STIGMA AS SOCIAL EXPOSOME: INTEGRATING SOCIOCULTURAL AND ENVIRONMENTAL DETERMINANTS OF DEMENTIA IN INDONESIA

Abstrak

Background: The prevalence of dementia in Indonesia continues to rise alongside the demographic transition, with estimated cases surging from 1.2 million in 2016 to a projected 4 million by 2050. The risk of this disease is not solely influenced by biological factors but is cumulative, resulting from the interaction of social and environmental factors throughout life course. Objective: This study aims to reconceptualize sociocultural stigma as an integral part of the exposome framework in understanding the determinants of dementia risk in Indonesia. Methods: This study employs a narrative review design by synthesizing relevant scientific literature and strategic report documents (published 2012–2024). The analysis focuses on three domains: the construction of dementia in Indonesia, the biological mechanisms of the exposome, and the reciprocal interaction between the two. Results: Findings indicate that stigma in Indonesia—manifested through perceptions of "normal senility," fear of impulsive behavior, and supernatural attributions—significantly hinders access to healthcare services. Meanwhile, the exposome concept explains how macro-environmental exposures and lifestyle interact with genetics to accelerate brain aging through inflammatory and epigenetic mechanisms. An integrative analysis confirms that stigma acts as a toxic “social exposome” that exacerbates biological risk through mechanisms of social isolation and chronic stress. Conclusion: Stigma and the exposome form a mutually reinforcing cycle that accelerates dementia progression. Therefore, national prevention strategies and policies must not be partial; a comprehensive approach targeting stigma reduction is required as a direct effort to break the chain of dementia risk exposome exposure.