# Prevalence of Cognitive Impairment and Its Associated Factors in a Rural Area of Ernakulam District, Kerala, India

## TL;DR

This study found that 27% of older adults in a rural area of Kerala, India, have cognitive impairment, with education and marital status being key factors.

## Contribution

The study provides new evidence on cognitive impairment prevalence and its sociodemographic associations in a rural Indian population.

## Key findings

- Cognitive impairment prevalence was 27% among older adults in rural Ernakulam.
- Never-married individuals had significantly higher odds of cognitive impairment.
- Lower educational attainment was strongly associated with cognitive impairment.

## Abstract

Introduction

Cognitive impairment is a growing public health concern, particularly among older adults in rural settings. Various factors, including physical activity, comorbidities, and lifestyle behaviors, influence cognitive function. However, evidence on these associations in rural Indian populations remains limited. The objective of this study was to assess the prevalence of cognitive impairment among older adults in a rural region of the Ernakulam district, Kerala, India, and examine its association with sociodemographic and lifestyle factors.

Methods

A community-based cross-sectional study was conducted over two weeks in Njarakkal Grama Panchayat, Ernakulam, Kerala, India, involving 175 participants aged 60 years and above. After obtaining informed consent, data on sociodemographic variables, BMI, physical activity, marital status, and education were collected using a semi-structured questionnaire. Cognitive function was assessed using the Mini-Mental State Examination (MMSE®), and physical activity using the Global Physical Activity Questionnaire (GPAQ). Data were analyzed using Jamovi software (The Jamovi Project, Sydney, Australia). Associations were tested using chi-square or Fisher’s exact tests, and a multivariable logistic regression model was applied to identify independent predictors of cognitive impairment.

Results

The prevalence of cognitive impairment was 27% (95%CI: 20.42%-33.58%). Never-married individuals had significantly higher odds of cognitive impairment compared to those who were ever married (adjusted OR (AOR) = 23.809, 95%CI: 1.445-392.218, p = 0.027). Individuals with only primary or middle school education had substantially higher odds of impairment (AOR = 30.525, 95%CI: 2.817-330.818, p = 0.005). Cognitive impairment was observed in 29.71%, 32.57%, and 37.71% of individuals with high, medium, and low physical activity levels, respectively; however, the association was not statistically significant.

Conclusion

This study highlights a considerable prevalence of cognitive impairment among older adults in rural Ernakulam and identifies significant associations with marital status and educational attainment. Although physical activity showed a graded trend with cognitive outcomes, the relationship was not statistically significant. These findings underscore the importance of addressing social and educational determinants in strategies aimed at preserving cognitive health among the elderly.