Aging Clin. Exp. Res. 4: 327-332, 1992 Unrecognized dementia: sociodemographic correlates R. Antonelli Incalzi, C. Marra, A. Gemma, O. Capparella, and P.U. Carbonin Department of Geriatrics, Universlta Cattolica del Sacro Cuore, Roma, Italy ABSTRACT Eighteen geriatric patients, aged 77±8 years, in whom a diagnosis of dementia was formulated during an unrelated hospital stay, were studied to clarify why dementia had not been detected at an earlier stage. The control group was composed of 20 patients aged 79±11 years with a comparable degree of cognitive impairment who had been recog- nized 1-3 years previously. The index group was characterized by a lower formal educa- tion (5.2±3.7 years vs 8.5±4.7 years, p<0.05), and higher prevalence of subjects living in rural areas (50% vs 10%, p<0.006); other sociodemographic variables (age, sex, marital status, employment before retirement) could not distinguish the groups. A multivari- ate logistic regression analysis showed that the end point late diagnosis was significantly correlated with the independent variables, ru- ral residence (odds ratio=4.65, C.I.=1.7-12.9) and lower occupational role (odds ratio=3.3, C.I.=1.2-9.5). A structured interview with rel- atives of the patients disclosed 3 main rea- sons accounting for later diagnosis : poor awareness of the problem of dementia; re- spect for parents and grandparents; and neg- ligible effect of this problem. on family life and economy. In the control group, dementia had been diagnosed earlier mostly because of its heavier social and economic impact on the family. (Aging Clin. Exp. Res. 4: 327-332, 1992) INTRODUCTION Cognitive impairment represents a major med- ical problem of the geriatric population (1). Re- ported prevalence rates range from 4% to 10% after the age of 65 years (2-4), and reach 20- 47% at the age of 80 years (5,6). A lower preva- lence, on average, was found in rural areas (7- 10), and the only exception was the study by Shibayama et al. (11). While the accuracy of health care professionals in diagnosing dementia repeatedly was proven to be poor (12-15), our experience in the field of Neuropsychology sug- gests that mental deterioration is frequently missed by the relatives of the patient, and is oc- casionally diagnosed during a hospital stay for medical or surgical problems. While it is likely that hospitalization exacerbates and then unmasks a mild cognitive impairment (16), it cannot be ex- cluded that the threshold for recognition of de- mentia by family members is to some extent re- lated to sociodemographic factors. To our knowl- edge, this possibility has not been explored. In this study, the sociodemographic profile of pa- tients with a cognitive impairment occasionally diagnosed during an unrelated hospital stay was examined, and compared with that of patients with a previous diagnosis of dementia; the results show that rural residence and lower social class characterize the former category of patients. SUBJECTS AND METHODS A hundred and seventy patients aged 65 years or more, who were admitted to the "A. Key words: Aged, dementia, mental deterioration, rural health. Correspondence: R. Antonelli Incalzi, M.D., Department of Geriatrics, Universita Cattolicadel Sacra Cuore, Largo A. Gemel- li 8, 00168 Roma, Italy. Received September 23, 1991; accepted January 10, 1992. Aging Clin. Exp. Res., Vol. 4, N. 4 327