Establishing A Dementia Prevention Framework In Rural India: The Smruthi Cohort's Baseline View:

Author Block: Anu Gupta¹, Hina Narzari¹, Nilima Nilima, M.Sc. Statistics², Shubham Gupta¹, Kritika Sharma¹, Bishakha Sen³, Shaily Bhushan⁴, Priyanka Kumari Meena⁵, Ambika YV⁶, Priya Darshanraj N⁶, Phaniraj Vastrad⁶, Sandip Bhattacharjee³, Arnav Verma⁴, Gajraj Singh Shekhawat⁵, Sneha Sneha, Masters of Physiotherapy⁷, Kamini Kamini¹, Sakshi Sharma¹, Maroof Ahmad Khan¹, Ashima Nehra¹, Kanika Vasudeva⁸, Nimin Hafeez⁸, Chanchal Goyal⁸, Meenakshi Sharma⁸, R S Dhaliwal⁸, Subarna Roy⁹, Manish Barvaliya⁹, Subrata Baidya³, Shampa Das³, P K Anand⁵, Sunil K. Raina⁴, Abhik Sinha¹⁰, Venugopalan Y. Vishnu¹, MV Padma Srivastava¹, SMRUTHI India Collaborators¹¹. 
¹All India Institute of Medical Sciences, New Delhi, India, ²Biostatistics, All India Institute of Medical Sciences Delhi, Gn, India, ³Model Rural Health Research Unit, Khumulwng, Tripura, India, ⁴Department of Community Medicine, Dr. RP Government Medical College, Tanda, Himachal Pradesh, India, ⁵Model Rural Health Research Unit, Jaipur, Rajasthan, India, ⁶Model Rural Health Research Unit, Sirwar, Raichur, Karnataka, India, ⁷NEUROLOGY, AIIMS, NEW DELHI, India, ⁸Indian Council of Medical Research, New Delhi, India, ⁹ICMR-NITM, Belagavi, MRHRU, Sirwar, Raichur, Karnataka, India, ¹⁰ICMR Center for Ageing and Mental Health, Kolkata, India, ¹¹All India Institute of Medical Sciences, ICMR-MRHRUs, New Delhi, India.

Abstract:
Background: Prevention of dementia in rural India is challenged by lack of high quality data, low-literacy, and lifestyle factors. India’s cultural and linguistic diversity needs to be addressed while conducting community based studies in rural India.
Methods: This ongoing multicentric cohort study has recruited 3,249 adults aged ≥55 years (CAIDE score ≥ 6) from four rural regions representing four zones of India (Himachal, Tripura, Karnataka and Rajasthan). After excluding 175 with confirmed cognitive impairment (Clinical dementia rating sum of boxes score ≥ 0.5), and 74 with incomplete data, 3,000 participants remain (figure 1). Trained investigators have conducted home-based assessments using Redcap case record forms.
Results: Among 3,000 participants (mean age 66.1 years; 62.9% women), 71.3% are illiterate; most are homemakers (54.9%), married (68.8%), and have a non-nuclear family (70.0%). Self-reported hypertension [974/3000 (32.5%)] and diabetes [355/3000 (11.8%)] are frequent, with an additional 734/2023 (36.3%) having at-least two high blood pressure recordings, and 131/1656 (7.9%) having fasting/random (single) blood glucose reading in the range defining diabetes. Other risk factors include - active smoking/alcohol/other substance abuse in 27.6%, 12.6% and 17.4% respectively, coronary artery disease in 2.0%, uncorrected vision loss in 5.0%, and hearing impairment in 0.6%. Using the WHO classification for BMI for Asians, overweight/obesity is seen in 49%, while 16.8% are underweight. Low to medium Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet scores are present in 43.7%. Over half (57.8%) meet activity thresholds (GPAQ total activity metabolic equivalents ≥ 600), though sedentary time is high (median 920 min/day). People have a median of 5 (4,5) high contact roles in their social network. Sleep problems (PSQI ≥5) affect 14.2%, while 3.7% have mild to moderate depression (PHQ-9≥5). In neuropsychological tests, the median Addenbrooke’s Cognitive Examination-III score is 86 in illiterate/low-literate and 89 in literate subjects. Regional variations are seen in the risk profile and domain wise neuropsychological test scores.
Conclusion: The SMRUTHI cohort highlights low literacy, high vascular and lifestyle risks, and variable performance on cognitive tests, emphasizing the need for studies representing the diversity of India and tailored multidomain dementia prevention interventions.