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Aravena JM, Lee J, Schwartz AE, Nyhan K, Wang SY, Levy BR. Beneficial Effect of Societal Factors on APOE-ε2 and ε4 Carriers' Brain Health: A Systematic Review. J Gerontol A Biol Sci Med Sci 2024; 79:glad237. [PMID: 37792627 PMCID: PMC10803122 DOI: 10.1093/gerona/glad237] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Apolipoprotein-E (APOE) ε4 and ε2 are the most prevalent risk-increasing and risk-reducing genetic predictors of Alzheimer's disease, respectively. However, the extent to which societal factors can reduce the harmful impact of APOE-ε4 and enhance the beneficial impact of APOE-ε2 on brain health has not yet been examined systematically. METHODS To fill this gap, we conducted a systematic review searching for studies in MEDLINE, Embase, PsycINFO, and Scopus until June 2023, that included: (a) 1 of 5 social determinants of health (SDH) identified by Healthy People 2030, (b) APOE-ε2 or APOE-ε4 allele carriers, (c) cognitive or brain-biomarker outcomes, and (d) studies with an analysis of how APOE-ε2 and/ or APOE-ε4 carriers differ on outcomes when exposed to SDH. RESULTS From 14 076 articles retrieved, 124 met the inclusion criteria. In most of the studies, exposure to favorable SDH reduced APOE-ε4's detrimental effect and enhanced APOE-ε2's beneficial effect on cognitive and brain-biomarker outcomes (cognition: 70.5%, n: 74/105; brain-biomarkers: 71.4%, n: 20/28). A similar pattern of results emerged in each of the 5 Healthy People 2030 SDH categories, where finishing high school, having resources to satisfy basic needs, less air pollution, less negative external stimuli that can generate stress (eg, negative age stereotypes), and exposure to multiple favorable SDH were associated with better cognitive and brain health among APOE-ε4 and APOE-ε2 carriers. CONCLUSIONS Societal factors can reduce the harmful impact of APOE-ε4 and enhance the beneficial impact of APOE-ε2 on cognitive outcomes. This suggests that plans to reduce dementia should include community-level policies promoting favorable SDH.
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Affiliation(s)
- José M Aravena
- Department of Social & Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Jakyung Lee
- Institute for Community Care and Health Equity, Chung-Ang University, Seoul, Republic of South Korea
| | - Anna E Schwartz
- Department of Social & Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Kate Nyhan
- Cushing/Whitney Medical Library, Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Shi-Yi Wang
- Department of Chronic Disease Epidemiology, School of Public Health, Yale University, New Haven, Connecticut, USA
| | - Becca R Levy
- Department of Social & Behavioral Sciences, School of Public Health, Yale University, New Haven, Connecticut, USA
- Department of Psychology, Yale University, New Haven, Connecticut, USA
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Steenkamp T, Mazibuko PS, Kotzé C. Factors associated with longer hospital admission in elderly patients with major neurocognitive disorder. S Afr J Psychiatr 2023; 29:2078. [PMID: 37928937 PMCID: PMC10623590 DOI: 10.4102/sajpsychiatry.v29i0.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/08/2023] [Indexed: 11/07/2023] Open
Abstract
Background Major neurocognitive disorder presents many challenges to patients, families and healthcare systems, especially when a patient requires admission to a psychiatric hospital. Aim To identify characteristics of older patients with major neurocognitive disorder at risk of prolonged admission in a psychiatric hospital. Setting A tertiary psychiatric hospital in Gauteng province, South Africa. Methods The authors conducted a retrospective review of the hospital database and clinical files. Clinical and demographic data were collected from the files of 50 inpatients, 60 years and older, who were diagnosed with major neurocognitive disorder and admitted between 2015 and 2019. Anonymised data from patient records were captured on an electronic spreadsheet and analysed using T-tests and analysis of variance (ANOVA) to investigate the relationship between patient characteristics and length of hospital admission. Results The mean duration of admission was 18.29 months. Involuntary admission status (β = 0.239, p = 0.049), level of assistance required (moderate level of assistance [β = 0.378, p = 0.005]; high level of assistance [β = 0.336, p = 0.015]), availability of social support (β = -0.319, p = 0.016) and the presence of behavioural or psychological problems (β = 0.437, p = 0.002) were significantly correlated with longer admission. Using a stepwise regression model, the only significant variable associated with a shorter length of stay was the presence of social support (β = -0.512, p = 0.009). Age, type of major neurocognitive disorder and number of comorbidities were not correlated with the duration of admission (p > 0.005). Conclusion and contribution Social support plays an important role in the management of patients with major neurocognitive disorder. The findings in this study highlight healthcare shortages and a need for adequate placement facilities in South Africa for patients who have no other form of support.
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Affiliation(s)
- Tarina Steenkamp
- Weskoppies Psychiatric Hospital, Institution of Gauteng Health, Pretoria, South Africa
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Paslius S. Mazibuko
- Weskoppies Psychiatric Hospital, Institution of Gauteng Health, Pretoria, South Africa
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Carla Kotzé
- Weskoppies Psychiatric Hospital, Institution of Gauteng Health, Pretoria, South Africa
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Naheed A, Hakim M, Islam MS, Islam MB, Tang EY, Prodhan AA, Amin MR, Stephan BC, Mohammad QD. Prevalence of dementia among older age people and variation across different sociodemographic characteristics: a cross-sectional study in Bangladesh. THE LANCET REGIONAL HEALTH. SOUTHEAST ASIA 2023; 17:100257. [PMID: 37849932 PMCID: PMC10577143 DOI: 10.1016/j.lansea.2023.100257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 04/06/2023] [Accepted: 07/19/2023] [Indexed: 10/19/2023]
Abstract
Background Dementia is a significant global health issue, particularly for low-income and middle-income countries which majorly contribute to the dementia cases reported globally (67%). We estimated the prevalence of dementia among older people in Bangladesh and compared the estimate across different sociodemographic characteristics and divisions. Methods A cross-sectional study was conducted in 2019 among individuals aged 60 years or older in seven administrative divisions in Bangladesh. Equal numbers of male and female participants were recruited from each division through a multi-stage random sampling technique. Recruitment was proportionally distributed in urban and rural areas in each division. Following consent, the Mini Mental State Examination (MMSE) was performed on all participants. Dementia was defined as an MMSE score of <24 out of 30. Data on age, sex, education, marital status, occupation, socioeconomic status, and type of community (urban or rural) were obtained using a structured questionnaire to compare the prevalence of dementia across different sociodemographic characteristics. Findings Between January and December 2019, 2795 individuals were recruited including ∼400 from each of the seven administrative divisions. The mean age was 67 years (SD: 7), 68% were from rural areas and 51% were female. The prevalence of dementia was 8.0% (95% CI: 7.0-8.9%) with variations across age, sex, education, marital status, occupation, and division. No variations in prevalence were observed across urban/rural locations or socioeconomic status. After adjusting for age, sex, education, occupation and marital status, the odds of dementia was two times higher in females than males (OR: 2.15, 95% CI: 1.43-3.28); nine times higher in people aged ≥90 years than people aged 60-69 years (OR: 9.62, 95% CI: 4.79-19.13), and three times higher in people with no education compared to those who had completed primary school (OR: 3.10, 95% CI: 1.95-5.17). Interpretations The prevalence of dementia is high in Bangladesh and varies across sociodemographic characteristics with a higher prevalence among females, older people, and people with no education. There is an urgent need to identify the key risk factors for dementia in developing countries, such as Bangladesh, to inform the development of context-relevant risk reduction and prevention strategies. Funding None.
