Urban-rural Comparative Assessment of Cognitive Impairment and its Determinants among Elderly Residents of Southern India: A Cross-sectional Study
TL;DR
Cognitive impairment is highly prevalent in South India elderly population and immediate steps for reducing the future burden of dementia include community-based screening, early detection and integration of geriatric cognitive care into primary healthcare services.
Abstract
Introduction: Cognitive impairment in older adults includes subjective memory complaints, Mild Cognitive Impairment (MCI) and major neurocognitive disorders. Cognitive impairment among older adults is an emerging public health challenge globally and in India. Aim: To estimate the prevalence of cognitive impairment and identify its associated factors among elderly residents in rural and urban area. Materials and Methods: A comparative community-based analytical cross-sectional study was done among elderly subjects (≥60 years) in Poolavari (rural) and Attayampatti (urban) field practice areas of the institution ensuring feasibility, accessibility and representativeness of typical rural and urban populations in the Salem district of Tamil Nadu, India from 1st November 2025 to 31st January 2026. Simple random sampling was used to select participants. A structured questionnaire was used to collect data. Cognition was evaluated using the Brief Interview for Mental Status (BIMS) and function was characterised with the KATZ Index of Activities of Daily Living (ADL). Data were analysed through Statistical Packages of Social Sciences (SPSS) version 22.0. A Chi-square test and a multivariable logistic regression were conducted. Results: Mean age was 65±4.7 years, majority were females 231 (57.7%) and 169 (42.3%) were males. The majority 235 (58.7%) were from lower class. Forgetting things often 228 (57%) was the most common dementia-related symptom and as per KATZ ADL scale 52 (13%) were dependent. Nearly 82 (20.5%) had moderate cognitive impairment and 11% had severe cognitive impairment. Multivariable analysis showed independent predictors of cognitive impairment were residence in rural area (AOR: 1.67), dependence in KATZ ADL scale {Adjusted Odds Ratios (AOR): 1.55}, and presence of dementiarelated symptoms (AOR: 1.87). Conclusion: Cognitive impairment is highly prevalent in South India elderly population. Immediate steps for reducing the future burden of dementia include community-based screening, early detection and integration of geriatric cognitive care into primary healthcare services.