Modifiable Risk Factors for Dementia in Indonesia’s Urban Population

Muhammad Khifzhon Azwar, Siti Setiati


Background: Indonesia is one of ten countries in the world with estimated number of dementia case exceeding a million. The number of elderly population living in Indonesian cities has exceeded the number in rural areas, but the country lacks data representing the urban population better related to modifiable risk factors for dementia, prevention of which is crucial. We aimed to identify the modifiable risk factors for dementia in Indonesia’s urban population. Methods: this case-control study used five-year data in Indonesia’s national general hospital by tracing back medical record books of individuals aged 60 years and above in geriatric medicine outpatient clinic to the first hospital visit. Statistical analyses included bivariate and multivariate analyses to adjust for confounding factors appropriately. Results: data from 345 patients suggested that the significant risk factors for dementia were history of smoking (adjusted OR 2.860, 95% CI 1.559-5.246), history of hearing loss (adjusted OR 7.962, 95% CI 3.534-17.941), history of depression (adjusted OR 12.473, 95% CI 2.533-61.417), hypertension (adjusted OR 1.751, 95% CI 1.006-3.048), and diabetes mellitus (adjusted OR 2.561, 95% CI 1.482-4.425). Dementia patients had longer median duration of diabetes mellitus (12 years) than elderly without dementia (9 years) before the diagnosis of dementia. Single point late-life underweight condition and low educational attainment were not associated with dementia in Indonesia’s urban setting. The risk factors for vascular dementia were largely similar to those of dementia. Conclusion: in Indonesian urban population, history of smoking, hearing loss, depression, hypertension, and diabetes mellitus are associated with dementia.


risk factor; dementia; Indonesia; urban; city; Jakarta


Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017;390(10113):2673–734.

Alzheimer’s Disease International. World Alzheimer report 2019: Attitudes to dementia. London, UK; 2019.

Prince M, Wimo A, Guerchet M, et al. World Alzheimer report 2015—the global impact of dementia: an analysis of prevalence, incidence, cost and trends. London, UK; 2015.

Direktorat Kesehatan Keluarga Direktoral Jenderal Kesehatan Masyarakat Kementerian Kesehatan RI. Panduan pelayanan kesehatan lanjut usia pada era pandemi COVID-19. Jakarta: Kementerian Kesehatan RI; 2020.

Suriastini N, Turana Y, Supraptilah B, Wicaksono T, Mulyanto E. Prevalence and risk factors of dementia and caregiver’s knowledge of the early symptoms of Alzheimer’s disease. Aging Med Healthc. 2020;11(2):60–6.

World Bank World Development Indicators. Rural population (% of total population) Indonesia.

Mukadam N, Sommerlad A, Huntley J, Livingston G. Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data. Lancet Glob Heal. 2019;7(5):e596–603.

Andreoulakis E, Hyphantis T, Kandylis D, Iacovides A. Depression in diabetes mellitus: A comprehensive review. Hippokratia. 2012;16(3):205–14.

Gao K, Shi X, Wang W. The life-course impact of smoking on hypertension, myocardial infarction and respiratory diseases. Sci Rep. 2017;7(1):4330.

García-Fabela L, Melano-Carranza E, Aguilar-Navarro S, García-Lara JMA, Gutiérrez-Robledo LM, Ávila-Funes JA. Hypertension as a risk factor for developing depressive symptoms among community-dwelling elders. Rev Investig Clin. 2009;61(4):274–80.

Jonas BS, Franks P, Ingram DD. Are symptoms of anxiety and depression risk factors for hypertension? Longitudinal evidence from the National Health and Nutrition Examination Survey I Epidemiologic Follow-up Study. Arch Fam Med. 1997.

Agarwal S, Mishra A, Jagade M, Kasbekar V, Nagle SK. Effects of hypertension on hearing. Indian J Otolaryngol Head Neck Surg. 2013;65(S3):614–8.