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Affiliation(s)
- Aliya Naheed
- Initiative for Non Communicable Diseases, Health Systems and Population Studies Division, icddr,b, Mohakhali, Dhaka, 1000, Bangladesh
| | - Maliha Hakim
- National Institute of Neurosciences & Hospital, Dhaka, 1207, Bangladesh
| | - Md Saimul Islam
- Initiative for Non Communicable Diseases, Health Systems and Population Studies Division, icddr,b, Mohakhali, Dhaka, 1000, Bangladesh
| | - Md Badrul Islam
- Laboratory Science and Services Division, icddr,b, Mohakhali, Dhaka, 1000, Bangladesh
| | | | - Abdul Alim Prodhan
- Non Communicable Disease Control Program, Directorate General of Health Services, Dhaka, 1212, Bangladesh
| | - Mohammad Robed Amin
- Non Communicable Disease Control Program, Directorate General of Health Services, Dhaka, 1212, Bangladesh
- Department of Medicine, Dhaka Medical College and Hospital, Dhaka, 1000, Bangladesh
| | - Blossom C.M. Stephan
- Institute of Mental Health, Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, UK
- Dementia Centre of Excellence, Curtin enAble Institute, Curtin University, Perth, Western Australia, Australia
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Santamaria-Garcia H, Moguilner S, Rodriguez-Villagra OA, Botero-Rodriguez F, Pina-Escudero SD, O'Donovan G, Albala C, Matallana D, Schulte M, Slachevsky A, Yokoyama JS, Possin K, Ndhlovu LC, Al-Rousan T, Corley MJ, Kosik KS, Muniz-Terrera G, Miranda JJ, Ibanez A. The impacts of social determinants of health and cardiometabolic factors on cognitive and functional aging in Colombian underserved populations. GeroScience 2023; 45:2405-2423. [PMID: 36849677 PMCID: PMC10651610 DOI: 10.1007/s11357-023-00755-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023] Open
Abstract
Global initiatives call for further understanding of the impact of inequity on aging across underserved populations. Previous research in low- and middle-income countries (LMICs) presents limitations in assessing combined sources of inequity and outcomes (i.e., cognition and functionality). In this study, we assessed how social determinants of health (SDH), cardiometabolic factors (CMFs), and other medical/social factors predict cognition and functionality in an aging Colombian population. We ran a cross-sectional study that combined theory- (structural equation models) and data-driven (machine learning) approaches in a population-based study (N = 23,694; M = 69.8 years) to assess the best predictors of cognition and functionality. We found that a combination of SDH and CMF accurately predicted cognition and functionality, although SDH was the stronger predictor. Cognition was predicted with the highest accuracy by SDH, followed by demographics, CMF, and other factors. A combination of SDH, age, CMF, and additional physical/psychological factors were the best predictors of functional status. Results highlight the role of inequity in predicting brain health and advancing solutions to reduce the cognitive and functional decline in LMICs.
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Affiliation(s)
- Hernando Santamaria-Garcia
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA.
- Pontificia Universidad Javeriana (Ph.D. Program in Neuroscience, Department of Psychiatry), Bogotá, Colombia.
- Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia.
| | - Sebastian Moguilner
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago de Chile, Chile
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, and CONICET, Buenos Aires, Argentina
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Felipe Botero-Rodriguez
- Pontificia Universidad Javeriana (Ph.D. Program in Neuroscience, Department of Psychiatry), Bogotá, Colombia
| | - Stefanie Danielle Pina-Escudero
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Gary O'Donovan
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago de Chile, Chile
- Facultad de Medicina, Universidad de los Andes, Bogotá, Colombia
| | - Cecilia Albala
- Instituto de Nutrición Y Tecnología de los Alimentos, Universidad de Chile, Avenida El Líbano 5524, Macul, Santiago, Chile
| | - Diana Matallana
- Pontificia Universidad Javeriana (Ph.D. Program in Neuroscience, Department of Psychiatry), Bogotá, Colombia
- Center of Memory and Cognition Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
- Mental Health Department, Hospital Universitario Fundación Santa Fe de Bogotá, Memory Clinic, Bogotá, Colombia
| | - Michael Schulte
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago de Chile, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department - Institute of Biomedical Sciences (ICBM), Neurocience and East Neuroscience Departments, Faculty of Medicine, University of Chile, Santiago de Chile, Chile
- Geroscience Center for Brain Health and Metabolism, (GERO), Santiago de Chile, Chile
- Memory and Neuropsychiatric Center (CMYN), Memory Unit - Neurology Department, Hospital del Salvador and Faculty of Medicine, University of Chile, Santiago de Chile, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago de Chile, Chile
| | - Jennifer S Yokoyama
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Katherine Possin
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA
- Department of Neurology, Memory and Aging Center, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | - Lishomwa C Ndhlovu
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Tala Al-Rousan
- Herbert Wertheim School of Public Health, University of California San Diego, La Jolla, CA, USA
| | - Michael J Corley
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA
| | - Kenneth S Kosik
- Neuroscience Research Institute. Department of Molecular Cellular and Developmental Biology, University of California Santa Barbara, Santa Barbara, CA, USA
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, University of Edinburgh, Edinburgh, UK
- Department of Primary Care, Ohio University, Athens, USA
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- The George Institute for Global Health, UNSW, Sydney, Australia
| | - Agustin Ibanez
- Global Brain Health Institute (GBHI), University of California San Francisco (UCSF), San Francisco, CA, USA.
- Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibañez, Santiago de Chile, Chile.
- Cognitive Neuroscience Center (CNC), Universidad de San Andrés, and CONICET, Buenos Aires, Argentina.
- Trinity College Dublin (TCD), Dublin, Ireland.
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Ayele BA, Ali S, Anbessie M, Zewde YZ, Yoseph S, Lee S, Valcour V, Miller B. The need for a tailored national dementia plan in Ethiopia: A call for action. Front Neurol 2023; 14:1126531. [PMID: 36925945 PMCID: PMC10011145 DOI: 10.3389/fneur.2023.1126531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 02/06/2023] [Indexed: 03/08/2023] Open
Abstract
Globally, a rapid demographic transition is occurring with a significant increment in the proportion of older individuals. For the first time in history, individuals aged 65 and above outnumber that of children under 5 years of age. In Ethiopia, the life expectancy has shown dramatic improvements in the past few decades and is expected to reach 74 years by mid-century. Older age is considered the most important non-modifiable risk factor for dementia. Likewise, other modifiable diseases such as infectious diseases, non-communicable diseases, particularly cardiovascular diseases, and traumatic brain injuries are associated with dementia. Despite, the high prevalence of dementia risk factors and impending economic and health impact from dementia, no country in the sub-Saharan Africa (SSA), including Ethiopia, has developed a standalone or an integrated national dementia strategic plan to guide the overall effort to improve dementia care in the country. It is vital to design and develop a national dementia plan in line with a framework outlined by the 2017 World Health Organization (WHO) global action plan. The health, social, and economic burden from dementia is expected to be high to the developing countries such as Ethiopia unless clear prevention and management strategies are designed at a national level to cascade the care to the primary care level. The planned strategic policy may focus on improving the knowledge and skills of health care professionals. Translation and cultural adaptation of cognitive, functional, and behavioral assessment batteries is of paramount importance in improving the diagnostic accuracy along with availability of advanced imaging, biomarkers, and dementia treatment.
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Affiliation(s)
- Biniyam A Ayele
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Department of Neurology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Seid Ali
- Department of Neurology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mohammed Anbessie
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Yared Z Zewde
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Department of Neurology, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Selam Yoseph
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Department of Psychiatry, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia
| | - Suzee Lee
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Victor Valcour
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
| | - Bruce Miller
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States.,Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
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Adewale BA, Coker MM, Ogunniyi A, Kalaria RN, Akinyemi RO. Biomarkers and Risk Assessment of Alzheimer's Disease in Low- and Middle-Income Countries. J Alzheimers Dis 2023; 95:1339-1349. [PMID: 37694361 DOI: 10.3233/jad-221030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Dementia is a chronic syndrome which is common among the elderly and is associated with significant morbidity and mortality for patients and their caregivers. Alzheimer's disease (AD), the most common form of clinical dementia, is biologically characterized by the deposition of amyloid-β plaques and neurofibrillary tangles in the brain. The onset of AD begins decades before manifestation of symptoms and clinical diagnosis, underlining the need to shift from clinical diagnosis of AD to a more objective diagnosis using biomarkers. Having performed a literature search of original articles and reviews on PubMed and Google Scholar, we present this review detailing the existing biomarkers and risk assessment tools for AD. The prevalence of dementia in low- and middle-income countries (LMICs) is predicted to increase over the next couple of years. Thus, we aimed to identify potential biomarkers that may be appropriate for use in LMICs, considering the following factors: sensitivity, specificity, invasiveness, and affordability of the biomarkers. We also explored risk assessment tools and the potential use of artificial intelligence/machine learning solutions for diagnosing, assessing risks, and monitoring the progression of AD in low-resource settings. Routine use of AD biomarkers has yet to gain sufficient ground in clinical settings. Therefore, clinical diagnosis of AD will remain the mainstay in LMICs for the foreseeable future. Efforts should be made towards the development of low-cost, easily administered risk assessment tools to identify individuals who are at risk of AD in the population. We recommend that stakeholders invest in education, research and development targeted towards effective risk assessment and management.
