Dementia prevalence in a population at high vascular risk: the Trinidad national survey of ageing and cognition

Sex differences in Alzheimer's disease blood biomarkers in a Caribbean population of African ancestry: The Tobago Health Study

INTRODUCTION

Alzheimer's disease (AD) is increasing in the Caribbean, especially for persons of African ancestry (PAA) and women. However, studies have mostly utilized surveys without AD biomarkers.

METHODS

In the Tobago Health Study (n = 309; 109 women, mean age 70.3 ± 6.6), we assessed sex differences and risk factors for serum levels of phosphorylated tau-181 (p-tau181), amyloid-beta (Aβ)42/40 ratio, glial fibrillary acidic protein (GFAP), and neurofilament light chain (NfL). Blood samples were from 2010 to 2013 for men and from 2019 to 2023 for women.

RESULTS

Women were more obese, hypertensive, and sedentary but reported less smoking and alcohol use than men (age-adjusted p < 0.04). Compared to men, women had worse levels of AD biomarkers, with higher p-tau181 and lower Aβ42/40, independent of covariates (p < 0.001). In sex-stratified analyses, higher p-tau181 was associated with older age in women and with hypertension in men. GFAP and NfL did not differ by sex.

DISCUSSION

Women had worse AD biomarkers than men, unexplained by age, cardiometabolic diseases, or lifestyle. Studying risk factors for AD in PAA is warranted, especially for women earlier in life.

A blood-based, metabolite and demographic characteristic markers panel for the diagnosis of Alzheimer's disease

Aims: This work was designed to provide early diagnosis strategies for Alzheimer's disease (AD) based on the identification of blood metabolic biomarkers. Patients & methods: A total of 90 subjects aged 60 years or older were included in this study; 45 patients were assigned to the case group and control group, respectively. A total of 31 target metabolites were quantitatively analyzed by parallel reaction monitoring between the two groups. Results & conclusion: Three metabolites were screened out, including cystine, serine and alanine/sarcosine. Logistic regression and random forest analysis were used to establish AD diagnosis models, and the model combining metabolic biomarkers and demographic variables had higher detection efficiency (area under the curve = 0.869). A combination diagnostic model to provide a scientific reference for early screening and diagnosis of AD was constructed.

Cultural Influences on Mental Health Provision in the Caribbean: How Do Contemporary Perceptions and Beliefs About Persons With Mental Illness Inform Workforce Transformation?

INTRODUCTION

Mental illness is a global phenomenon in society, including trained health professionals, often responding to people with mental illness based on perceptions and beliefs. The research examined "contemporary perceptions and beliefs about mental illness held by stakeholders" attending a mental health symposium in Trinidad.

METHODS

Data were collected using a 43-item questionnaire and analyzed using SPSS Version 22. Overall, 84 attendees working directly or experienced in mental health completed the survey.

RESULTS

Respondents believed mental illness should be treated within local community settings. Participants who were more comfortable sharing their mental health diagnosis with friends were more likely to share with others, including their employers. There was a relationship between perception of the superstitious causes of mental illness and its effects on healing.

DISCUSSION

Qualifications and experience in mental health do not reduce stigma associated with mental illness which has implications for addressing mental health literacy among health professionals.

Prevalence of dementia in Latin America and Caribbean countries: Systematic review and meta-analyses exploring age, sex, rurality, and education as possible determinants

BACKGROUND

Studies have shown that the prevalence of dementia in Latin America and the Caribbean (LAC) may be higher than in high-income countries. Thus, we sought to systematically analyse the prevalence of dementia and explore possible drivers that lead to this disparity in LAC countries.

METHOD

We searched Pubmed, Web of Knowledge, Scopus, Lilacs, and SciELO for studies on dementia in LAC countries published in English, Spanish, and Portuguese. Random-effects model was applied.

RESULTS

Thirty-one studies from 17 LAC countries were included. Pooled prevalence of all-cause dementia was 10.66%. Further analyses with studies providing raw prevalence by sex, area, and educational level showed a higher prevalence for women (8.97%) than for men (7.26%). Also, dementia prevalence was higher for rural than urban residents (7.71% vs 8.68%, respectively). Participants without formal education presented more than double the prevalence of dementia (21.37%) compared to those with at least one year of formal education (9.88%). Studies with more recent data collection showed higher dementia prevalence.

CONCLUSION

Our findings suggest a high global dementia prevalence in LAC countries and an unequal burden of dementia for women, lower-educated, and rural residents. Secular increases in dementia prevalence call for greater public health efforts for preventative actions.

