Gender disparity in late-life cognitive functioning in India: findings from the longitudinal aging study in India.

OBJECTIVES To examine gender disparities in cognitive functioning in India and the extent to which education explains this disparity in later life. METHODS This study uses baseline interviews of a prospective cohort study of 1,451 community-residing adults 45 years of age or older in four geographically diverse states of India (Karnataka, Kerala, Punjab, Rajasthan). Data collected during home visits includes cognitive performance tests, and rich sociodemographic, health, and psychosocial variables. The cognitive performance tests include episodic memory, numeracy, and a modified version of the Mini-Mental State Examination. RESULTS We find gender disparity in cognitive function in India, and this disparity is greater in the north than the south. We also find that gender disparities in educational attainment, health, and social and economic activity explain the female cognitive disadvantage in later life. DISCUSSION We report significant gender disparities in cognitive functioning among older Indian adults, which differ from gender disparities in cognition encountered in developed countries. Our models controlling for education, health status, and social and economic activity explain the disparity in southern India but not the region-specific disparity in the northern India. North Indian women may face additional sources of stress associated with discrimination against women that contribute to persistent disadvantages in cognitive functioning at older ages.

[1]  Ivan Faiella,et al.  The Use of Survey Weights in Regression Analysis , 2010 .

[2]  P. Engle.  Inequality in early childhood: risk and protective factors for early child development , 2011 .

[3]  Manjistha Banerji.  Is education associated with a transition towards autonomy in partner choice? A case study of India , 2008 .

[4]  K. Anstey,et al.  Dynamic links of cognitive functioning among married couples: longitudinal evidence from the Australian Longitudinal Study of Ageing. , 2009, Psychology and aging.

[5]  Amartya Sen,et al.  More Than 100 Million Women Are Missing , 1990 .

[6]  Denis Gerstorf,et al.  Memory and depressive symptoms are dynamically linked among married couples: longitudinal evidence from the AHEAD study. , 2009, Developmental psychology.

[7]  S. MacDonald,et al.  Intraindividual Variability in Vigilance Performance: Does Degrading Visual Stimuli Mimic Age-Related “Neural Noise”? , 2006, Journal of clinical and experimental neuropsychology.

[8]  M. Zunzunegui,et al.  Explaining health differences between men and women in later life: a cross-city comparison in Latin America and the Caribbean. , 2009, Social science & medicine.

[9]  Y. Stern.  What is cognitive reserve? Theory and research application of the reserve concept , 2002, Journal of the International Neuropsychological Society.

[10]  G. Ratcliff,et al.  Cognitive Test Performance in a Community-Based Nondemented Elderly Sample in Rural India: The Indo-U.S. Cross-National Dementia Epidemiology Study , 1996, International Psychogeriatrics.

[11]  M. Gupta.  Selective Discrimination against Female Children in Rural Punjab, India , 1987 .

[12]  L A Beckett,et al.  Education and other measures of socioeconomic status and risk of incident Alzheimer disease in a defined population of older persons. , 1997, Archives of neurology.

[13]  N. Cook,et al.  The Relation of Education and Income to Cognitive Function among Professional Women , 2006, Neuroepidemiology.

[14]  Amartya Sen,et al.  Missing women--revisited. , 2003, BMJ.

[15]  V. Gqamane.  The Millennium Development Goals Report, 2009 , 2009 .

[16]  M. Prince,et al.  The Predictive Validity of the 10/66 Dementia Diagnosis in Chennai, India: A 3-Year Follow-up Study of Cases Identified at Baseline , 2010, Alzheimer disease and associated disorders.

[17]  Steven H. Belle,et al.  A hindi version of the MMSE: The development of a cognitive screening instrument for a largely illiterate rural elderly population in india , 1995 .

[18]  S. Taboonpong,et al.  Factors related to cognitive status among elders in southern Thailand. , 2008, Nursing & health sciences.

[19]  Piero Antuono,et al.  Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors , 2008, The Lancet Neurology.

[20]  J. Karlawish,et al.  Trends in the prevalence and mortality of cognitive impairment in the United States: Is there evidence of a compression of cognitive morbidity? , 2008, Alzheimer's & Dementia.

[21]  M. Albert,et al.  Level of education and change in cognitive function in a community population of older persons. , 1993, Annals of epidemiology.

[22]  C. Skinner,et al.  Weighting in the regression analysis of survey data with a cross‐national application , 2012 .

[23]  P. McDonough,et al.  Gender and health: reassessing patterns and explanations. , 2001, Social science & medicine.

[24]  Xiangfei Meng,et al.  Education and Dementia in the Context of the Cognitive Reserve Hypothesis: A Systematic Review with Meta-Analyses and Qualitative Analyses , 2012, PloS one.

[25]  D. Lauderdale,et al.  Education, wealth, and cognitive function in later life. , 2002, The journals of gerontology. Series B, Psychological sciences and social sciences.

[26]  M. Albert,et al.  High, usual and impaired functioning in community-dwelling older men and women: findings from the MacArthur Foundation Research Network on Successful Aging. , 1993, Journal of clinical epidemiology.

[27]  A. Chandra,et al.  Markers and Drivers: Cardiovascular Health of Middle-Age and Older Indians , 2011 .

