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IJE Advance Access published online on June 26, 2008
International Journal of Epidemiology, doi:10.1093/ije/dyn125
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2008; all rights reserved.

Risk factors across the life course and dementia in a Brazilian population: results from the Sao Paulo Ageing & Health Study (SPAH)

Marcia Scazufca1,2,3,*, Paulo R Menezes2,3,4, Ricardo Araya2, Vanessa D Di Rienzo1,3, Osvaldo P Almeida5, David Gunnell6 and Debbie A Lawlor6

1Department of Psychiatry, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
2Department of Community Based Medicine, Academic Unity of Psychiatry, University of Bristol, Bristol, UK.
3Section of Epidemiology, University Hospital, University of Sao Paulo, Sao Paulo, Brazil.
4Department of Preventive Medicine, Faculty of Medicine, University of Sao Paulo, Sao Paulo, Brazil.
5Western Australian Centre for Health and Ageing, University of Western Australia & Royal Perth Hospital, Perth, Australia.
6 Department of Social Medicine, University of Bristol, Bristol, UK.

*Corresponding author. Institute of Psychiatry, LIM-23, R. Dr Ovídio Pires de Campos 785, CEP 05403-010, Sao Paulo, SP, Brazil. E-mail: scazufca{at}usp.br


  Abstract

Background Several mechanisms have been suggested to explain the association between adversities across life and dementia. This study aimed to investigate the association between indicators of socioeconomic disadvantages throughout the life-course and dementia among older adults in Sao Paulo, Brazil and to explore possible causal pathways.

Methods We used baseline data from the SPAH study which involved participants aged 65 years and older (n = 2005). The outcome of interest was prevalent dementia. Exposures included in the analyses were socioeconomic position (SEP) indicators in childhood (place of birth and literacy) and adulthood (occupation and income), anthropometric measurements as markers of intrauterine and childhood environment (head circumference and leg length), smoking, diabetes and hypertension. Logistic regression models were used to test the hypothesized pathways and to assess whether there was an association between cumulative adversities across the life course and prevalent dementia.

Results Indicators of socioeconomic disadvantage in early life were associated with increased prevalence of dementia. This association was partially mediated through adulthood SEP. Head circumference and leg length were also clearly associated with dementia but there was no evidence that this association was mediated by early life socioeconomic disadvantage. There was an association between cumulative unfavourable conditions across the life course and dementia.

Conclusions Early life disadvantages seem to operate through biological mechanisms associated with passive brain reserve and opportunities in life representing active cognitive reserve. Prevention of dementia should start early in life and continue through life span as seen with many other chronic diseases.

Keywords Dementia, life course epidemiology, prevalence, socioeconomic position, leg length, head circumference, ageing, Brazil, LAMIC

Accepted 29 May 2008


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