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Affiliation(s)
- Boluwatife Adeleye Adewale
- Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Motunrayo Mojoyin Coker
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Rajesh N Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| | - Rufus Olusola Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
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Phetsitong R, Vapattanawong P, Mayston R, Prince M, Chua KC. In Caring for Older People in Low- and Middle-Income Countries, Do Older Caregivers Have a High Level of Care Burden and Psychological Morbidity Compared to Younger Caregivers? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416405. [PMID: 36554286 PMCID: PMC9778435 DOI: 10.3390/ijerph192416405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/25/2022] [Accepted: 11/30/2022] [Indexed: 06/02/2023]
Abstract
Caregivers have become older as longevity increases. Caregiving for older people can cause burdens and psychological morbidity, which are the chronic stresses perceived by informal caregivers. This study aimed to compare the levels of care burden and psychological morbidity between older and younger caregivers in low- and middle-income countries. A cross-sectional survey was conducted in Cuba, the Dominican Republic, Peru, Venezuela, Mexico, Puerto Rico, and China. Data were collected by the 10/66 Dementia Research Group. The Zarit Burden Inventory was used to measure the levels of burden on caregivers. Psychological morbidity was assessed through the Self-Reporting Questionnaire. Data from 1348 households in which informal caregivers provided home care for one older person were included in the analysis. Multivariable logistic regression was used to investigate the effects of caregiver age upon care burden and psychological morbidity. A fixed-effect meta-analysis model was used to obtain a pooled estimate of the overall odds ratios of each country. The unadjusted and the adjusted model for potential covariates revealed no significant difference in care burden and psychological morbidity between older caregivers and younger caregivers. The adjusted pooled estimates, however, indicated a lower psychological morbidity among older caregivers (OR = 0.61, 95% CI: 0.41-0.93, I2 = 0.0%). The demographic implications of caregiver age may suggest different policy responses across low- and middle-income countries.
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Affiliation(s)
- Ruttana Phetsitong
- Faculty of Physical Therapy, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Patama Vapattanawong
- Institute for Population and Social Research, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Rosie Mayston
- Department of Global Health and Social Medicine, Social Science and Public Policy, King’s College London, London WC2R 2LS, UK
| | - Martin Prince
- King’s Global Health Institute, King’s College London, London WC2R 2LS, UK
| | - Kia-Chong Chua
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
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8
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Molinari-Ulate M, Mahmoudi A, Franco-Martín MA, van der Roest HG. Psychometric characteristics of comprehensive geriatric assessments (CGAs) for long-term care facilities and community care: A systematic review. Ageing Res Rev 2022; 81:101742. [PMID: 36184026 DOI: 10.1016/j.arr.2022.101742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/27/2022] [Accepted: 09/27/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Comprehensive Geriatric Assessments (CGAs) have been incorporated as an integrated care approach effective to face the challenges associated to uncoordinated care, risk of hospitalization, unmet needs, and care planning experienced in older adult care. As they assessed different dimensions, is important to inform about the content and psychometric properties to guide the decisions when selecting and implementing them in practice. This systematic review provides a comprehensive insight on the strengths and weaknesses of the CGAs used in long-term care settings and community care. METHODS A systematic search was conducted in PubMed, CINAHL, and Web of Science Core Collection. Studies published up to July 13, 2021, were considered. Quality appraisal was performed for the included studies. RESULTS A total of 10 different CGAs were identified from 71 studies included. Three instruments were reported for long-term care settings, and seven for community care. The content was not homogenous and differed in terms of the detail and clearness of the areas being evaluated. Evidence for good to excellent validity and reliability was reported for various instruments. CONCLUSIONS Setting more specific and clear domains, associated to the special needs of the care setting, could improve informed decisions at the time of selecting and implementing a CGA. Considering the amount and quality of the evidence, the instrument development trajectory, the validation in different languages, and availability in different care settings, we recommend the interRAI LTCF and interRAI HC to be used for long-term facilities and community care.
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Affiliation(s)
- Mauricio Molinari-Ulate
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Spain; Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain.
| | - Aysan Mahmoudi
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Spain; Department of Research and Development, Iberian Institute of Research in Psycho-Sciences, INTRAS Foundation, Zamora, Spain.
| | - Manuel A Franco-Martín
- Psycho-Sciences Research Group, Institute of Biomedical Research of Salamanca, University of Salamanca, Spain; Psychiatric and Mental Health Department, Zamora Healthcare Complex, Zamora, Spain.
| | - Henriëtte G van der Roest
- Department on Aging, Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, the Netherlands.
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9
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Banerjee S. Dementia-so much done, so much to do, so much to gain by doing so. Age Ageing 2022; 51:6713147. [PMID: 36156705 DOI: 10.1093/ageing/afac204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND it has been a busy 50 years for dementia, a complicated voyage from obscurity and neglect towards recognition, knowledge and action. This commentary sets out that path through research, practice and policy to examine what we have achieved, where we are now and what more there is to be done. FINDINGS the main themes identified were as follows. CONCLUSIONS we have made substantial advances in cause, cure, and care research and practice. Moving to deliver solutions to improve dementia care would be of major value to the whole health and care system.
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Affiliation(s)
- Sube Banerjee
- Professor and Executive Dean, Faculty of Health, University of Plymouth, UK
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Alenius M, Hokkanen L, Koskinen S, Hallikainen I, Hänninen T, Karrasch M, Raivio MM, Laakkonen ML, Krüger J, Suhonen NM, Kivipelto M, Ngandu T. Cognitive Performance at Time of AD Diagnosis: A Clinically Augmented Register-Based Study. Front Psychol 2022; 13:901945. [PMID: 35846684 PMCID: PMC9284003 DOI: 10.3389/fpsyg.2022.901945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/02/2022] [Indexed: 12/02/2022] Open
Abstract
We aimed to evaluate the feasibility of using real-world register data for identifying persons with mild Alzheimer’s disease (AD) and to describe their cognitive performance at the time of diagnosis. Patients diagnosed with AD during 2010–2013 (aged 60–81 years) were identified from the Finnish national health registers and enlarged with a smaller private sector sample (total n = 1,268). Patients with other disorders impacting cognition were excluded. Detailed clinical and cognitive screening data (the Consortium to Establish a Registry for Alzheimer’s Disease neuropsychological battery [CERAD-nb]) were obtained from local health records. Adequate cognitive data were available for 389 patients with mild AD (31%) of the entire AD group. The main reasons for not including patients in analyses of cognitive performance were AD diagnosis at a moderate/severe stage (n = 266, 21%), AD diagnosis given before full register coverage (n = 152, 12%), and missing CERAD-nb data (n = 139, 11%). The cognitive performance of persons with late-onset AD (n = 284), mixed cerebrovascular disease and AD (n = 51), and other AD subtypes (n = 54) was compared with that of a non-demented sample (n = 1980) from the general population. Compared with the other AD groups, patients with late-onset AD performed the worst in word list recognition, while patients with mixed cerebrovascular disease and AD performed the worst in constructional praxis and clock drawing tests. A combination of national registers and local health records can be used to collect data relevant for cognitive screening; today, the process is laborious, but it could be improved in the future with refined search algorithms and electronic data.