EGb in the Treatment for Patients with VCI: A Systematic Review and Meta-Analysis

Background

Ginkgo biloba extract (EGb) is widely used to treat impairments in memory, cognition, activities of daily living, inflammation, edema, stroke, Alzheimer's dementia, and aging.

Aim

We aimed to evaluate the safety and efficacy of EGb in treating vascular cognitive impairment (VCI).

Methods

The systematic review was performed using the latest guidelines. We searched for EGb-related trials up to March 1, 2021, in four Chinese databases, three English databases, and clinical trial registry platforms. Randomized controlled trials (RCTs) were included if the study enrolled participants with VCI. Two reviewers independently extracted the data and critically appraised the study quality. Heterogeneity was quantified with I ². Both sensitivity and subgroup analyses were used to identify the sources of heterogeneity. Publication bias was assessed with funnel plots. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach to rate the evidence quality. Outcomes included assessments using the Activities of Daily Living (ADL), Montreal Cognitive Assessment (MoCA), Mini-Mental State Examination (MMSE), Hasegawa Dementia Scale (HDS), Barthel Index (BI), Functional Activity Questionnaire (FAQ), and adverse events.

Results

In this study, a total of 2019 patients in 23 RCTs were included. EGb appeared to be more effective than control conditions as assessed by the results of cognitive function evaluation, including MMSE (MD_{MMSE,EGb vs.blank} = 3.04, 95% CI: 0.10-5.98; MD_{MMSE,EGb vs.drugs for VCI} = 2.70, 95% CI: 1.39-4.01; MD_{MMSE,EGb+drugs for VCI vs.blank} = 5.90, 95% CI: 4.21-7.59; and MD_{MMSE,EGb+drugs for VCI vs.drugs for VCI} = 3.14, 95% CI: 2.14-4.15), MoCA (MD_{MoCA,EGb vs.blank} = 5.30, 95% CI: 2.15-8.46; MD_{MoCA,EGb+drugs for VCI vs.blank} = 2.66, 95% CI: 1.82-3.50; and MD_{MoCA,EGb+drugs for VCI vs.drugs for VCI} = 2.56, 95% CI: 1.85-3.27), HDS (MD_{HDS,EGb vs.blank} = 6.50; 95% CI: 4.86-8.14; MD_{HDS,EGb+drugs for VCI vs.drugs for VCI} = 3.60, 95% CI: 2.50-4.70), ADL (MD_{ADL,EGb vs.blank} = 7.20, 95% CI: 3.28-11.12; MD_{ADL,EGb+drugs for VCI vs.blank} = 10.00, 95% CI: 7.51-12.49; and MD_{ADL,EGb+drugs for VCI vs.drugs for VCI} = 9.20, 95% CI: 7.26-11.14), BI (MD_{BI,EGb+drugs for VCI vs.drugs for VCI} = 5.71, 95% CI: 2.99-8.43; MD_{FAQ,EGb vs.drugs for VCI} = -1.43, 95% CI: -2.78 to 0.08), and FAQ (MD_{FAQ,EGb+drugs for VCI vs.drugs for VCI} = -2.17, 95% CI: -4.13 to 0.21). Evidence of certainty ranged from medium certainty to very low certainty.

Conclusion

This meta-analysis showed that EGb may be an effective and safe treatment in improving MMSE, MOCA, ADL, and BI for VCI patients within three months of diagnosis. However, given the quality of the included RCTs, more preregistered trials are needed that explicitly examine the efficacy of EGb. This systematic review has been registered on PROSPERO, with the registration number CRD42021232967.

Health status risk factors and quality of life in 75-84-year-old individuals assessed for dementia using the short 10/66 dementia diagnostic schedule

BACKGROUND

Trinidad is an island that not only has a population at high vascular risk but also one that is in epidemiological transition with high dementia prevalence. The aim of the study was to investigate modifiable risk factors associated with dementia in middle-old (75-84 years) individuals.

METHODS

As part of a large national community survey of dementia prevalence in Trinidad, 811 people aged 75-84 years were evaluated for dementia using the 10/66 short algorithm. Demographic data collected included information on age, gender, ethnicity, religion, education, occupation, living accommodation, smoking, alcohol consumption, self-reported medical conditions, impairments and ability to do instrumental activities of daily living (IADL). Data were analysed using multivariable logistic regression models.

