the caregivers, the very high odds ratio for hypertension is misleading. Further more with such a small number of subjects, the selection of the controls should have been more stringent. It would be advisable to take more number of controls for such a small sample size of patients with vascular dementia (n=22).

Although age has been shown to be a risk factor for dementia in many studies, how this conclusion was reached in this study is not clear.

Another issue of how the number of patients on treatment for Alzheimers dementia (21 out of 31) is more than the total number of alzheimers dementia detected in the study (n=30) also needs to be addressed.

Despite a few limitations the study adds to the growing literature of the epidemiology of dementia in developing countries and would be helpful for health care planners for adequate resource allocation for preventive and curative services.