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Affiliation(s)
- Minna Alenius
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- *Correspondence: Minna Alenius,
| | - Laura Hokkanen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Sanna Koskinen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Ilona Hallikainen
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | - Tuomo Hänninen
- Unit of Neurology, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Neurology of Neuro Center, Kuopio University Hospital, Kuopio, Finland
| | - Mira Karrasch
- Department of Psychology, Abo Akademi University, Turku, Finland
| | - Minna M. Raivio
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
| | - Marja-Liisa Laakkonen
- Department of General Practice, University of Helsinki, Helsinki, Finland
- Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
- Geriatric Clinic, Department of Social Services and Health Care, Laakso Hospital, Helsinki, Finland
| | - Johanna Krüger
- Research Unit of Clinical Neuroscience, Neurology, University of Oulu, Oulu, Finland
- MRC, Oulu University Hospital, Oulu, Finland
| | | | - Miia Kivipelto
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
- Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Tiia Ngandu
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
- Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden
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11
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Huang Y, Li X, Liu Z, Huo J, Guo J, Chen Y, Chen Y, Chen R. Projections of the economic burden of care for individuals with dementia in mainland China from 2010 to 2050. PLoS One 2022; 17:e0263077. [PMID: 35113895 PMCID: PMC8812891 DOI: 10.1371/journal.pone.0263077] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 01/11/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND China has stepped into an era of aging society, where the impending considerable economic burden attributed to high prevalence of dementia in the elderly appears to be one of the most important health and social issues to deal with for the country. However, population-based quantification and projections for the economic burden of dementia in China are lacking for further health action and policy making. OBJECTIVE To estimate and predict the costs of managing dementia in the elderly population aged 60 and above from 2010 to 2050 in China. METHODS Data were collected from a six-province study (n = 7072) and other multiple sources for calculation of the economic burden of dementia. With the convincing data from published studies, we quantified and projected the costs attributed to dementia in China from 2010 to 2050. RESULTS The national cost of dementia in 2010 was estimated to be US$22.8 billion by the opportunity cost method and US$26.4 billion by the proxy method. In 2050, the costs would increase to US$372.3 billion by the opportunity cost method and US$430.6 billion by the proxy method, consuming 0.53% and 0.61% of China's total GDP, respectively. A series of sensitivity analyses showed that the changes in the proportions of informal caregiving led to the most robust changes in the total burden of care for dementia in China. CONCLUSION Dementia represents an enormous burden on China's population health and economy. Due to the changes in policies and population structure, policymakers should give priority to dementia care.
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Affiliation(s)
- Yixiang Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Health Economics Association, Guangzhou, China
| | - Xiande Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Zifeng Liu
- Department of Clinical Data Center, The 3 Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinhai Huo
- Department of Health Services Research, Management and Policy, The University of Florida, Gainesville, Florida, United States of America
| | - Jianwei Guo
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yingying Chen
- Guangdong Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Yanmei Chen
- The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ruoling Chen
- Centre for Health and Social Care Improvement (CHSCI), Faculty of Education, Health and Wellbeing (FEHW), University of Wolverhampton Millennium City Building, Wolverhampton, United Kingdom
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12
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Llibre-Guerra JJ, Prina M, Sosa AL, Acosta D, Jimenez-Velazquez IZ, Guerra M, Salas A, Llibre-Guerra JC, Valvuerdi A, Peeters G, Ziegemeier E, Acosta I, Tanner C, Juncos J, Llibre Rodriguez JJ. Prevalence of parkinsonism and Parkinson disease in urban and rural populations from Latin America: A community based study. LANCET REGIONAL HEALTH. AMERICAS 2021; 7:None. [PMID: 35300390 PMCID: PMC8920908 DOI: 10.1016/j.lana.2021.100136] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Age and gender specific prevalence rates for parkinsonism and Parkinson's disease (PD) are important to guide research, clinical practice, and public health planning; however, prevalence estimates in Latin America (LatAm) are limited. We aimed to estimate the prevalence of parkinsonism and PD and examine related risk factors in a cohort of elderly individuals from Latin America (LatAm). Methods Data from 11,613 adults (65+ years) who participated in a baseline assessment of the 10/66 study and lived in six LatAm countries were analyzed to estimate parkinsonism and PD prevalence. Crude and age-adjusted prevalence were determined by sex and country. Diagnosis of PD was established using the UK Parkinson's Disease Society Brain Bank's clinical criteria. Findings In this cohort, the prevalence of parkinsonism was 8.0% (95% CI 7.6%-8.5%), and the prevalence of PD was 2.0% (95% CI 1.7%-2.3%). PD prevalence increased with age from 1.0 to 3.5 (65-69vs. 80 years or older, p < 0.001). Age-adjusted prevalence rates were lower for women than for men. No significant differences were found across countries, except for lower prevalence in urban areas of Peru. PD was positively associated with depression (adjusted prevalence ratio [aPR] 2.06, 95% CI 1.40-3.01, I 2 = 56.0%), dementia (aPR 1.57, 95% CI 1.07- 2.32, I 2 = 0.0%) and educational level (aPR 1.14, 95% CI 1.01- 1.29, I 2 = 58.6%). Interpretation The reported prevalence of PD in LatAm is similar to reports from high-income countries (HIC). A significant proportion of cases with PD did not have a previous diagnosis, nor did they seek any medical or neurological attention. These findings underscore the need to improve public health programs for populations currently undergoing rapid demographic aging and epidemiological transition. Funding The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
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Affiliation(s)
- Jorge J Llibre-Guerra
- Department of Neurology, Washington University School of Medicine in St. Louis, USA,Department of Neurology, National Institute of Neurology and Neurosurgery, La Habana, Cuba,Corresponding author: Jorge J Llibre Guerra, MD, MSc, Department of Neurology, Washington University School of Medicine in St.Louis, USA
| | - Matthew Prina
- Health Service and Population Research Department, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, United Kingdom
| | - Ana Luisa Sosa
- Laboratory of the Dementias, National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Daisy Acosta
- Universidad Nacional Pedro Henriquez Ureña (UNPHU), Internal Medicine Department, Geriatric Section, Santo Domingo, Dominican Republic
| | - Ivonne Z. Jimenez-Velazquez
- Internal Medicine Department, Geriatrics Program, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Mariella Guerra
- Instituto de la Memoria Depresion y Enfermedades de Riesgo IMEDER, Lima, Perú
| | - Aquiles Salas
- Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | | | | | - Geeske Peeters
- Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ellen Ziegemeier
- Department of Neurology, Washington University School of Medicine in St. Louis, USA
| | - Isaac Acosta
- Laboratory of the Dementias, National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Caroline Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of San Francisco, California, USA
| | - Jorge Juncos
- Department of Neurology, Emory University School of Medicine
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13
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Nguyen TA, Tran K, Esterman A, Brijnath B, Xiao LD, Schofield P, Bhar S, Wickramasinghe N, Sinclair R, Dang TH, Cullum S, Turana Y, Hinton L, Seeher K, Andrade AQ, Crotty M, Kurrle S, Freel S, Pham T, Nguyen TB, Brodaty H. Empowering Dementia Carers With an iSupport Virtual Assistant (e-DiVA) in Asia-Pacific Regional Countries: Protocol for a Pilot Multisite Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e33572. [PMID: 34783660 PMCID: PMC8663455 DOI: 10.2196/33572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 12/04/2022] Open
Abstract
Background Dementia is a global public health priority with an estimated prevalence of 150 million by 2050, nearly two-thirds of whom will live in the Asia-Pacific region. Dementia creates significant care needs for people with the disease, their families, and carers. iSupport is a self-help platform developed by the World Health Organization (WHO) to provide education, skills training, and support to dementia carers. It has been adapted in some contexts (Australia, India, the Netherlands, and Portugal). Carers using the existing adapted versions have identified the need to have a more user-friendly version that enables them to identify solutions for immediate problems quickly in real time. The iSupport virtual assistant (iSupport VA) is being developed to address this gap and will be evaluated in a randomized controlled trial (RCT). Objective This paper reports the protocol of a pilot RCT evaluating the iSupport VA. Methods Seven versions of iSupport VA will be evaluated in Australia, Indonesia, New Zealand, and Vietnam in a pilot RCT. Feasibility, acceptability, intention to use, and preliminary impact on carer-perceived stress of the iSupport VA intervention will be assessed. Results This study was funded by the e-ASIA Joint Research Program in November 2020. From January to July 2023, we will enroll 140 dementia carers (20 carers per iSupport VA version) for the pilot RCT. The study has been approved by the Human Research Committee, University of South Australia, Australia (203455). Conclusions This protocol outlines how a technologically enhanced version of the WHO iSupport program—the iSupport VA—will be evaluated. The findings from this intervention study will provide evidence on the feasibility and acceptability of the iSupport VA intervention, which will be the basis for conducting a full RCT to assess the effectiveness of the iSupport VA. The study will be an important reference for countries planning to adapt and enhance the WHO iSupport program using digital health solutions. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12621001452886; https://tinyurl.com/afum5tjz International Registered Report Identifier (IRRID) PRR1-10.2196/33572
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Affiliation(s)
- Tuan Anh Nguyen
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia.,UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia.,Health Strategy and Policy Institute, Ministry of Health, Hanoi, Vietnam
| | - Kham Tran
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia.,UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Adrian Esterman
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, Australia
| | - Bianca Brijnath
- Social Gerontology Division, National Ageing Research Institute, Melbourne, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Penelope Schofield