RESULTS

Of the 811 participants, nearly 55% were female. The mean age was 78.8 (SD = 2.8) years and dementia was present in 198 (24.4%). Having less than ten years of education, being an agricultural worker, skilled labourer or housewife and having more than four co-morbidities were significantly associated with dementia. The odds ratio for dementia for those having self-reported stroke was 4.93 (95% CI [2.64-9.23]) and for diabetes was 1.76 (95% CI [1.17-2.65]) adjusting for age, age2, gender, ethnicity, religion, education and occupation. Impairment in eyesight, hearing, climbing stairs, and walking were also more common in the group with dementia. Ability to perform IADLs was linked with dementia. Individuals with dementia were more likely to be unable to perform any of the eight IADLs. Those who did not exercise at all (OR 6.95, 95% CI [2.02-23.90]) and those who did low exercise (OR 1.83, 95% CI [1.07-3.13]) compared to those who did moderate to high exercise were also more likely to have dementia.

CONCLUSION

In the middle-old population in Trinidad having diabetes and stroke, low IADL score, and no exercise were more common in people with dementia.

Migration and dementia: a meta-analysis of epidemiological studies in Europe

BACKGROUND

To provide an overview of epidemiological studies of dementia among migrant groups in Europe and to estimate their pooled odds ratio (OR) v. the reference population.

METHODS

Search for articles reporting on incidence or prevalence of dementia among ethnic minorities and migrants in Europe, published before 21 December 2018. We performed several meta-analyses, using a random-effects model, and, when there was no evidence of heterogeneity, a fixed-effects model. We distinguished between all migrants, African-Europeans and Asian-Europeans.

RESULTS

We retrieved five population-based surveys and two health care record studies. The latter included one incidence study, the remainder were prevalence studies. The meta-analysis of all studies yielded a pooled OR, adjusted for age and sex, of 1.73 (95% CI 1.42-2.11) for dementia in all migrant groups. However, the pooled OR of population surveys (3.10; 95% CI 2.12-4.51) was significantly higher than that for the health care record studies (OR 0.94; 95% CI 0.80-1.11). The pooled ORs for African-Europeans and Asian-Europeans, based on population surveys, were 2.54 (95% CI 1.70-3.80) and 5.36 (95% CI 2.78-10.31), respectively.

CONCLUSIONS

The discrepancy between health care record studies and population surveys suggests that many migrants remain undiagnosed. Migrants from Asia and Africa seem to be at significantly increased risk of dementia in Europe. Since the prevalence rates in their countries of origin are generally not higher than those for natives in Europe, there may be a parallel with the epidemiology of schizophrenia.

Systematic Review Estimating the Burden of Dementia in the Latin America and Caribbean Region: A Bayesian Approach

Background: The global burden of dementia has increasingly shifted to low- and middle-income regions that lack essential data for monitoring epidemiological progression, and policy and planning support. Drawing upon data that have emerged since the last known estimates published in 2015, this study aims to update dementia estimates in the Latin America and Caribbean (LAC) region for the years 2020, 2030, and 2050 through the application of a recently validated Bayesian approach for disease estimates useful when data sources are scarce.

Methods: A comprehensive parallel systematic review of PubMed, EMBASE, PsycINFO, Global Health, and LILACS was conducted to identify prospective population-based epidemiological studies on dementia published in English from 2013 to 2018 in LAC. English and non-English data cited by a recent review on dementia estimates in LAC were also examined for additional data. A Bayesian normal-normal hierarchical model (NNHM) was developed to estimate age-specific and age-adjusted dementia prevalence in people aged 60+. Using age-specific population projections from the UN, the total number of people affected by dementia for the years 2020, 2030, and 2050 were estimated.

Results: 1,414 studies were identified, of which only 7 met the inclusion criteria. The studies had 7,684 participants and 1,191 dementia cases. The age-standardized prevalence of all forms of dementia in LAC was 8% (95% CI: 5–11.5%) in people aged 60+. The estimated prevalence varied with age, increasing from 2.5% (95% CI: 0.08–4.0%) in the 60-69 age group, to 9.4% (95% CI: 5.4–13.2%) in the 70–79 age group and 28.9% (95% CI: 20.3–37.2%) in the ≥80 age group. The number of people age 60 and older living with dementia in LAC in 2020 was estimated at 6.86 (95% CI: 4.3–9.8) million, 9.94 (95% CI: 6.16–14.15) million in 2030, and 19.33 (95% CI: 12.3–13.6) million in 2050.