Yikawe SS, Iseh KR, Sabir AA, Inoh MI, Solomon JH, Aliyu N. Cardiovascular risk factors and hearing loss among adults in a tertiary center of Northwestern Nigeria. World J Otorhinolaryngol - Head Neck Surg. 2018.

Croll PH, Voortman T, Vernooij MW, et al. The association between obesity, diet quality and hearing loss in older adults. Aging (Albany NY). 2019;11(1):48–62.

Kim SY, Kim H-J, Park E-K, Joe J, Sim S, Choi HG. Severe hearing impairment and risk of depression: A national cohort study. Malmierca MS, editor. PLoS One. 2017;12(6):e0179973.

Mener DJ, Betz J, Genther DJ, Chen D, Lin FR. Hearing loss and depression in older adults. J Am Geriatr Soc. 2013;61(9):1627–9.

Mozaffari M, Tajik A, Ariaei N, Ali Ehyaii F, Behnam H. Diabetes mellitus and sensorineural hearing loss among non-elderly people. East Mediterr Heal J. 2010 Sep;16(9):947–52.

Maddatu J, Anderson-Baucum E, Evans-Molina C. Smoking and the risk of type 2 diabetes. Translational Research. 2017.

Piirtola M, Jelenkovic A, Latvala A, et al. Association of current and former smoking with body mass index: A study of smoking discordant twin pairs from 21 twin cohorts. Remuzzi G, editor. PLoS One. 2018;13(7):e0200140.

Flensborg-Madsen T, Bay von Scholten M, Flachs EM, Mortensen EL, Prescott E, Tolstrup JS. Tobacco smoking as a risk factor for depression. A 26-year population-based follow-up study. J Psychiatr Res. 2011 Feb;45(2):143–9.

Yun C, Wang Z, Gao J, et al. Prevalence and social risk factors for hearing impairment in Chinese children—A National Survey. Int J Environ Res Public Health. 2017;14(1):88.

Kiely DK, Gross AL, Kim DH, Lipsitz LA. The association of educational attainment and SBP among older community-living adults. J Hypertens. 2012;30(8):1518–25.

Sacerdote C, Ricceri F, Rolandsson O, et al. Lower educational level is a predictor of incident type 2 diabetes in European countries: The EPIC-InterAct study. Int J Epidemiol. 2012;41(4):1162–73.

Cohen AK, Rai M, Rehkopf DH, Abrams B. Educational attainment and obesity: a systematic review. Obes Rev. 2013;14(12):989–1005.

Mezuk B, Eaton WW, Golden SH, Ding Y. The influence of educational attainment on depression and risk of type 2 diabetes. Am J Public Health. 2008;98(8):1480–5.

Azwar MK, Setiati S. The clinical profile of dementia in Indonesia’s National General Hospital. The 11th IAGG Asia/Oceania Regional Congress Program Book. IAGG Asia Oceania; 2019.

Ariawan I. Besar dan metode sampel pada penelitian kesehatan. 1st ed. Depok, ID: Jurusan Biostatistik dan Kependudukan Fakultas Kesehatan Masyarakat, Universitas Indonesia; 1998.

Febianora M, Achmad C. Trends in population blood pressure and prevalence, awareness, treatment, and control of hypertension among middle aged and elderly in rural area of Riau Archipelago, Indonesia from 2007 to 2015. J Hypertens. 2015;33:e25.

Fitzpatrick AL, Kuller LH, Lopez OL, et al. Midlife and late-life obesity and the risk of dementia. Arch Neurol. 2009.

Atti AR, Palmer K, Volpato S, Winblad B, De Ronchi D, Fratiglioni L. Late-life body mass index and dementia incidence: Nine-year follow-up data from the Kungsholmen Project. J Am Geriatr Soc. 2008;56(1):111–6.

Turana Y, Handajani YS, Widjaja NT. Association between APOE ε4 genotype and memory impairment in elderly with normal global cognitive assessment. Diagnostics. 2015;5(4):615–23.