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Sunil Bhar
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Nilmini Wickramasinghe
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Ronald Sinclair
- Faculty of Sciences, University of Adelaide, Adelaide, Australia
| | - Thu Ha Dang
- Department of Psychology, School of Health Sciences, Swinburne University of Technology, Melbourne, Australia
| | - Sarah Cullum
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Yuda Turana
- School of Medicine, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Ladson Hinton
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Katrin Seeher
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Andre Q Andrade
- Quality Use of Medicines and Pharmacy Research Centre, University of South Australia, Adelaide, Australia
| | - Maria Crotty
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Susan Kurrle
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Stefanie Freel
- Department of Germanic Languages and Literature, University of Toronto, Toronto, ON, Canada
| | - Thang Pham
- Department of Neurology and Alzheimer Disease, Vietnam National Geriatric Hospital, Hanoi, Vietnam
| | - Thanh Binh Nguyen
- Department of Neurology and Alzheimer Disease, Vietnam National Geriatric Hospital, Hanoi, Vietnam
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia
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14
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Mooldijk SS, Licher S, Wolters FJ. Characterizing Demographic, Racial, and Geographic Diversity in Dementia Research: A Systematic Review. JAMA Neurol 2021; 78:1255-1261. [PMID: 34491284 DOI: 10.1001/jamaneurol.2021.2943] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance For informed decision making on diagnosis and treatment of dementia, physicians and their patients rely on the generalizability of evidence from published studies to clinical practice. However, it is uncertain whether everyday care of elderly patients with dementia is sufficiently captured in contemporary research. Objective To systematically review contemporary dementia research in terms of study and patient characteristics in order to assess generalizability of research findings. Evidence Review PubMed was searched for dementia studies published in the top 100 journals in the fields of neurology and neuroscience, geriatrics, psychiatry, and general medicine between September 1, 2018, and August 31, 2019. Two reviewers extracted study characteristics, including setting, number of participants, age at diagnosis, and use of biomarkers. Findings Among 513 identified studies, 211 (41%) included fewer than 50 individuals with dementia and were excluded. The remaining 302 studies included a median (interquartile range) of 214 patients (98-628) with a mean (SD) age at diagnosis of 74.1 years (8.0). Age at diagnosis differed with study setting. Patients in the 180 clinic-based studies had a mean (SD) age of 71.8 (6.4) years at time of diagnosis compared with 80.6 (4.7) years among patients in the 79 population-based studies (mean difference, 8.8 years; 95% CI, 7.3-10.2). Use of magnetic resonance imaging, positron emission tomography imaging, and cerebrospinal fluid imaging was mostly done in clinic-based studies (80% to 96%) and consequently in relatively young patients (mean [SD] age, 71.6 [5.1] years). A longitudinal design was more common in population-based studies than in clinic-based studies (82 % vs 40%). Most studies originated from North America and Europe (89%), including almost exclusively White participants (among 74 studies [22%] reporting on ethnicity: median [interquartile range], 89% [78-97]). The 3 most studied cohorts represented 21% of all included study populations. Conclusions and Relevance Contemporary dementia research is limited in terms of racial and geographic diversity and draws largely from clinic-based populations with relatively young patients. Greater inclusivity and deeper phenotyping in unselected cohorts could improve generalizability as well as diagnosis and development of effective treatments for all patients with dementia.
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Affiliation(s)
- Sanne S Mooldijk
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Silvan Licher
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Frank J Wolters
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.,Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
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15
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Mlaki DA, Asmal L, Paddick SM, Gray WK, Dotchin C, Walker R. Prevalence and associated factors of depression among older adults in rural Tanzania. Int J Geriatr Psychiatry 2021; 36:1559-1566. [PMID: 34018234 DOI: 10.1002/gps.5584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 05/17/2021] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Depression is the commonest mental disorder in older adults worldwide, affecting 7% of the world's older population and accounting for 5.7% of years lived with disability among adults aged over 60 years. We conducted a secondary data analysis to determine the point prevalence, associated risk factors and treatment gap for DSM-IV depression among older adults in the Hai District, rural Tanzania. METHODS The primary data source was a cross-sectional two-stage community-based dementia study where older adults aged ≥70 years (n = 296) were fully-assessed for dementia and depression in the second stage. Age-adjusted prevalence of depression was determined based on the WHO standard population using the Direct Method. Univariate and multivariate logistic regression models were performed. RESULTS Of the 296 older adults assessed for depression, 48 were diagnosed with depression based on Diagnostic and Statistical Manual of Mental Disorders-IV criteria. The median (Inter Quartile Range; QR) age was 80 (75-88) years. Age-adjusted point prevalence of depression was 21.2% (95% CI: 16.6-21.9) and the treatment gap for depression was 100%. There was reduced odds of depression in older adults who rated their physical health as good or very good (adjusted odds ratio [AOR] = 0.22; 95%CI: 0.10-0.46; p < 0.001), or moderate (AOR 0.26; 95%CI: 0.10-0.66; p = 0.005). CONCLUSIONS Depression in older adults is associated with physical health status and there is an alarmingly high treatment gap. Future research on depression in older adults should focus on effective interventions to address physical morbidity, psychosocial factors and the treatment gap.
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Affiliation(s)
- Damas Andrea Mlaki
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Directorate of Clinical Services, Mirembe Mental Health Hospital, Dodoma, Tanzania
| | - Laila Asmal
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Stella-Maria Paddick
- Translational and Clinical Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - William K Gray
- Department of Old Age Psychiatry Gateshead Health, Northumbria Healthcare NHS Foundation Trust, UK
| | - Catherine Dotchin
- Department of Old Age Psychiatry Gateshead Health, Northumbria Healthcare NHS Foundation Trust, UK
| | - Richard Walker
- Translational and Clinical Medicine, Newcastle University, Newcastle upon Tyne, UK.,Department of Old Age Psychiatry Gateshead Health, Northumbria Healthcare NHS Foundation Trust, UK
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16
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Contreras ML, Mioshi E, Kishita N. Factors Related to the Quality of Life in Family Carers of People With Dementia: A Meta-Analysis. J Geriatr Psychiatry Neurol 2021; 34:482-500. [PMID: 32394770 PMCID: PMC8326913 DOI: 10.1177/0891988720924713] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This meta-analysis aimed to (1) quantitatively synthesize evidence of factors related to the quality of life (QoL) of family carers of people with dementia and (2) explore moderating factors that may influence the strength of the relationship between such potential predictive factors and carer QoL. METHODS Studies that investigated correlations between patient/carer factors and QoL in unpaid family carers of people with dementia and were published in English, Spanish, Portuguese, or Japanese were included. RESULTS Thirty-three studies were identified. The pooled correlations with carer QoL (effect size) were significantly large for depression (-0.58), significantly moderate for subjective burden (-0.47), and significantly small for people with dementia's neuropsychiatric symptoms (-0.24). These results indicated to be robust in the context of publication bias. The results of subgroup analyses demonstrated the social and economic development status of the country where study participants resided did not moderate these effects. CONCLUSION Carer depression, subjective burden, and people with dementia's neuropsychiatric symptoms may play a critical role in maintaining QoL of family carers regardless of the social and economic circumstances.
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Affiliation(s)
- Milena L. Contreras
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom,Naoko Kishita, School of Health Sciences, University of East Anglia, Norwich NR4 7TJ, United Kingdom.
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Naoko Kishita
- School of Health Sciences, University of East Anglia, Norwich, United Kingdom
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17
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Ibnidris A, Piumatti G, Carlevaro F, Fadda M, Magno F, Magistro D, Albanese E. Italian version of the short 10/66 dementia diagnostic schedule: a validation study. BMJ Open 2021; 11:e045867. [PMID: 34193490 PMCID: PMC8246379 DOI: 10.1136/bmjopen-2020-045867] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To determine the criterion and concurrent validity of the Italian version of the short 10/66 Dementia Diagnostic Schedule and algorithm in a sample of Italian native speakers, older adults. DESIGN A cross-sectional, validation study. SETTING The study was conducted with older adults living in the community and in nursing homes in the Canton of Ticino, Switzerland, and the Piedmont region in Italy between March and August 2019. PARTICIPANTS A convenience sample of 229 participants (69% females) were recruited. The eligibility criteria were being ≥60 years old and having an informant. The final sample included 74 participants (32%) with a previous clinical diagnosis of dementia and 155 (68%) cognitively healthy older adults. PRIMARY AND SECONDARY OUTCOME MEASURES The short version of 10/66 Dementia Diagnostic Schedule consists of the Community Screening Instrument for Dementia, the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) 10-word list learning task with delayed recall and the depression scale, Euro-Depression (EURO-D) scale. Disability was measured using the WHO Disability Assessment Schedule (WHO-DAS II). RESULTS The Italian version of the short 10/66 Dementia Diagnostic Schedule showed fair sensitivity (87%), specificity (61%) and agreement with the clinical diagnosis of dementia (kappa=0.40, area under the receiver operating characteristics curve=0.74). Older adults with dementia living in nursing homes had higher disability scores (WHO-DAS II mean=23.14, SE=1.29) than those living in the community (WHO-DAS II mean=7.08, SE=0.66). WHO-DAS II was positively correlated with the short version of the 10/66 dementia diagnosis (β=5.23, 95% CI 2.05 to 8.41). CONCLUSIONS In settings where lengthy diagnostic procedures are not feasible, the short 10/66 is a practical tool to identify dementia in older adults. Our findings extend evidence on the validity of the 10/66 dementia diagnostic algorithm to high-income countries, where epidemiological evidence on dementia and its impact is outdated.
