Introduction: Despite cognitive impairment being a major health issue within the older population, limited information is available on factors associated with cognitive function among Asian ethnic groups. The objective of this study was to identify ethnic-specific sociodemographic risk factors which are associated with cognitive performance. Methods: Cross-sectional analysis of the Malaysian Elders Longitudinal Research (MELoR) study involving community-dwelling individuals aged >55 years was conducted. Information on sociodemographic factors, medical history, and lifestyle were obtained by computer-assisted interviews in participants’ homes. Cognitive performance was assessed with the Montreal Cognitive Assessment (MoCA) tool during subsequent hospital-based health checks. Hierarchical multiple linear regression analyses were conducted with continuous MoCA scores as the dependent variable. Results: Data were available for 1,140 participants, mean (standard deviation [SD]) = 68.48 (7.23) years, comprising 377 (33.1%) ethnic Malays, 414 (36.3%) Chinese, and 349 (30.6%) Indians. Mean (SD) MoCA scores were 20.44 (4.92), 23.97 (4.03), and 22.04 (4.83) for Malays, Chinese, and Indians, respectively (p = 0.01). Age >75 years, <12 years of education, and low functional ability were common risk factors for low cognitive performance across all three ethnic groups. Cognitive performance was positively associated with social engagement among the ethnic Chinese (β [95% CI] = 0.06 [0.01, 0.11]) and Indians (β [95% CI] = 0.16 [0.09, 0.23]) and with lower depression scores (β [(95% CI] = −0.08 [−0.15, −0.01]) among the ethnic Indians. Conclusion: Common factors associated with cognitive performance include age, education, and functional ability, and ethnic-specific factors were social engagement and depression. Interethnic comparisons of risk factors may form the basis for identification of ethnic-specific modifiable risk factors for cognitive decline and provision of culturally acceptable prevention measures.

Keywords:
Cognition, Ethnic-specific factors, Malaysia, Sociodemographic factors, Ethnicity, Aged, Dementia
1.
National Institutes of Health. National health and morbidity survey 2018: elderly health. Volume two: elderly health findings. Malaysia: Institute for Public Health, National Institutes of Health (NIH), Ministry of Health; 2018. Vol. 2. p. 132.
2.
Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement. 2013;9(1):63–75.e2.
3.
World Health Organization. Risk reduction of cognitive decline and dementia: WHO guidelines: WHO; 2019. Available from: https://www.who.int/mental_health/neurology/dementia/risk_reduction_gdg_meeting/en/.
4.
Alzheimer’s Association. Alzheimer’s disease facts and figures special report race, ethnicity and Alzheimer’s in America. Alzheimers Dement. 2021;17(3):327–406.
5.
Wu YT, Brayne C, Matthews FE. Prevalence of dementia in East Asia: a synthetic review of time trends. Int J Geriatr Psychiatry. 2015;30(8):793–801.
6.
Babulal GM, Quiroz YT, Albensi BC, Arenaza-Urquijo E, Astell AJ, Babiloni C, et al. Perspectives on ethnic and racial disparities in Alzheimer’s disease and related dementias: update and areas of immediate need. Alzheimers Dement. 2019;15(2):292–312.
7.
Díaz-Venegas C, Downer B, Langa KM, Wong R. Racial and ethnic differences in cognitive function among older adults in the USA. Int J Geriatr Psychiatry. 2016 Sep;31(9):1004–12.
8.
Venketasubramanian N, Sahadevan S, Kua EH, Chen CPL, Ng TP. Interethnic differences in dementia epidemiology: global and Asia-Pacific perspectives. Dement Geriatr Cogn Disord. 2010;30(6):492–8.
9.
Alzheimers Association. Alzheimer’s disease facts and figures. Alzheimers Dement. 2020 Mar 10;16(3):391–460. https://onlinelibrary.wiley.com/doi/abs/10.1002/alz.12068.
10.
Ganapathy SS, Sooryanarayana R, Ahmad NA, Jamaluddin R, Abd Razak MA, Tan MP, et al. Prevalence of dementia and quality of life of caregivers of people living with dementia in Malaysia. Geriatr Gerontol Int 2020;20(Suppl 2):16–20. https://onlinelibrary.wiley.com/doi/abs/10.1111/ggi.14031.
11.
Hussin NM, Shahar S, Yahya HM, Din NC, Singh DKA, Omar MA. Incidence and predictors of mild cognitive impairment (MCI) within a multi-ethnic Asian populace: a community-based longitudinal study. BMC Public Health. 2019;19(1):1159–11.
12.
Department of Statistics Malaysia Official Portal; National Registration Department M of HA (Malaysia). Malaysia demographic statistics quarter 4 2020. Malaysia: Malaysia Dep Stat; 2021.
13.
Tey NP, Siraj SB, Kamaruzzaman SBB, Chin AV, Tan MP, Sinnappan GS, et al. Aging in multi-ethnic Malaysia. Gerontologist. 2016;56(4):603–9.
14.
Lim LM, McStea M, Chung WW, Nor Azmi N, Abdul Aziz SA, Alwi S, et al. Prevalence, risk factors and health outcomes associated with polypharmacy among urban community-dwelling older adults in multiethnic Malaysia. PLoS One. 2017;12(3):e0173466–18.
15.
Lovibond SH, Lovibond PF. Manual for the depression anxiety & stress scales. 2nd ed. Sydney: Psychology Foundation; 1995.
16.
Gloster AT, Rhoades HM, Novy D, Klotsche J, Senior A, Kunik M, et al. Psychometric properties of the depression anxiety and stress scale-21 in older primary care patients. J Affect Disord. 2008;110(3):248–59.
