Constructs underlying mild cognitive impairment of relevance to low and middle income countries

Student thesis: Doctoral ThesisDoctor of Philosophy


Background: Numbers of older people are increasing rapidly in most low and middle income
countries and there is a pressing need for adequate information on dementia and
cognitive disorders in these regions. Mild cognitive impairment is increasingly recognized
as an important ‘transition’ prior to dementia onset, but is poorly understood outside
Western settings, as are key constructs underlying this concept: namely, subjective memory
complaints, informant-reported memory deficits and the relationship between cognition and disability.

Methods: Data were analysed in relation to these questions from a series of catchment area
surveys of older people carried out following identical methodologies in Cuba, Mexico,
Dominican Republic, Peru, Venezuela, India and China, involving over 15,000
participating residents aged 65 years and over. Measurements had been rigorously assessed
for cross-cultural applicability and were identically administered.
Results: Normative data for cognitive function are described and compared, followed by
the prevalence of amnestic mild cognitive impairment. Substantial variations were found
between sites in the prevalence of subjective memory complaints and informant-reported
memory deficits, and in their associations with dementia, and with cognitive function in
participants without dementia. Variation was also found in the association between
cognitive function and informant-reported disability in participants. For example,
subjective memory complaints in China were relatively rare but much more strongly
associated with dementia and/or cognitive function than in other sites.

Conclusions: The high level of between-site variability in the associations in question suggests that mild cognitive impairment as a construct is strongly influenced by cultural factors which need to be taken into account when interpreting it or applying it in healthcare.
Date of Award2012
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorRobert Stewart (Supervisor)

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