Miciko Umeda, Aris Widiyanto, Dedy Muhdiana, Lily Herlina, Joko Tri Atmojo, Bhisma Murti

Determinants of Dementia Among the Elderly in Jakarta, Indonesia

Introduction

Determinants of dementia among the elderly in jakarta, indonesia. Explore dementia determinants among Jakarta's elderly. Study reveals higher education, marriage, and regular exercise linked to lower risk, with exercise a significant protective factor.

Abstract

Background: The incidence of dementia rises sharply, and it is expected to grow worldwide in the decades ahead. This study aimed to investigate the determinants of dementia among the elderly in Jakarta, Indonesia.Subjects and Method: A cross-sectional design was employed in the Aisyah organization at Jakarta City, Indonesia. A total of 65 elderly people were selected using Stratified random sampling. The dependent variable was dementia. The independent variables were education, occupation, married status, and exercise routine. The dementia was assessed using the Mini-Mental State Examination (MMSE) questionnaire, which was translated into Bahasa. Results: The participants had an education level of high school or below (52.31%), were not married (53.85%), and were not working (55.38%). The majority reported frequent exercise (92.31%), and 44.62% were identified with dementia. Bivariate analysis showed that higher education (OR = 0.92; 95% CI= 0.26 to 3.22; p= 0.002) and being married (OR= 0.94; 95% CI= 0.34 to 2.61; p= 0.020) were significantly associated with lower dementia risk. Exercise routine showed a strong protective effect (OR = 0.17; 95% CI= 0.01 to 1.79; p= 0.043), while occupational status was not significantly associated (p= 0.074). In multivariate analysis, only exercise routine remained significantly associated with dementia (OR= 0.17; 95% CI= 0.01 to 1.78; p= 0.042), suggesting it as an independent protective factor after controlling for confounders.Conclusion: Regular physical activity was identified as a significant protective factor against dementia among the elderly. Promoting exercise may be an effective strategy for dementia prevention in this population.

Review

This study investigates crucial determinants of dementia among the elderly in Jakarta, Indonesia, addressing a globally escalating public health concern. The researchers effectively outline their objective to identify factors influencing dementia risk in this specific population. The use of the Mini-Mental State Examination (MMSE), a widely recognized screening tool, translated into Bahasa, is a strength that ensures cultural appropriateness. The finding that regular physical activity emerged as a significant protective factor, even after controlling for confounders, is a valuable insight with direct implications for public health interventions aimed at dementia prevention. Furthermore, the initial exploration of education, occupation, and marital status provides a broader context for understanding dementia risk in this demographic. However, the study presents several significant methodological and statistical concerns that limit the robustness and generalizability of its findings. Firstly, the sample size of only 65 elderly individuals is exceptionally small for a study investigating multiple determinants of a complex condition like dementia, severely impacting statistical power and the reliability of the observed associations. The cross-sectional design inherently restricts the ability to establish causality, meaning the study can only identify associations rather than prove that the independent variables directly cause changes in dementia risk. A more critical issue lies in the interpretation of the results: for several key variables (education, married status, and exercise routine in both bivariate and multivariate analyses), the reported odds ratios (ORs) are presented as statistically significant (p < 0.05), yet their 95% confidence intervals (CIs) clearly cross 1. This is a fundamental statistical contradiction, as a 95% CI that includes 1 typically indicates that the association is not statistically significant at the 0.05 level. This inconsistency casts doubt on the validity of the reported "significant associations." Additionally, using MMSE scores alone to classify 44.62% of participants as having "dementia" without further clinical validation is problematic, as MMSE is a screening tool and not a definitive diagnostic instrument. Despite these limitations, the study makes a preliminary contribution to understanding dementia risk factors in Indonesia, particularly highlighting the potential protective role of regular physical activity. To build upon these initial findings, future research should prioritize a substantially larger and more representative sample drawn from diverse settings within Jakarta to enhance generalizability. A longitudinal study design would be essential to establish temporal relationships and move closer to causal inferences. Furthermore, the diagnosis of dementia should ideally be confirmed through comprehensive clinical assessments beyond just the MMSE. Crucially, researchers must meticulously re-evaluate the statistical analyses, ensuring consistency between p-values and confidence intervals to present accurate and interpretable results. Addressing these points would significantly strengthen the evidence base for dementia prevention strategies in Indonesia and similar low-and-middle-income country contexts.

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