17.
Lubben JE. Assessing social networks among elderly populations. Fam Community Health. 1988 Nov;11(3):42–52.
18.
Ashendorf L. A compendium of tests, scales, and questionnaires: the practitioner’s guide to measuring outcomes after acquired brain impairment. Appl Neuropsychol Adult. 2012;19(1):78–9.
19.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179–86.
20.
Borrat-Besson C, Ryser V-A, Gonçalves J. An evaluation of the CASP-12 scale used in the Survey of Ageing and Retirement in Europe (SHARE) to measure Quality of Life among people aged 50+. (FORS Working Paper Series); 2015. Available from: www.share-project.org.
21.
Nasreddine ZS, Phillips NA, Bãdirian V, Charbonneau S, Whitehead V, Collin I, et al. The montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005 Apr;53(4):695–9.
22.
Ng KP, Chiew HJ, Lim L, Rosa-Neto P, Kandiah N, Gauthier S. The influence of language and culture on cognitive assessment tools in the diagnosis of early cognitive impairment and dementia. Expert Rev Neurother. 2018;18(11):859–69.
23.
Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet commission. Lancet. 2020 Aug;396(10248):413–46.
24.
Li JQ, Tan L, Wang HF, Tan MS, Tan L, Xu W, et al. Risk factors for predicting progression from mild cognitive impairment to Alzheimer’s disease: a systematic review and meta-analysis of cohort studies. J Neurol Neurosurg Psychiatry. 2016;87(5):476–84.
25.
Blue EE, Horimoto ARVR, Mukherjee S, Wijsman EM, Thornton TA. Local ancestry at APOE modifies Alzheimer’s disease risk in Caribbean Hispanics. Alzheimers Dement. 2019;15(12):1524–32.
26.
Seet WT, Mary Anne TJA, Yen TS. Apolipoprotein e genotyping in the Malay, Chinese and Indian ethnic groups in Malaysia: a study on the distribution of the different apoE alleles and genotypes. Clin Chim Acta. 2004;340(1–2):201–5.
27.
Hamid TA, Krishnaswamy S, Abdullah SS, Momtaz YA. Sociodemographic risk factors and correlates of dementia in older Malaysians. Dement Geriatr Cogn Disord. 2010;30(6):533–9.
28.
Elobeid A, Libard S, Leino M, Popova SN, Alafuzoff I. Altered proteins in the aging brain. J Neuropathol Exp Neurol. 2016 Apr;75(4):316–25.
29.
Krell-Roesch J, Syrjanen JA, Vassilaki M, MacHulda MM, Mielke MM, Knopman DS, et al. Quantity and quality of mental activities and the risk of incident mild cognitive impairment. Neurology. 2019;93(6):e548–58.
30.
Foubert-Samier A, Catheline G, Amieva H, Dilharreguy B, Helmer C, Allard M, et al. Education, occupation, leisure activities, and brain reserve: a population-based study. Neurobiol Aging. 2012;33(2):423.e15–25.
31.
Colombo B, Antonietti A, Daneau B. The relationships between cognitive reserve and creativity. A study on American aging population. Front Psychol. 2018 May 23;9:764.
32.
Deckers K, Cadar D, van Boxtel MPJ, Verhey FRJ, Steptoe A, Köhler S. Modifiable risk factors explain socioeconomic inequalities in dementia risk: evidence from a population-based prospective cohort study. J Alzheimers Dis. 2019;71(2):549–57.
33.
Mecocci P, Boccardi V. The impact of aging in dementia: it is time to refocus attention on the main risk factor of dementia. Ageing Res Rev. 2021 Jan;65:101210.
34.
Effendi-Tenang I, Tan MP, Khaliddin N, Jamaluddin Ahmad M, Amir NN, Kamaruzzaman SB, et al. Vision impairment and cognitive function among urban-dwelling Malaysians aged 55 years and over from the Malaysian elders Longitudinal research (MELoR) study. Arch Gerontol Geriatr. 2020;90:104165.
35.
Anstey KJ, Ee N, Eramudugolla R, Jagger C, Peters R. A systematic review of meta-analyses that evaluate risk factors for dementia to evaluate the quantity, quality, and global representativeness of evidence. J Alzheimers Dis. 2019;70(s1):S165–86.
36.
Frost M, Wraae K, Gudex C, Nielsen T, Brixen K, Hagen C, et al. Chronic diseases in elderly men: underreporting and underdiagnosis. Age Ageing. 2012;41(2):177–83.
37.
Zaremba D, Schulze Kalthoff I, Förster K, Redlich R, Grotegerd D, Leehr EJ, et al. The effects of processing speed on memory impairment in patients with major depressive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2019;92:494–500.
38.
Qiu C, Kivipelto M, Von Strauss E. Epidemiology of Alzheimer’s disease: occurrence, determinants, and strategies toward intervention. Dialogues Clin Neurosci. 2009;11(2):111–28.
39.
Ng TP, Niti M, Chiam PC, Kua EH. Physical and cognitive domains of the instrumental activities of daily living: validation in a multiethnic population of Asian older adults. J Gerontol A Biol Sci Med Sci. 2006;61(7):726–35.
40.
Din NC, Shahar S, Zulkifli BH, Razali R, Vyrn CA, Omar A. Validation and optimal cut-off scores of the Bahasa Malaysia version of the Montreal Cognitive Assessment (MoCA-BM) for mild cognitive impairment among community dwelling older adults in Malaysia. Sains Malaysiana. 2016;45:1337–43.
© 2022 S. Karger AG, Basel
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
2022
You do not currently have access to this content.