Academic journal article Generations

Dementia: A Cross-Cultural Perspective on Risk Factors

Academic journal article Generations

Dementia: A Cross-Cultural Perspective on Risk Factors

Article excerpt

Dementia is one of the most devastating mental illnesses that affect older adults, accounting for a large proportion of new cases of mental illness in old age and causing significant distress to individuals and their families. This paper provides a review of research on the frequency of dementia and the factors that put people at risk, with implications for prevention and intervention. Where possible, we address ethnic or cultural differences. However, while ethnic minority elders are a rapidly growing group in the United States, too little research has been conducted about dementia in these groups, including differences in rates of the disorder and risk-factor profiles.

DEFINITION AND PREVALENCE

According to the Diagnostic and Statistical Manual/Mental Disorders (DSM-IV), dementia is a decline in memory and other cognitive abilities whereby the decline interferes with daily, social, and occupational functioning (American Psychiatric Association, 1994). Other cognitive disturbances include aphasia (especially problems remembering names of people or things), apraxia (impaired physical movements despite intact physical capability), agnosia (trouble identifying objects), and problems with executive functioning (e.g., difficulty with planning or thinking abstractly). Dementia has a number of causes, which makes this complex disorder difficult to diagnose. For diagnosis, it is important to rule out other reasons for cognitive impairment such as delirium, depression, malnutrition, medication side effects, alcohol abuse, and infections.

The overall prevalence of dementia in adults aged 65 and older ranges from 1.8 percent to 6.7 percent (Chui, 1998). The prevalence of dementia increases with age, doubling every 5. years until age 95 (Jorm, Korten, and Henderson, 1987). The two most common types of dementia are Alzheimer's disease and vascular dementia.

Alzheimer's disease is a brain disorder that impairs multiple areas of cognitive functioning and worsens over time. Onset of the disease is typically insidious, usually beginning with loss of recent memory, then progressively affecting other areas of cognition such as language production and comprehension. The clinical diagnosis typically entails a neurological examination, neuropsychological assessment, evaluation of the course of cognitive and behavioral impairments, neuroimaging, and exclusion of other potential causes of cognitive impairment (Reisberg et al., 1997).

Vascular dementia is based on the understanding that cerebrovascular types of diseases like stroke can cause brain injury and lead to cognitive impairment. A diagnosis of vascular dementia requires the following: (i) the presence of dementia, (2) evidence of cerebrovascular disease, and (3) onset of the dementia soon after a vascular "event" (Roman et al., 1993). Unlike the course of Alzheimer's disease, the course of vascular dementia may not be smoothly progressive but rather may be characterized by plateaus.

Researchers have observed ethnic and crossnational differences in the frequency of these types of dementia. In general, overall rates of dementia are similar cross-nationally and crossculturally, but notable differences exist in rates of different subtypes of dementia. For example, in the United States and Northern Europe, Alzheimer's disease is the most common type of dementia, followed by vascular dementia (Skoog, 1998), whereas Japan and China have higher rates of vascular dementia, followed by Alzheimer's disease (Joan, iggi; Yoshitake et al., 1995).

Within ethnic groups in the United States, African Americans tend to have higher rates of vascular dementia than whites (Yeo, Gallagher-- Thompson, and Lieberman,1996). In addition, mixed dementia (with features of both vascular dementia and Alzheimer's disease) may be more common among African Americans than among whites.

Some findings suggest that rates of different types of dementia vary by gender. …

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