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Advanced Neurology LBD prevalence and incidence in India

or diagnostic bias that disadvantages or underestimates and government sectors may affect the diagnosis and
minority or marginalized groups. Second, although the treatment of dementia, resulting in significant differences
global use of MMSE might make it a suitable candidate for in care across different regions. Third, any analysis of
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wider validation, its lack of sensitivity in capturing some LBD prevalence must consider routine LBD detection,
cognitive deficits may support an alternative scale, such which is inevitably influenced by access to education,
40
as Montreal Cognitive Assessment (MoCA). An exercise training, and biomarkers. 49,50 Our study identified only one
in establishing a core outcome set for DLB, informed by study leveraging biomarkers in LBD diagnosis. Access to
all stakeholder groups and at an international level, may diagnostic biomarkers is associated with better detection
37
help support a consensus in future directions for validating and a higher clinical prevalence; any epidemiological
cognitive scales in India. 41 study of LBD in India must therefore consider access to
biomarkers as a significant factor.
Another important factor in promoting harmonization
and evidence synthesis is the common use of diagnostic Our study investigated LBD epidemiology in the world’s
criteria. All four studies included in the present study most populous country, contextualizing our findings in
adopted different diagnostic criteria. The international the broader field. Our broad search strategy included both
consensus criteria, revised in 2017, were partly designed anglicized and native names and followed robust quality
7
to promote such harmonization and support a consistent assessment and reporting guidelines. The drawbacks of our
approach to diagnosis and nomenclature. This was also study include limiting the papers to the English language
highlighted by our manuscript; LBD and DLB are often and not including some less commonly used names for
erroneously used interchangeably, and the absence of LBD, such as “diffuse Lewy body disease,” in our search
discussion of PDD and DLB in Patel et al.’s paper suggests strategy. Nevertheless, this did not preclude extracting a
that DLB represented a more precise definition of findings paper using these terminologies. 19
compared to the LBD used throughout. 21 Our work highlights the paucity of published research on
We were unable to identify any studies investigating LBD epidemiology in India. Further epidemiological work is
LBD incidence in India. Understanding the relationship required to determine the disease’s impact on communities,
between the incidence and prevalence is critical in public healthcare systems, and individuals, particularly in a larger
health. Although the prevalence and incidence of all-cause and more representative cohort than what is currently
dementia are increasing globally, the age-adjusted incidence available.
is decreasing, probably due to advances in cardiovascular 5. Conclusion
healthcare. The modifiable risk factors for dementia evolve
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throughout the lifespan, and amelioration of such factors Our comprehensive review underscores a notable
43
in India in recent decades, such as child literacy and visual deficiency in the epidemiological comprehension of LBD
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impairment, may similarly diminish the age-adjusted in India. The scarcity of studies, methodological disparity,
45
dementia incidence in the country. Therefore, we hope that and diverse diagnostic criteria present challenges in
the Longitudinal Aging Study in India-Diagnostic Assessment determining the precise prevalence rates. DLB accounted
of Dementia will provide some insight into these risk factors for 1.0 – 8.9% of dementia cases, indicating considerable
by assessing 3000 LASI participants aged ≥60 years. 46 variability that may be influenced by study design and
context. The insufficiency of incidence data further
Several factors limit our finding’s generalizability. First, emphasizes the necessity of further research.
the sample sizes of the included studies were relatively low.
Recruiting large LBD samples is challenging at any single Acknowledgments
site, and the global DLB research community supports the
adoption of multicenter consortia in aggregating sufficient Harshini Priya Kirushnakumar wishes to thank Jey, Uma,
data to support thorough analysis. Second, the setting Kirshna Kumar, and Soundarya for their support in
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for each study was urban and reflected specialist clinics in developing this project and the manuscript.
three of four studies. This recruitment bias fails to provide Funding
insight into rural or underserved communities, which is
compounded by the infrastructure of Indian healthcare, Access to the use of the Covidence platform for this
including government and private facilities. Approximately project funded by the Centre for Public Health at Queen’s
80% of India’s population receives outpatient care at private University Belfast.
facilities because of the perceived higher quality of care. Conflict of interest
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However, not everyone can afford private care. Thus, the
variation in hospital infrastructure between the private The authors declare that they have no competing interests.

Volume 3 Issue 4 (2024) 6 doi: 10.36922/an.4098