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Affiliation(s)
- Aliaa Ibnidris
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Giovanni Piumatti
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Division of Primary Care, Geneva University Hospitals, Geneve, Switzerland
| | - Fabio Carlevaro
- Polo Universitario Asti Studi Superiori (Uni-Astiss), University of Turin, Torino, Italy
| | - Marta Fadda
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
| | - Francesca Magno
- Polo Universitario Asti Studi Superiori (Uni-Astiss), University of Turin, Torino, Italy
| | - Daniele Magistro
- Department of Sport Science, Nottingham Trent University, Nottingham, UK
| | - Emiliano Albanese
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
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18
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Gonçalves-Pereira M, Verdelho A, Prina M, Marques M, Xavier M. How Many People Live with Dementia in Portugal? A Discussion Paper of National Estimates. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2021. [DOI: 10.1159/000516503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Dementia poses major public health challenges, and high-quality epidemiological data are needed for service planning. Published estimates of numbers of people with dementia in Portugal have been based, in most cases, on prevalence rates derived from international studies or expert consensus. As in many other countries, Portuguese community prevalence studies’ results are nongeneralizable to a country level. Moreover, their prevalence estimates differ (not surprisingly, owing to different methodologies, e.g., design, sampling, and diagnostic criteria). Regardless, the Portuguese 10/66 Dementia Research Group (10/66 DRG) population-based survey fulfilled 10 out of 11 Alzheimer’s Disease International quality criteria for prevalence studies. It relied on cross-culturally validated methods, fostering a wide comparability of results. Therefore, we can provide rough estimates of 217,549 community dwellers with dementia in Portugal according to the 10/66 DRG criteria (that would be only 85,162 according to DSM-IV criteria). This refers to people aged 65 years or older who are not institutionalized. Although broadly consistent with international projections, these estimates must be cautiously interpreted. Particularly in the context of scarce funding, which will probably last for years, we need more efficient, evidence-based dementia policies. Concerning further epidemiological studies, high-quality methods are needed but also their comparability potential should be improved at national and international levels. Most of all, fund allocation in Portugal should now privilege routine dementia information systems in both health and social services.
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19
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Robert C, Wilson CS, Lipton RB, Arreto CD. Evolution of the Research Literature and the Scientific Community of Alzheimer's Disease from 1983-2017: A 35-Year Survey. J Alzheimers Dis 2021; 75:1105-1134. [PMID: 32390624 DOI: 10.3233/jad-191281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
This study surveys the development of Alzheimer's disease (AD) in the research literature, the scientific community, and the journals containing AD papers over a 35-year period. Research papers on AD published from 1983 to 2017 in journals indexed in the Web of Science were analyzed in seven five-year periods. The number of AD papers increased from 1,095 in 1983-1987 to 50,532 by 2013-2017 and in the same time period, the number of participating countries went from 27 to 152. The US was the most prolific country throughout, followed by several European countries, Canada, Australia, and Japan. Asian countries have emerged and by 2013-2017, China surpassed all but the US in productivity. Countries in Latin America and Africa have also contributed to AD research. Additionally, several new non-governmental institutions (e.g., ADNI, ADI) have emerged and now play a key role in the fight against AD. Likewise the AD scientific publishing universe evolved in various aspects: an increase in number of journals containing AD papers (227 journals in 1983-1987 to 3,257 in 2013-2017); appearance of several AD-focused journals, e.g., Alzheimer's & Dementia, Journal of Alzheimer's Disease; and the development of special issues dedicated to AD. Our paper complements the numerous extant papers on theoretical and clinical aspects of AD and provides a description of the research landscape of the countries and journals contributing papers related to AD.
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Affiliation(s)
- Claude Robert
- Université Paris Descartes, Paris, France.,Gliaxone, Saint Germain Sous Doue, France
| | - Concepción S Wilson
- Formerly at: School of Information Systems, Technology and Management, University of New South Wales, UNSW Sydney, Australia
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Charles-Daniel Arreto
- Gliaxone, Saint Germain Sous Doue, France.,Université Paris Descartes, Faculté de Chirurgie Dentaire, Hôpital Bretonneau, HUPNVS, AP-HP, Paris, France
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20
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Gao Q, Prina AM, Prince M, Acosta D, Luisa Sosa A, Guerra M, Huang Y, Jimenez-Velazquez IZ, Llibre Rodriguez JJ, Salas A, Williams JD, Liu Z, Acosta Castillo I, Mayston R. Loneliness Among Older Adults in Latin America, China, and India: Prevalence, Correlates and Association With Mortality. Int J Public Health 2021; 66:604449. [PMID: 34744572 PMCID: PMC8565277 DOI: 10.3389/ijph.2021.604449] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/02/2021] [Indexed: 11/26/2022] Open
Abstract
Objectives: This study was designed to explore prevalence and correlates of self-reported loneliness and to investigate whether loneliness predicts mortality among older adults (aged 65 or above) in Latin America, China and India. Methods: The study investigated population-based cross-sectional (2003-2007) and longitudinal surveys (follow-up 2007-2010) from the 10/66 Dementia Research Group project. Poisson regression and Cox regression analyses were conducted to analyse correlates of loneliness and its association with mortality. Results: The standardised prevalence of loneliness varied between 25.3 and 32.4% in Latin America and was 18.3% in India. China showed a low prevalence of loneliness (3.8%). In pooled meta-analyses, there was robust evidence to support an association between loneliness and mortality across Latin American countries (HR = 1.13, 95% CI 1.01-1.26, I2 = 10.1%) and China (HR = 1.58, 95% CI 1.03-2.41), but there were no associations in India. Conclusion: Our findings suggest potential cultural variances may exist in the concept of loneliness in older age. The effect of loneliness upon mortality is consistent across different cultural settings excluding India. Loneliness should therefore be considered as a potential dimension of public health among older populations.
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Affiliation(s)
- Qian Gao
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - A. Matthew Prina
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Martin Prince
- Health Service and Population Research, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Daisy Acosta
- Geriatric Section, Internal Medicine Department, Universidad Nacional Pedro Henriquez Ureña, Santo Domingo, Dominican Republic
| | - Ana Luisa Sosa
- National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Mariella Guerra
- Instituto de la Memoria Depresion y Enfermedades de Riesgo, Lima, Peru
| | - Yueqin Huang
- Social Psychiatry and Behavioral Medicine, Institute of Mental Health, Peking University, Beijing, China
| | - Ivonne Z. Jimenez-Velazquez
- Geriatrics Program, Internal Medicine Department, School of Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | | | - Aquiles Salas
- Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central de Venezuela, Caracas, Venezuela
| | - Joseph D. Williams
- Department of Community Health, Voluntary Health Services, Chennai, India
| | - Zhaorui Liu
- Social Psychiatry and Behavioral Medicine, Institute of Mental Health, Peking University, Beijing, China
| | - Isaac Acosta Castillo
- National Institute of Neurology and Neurosurgery of Mexico, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rosie Mayston
- Global Health and Social Medicine, King’s Global Health Institute, Social Science and Public Policy, King’s College London, London, United Kingdom
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21
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Sexton C, Snyder HM, Chandrasekaran L, Worley S, Carrillo MC. Expanding Representation of Low and Middle Income Countries in Global Dementia Research: Commentary From the Alzheimer's Association. Front Neurol 2021; 12:633777. [PMID: 33790849 PMCID: PMC8005715 DOI: 10.3389/fneur.2021.633777] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022] Open
Abstract
Alzheimer's disease (AD) and all other dementia represent a global challenge, with an estimated 50 million individuals in the world living with dementia today. In low and middle income countries (LMICs), the burden of disease often is greater, and some of these countries are projected to have some of the largest increases in dementia prevalence during the next few decades. As the world's largest voluntary health organization dedicated to AD and all other dementia, the Alzheimer's Association is committed to its vision of a world without dementia and recognizes the needs, challenges, and opportunities for dementia research in all parts of the world, and especially in LMICs. Currently, the Association is devoting more than $215 million in funding to nearly 600 best-of-field projects in 31 countries, including a significant number of projects that advance and support LMIC-specific research. The innovative work in LMICs is focused on addressing unmet needs or challenges associated with the many unique cultural, demographic, and economic characteristics of these countries. The Association also is expanding leading global forums such as the Alzheimer's Association International Conference (AAIC). In an effort to create new learning and participation opportunities, the Association also has been partnering with other international organizations and collaborating with local leadership to provide AAIC Satellite Symposia (AAIC SS) in LMIC regions around the world. In 2021 and beyond, the Association is committed to continuing these LMIC-focused initiatives, identifying gaps in LMIC research and resources, and enhancing collaboration and communication among researchers in these regions.
