In Afghanistan, poverty, lack of education associated with dementia

Poverty was closely associated with higher rates of dementia among older adults in Afghanistan, according to a newly published study in eClinicalMedicine by Jean-Francois Trani, an associate professor at the Brown School.

The results suggest that addressing education, health, employment and living conditions earlier in life can have an impact on dementia risk in later life, particularly in countries that are frequently in crisis, such as Afghanistan.

"It's important to start now to understand the causes of dementia so we can change policy to benefit people who will age in the coming decades," Trani said. "The problem of dementia is growing in low- and middle-income countries, and we can't explain it just by genetic factors. This research is urgent and it has to be global."

The study was part of a larger project looking at social determinants of health associated with the risk of cognitive impairment and dementia in Afghanistan, Pakistan, and South Africa. The research team collected information among adults over 50 in two Afghan provinces between February and April 2022, examining multiple dimensions of deprivation.

They found that a higher proportion of adults with moderate-to-severe dementia were significantly more deprived of education, health, and employment and were more often distressed compared to adults without dementia. Only 21.8% adults without dementia were poor compared to 33.9% among those with mild dementia and 51.2% among those with moderate-to-severe dementia.

Important contributors to poverty were low education, poor health care access and unemployment, comparable to the team's findings in South Africa. Poorer older adults in both countries were at higher risk of cognitive impairment and dementia, particularly those over 70 years old.

"Our findings suggest that universal access to free quality education and health care during the life course might contribute to both prevention and lower dementia severity in later life, particularly in low-income countries in crisis such as Afghanistan, where difficulties are heightened," Trani said.

Further research is needed, he added, to follow people over time to see if the poverty is a factor in causing dementia or simply associated with it.