Setiawan D, Bidjuni H, Karundeng M. Hubungan tingkat pendidikan dengan kejadian demensia pada lansia di balai penyantunan lanjut usia senja cerah paniki kecamatan mapanget manado. J Keperawatan UNSRAT. 2014;2(2):1–7.

Rawtaer I, Gao Q, Nyunt MSZ, et al. Psychosocial risk and protective factors and incident mild cognitive impairment and dementia in community dwelling elderly: Findings from the Singapore Longitudinal Ageing Study. Anstey K, editor. J Alzheimer’s Dis. 2017;57(2):603–11.

Lang L, Clifford A, Wei L, et al. Prevalence and determinants of undetected dementia in the community: A systematic literature review and a meta-analysis. BMJ Open. 2017;7(2):e011146.

Swan GE, Lessov-Schlaggar CN. The effects of tobacco smoke and nicotine on cognition and the brain. Neuropsychology Review. 2007.

Indonesia KKR. Analisis lansia di Indonesia. Jakarta, ID: Kementerian Kesehatan Republik Indonesia; 2017. p. 7–8.

Choi D, Choi S, Park S. Effect of smoking cessation on the risk of dementia: a longitudinal study. Ann Clin Transl Neurol. 2018;5(10):1192–9.

Lecic-Tosevski D. Is urban living good for mental health? Curr Opin Psychiatry. 2019;32(3):204–9.

Alexopoulos GS. Vascular disease, depression, and dementia. J Am Geriatric Soc. 2003.

Luchsinger JA, Honig LS, Tang MX, Devanand DP. Depressive symptoms, vascular risk factors, and Alzheimer’s disease. Int J Geriatr Psychiatry. 2008.

Turana Y, Tengkawan J, Chia YC, et al. Hypertension and dementia: A comprehensive review from the HOPE Asia Network. J Clin Hypertens. 2019;21(8):1091–8.

Peltzer K, Pengpid S. The prevalence and social determinants of hypertension among adults in Indonesia: A cross-sectional population-based National Survey. Int J Hypertens. 2018;2018(3):1–9.

Benetos A, Petrovic M, Strandberg T. Hypertension management in older and frail older patients. Circ Res. 2019;124(7):1045–60.

Chiu W-C, Ho W-C, Lin M-H, et al. Angiotension receptor blockers reduce the risk of dementia. J Hypertens. 2014;32(4):938–47.

Hwang D, Kim S, Choi H, et al. Calcium-channel blockers and dementia risk in older adults – National health insurance service – Senior cohort (2002–2013). Circ J. 2016.

Williamson JD, Pajewski NM, Auchus AP, et al. Effect of intensive vs standard blood pressure control on probable dementia. JAMA. 2019;321(6):553.

Peters R, Beckett N, Forette F, et al. Incident dementia and blood pressure lowering in the hypertension in the very elderly Trial cognitive function assessment (HYVET-COG): a double-blind, placebo controlled trial. Lancet Neurol. 2008;7(8):683–9.

Xu G, Bai F, Lin X, et al. Association between antihypertensive drug use and the incidence of cognitive decline and dementia: A meta-analysis of prospective cohort studies. Biomed Res Int. 2017;2017(11):1–11.

Katsanos AH, Filippatou A, Manios E, et al. Blood pressure reduction and secondary stroke prevention. Hypertension. 2017;69(1):171–9.

Hanyu H. Diabetes-related dementia. Advances in experimental medicine and biology. 2019. p. 147–60.

Gold M, Alderton C, Zvartau-Hind M, et al. Rosiglitazone monotherapy in mild-to-moderate alzheimer’s disease: Results from a randomized, double-blind, placebo-controlled phase III study. Dement Geriatr Cogn Disord. 2010.

Mcguinness B, Craig D, Bullock R, Passmore P. Statins for the prevention of dementia. Cochrane Database of Systematic Reviews. 2016. p. CD003160.

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