Review: Cognitive Impairment in Rural and Urban Populations in Northern Portugal

The article reviewed here is ‘Prevalence and Pattern of Cognitive Impairment in Rural and Urban Populations from Northern Portugal’ by Nunes and colleagues and is an open-access article available here.

Aims: To compare the prevalence of cognitive impairment in rural and urban populations in Portugal.

Method: The researchers sampled residents in Portuguese urban and rural areas. The residents were aged between 55 and 79. The Mini Mental State Examination (MMSE) and the Blessed Dementia Scale were administered by trained psychologists and depression and alcohol misuse were screened using the Geriatric Depression Scale and CAGE questionnaire respectively. A cut-off point for Cognitive Impairment Non Dementia (CIND) on the MMSE was used. Identified cases were further examined by a neurologist. A set of neuropsychological tests – the Lisbon Battery – were also administered.

Results: The results were as follows

  • 1315 people were contacted in the rural area.
  • 863 people were contacted in the urban area.
  • The study included 713 participants from the rural community and 433 participants from the urban community.
  • The prevalence of dementia was 2.7% (95% CI 1.9-3.8)
  • The prevalence of CIND was 12.3% (95% CI 10.4-14.4)
  • The ratio of prevalences of CIND in Rural/Urban areas was 13.5/10.4
  • The ratio of prevalences of Dementia in Rural/Urban areas was 3.4/1.6
  • The age stratified figures showed the characteristic trends of age associated increases in prevalence of both dementia and CIND


Firstly this study investigated an urban and rural area in Portugal and because of factors such as healthcare provision, socioeconomic factors, local culture (including diet and exercise related activities) it is difficult to know to what extent these findings can be generalised to other countries. The sample populations were chosen as they were identified from a previous Census as having extreme scores in a number of categories including illiteracy. This also influences the extent to which these results can be generalised to other areas in Portugal. Using the MMSE as a screening tool has benefits including the relative ease of administration. However, using this as a screening tool for cognitive impairment non dementia on the basis of an assigned cut-off point is more difficult as cognitive impairment can affect a number of domains which are either not sufficiently examined with this tool or else are missing altogether. Nevertheless I think the combination of neuropsychological testing and neurological examination of identified cases is a strong point in the study and this design is one that can be replicated in other areas. Indeed standardisation of these protocols would be extremely useful in identifying the needs of a given population.

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