Material and Methods:

In this cross sectional analytical study, 100 consecutive elderly subjects of >65 years age, attending the Medicine OPD of VMMC and SAFDARJUNG HOSPITAL,NEW DELHI meeting the eligibility criteria of having > 65yrs of age were enrolled. Cases with cerebrovascular stroke, hepatic / hypoxic encephalopathy, megaloblastic anemias, Hb% <10 gm%, thyroid disoder, electrolyte imbalance, head injuries and altered consciousness were excluded. Informed consent was obtained from all subjects and the study was approved by Institutional Ethics Committee (IEC). All subjects were assessed for the traditional cardiovascular risk factors (hypertension, diabetes mellitus, dyslipidemia, smoking, waist circumference and alcohol intake). Education status was graded into 7 classes based on years of formal schooling. Literacy was defined as ability to read local news paper and write a sentence.3 Participants who left school before matriculation were classified to have low education4. Socioeconomic status of subject was determined with modified Kuppuswamy scale adapted to current price index.5 In the present study, subjects belonging to social class, lower-middle, upper-lower and lower were classified as low social class.4 Retired people were coded according to their former occupation. Married and Widowed women were coded according to their husbands former occupation.4 Subjects with waist circumference of 90 cm in men and 80cm in women were said to have central obesity.6 Detailed history of alcohol intake was noted. Cognitive score was assessed by applying abbreviated mental test score (AMTS). AMTS 30 point scale consisting of several orientation questions. If subject did not complete a test for any reason the missing score on this test was treated as if it was an indicator of impairment. Based on their cognitive score, subject were classified as Normal > 6(score), Dementia 6 (score). All the subjects who fulfilled < 6 score forms criteria for dementia underwent brain CT scan primary and vascular dementia were differentiated on clinical exam supported by imaging findings. Cortical and/or subcortical infarctions, confluent white matter disease on imaging was considered as vascular dementia.

Statistical Analysis
Analysis included the usual descriptive and univariate analysis. Discrete (categorical) variable were compared by Chi-square test and for continuous variables student t test was used. Unadjusted odds ratio with 95% confident interval (CI) was calculated and p values were computed. All p values were two tailed and values <0.05 were considered statistically significant. To determine factors independently associated with cognitive decline, multivariate analysis was carried out by means of multiple logistic regression analysis. The independent variables included in logistic regression model were age, gender and cardiovascular risk factors. Their association with cognitive impairment was studied with abnormal cognitive score (AMTS <6 ) as dichotomous dependent outcome variable.