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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: [email protected].
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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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References

Bartholomeusz, H. H., Courchesne, E. and Karns, C. M. (2002). Relationship between head circumference and brain volume in healthy normal toddlers, children, and adults. Neuropediatrics, 33, 239–241.CrossRefGoogle ScholarPubMed
Bickel, H., Riemenschneider, M. and Kurz, A. (2006). [Associations between dementia and head circumference as a measure of brain reserve: results from the Bavarian School Sisters Study]. Psychiatrische Praxis, 33, 138–144.CrossRefGoogle ScholarPubMed
Borenstein, G. A. et al. (2001). Head circumference and incident Alzheimer's disease: modification by apolipoprotein E. Neurology, 57, 1453–1460.CrossRefGoogle Scholar
Copeland, J. R. M., Dewey, M. E. and Griffith-Jones, H. M. (1986). A computerised psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT. Psychological Medicine, 16, 89–99.CrossRefGoogle ScholarPubMed
Edland, S. D. et al. (2002). Total intracranial volume: normative values and lack of association with Alzheimer's disease. Neurology, 59, 272–274.CrossRefGoogle ScholarPubMed
Ganguli, M., Chandra, V. and Gilbey, J. (1996). Cognitive test performance in a community-based non demented elderly sample in rural India: the Indo-US cross national dementia epidemiology study. International Psychogeriatrics, 8, 507–524.CrossRefGoogle Scholar
Gigante, D. P., Nazmi, A., Lima, R. C., Barros, F. C. and Victora, C. G. (2009). Epidemiology of early and late growth in height, leg and trunk length: findings from a birth cohort of Brazilian males. European Journal of Clinical Nutrition, 63, 375–381.CrossRefGoogle ScholarPubMed
Gunnell, D. J. et al. (1998). Childhood leg length and adult mortality: follow up of the Carnegie (Boyd Orr) survey of diet and health in pre-war Britain. Journal of Epidemiology and Community Health, 52, 142–152.CrossRefGoogle ScholarPubMed
Hall, K. S. et al. (1993). The development of a dementia screening interview in two distinct languages. International Journal of Methods in Psychiatric Research, 3, 1–28.Google Scholar
Higgins, J. P. and Thompson, S. G. (2002). Quantifying heterogeneity in a meta-analysis. Statistics in Medicine, 21, 1539–1558.CrossRefGoogle ScholarPubMed
Huang, T. L., Carlson, M. C., Fitzpatrick, A. L., Kuller, L. H., Fried, L. P. and Zandi, P. P. (2008). Knee height and arm span: a reflection of early life environment and risk of dementia. Neurology, 70, 1818–1826.CrossRefGoogle Scholar
Jenkins, R., Fox, N. C., Rossor, A. M., Harvey, R. J. and Rossor, M. N. (2000). Intracranial volume and Alzheimer disease: evidence against the cerebral reserve hypothesis. Archives of Neurology, 57, 220–224.CrossRefGoogle ScholarPubMed
Jotheeswaran, A. T., Williams, J. and Prince, M. J. (2010a). The predictive validity of the 10/66 Dementia diagnosis in Chennai, India – a three year follow-up study of cases identified at baseline. In Press, Alzheimer's Disease and Associated Disorders. Epublished ahead of print, doi: 10.1097/WAD.0b013e3181d5e540.CrossRefGoogle Scholar
Jotheeswaran, A. T., Williams, J. D., Stewart, R. J. and Prince, M. J. (2010b). Could reverse causality or selective mortality explain associations between leg length, skull circumference and dementia? A South Indian Cohort Study [Letter]. International Psychogeriatrics. [This issue].CrossRefGoogle Scholar
Kim, J. M., Stewart, R., Shin, I. S. and Yoon, J. S. (2003). Limb length and dementia in an older Korean population. Journal of Neurology, Neurosurgery and Psychiatry, 74, 427–432.CrossRefGoogle Scholar
Kim, J. M., Stewart, R., Shin, I. S., Kim, S. W., Yang, S. J. and Yoon, J. S. (2008). Associations between head circumference, leg length and dementia in a Korean population. International Journal of Geriatric Psychiatry, 23, 41–48.CrossRefGoogle Scholar
