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Leg length, skull circumference, and the prevalence of dementia in low and middle income countries: a 10/66 population-based cross sectional survey

Published online by Cambridge University Press:  12 August 2010

Martin Prince ,
Daisy Acosta ,
Alan D Dangour ,
Ricardo Uauy ,
Mariella Guerra ,
Yueqin Huang ,
K. S. Jacob ,
Juan J. Llibre Rodriguez ,
Aquiles Salas  and
Ana Luisa Sosa
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Martin Prince*
Affiliation:
King's College London, Institute of Psychiatry, Centre for Public Mental Health, Health Service and Population Research Department, London, U.K.
Daisy Acosta
Affiliation:
Universidad Nacional Pedro Henriquez Ureña (UNPHU), Internal Medicine Department, Geriatric Section, Santo Domingo, Dominican Republic
Alan D Dangour
Affiliation:
London School of Hygiene and Tropical Medicine, London, U.K.
Ricardo Uauy
Affiliation:
London School of Hygiene and Tropical Medicine, London, U.K.
Mariella Guerra
Affiliation:
Universidad Peruana Cayetano Heredia and Instituto de la Memoria y Desordenes Relacionados, Lima, Perú
Yueqin Huang
Affiliation:
Peking University, Institute of Mental Health, Beijing, China
K. S. Jacob
Affiliation:
Christian Medical College, Vellore, India
Juan J. Llibre Rodriguez
Affiliation:
Facultad de Medicina Finley-Albarran, Medical University of Havana, Cuba
Aquiles Salas
Affiliation:
Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas
Ana Luisa Sosa
Affiliation:
The Cognition and Behavior Unit, National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Delegacion Tlalpan, Mexico City, Mexico
Joseph D. Williams
Affiliation:
Voluntary Health Services, Chennai, India
Isaac Acosta
Affiliation:
The Cognition and Behavior Unit, National Institute of Neurology and Neurosurgery of Mexico, Autonomous National University of Mexico, Delegacion Tlalpan, Mexico City, Mexico
Emiliano Albanese
Affiliation:
King's College London, Institute of Psychiatry, Centre for Public Mental Health, Health Service and Population Research Department, London, U.K.
Michael E. Dewey
Affiliation:
King's College London, Institute of Psychiatry, Centre for Public Mental Health, Health Service and Population Research Department, London, U.K.
Cleusa P. Ferri
Affiliation:
King's College London, Institute of Psychiatry, Centre for Public Mental Health, Health Service and Population Research Department, London, U.K.
Robert Stewart
Affiliation:
King's College London, Institute of Psychiatry, Centre for Public Mental Health, Health Service and Population Research Department, London, U.K.
Ciro Gaona
Affiliation:
Clínica Loira, Caracas, Venezuela
A. T. Jotheeswaran
Affiliation:
Voluntary Health Services, Chennai, India
P. Senthil Kumar
Affiliation:
Christian Medical College, Vellore, India
Shuran Li
Affiliation:
Peking University, Institute of Mental Health, Beijing, China
Juan C. Llibre Guerra
Affiliation:
Instituto de Neurologia y Neurocirugia, Havana, Cuba
Diana Rodriguez
Affiliation:
Instituto de la Memoria y Desordenes Relacionados, Lima, Perú
Guillermina Rodriguez
Affiliation:
Dirección General de Salud Pública. Ministerio de Protección Social (6th District), Santo Domingo, Dominican Republic
*
Correspondence should be addressed to: Professor Martin Prince, Institute of Psychiatry, P060, De Crespigny Park, London SE5 8AF, U.K. Phone: +44 20 7848 0137; Fax: +44 20 7277 0283. Email: m.prince@iop.kcl.ac.uk.
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Abstract

Background: Adult leg length is influenced by nutrition in the first few years of life. Adult head circumference is an indicator of brain growth. There is a limited literature linking short legs and small skulls to an increased risk for cognitive impairment and dementia in late life.

Methods: One phase cross-sectional surveys were carried out of all residents aged over 65 years in 11 catchment areas in China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru (n = 14,960). The cross-culturally validated 10/66 dementia diagnosis, and a sociodemographic and risk factor questionnaire were administered to all participants, and anthropometric measures taken. Poisson regression was used to calculate prevalence ratios for the effect of leg length and skull circumference upon 10/66 dementia, controlling for age, gender, education and family history of dementia.

Results: The pooled meta-analyzed fixed effect for leg length (highest vs. lowest quarter) was 0.82 (95% CI, 0.68–0.98) and for skull circumference 0.75 (95% CI, 0.63–0.89). While point estimates varied between sites, the proportion of the variability attributable to heterogeneity between studies as opposed to sampling error (I2) was 0% for leg length and 22% for skull circumference. The effects were independent and not mediated by family history of dementia. The effect of skull circumference was not modified by educational level or gender, and the effect of leg length was not modified by gender.

Conclusions: Since leg length and skull circumference are said to remain stable throughout adulthood into old age, reverse causality is an unlikely explanation for the findings. Early life nutritional programming, as well as neurodevelopment may protect against neurodegeneration.

Keywords

anthropometrygrowth and developmentageddeveloping countriesetiology
Type
Research Article
Information
International Psychogeriatrics , Volume 23 , Issue 2 , March 2011 , pp. 202 - 213
Copyright
Copyright © International Psychogeriatric Association 2010

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