Title:Childhood and Adulthood Rural Residence Increases the Risk of Dementia: NEDICES Study
Volume: 12
Issue: 4
Author(s): Israel Contador, Felix Bermejo-Pareja, Veronica Puertas-Martin and Julian Benito-Leon
Affiliation:
Keywords:
Cognitive reserve, dementia, education, life stages, risk factors, rural residence.
Abstract: Objective. This research aims to determine whether residence (rural vs. urban) at different life stages (childhood,
adulthood, and late life) is associated with increased risk of incident dementia in a population-based cohort of older
Spaniards. Methods. In this prospective study, 2,711 participants aged 65 years and older were assessed at baseline and 3
years later. All cases of incident dementia were diagnosed using DSM-IV criteria. The relationship between residence and
the relative risk of dementia was analysed using Cox's regression models. Demographics, comorbidity index, consumption
(tobacco / alcohol) and doubtful dementia diagnosis were considered as possible confounders. Results. At the three-year
follow-up, 91 cases of dementia were detected. Lower education and occupational attainment were associated with a
higher incidence of dementia three years later. Rural residence in adulthood was associated with a significantly higher risk
of dementia at the follow-up. Childhood rural residence revealed a marked trend for risk of dementia (p = 0.08), but it was
nonsignificant in later life. The risk of dementia was considerably higher for the rural/low-education group than for the
urban/high-education group, for both childhood and adulthood residence. Finally, people from areas with the lowest socio-
economic status Arévalo (rural, blue-collar) and Margaritas (urban, blue-collar) showed higher risk of dementia than
people from Lista (urban, mixed white/blue collar). Conclusion. In this cohort, early and mid-life stages rural residence
was a risk factor for dementia, but not later-life rural residence. The rural residence effect was noticeably higher in people
with a lower educational level.