Skip to comments.How Come People Rarely Die of Dementia in Poor Countries?
Posted on 07/31/2012 10:28:54 AM PDT by SeekAndFind
When I was a young doctor working in poor countries, I made a casual observation that old people in them did not seem to suffer very often from dementia. It occurred to me that properly conducted surveys, of the kind that I was not suited to performing, might be valuable, because a difference in the incidence and prevalence of dementia in various countries might offer a clue to the cause of the disease. As populations throughout the world age, this is a matter of increasing importance.
But was my initial casual observation true? And, if true, might the explanation not be that people who survived to old age in poor countries were simply the kind of people who, in richer countries, would not have got the disease anyway?
A survey has been published recently in the Lancet, in which researchers interviewed and tested 12,887 people over the age of 65 in various locations in the Dominican Republic, Cuba, Venezuela, Peru, Mexico, and China. Rather strangely, they write that “11,718 were dementia-free,” rather than that 1,169 showed signs of dementia. This means that 9.1 percent of their initial sample showed such signs, and oddly enough the authors do not attempt to answer the rather obvious question of whether this percentage is higher or lower than you would have expected of a similar sample taken in richer countries.
They did, however, note that the death rate among those who initially showed signs of dementia during a 3-5 year period of follow-up was 1.56 to 5.69 times as high as among those with no such signs. The relative risk of death for people with dementia in poor countries was higher than that in richer countries; not altogether surprisingly, since it is likely that the medical treatment for the intercurrent but curable illnesses to which the demented are prone would be less assiduously treated in poor countries.
The researchers followed up 69 percent of their initial cohort who showed no signs of dementia for between 3 and 5 years (31 percent were lost to follow-up), to establish a rate at which dementia developed, and also to try to identify what factors, if any, protected against it.
What they found was roughly similar to what has been found in richer countries. Between 2 and 3 percent of people aged over 65 developed dementia each year, though of course the proportion was proportional to initial age. In Europe, a comparable age-adjusted figure would be 1.84 percent.
As in richer countries, the chances of developing dementia were lower among the better-educated. The particular protective factor was found to be literacy, not number of years at school, because in some countries literacy is not necessarily the outcome of prolonged schooling. We in the west know all about that.
If literacy protects against the development of dementia, ask the authors, why is there no epidemic of dementia in countries with aging populations but low literacy rates among the elderly? They answer that it is probably because those who are demented die disproportionately in such countries. However, they have not shown that there is no such epidemic; and furthermore, there is no proof that the statistical correlation between illiteracy and dementia is a causative one.
For the moment, however, the prevailing orthodoxy is that reading (and other such educated activities) create a “cognitive reserve” that protects against the development of dementia. The educated do not show signs of losing their mind because they have more of it to use, just as very rich people rarely suffer poverty.
It seems a good plan, then, to continue to read. Personally, I was planning on it anyway.
BUMP! Pretty simple isn’t it.
Exactly. They die of infectious diseases first.
Besides people don’t really die of dementia, they die fr CHF or COPD or other organ failure.
Not the best logic in this article.
Because for whatever reason, they just don’t diagnose dementia. My father suffered from dementia, but all his lab signs were normal, and they gave him a clean bill of health.
They are not a Democrat subjected to listening to the likes of ∅™, Pelosi, Reid, Maxine Waters, Debbie Wasserman Schultzie, Sharpton, JJ , a host of the other usual suspects including MSNBC, CNN, NPR, etc.
I don’t think we want to die of the things that people die of in poor countries!
Some liked to point out that cancer diagnosis is more common in nations with advanced medical care that are (gasp! the horror!) industrialized - trying to say that industrialization causes cancer - that if we all lived in a pristine natural environment we would have lower cancer rates.
While there may be some truth to that, once separated from the outlandish claims; the truth of the matter is that even if cancer rates were exactly the same - one is more likely to get DIAGNOSED with cancer where there is advanced medical care.
An old Guatemalan in a hut may or may not get his stomach cancer properly diagnosed - but even without a proper diagnosis - he still got stomach cancer. And absent a proper diagnosis and proper care - he is much more likely to DIE of the cancer.
But you ask his family what he died of - they say - ‘He was old, had stomach problems, blood in his stool, and then died.’.
Wow - so he didn't have cancer! Miraculously free of cancer! People in Guatemalan pastoral living conditions are less likely to get (diagnosed with) cancer!
The majority of my dementia pt.s (hospice nurse) are mostly healthy otherwise.
Dementia pt’s usually die of aspiration pneumonia after they lose the ability to swallow their food/drink.
May G-d Bless you clee1. Thank you for all you do for our sick and disabled. You are appreciated more than you’ll ever know.
The comparison is between countries is between those people who do reach the relevant age group. Anywho, there is surprisingly little difference in life expectancy between countries anymore. Especially if you factor out higher infant mortality in poorer countries, which has a huge impact on life expectancy stats.
