REFERENCE ID: 2024 -

Title:

COGNITIVE IMPAIRMENT AMONG THE ELDERLY RURAL

POPULATION

INTRODUCTION

Ageing is a normal physiological process. Rapid growth in health care technologies,

inventions of new antibiotics, antimicrobials and active immunization, preventive, curative,

promotive approaches led to increase in life expectancy. Hence, by all these improvements in

health facility, the number of old age population also increased.1

Due to an increase in old-age population globally, cognitive impairment (CI) is

becoming a major public health problem. It can progress into other conditions like dementia

and Alzheimer's disease which could affect the quality of life and dependency on family

members.2

CI refers to mainly when elderly people have trouble in remembering things, learning,

concentrating and memorizing or could not make any kind of decisions which affects the

quality of their day to-day life. It may be mild to severe form. In persons with mild CI, decline

in cognitive functions are visible but, they can perform their daily activities independently. In

severe cases of impairment, there may be inability to understand, lack of memorization,

inability to talk or write.3

Cognitive impairment imposes a heavy burden on public health and is associated with

shortened life expectancy and people generally don't receive a diagnosis for this. The failure to

evaluate memory or cognitive complaints is likely to hinder treatment of underlying disease

and co-morbid conditions.3

 In India, the prevalence of cognitive impairment varies from 3.5% to 11.5% from north

to southern parts of India in people aged >65 years. The prevalence of CI is high in rural areas

of India compared to urban areas, whereas the studies in rural areas are very few compared to

urban population.4

Very few studies have been done on CI in rural India. It is therefore important to detect

the prevalence of CI and then to have a step wise systematic approach to promote a healthy,

graceful and active ageing.

 OBJECTIVES

1. To study the prevalence of Cognitive Impairment in the elderly population.

2. To study the factors affecting the Cognitive Impairment in the elderly population.
 METHODOLOGY

Type of Study and Study Design: Cross- Sectional Observational study

Place of Study: The study would be conducted in Chinakakani village, the rural field practice

of the present rural teaching hospital located in Guntur district of Andhra Pradesh. The

population of Chinakakani village is 6230, consisting of 1175 families residing in the village.

Among them all the elderly population aged ≥60 years of age would be enlisted for the study.

Study Subjects/ Participants: All the elderly population aged ≥ 60 years residing in the

village are eligible to participate in the study.

Duration of the Study: Data collection shall be carried out for two months upon receiving the

approval from the competent authority.

Sample Size Calculation: Review of different studies showed the prevalence of between

9.5%5 and 41%6 in resource-limited settings. The sample size was calculated based upon the

formula 4PQ/L2, where P = prevalence of cognitive impairment among the elderly population,

Q= 100-P, and L (Allowable Error) = taken at 20% of P which comes to 8.2.

So, considering the maximum prevalence of 41% as P, the sample size is calculated as n=4x

41 x 59/ 8.2 x 8.2 = 9676/67.24= 143.9.

The sample size is rounded off to 150 study subjects

Selection Criteria:

Inclusion Criteria: All the elderly population aged ≥ 60 years of age, residents of the

village, who are willing to provide an informed consent form shall be eligible to participate in

the study.

Exclusion Criteria: The study participants who are unwilling to participate, those who

refuse consent to participate are excluded from the study. All the eligible residents with history

of neuropsychiatric disorders who could not understand and/or obey the research procedures
and those with a history of nervous system disorders causing brain dysfunction shall also be

excluded from the study.

Proposed Intervention: As it is an observational study, no interventions would be done on the

study participants.

Data Collection Procedures: After enlisting all the eligible study participants, the rationale of

the study shall be explained and a written consent form shall be taken from them. They would

be administered a pre- designed, pre-validated semi - structured schedule by the principal

investigator using interview method.

Instruments Used: A pre- designed, pre-validated, semi-structured schedule shall be used in

the present study.

The study instrument consists of three parts.

Part-1 consists of the Socio-demographic profile of the elderly population which includes

variables such as age, sex, religion, caste, current occupation, type of family, total family

income, current marital status, etc.

Part- 2 consists of Mini Mental State Examination7 (MMSE) questionnaire which is a 11-

question measure that tests five areas of cognitive function which includes questions related to

Orientation (Max. score=10), Registration (Max. score=3), Attention & Calculation (Max.

score=5), Recall (Max. score=3), Language (Max. score=8), and Copying (Max. score=1). The

maximum score is 30. Scores between 24 to 30= No cognitive impairment, 18 to 23= Mild

Cognitive impairment and scores between 0 to 17 = Severe cognitive impairment.

The MMSE is utilized to gauge mental hindrance in more seasoned grown-ups as it

tends to be utilized to evaluate for mental hindrance, to gauge the seriousness of mental

weakness at a given moment, to follow the course of mental changes in a person after some

time, and to record a singular's reaction to treatment.

 Part- 3 consists of Factors affecting Cognitive Impairment which includes

Morbidity profile (pre - existing illnesses loke Diabetes, Hypertension, Coronary Heart

diseases, etc.,), Habits like tobacco usage ang alcohol consumption, Physical and Mental

Health and Activity limitation for the past 30 days.

Quality Control: Pre-validation of the semi-structured schedule shall be done on a small

sample of elderly people in the hospital setting for validation. To avoid inter- observer

variation, the study schedule would be administered by the principal investigator only.

Plan of Analysis/ Statistical Tools: The data collected shall be entered into Microsoft Excel

and shall be analysed using Epi Info software. Relevant tests of significance applicable would

be done in the analysis. The data thus analysed shall be summarised in the form of tables and

graphs.

Ethical Considerations: The present research project is approved by Institutional Ethics

Committee on Human subjects Research. Informed written consent shall be obtained from all

the prospective eligible study subjects before data collection and those elderly people who are

unwilling to participate shall be excluded from the study.

IMPLICATIONS

Cognitive Impairment is one of the neglected disorders in India, compared to developed

countries and one amongst the emerging public health issues. In older cohort if left

undiagnosed, it may lead to dementia or Alzheimer's disease. Till now, treatment for Cognitive

Impairment isn't available. Hence, only preventive measures are being taken at a right time,

which may help to relieve the burden of disease. The present study attempts to bridge the

knowledge gap.
 REFERENCES

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