[28]  G. Kingdon.  The Gender Gap in Educational Attainment in India: How Much Can Be Explained? , 2002 .

[29]  A. Kramer,et al.  Fitness Effects on the Cognitive Function of Older Adults , 2003, Psychological science.

[30]  V. Mishra,et al.  Sex Differentials in Childhood Feeding, Health Care, and Nutritional Status in India , 2004 .

[31]  D. Aizenberg,et al.  Suicide amongst Alzheimer’s Disease Patients: A 10-Year Survey , 2002, Dementia and Geriatric Cognitive Disorders.

[32]  J. Jolles,et al.  The relation between morbidity and cognitive performance in a normal aging population. , 1998, The journals of gerontology. Series A, Biological sciences and medical sciences.

[33]  R. Hausmann,et al.  The Global Gender Gap Report 2011: Rankings and Scores , 2011 .

[34]  M. Folstein,et al.  Alzheimer's disease in the National Academy of Sciences-National Research Council Registry of Aging Twin Veterans. III. Detection of cases, longitudinal results, and observations on twin concordance. , 1995, Archives of neurology.

[35]  I. Lang,et al.  Cognitive health among older adults in the United States and in England , 2009, BMC geriatrics.

[36]  Sukkoo Kim,et al.  Caste, Kinship and Sex Ratios in India , 2008 .

[37]  J. Mcardle,et al.  Gender Differences in Cognition among Older Adults in China , 2011, The Journal of Human Resources.

[38]  J. Strauss,et al.  Chapter 34 Human resources: Empirical modeling of household and family decisions , 1995 .

[39]  P. Mathuranath,et al.  Effects of Age, Education and Gender on Verbal Fluency , 2003, Journal of clinical and experimental neuropsychology.

[40]  Y. Stern.  Cognitive Reserve and Alzheimer Disease , 2006, Alzheimer disease and associated disorders.

[41]  I. Kawachi,et al.  Are self-reports of health and morbidities in developing countries misleading? Evidence from India. , 2009, Social science & medicine.

[42]  Bruce G. Link,et al.  Relationship between lifetime occupation and parietal flow , 1995, Neurology.

[43]  R. Katzman.,et al.  Education and the prevalence of dementia and Alzheimer's disease , 1993, Neurology.

[44]  C. Bird,et al.  Rethinking Gender Differences in Health: Why We Need to Integrate Social and Biological Perspectives. , 2005, The journals of gerontology. Series B, Psychological sciences and social sciences.

[45]  P. Mathuranath,et al.  Dementia in Kerala, South India: prevalence and influence of age, education and gender , 2010, International journal of geriatric psychiatry.

[46]  Perianayagam Arokiasamy,et al.  Longitudinal Aging Study in India: Vision, Design, Implementation, and Preliminary Findings * , 2012 .

[47]  Hui-Xin Wang,et al.  Brain reserve hypothesis in dementia. , 2007, Journal of Alzheimer's disease : JAD.

[48]  Michelle Grayson,et al.  Cognitive health , 2016, Nature.

[49]  M. Albert,et al.  Social relationships, social support, and patterns of cognitive aging in healthy, high-functioning older adults: MacArthur studies of successful aging. , 2001, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[50]  W. Rocca,et al.  Education and occupation as risk factors for dementia: a population-based case-control study. , 1995, Neuroepidemiology.

[51]  D. Snowdon,et al.  Age, Education, and Changes in the Mini‐Mental State Exam Scores of Older Women: Findings from the Nun Study , 1996, Journal of the American Geriatrics Society.

[52]  E. Tangalos,et al.  Mild Cognitive Impairment Clinical Characterization and Outcome , 1999 .

[53]  L. Radloff.  The CES-D Scale , 1977 .

[54]  C. Schooler,et al.  The continuing effects of substantively complex work on the intellectual functioning of older workers. , 1999, Psychology and aging.

[55]  P. Satz.  Brain reserve capacity on symptom onset after brain injury: A formulation and review of evidence for threshold theory. , 1993 .

[56]  G. Sperling,et al.  "What Works in Girls' Education: Evidence and Policies from the Developing World" , 2004 .

[57]  R. Mayeux,et al.  Influence of education and occupation on the incidence of Alzheimer's disease. , 1994, JAMA.

[58]  K. Yount.  Gender, resources across the life course, and cognitive functioning in Egypt , 2008, Demography.

[59]  Takehiko Doi,et al.  Characteristics of cognitive function in early and late stages of amnestic mild cognitive impairment , 2013, Geriatrics & gerontology international.

[60]  Hanan G. Jacoby,et al.  EARLY CHILDHOOD NUTRITION AND ACADEMIC ACHIEVEMENT: A LONGITUDINAL ANALYSIS , 2001 .

[61]  Jürgen Maurer.  Education and Male-Female Differences in Later-Life Cognition: International Evidence From Latin America and the Caribbean , 2011, Demography.

[62]  Robert Mathew,et al.  Mini mental state examination and the Addenbrooke's cognitive examination: effect of education and norms for a multicultural population. , 2007, Neurology India.

[63]  T. Dyson,et al.  On kinship structure, female autonomy, and demographic behavior in India. , 1983 .