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Affiliation(s)
| | | | | | - Susan Worley
- Independent Science Writer, Bryn Mawr, PA, United States
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22
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Acosta D, Llibre-Guerra JJ, Jiménez-Velázquez IZ, Llibre-Rodríguez JJ. Dementia Research in the Caribbean Hispanic Islands: Present Findings and Future Trends. Front Public Health 2021; 8:611998. [PMID: 33537283 PMCID: PMC7848137 DOI: 10.3389/fpubh.2020.611998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
During the last decade, the Caribbean Hispanic islands experienced accelerated demographic aging, representing the fastest aging region within Latin America. Age-related non-communicable diseases, including dementia, are now reported at high prevalence. The Caribbean islands share similar genetic ancestry, culture, migration patterns, and risk profiles, providing a unique setting to understand dementia in the Caribbean-Hispanics. This perspective article aimed to describe the impact of dementia in the Caribbean, at a local and regional level and reflect on research strategies to address dementia. We report on 10/66 project findings, described research projects and regional plans for the region. According to our results, the prevalence of dementia in the Caribbean is the highest in Latin America, with 11.7% in Dominican Republic, 11.6% in Puerto Rico, and 10.8% in Cuba. Preliminary data from new waves of the 10/66 study shows increasing numbers of dementia cases. Furthermore, dementia is expected to be one of the most serious medical and social issues confronted by Caribbean health systems. However, there is a scarcity of knowledge, awareness, and health services to deal with this public health crisis. In light of the new evidence, local and regional strategies are underway to better understand dementia trends for the region and develop policies aimed to decrease the impact of dementia. Implementation of our national plans is critical to deal with an aging population with high dementia rates. Current recommendations include emphasizing public health prevention campaigns to address modifiable risk factors and expand support to caregiver and family interventions.
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Affiliation(s)
- Daisy Acosta
- Department of Internal Medicine, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic
| | - Jorge J Llibre-Guerra
- Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO, United States.,National Institute of Neurology and Neurosurgery, Habana, Cuba
| | - Ivonne Z Jiménez-Velázquez
- Department of Internal Medicine, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Juan J Llibre-Rodríguez
- Department of Internal Medicine, Universidad Nacional Pedro Henriquez Urena, Santo Domingo, Dominican Republic.,Finlay-Albarrán Medicine Faculty, Universidad de Ciencias Medicas, Habana, Cuba
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23
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Rodríguez-Salgado AM, Llibre-Guerra JJ, Tsoy E, Peñalver-Guia AI, Bringas G, Erlhoff SJ, Kramer JH, Allen IE, Valcour V, Miller BL, Llibre-Rodríguez JJ, Possin KL. A Brief Digital Cognitive Assessment for Detection of Cognitive Impairment in Cuban Older Adults. J Alzheimers Dis 2021; 79:85-94. [PMID: 33216033 DOI: 10.3233/jad-200985] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Rapid technological advances offer a possibility to develop cost-effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and middle-income countries (LMIC). OBJECTIVE To examine the accuracy and validity of the Brain Health Assessment (BHA) in detecting cognitive impairment in a Cuban population. METHODS In this cross-sectional study, 146 participants (cognitively healthy = 53, mild cognitive impairment (MCI) = 46, dementia = 47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA and the Montreal Cognitive Assessment (MoCA) in discriminating between controls and cognitively impaired groups (MCI and dementia) and correlations between the BHA subtests of memory, executive functions, and visuospatial skills and criterion-standard paper-and-pencil tests in the same domains. RESULTS The BHA had an AUC of 0.95 (95% CI: 0.91-0.98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with 0.91 sensitivity at 0.85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of 0.94 (95% CI: 0.90-0.99) with 0.71 sensitivity at 0.85 specificity. Performance was superior to the MoCA across all diagnostic groups. Concurrent and discriminant validity analyses showed moderate to strong correlations between the BHA tests and standard paper-and-pencil measures in the same domain and weak correlations with standard measures in unrelated domains. CONCLUSION The BHA has excellent performance characteristics in detecting cognitive impairment including dementia and MCI in a Hispanic population in Cuba and outperformed the MoCA. These results support potential application of digital cognitive assessment for older adults in LMIC.
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Affiliation(s)
- Ana M Rodríguez-Salgado
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Jorge J Llibre-Guerra
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba.,Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology, Washington University in St Louis, St Louis, MO, USA
| | - Elena Tsoy
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Ana Ibis Peñalver-Guia
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba
| | - Giosmany Bringas
- Department of Neurology, National Institute of Neurology and Neurosurgery, La Havana, Cuba
| | - Sabrina J Erlhoff
- Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Joel H Kramer
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Isabel Elaine Allen
- Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Victor Valcour
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | - Bruce L Miller
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
| | | | - Katherine L Possin
- Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA.,Department of Neurology,Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA
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24
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de Lima JD, Teixeira IA, Silva FDO, Deslandes AC. The comorbidity conditions and polypharmacy in elderly patients with mental illness in a middle income country: a cross-sectional study⋆. IBRO Rep 2020; 9:96-101. [PMID: 33336105 PMCID: PMC7733142 DOI: 10.1016/j.ibror.2020.07.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 07/14/2020] [Indexed: 12/18/2022] Open
Abstract
Polypharmacy is extremely high in elderlies with mental illness. Dementia and Depression patients have a significantly higher risk for dyslipidemia. The prevention of comorbidities and polypharmacy should be high-priority in MICs.
Background Mental disorders increase the risk factor for developing physical comorbidity conditions, such as cardiometabolic diseases. There is a high prevalence of multimorbidity and polypharmacy in the elderly population which hampers clinical response. Studies have shown that this positive correlation between the aging process and enhancement of physical comorbidities is especially high among older adults who live in low or middle income countries. Objective To investigate the association between physical disease comorbidities and polypharmacy in older adults with a clinical diagnosis of Alzheimer’s disease (AD), mild cognitive impairment (MCI) or major depressive disorder (MDD), living in a middle income country. Methods Cross-sectional study of community-dwelling elderly individuals who are cognitively healthy and those with AD, MCI, or MDD. The severity scale of the Charlson Comorbidity Index (CCI) was calculated to classify the severity of comorbidity condition. Logistic regression model (unadjusted and adjusted for age) were used to calculate odds ratios (OR) and 95 % confidence intervals (CI) for cardiometabolic comorbidity (hypertension, diabetes, dyslipidemia and overweight), and polypharmacy. Results Although there was not an increased risk of hypertension, diabetes, and obesity among the groups, elderly people with mental disorders presented higher odds for polypharmacy condition. Polypharmacy was significantly higher for all groups in comparison with cognitively healthy participants: AD (OR 22.00, 95 % CI 6.11–79.11), MDD (OR 14.73, 95 % CI 3.69–58.75) and MCI (OR 10.31, 95 % CI 2.44–43.59). Elderly patients with AD presented more severe comorbidities and higher risks for dyslipidemia. Conclusion Elderly patients with depression, dementia and mild cognitive impairment have considerably higher odds for polypharmacy. People with dementia also have greater comorbidity severity than those who are cognitively healthy. In middle income countries, there is an urgent need to focus on promoting age-appropriate health approaches for the elderly with mental illness to prevent the development of aggravated cardiometabolic conditions and polypharmacy.
