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From the Department of Epidemiology (Drs. Chandra, Dodge, Johnston, Belle, and Ganguli, and R. Pandav), University of Pittsburgh Graduate School of Public Health, PA; the Centre for Ageing Research in India (Dr. Chandra and R. Pandav), New Delhi; the Division of Geriatrics and Neuropsychiatry (Drs. DeKosky and Ganguli) and the Alzheimer’s Disease Research Center and the Department of Neurology (Dr. DeKosky), University of Pittsburgh School of Medicine, Pittsburgh, PA.
Address correspondence and reprint requests to Dr. Mary Ganguli, WPIC, 3811 O’Hara Street, Pittsburgh, PA 15213–2593; e-mail: gangulim{at}msx.upmc.edu
Objective:— To determine overall and age-specific incidence rates of AD in a rural, population-based cohort in Ballabgarh, India, and to compare them with those of a reference US population in the Monongahela Valley of Pennsylvania.
Methods:— A 2-year, prospective, epidemiologic study of subjects aged 
55 years utilizing repeated cognitive and functional ability screening, followed by standardized clinical evaluation using the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and the National Institute of Neurological and Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association criteria for the diagnosis, and the Clinical Dementia Rating scale for the staging, of dementia and AD.
Results:— Incidence rates per 1000 person–years for AD with CDR 0.5 were 3.24 (95% CI: 1.48–6.14) for those aged 65 years and 1.74 (95% CI: 0.84–3.20) for those aged 55 years. Standardized against the age distribution of the 1990 US Census, the overall incidence rate in those aged 65 years was 4.7 per 1000 person–years, substantially lower than the corresponding rate of 17.5 per 1000 person–years in the Monongahela Valley.
Conclusion:— These are the first AD incidence rates to be reported from the Indian subcontinent, and they appear to be among the lowest ever reported. However, the relatively short duration of follow-up, cultural factors, and other potential confounders suggest caution in interpreting this finding.
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