USA is 50th (!) in the world.
My privilege, poobear.
I see it as a type of ministry, similar to the mission field. God has amply blessed me and my family - it is my duty to help when and where I can.
AFAIK, tests for dementia are initiated because the patient is starting to exhibit symptoms thereof. In those 3rd-world environments, those symptoms are far more likely to get you killed.
Consider a common symptom. A red flag for dementia is turning the kitchen stove on and leaving it on unused; in a first-world environment there are layers of safety protecting against the consequences of that mistake (metal surfaces, fireproof/resistant counters, smoke detectors, fire departments). The equivalent mistake in a third-world environment would burn the house down.
Many diseases seem prevalent in developed countries only because other dominating diseases have been mitigated. Cancer is more common where food poisoning isn’t.
I would add that in those countries the services/organizations used to track these things probably either do not exist or they are not high on the list of priorities due to other, more pressing matters (i.e., civil war/ unrest, coups, famine, etc.).
That is very good to hear. Turns out I’ve been Blessed just hearing this.
May you, your family and your patients sleep well tonight and again, may G-d Bless all of you!
RE: Because they don’t live long enough to get into the age range.Malnutrition...malaria...cholera....or war usually gets them long before.
I don’t think the author ( a doctor ) excluded these diseases in his observation. He said this at the beginning of his article:
When I was a young doctor working in poor countries, I made a casual observation that old people in them did not seem to suffer very often from dementia.
That could mean, that taking these diseases into consideration, he still observes that they seldom get dementia.
My wife and I are primary caregivers to five elderly relatives. They are aged 76 to 94. We have had experience with hospice several times. You are Gods hands on earth. Thanks for what you do.
No FRiend... YOU and your wife are God’s Hands. You have the toughest job on earth, caring for elderly loved ones.
I am privileged to serve my pt.’s and their families, and to ensure that when the end does come, it it with as much peace and dignity as is possible.
Thank you for your kind words, but YOURS is the the true calling.
It could also be environmental and diet. They might live closer to the earth, eating more natural things and less processed things. Less vaccines (including flus). Less chronic inflammation in the body. Less sugar.
If they are actually poor, they may also have periods of fasting, or overall low caloric intake. That can help too.
They are not a Democrat, or a Republican that is subjected to listening to the likes of ∅, Pelosi, Reid, Maxine Waters, Debbie Wasserman Schultzie, Sharpton, JJ , a host of the other usual suspects including MSNBC, CNN, NPR, etc.
One reason we rank higher in Infant Mortality is that we try to save a lot of premature babies that would (under socialist medicine) be counted as a miscarriage.
One reason we rank higher is that we try to save a lot of premature babies that would (under socialist medicine) be counted as a miscarriage.
Low birth weight infants are not counted against the live birth statistics for many countries reporting low infant mortality rates.
According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500gGgAgHgMgPGVGcgjgkglgmgpgG’sGAGEGIGUGaGegoGBGMGPGdGkGrgmgrgsgtFHfhCJKQcjkqWYwyABDEI is not considered a living child.
But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies - considered unsalvageableunsolvableinsolvable outside of the U.S. and therefore never alive - is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.
Let me try that again......
Low birth weight infants are not counted against the “live birth” statistics for many countries reporting low infant mortality rates.
According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing <500g is not considered a living child.
But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies - considered “unsalvageable” outside of the U.S. and therefore never alive - is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.
Some of the countries reporting infant mortality rates lower than the U.S. classify babies as “stillborn” if they survive less than 24 hours whether or not such babies breathe, move, or have a beating heart at birth.
Forty percent of all infant deaths occur in the first 24 hours of life.
In the United States, all infants who show signs of life at birth (take a breath, move voluntarily, have a heartbeat) are considered alive.
If a child in Hong Kong or Japan is born alive but dies within the first 24 hours of birth, he or she is reported as a “miscarriage” and does not affect the country’s reported infant mortality rates.
Too short to count?
In Switzerland and other parts of Europe, a baby born who is less than 30 centimeters long is not counted as a live birth. Therefore, unlike in the U.S., such high-risk infants cannot affect Swiss infant mortality rates.
Efforts to salvage these tiny babies reflect this classification. Since 2000, 42 of the world’s 52 surviving babies weighing less than 400g (0.9 lbs.) were born in the United States.
Thanks. I was actually somewhat aware of the complexities of comparing statistics from one nation to another. Similar problems pop up with comparing crime rates and other factors.
Statistics compiled with wildly different criteria can’t really be compared very profitably.
As I pointed out, life expectancy is usually calculated at birth, which makes infant mortality, however calculated, wildly influential.
I have seen life expectancy tables at age 20 and 50, and those seem to be more likely to be comparable.
Shame on me for overlooking the obvious. Thanx.
My grandmother was an avid reader, several books a week; didn’t spare her from senile dementia.
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