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How Come People Rarely Die of Dementia in Poor Countries?
PJMedia ^ | 07/31/2012 | THEODORE DALRYMPLE

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.

***


TOPICS: Health/Medicine; Science; Society
KEYWORDS: dementia; healthcare; medical; medicine; poorcountries
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To: QT3.14
minor wording correction

Easy answer:

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.

21 posted on 07/31/2012 2:00:08 PM PDT by DrDavid (George Orwell was an optimist.)
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To: Sherman Logan

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.

http://www.americanthinker.com/blog/2011/08/infant_mortality_figures_for_us_are_misleading.html

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.

http://www.americanthinker.com/blog/2011/08/infant_mortality_figures_for_us_are_misleading.html

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.


22 posted on 07/31/2012 3:08:42 PM PDT by allmendream (Tea Party did not send GOP to D.C. to negotiate the terms of our surrender to socialism)
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To: Sherman Logan

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.

Read more: http://www.americanthinker.com/blog/2011/08/infant_mortality_figures_for_us_are_misleading.html#ixzz22EzF6Dw8


23 posted on 07/31/2012 3:10:50 PM PDT by allmendream (Tea Party did not send GOP to D.C. to negotiate the terms of our surrender to socialism)
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To: allmendream

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.


24 posted on 07/31/2012 3:40:03 PM PDT by Sherman Logan
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To: DrDavid

Shame on me for overlooking the obvious. Thanx.


25 posted on 07/31/2012 4:01:26 PM PDT by QT3.14 (We live in an era with Smart Phones and Dumb People)
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To: SeekAndFind

My grandmother was an avid reader, several books a week; didn’t spare her from senile dementia.


26 posted on 08/01/2012 11:29:49 AM PDT by Fire_on_High (WTB new tagline, PST!)
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