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Affiliation(s)
- Juliana Dias de Lima
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Ivan Abdalla Teixeira
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
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25
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McGrattan A, van Aller C, Narytnyk A, Reidpath D, Keage H, Mohan D, Su TT, Stephan B, Robinson L, Siervo M. Nutritional interventions for the prevention of cognitive impairment and dementia in developing economies in East-Asia: a systematic review and meta-analysis. Crit Rev Food Sci Nutr 2020; 62:1838-1855. [DOI: 10.1080/10408398.2020.1848785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Andrea McGrattan
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Carla van Aller
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Alla Narytnyk
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Daniel Reidpath
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Selangor, Malaysia
| | - Hannah Keage
- Cognitive Ageing and Impairment Neurosciences, Unit of Justice and Society, University of South Australia, Adelaide, Australia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Selangor, Malaysia
| | - Tin Tin Su
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Selangor, Malaysia
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Selangor, Malaysia
| | - Blossom Stephan
- School of Medicine, The University of Nottingham, Nottingham, UK
| | - Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Mario Siervo
- School of Life Sciences, The University of Nottingham Medical School, Nottingham, UK
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26
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D'Cruz M, Banerjee D. Caring for Persons Living With Dementia During the COVID-19 Pandemic: Advocacy Perspectives From India. Front Psychiatry 2020; 11:603231. [PMID: 33192744 PMCID: PMC7652726 DOI: 10.3389/fpsyt.2020.603231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 09/28/2020] [Indexed: 01/10/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic has presented an unprecedented threat to global public and psychosocial health. Certain vulnerable populations, especially the older adults, are at disproportionate risks both to the physiological and social effects of the outbreak. A special section among them who face unique challenges during this pandemic, are those living with neurocognitive disorders, like dementia. Limited research in the field shows ApoE4 allele to confer an increased risk for COVID-19 severity, while the behavioral problems associated with dementia reduces compliance to precautionary measures, thereby exposing them to the virus and increasing caregiver strain. Reduced healthcare access, limited resources and fear of the infection act as major barriers to dementia care during such a crisis. Besides, there are the additional burden of stigma, abuse, ageism and financial impoverishment. Institutionalization, loneliness and lack of stimulation can potentially accelerate the cognitive decline and worsen the behavioral and psychological problems. India has been one of the worst hit countries by COVID-19 and shares a significant dementia load. As the country is aging fast along with the world, this commentary reviews the risks of people living with dementia during the pandemic and discusses certain advocacies for their care.
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Affiliation(s)
- Migita D'Cruz
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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27
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The MemClin project: a prospective multi memory clinics study targeting early stages of cognitive impairment. BMC Geriatr 2020; 20:93. [PMID: 32138686 PMCID: PMC7059672 DOI: 10.1186/s12877-020-1478-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/17/2020] [Indexed: 12/17/2022] Open
Abstract
Background There remains a lack of large-scale clinical studies of cognitive impairment that aim to increase diagnostic and prognostic accuracy as well as validate previous research findings. The MemClin project will amass large quantities of cross-disciplinary data allowing for the construction of robust models to improve diagnostic accuracy, expand our knowledge on differential diagnostics, strengthen longitudinal prognosis, and harmonise examination protocols across centres. The current article describes the Memory Clinic (MemClin) project’s study-design, materials and methods, and patient characteristics. In addition, we present preliminary descriptive data from the ongoing data collection. Methods Nine out of ten memory clinics in the greater Stockholm area, which largely use the same examination methods, are included. The data collection of patients with different stages of cognitive impairment and dementia is coordinated centrally allowing for efficient and secure large-scale database construction. The MemClin project rest directly on the memory clinics examinations with cognitive measures, health parameters, and biomarkers. Results Currently, the MemClin project has informed consent from 1543 patients. Herein, we present preliminary data from 835 patients with confirmed cognitive diagnosis and neuropsychological test data available. Of those, 239 had dementia, 487 mild cognitive impairment (MCI), and 104 subjective cognitive impairment (SCI). In addition, we present descriptive data on visual ratings of brain atrophy and cerebrospinal fluid markers. Conclusions Based on our current progress and preliminary data, the MemClin project has a high potential to provide a large-scale database of 1200–1500 new patients annually. This coordinated data collection will allow for the construction of improved diagnostic and prognostic models for neurodegenerative disorders and other cognitive conditions in their naturalistic setting.
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28
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Wu Y, Kralj C, Acosta D, Guerra M, Huang Y, Jotheeswaran AT, Jimenez‐Velazquez IZ, Liu Z, Llibre Rodriguez JJ, Salas A, Sosa AL, Alkholy R, Prince M, Prina AM. The association between, depression, anxiety, and mortality in older people across eight low- and middle-income countries: Results from the 10/66 cohort study. Int J Geriatr Psychiatry 2020; 35:29-36. [PMID: 31608478 PMCID: PMC6916169 DOI: 10.1002/gps.5211] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 09/15/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Depression and anxiety are common mental disorders in later life. Few population-based studies have investigated their potential impacts on mortality in low- and middle-income countries (LMICs). The aim of this study is to examine the associations between depression, anxiety, their comorbidity, and mortality in later life using a population-based cohort study across eight LMICs. METHODS This analysis was based on the 10/66 cohort study including 15 991 people aged 65 years or above in Cuba, Dominican Republic, Venezuela, Mexico, Peru, Puerto Rico, China, and India, with an average follow-up time of 3.9 years. Subthreshold and clinical levels of depression were determined using EURO-D and ICD-10 criteria, and anxiety was based on Geriatric Mental State (GMS)-Automated Geriatric Examination for Computer Assisted Taxonomy (AGECAT). Cox proportional hazard modelling was used to estimate how having depression, anxiety, or both was associated with mortality adjusting for sociodemographic and health factors. RESULTS Participants with clinical depression (hazard ratio [HR]: 1.45; 95% CI, 1.24-1.70) and subthreshold anxiety (HR: 1.26; 95% CI, 1.15-1.38) had higher risk of mortality than those without the conditions after adjusting for sociodemographic factors and health conditions. Comorbidity of depression and anxiety was associated with a 30% increased risk of mortality but the effect sizes varied across countries (Higgins I2 = 58.8%), with the strongest association in India (HR: 1.99; 95% CI, 1.21-3.27). CONCLUSIONS Depression and anxiety appear to be associated with mortality in older people living in LMICs. Variation in effect sizes may indicate different barriers to health service access across countries. Future studies may investigate underlying mechanisms and identify potential interventions to reduce the impact of common mental disorders.
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Affiliation(s)
- Yu‐Tzu Wu
- King's College London, Social Epidemiology Research Group, Health Service and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceLondonUK
| | | | - Daisy Acosta
- Internal Medicine Department, Geriatric SectionUniversidad Nacional Pedro Henriquez Ureña (UNPHU)Santo DomingoDominican Republic
| | - Mariella Guerra
- Psychogeriatric UnitNational Institute of Mental Health Honorio Delgado Hideyo Noguchi, Lima, Peru and Centro de la Memoria y Desordenes RelacionadosLimaPerú
| | - Yueqin Huang
- Peking University, Institute of Mental HealthBeijingChina
| | | | - Ivonne Z. Jimenez‐Velazquez
- Internal Medicine Department, Geriatrics Program, School of Medicine, Medical Sciences CampusUniversity of Puerto RicoSan JuanPuerto Rico
| | - Zhaorui Liu
- Peking University, Institute of Mental HealthBeijingChina
| | | | - Aquiles Salas
- Medicine Department, Caracas University Hospital, Faculty of MedicineUniversidad Central de VenezuelaCaracasVenezuela
| | - Ana Luisa Sosa
- National Institute of Neurology and Neurosurgery of MexicoNational Autonomous University of MexicoMexico CityMexico
| | - Rasha Alkholy
- King's College London, Social Epidemiology Research Group, Health Service and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceLondonUK
| | - Martin Prince
- King's College LondonGlobal Health InstituteLondonUK
| | - A. Matthew Prina
- King's College London, Social Epidemiology Research Group, Health Service and Population ResearchInstitute of Psychiatry, Psychology & NeuroscienceLondonUK
- King's College LondonGlobal Health InstituteLondonUK
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