Lenroot, R. K. and Giedd, J. N. (2006). Brain development in children and adolescents: insights from anatomical magnetic resonance imaging. Neuroscience and Biobehavioral Reviews, 30, 718–729.CrossRefGoogle ScholarPubMed
Llibre Rodriguez, J. J. et al. (2008). Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey. Lancet, 372, 464–474.CrossRefGoogle Scholar
Llibre, R. J. et al. (2008). The prevalence, correlates and impact of dementia in Cuba. a 10/66 Group population-based survey. Neuroepidemiology, 31, 243–251.CrossRefGoogle Scholar
Mak, Z., Kim, J. M. and Stewart, R. (2006). Leg length, cognitive impairment and cognitive decline in an African-Caribbean population. International Journal of Geriatric Psychiatry, 21, 266–272.CrossRefGoogle Scholar
Miller, D. B. and O'Callaghan, J. P. (2008). Do early-life insults contribute to the late-life development of Parkinson and Alzheimer diseases? Metabolism, 57 (Suppl. 2), S44–S49.CrossRefGoogle Scholar
Mortimer, J. A., Snowdon, D. A. and Markesbery, W. R. (2003). Head circumference, education and risk of dementia: findings from the Nun Study. Journal of Clinical and Experimental Neuropsychology, 25, 671–679.CrossRefGoogle ScholarPubMed
Prince, M., Acosta, D., Chiu, H., Scazufca, M. and Varghese, M. (2003). Dementia diagnosis in developing countries: a cross-cultural validation study. Lancet, 361, 909–917.CrossRefGoogle ScholarPubMed
Prince, M. et al. (2007). The protocols for the 10/66 Dementia Research Group population-based research programme. BMC Public Health, 7, 165.CrossRefGoogle Scholar
Prince, M. J. et al. (2008). The 10/66 Dementia Research Group's fully operationalised DSM-IV dementia computerized diagnostic algorithm, compared with the 10/66 dementia algorithm and a clinician diagnosis: a population validation study. BMC Public Health, 8, 219.CrossRefGoogle Scholar
Reynolds, M. D., Johnston, J. M., Dodge, H. H., DeKosky, S. T. and Ganguli, M. (1999). Small head size is related to low Mini-mental State Examination scores in a community sample of nondemented older adults. Neurology, 53, 228–229.CrossRefGoogle Scholar
Riley, K. P., Snowdon, D. A., Desrosiers, M. F. and Markesbery, W. R. (2005). Early life linguistic ability, late life cognitive function, and neuropathology: findings from the Nun Study. Neurobiology of Aging, 26, 341–347.CrossRefGoogle ScholarPubMed
Scazufca, M. et al. (2008). Risk factors across the life course and dementia in a Brazilian population: results from the Sao Paulo Ageing and Health Study (SPAH). International Journal of Epidemiology, 37, 879–890.CrossRefGoogle Scholar
Schofield, P. W., Logroscino, G., Andrews, H. F., Albert, S. and Stern, Y. (1997). An association between head circumference and Alzheimer's disease in a population-based study of aging and dementia. Neurology, 49, 30–37.CrossRefGoogle Scholar
Smith, G. D., Greenwood, R., Gunnell, D., Sweetnam, P., Yarnell, J. and Elwood, P. (2001). Leg length, insulin resistance, and coronary heart disease risk: the Caerphilly Study. Journal of Epidemiology and Community Health, 55, 867–872.CrossRefGoogle ScholarPubMed
Tanner, J. M., Hayashi, T., Preece, M. A. and Cameron, N. (1982). Increase in length of leg relative to trunk in Japanese children and adults from 1957 to 1977: comparison with British and with Japanese Americans. Annals of Human Biology, 9, 411–423.CrossRefGoogle ScholarPubMed
Wadsworth, M. E., Hardy, R. J., Paul, A. A., Marshall, S. F. and Cole, T. J. (2002). Leg and trunk length at 43 years in relation to childhood health, diet and family circumstances: evidence from the 1946 national birth cohort. International Journal of Epidemiology, 31, 383–390.CrossRefGoogle ScholarPubMed
Whalley, L. J., Starr, J. M., Athawes, R., Hunter, D., Pattie, A. and Deary, I. J. (2000). Childhood mental ability and dementia. Neurology, 55, 1455–1459.CrossRefGoogle ScholarPubMed
Whalley, L. J., Dick, F. D. and McNeill, G. (2006). A life-course approach to the aetiology of late-onset dementias. Lancet Neurology, 5, 87–96.CrossRefGoogle Scholar