Conclusion: We project an upward disease trajectory for dementia in LAC countries. The projection is likely an underestimation of the true dementia burden given the underrepresentation of rural and socio-economically deprived populations. More research is urgently needed to improve the accuracy of disease estimates, guide clinicians to improve evaluations for earlier recognition of dementia, and support the development of effective policies for improving dementia prevention, diagnosis and clinical management in LAC's diverse and aging communities.

Exploring Dementia Care Systems Across the African Caribbean Diaspora: A Scoping Review and Consultation Exercise

BACKGROUND AND OBJECTIVES

Understanding the influences of marginalized cultural and social identities as experienced by the African Caribbean diaspora within the context of dementia care is essential to minimize the gaps in current practice and policy in the health care setting. This study explores the impact of marginalized identities upon the meaning-making process, access to services and experience of care provisions through a scoping review and consultancy exercises with key stakeholders.

RESEARCH DESIGN

Fourteen databases were searched using key terms. Primary studies in English, any year, study design, and country of origin were eligible. Titles, abstracts, and full texts were screened for inclusion and data were extracted in stages. Thematic analysis was performed and the findings were discussed in a series of consultation meetings with people with dementia, carers, and health care professionals in Manchester (United Kingdom) and Jamaica.

RESULTS

The scoping review retrieved n = 1,989 research articles. Nineteen were included, most were qualitative (n = 14), 3 quantitative, and 2 mixed-method. The findings revealed limited insight into cultural and multiple individual identities in explaining conceptualization and service access. Consultation meetings confirmed these findings and highlighted differences in health care services and systems in the United Kingdom and Jamaica.

DISCUSSION AND IMPLICATIONS

This study suggests there is a complex interaction of sociocultural processes that marginalize African Caribbean persons in and across various national settings within the context of dementia care. The study highlights the importance of acknowledging and addressing how prevalent racialized- and class-based divides and related marginalized social locations are reflected in inequities in access to and use of dementia services.

Italian version of the short 10/66 dementia diagnostic schedule: a validation study

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.

Prevalence and Patterns of Multimorbidity in a Nationally Representative Sample of Older Chinese: Results From the China Health and Retirement Longitudinal Study

BACKGROUND

Multimorbidity has become a prominent problem worldwide; however, few population-based studies have been conducted among older Chinese with multimorbidity. This study aimed to examine the prevalence of multimorbidity and explore its common patterns among a nationally representative sample of older Chinese.

METHODS

This study used data from the China Health and Retirement Longitudinal Study and included 19,841 participants aged at least 50 years. The prevalence of individual chronic diseases and multimorbidity during 2011-2015 were evaluated among the entire cohort and according to residential regions and gender. The relationships between participants' demographic characteristics and multimorbidity were examined using logistic regression model. Patterns of multimorbidity were explored using hierarchical cluster analysis and association rule mining.

RESULTS

Multimorbidity occurred in 42.4% of the participants. The prevalence of multimorbidity was higher among women (odds ratio [OR] = 1.31, 95% confidence interval [CI]: 1.13-1.51) and urban residents (OR = 1.14, 95% CI: 1.02-1.27) than their respective counterparts after accounting for potential confounders of age, education, smoking, and alcohol consumption. Hierarchical cluster analysis revealed four common multimorbidity patterns: the vascular-metabolic cluster, the stomach-arthritis cluster, the cognitive-emotional cluster, and the hepatorenal cluster. Regional differences were found in the distributions of stroke and memory-related disease. Most combinations of conditions and urban-rural difference in multimorbidity patterns from hierarchical cluster analysis were also observed in association rule mining.

CONCLUSION

The prevalence and patterns of multimorbidity vary by gender and residential regions among older Chinese. Women and urban residents are more vulnerable to multimorbidity. Future studies are needed to understand the mechanisms underlying the identified multimorbidity patterns and their policy and interventional implications.

Vascular and metabolic risk factor differences prior to dementia diagnosis: a multidatabase case-control study using European electronic health records

OBJECTIVE

The objective of the study is to compare body mass index (BMI), systolic/diastolic blood pressure (SBP/DBP) and serum total cholesterol levels between dementia cases and controls at multiple time intervals prior to dementia onset, and to test time interval as a modifying factor for these associations.

DESIGN

Case-control study.

SETTING

Six European electronic health records databases.

PARTICIPANTS

291 780 cases at the date of first-recorded dementia diagnosis, compared with 29 170 549 controls randomly selected from the same databases, age matched and sex matched at this index date.

EXPOSURE

The following measures were extracted whenever recorded within each dataset: BMI (kg/m2), SBP and DBP (mm Hg) and serum total cholesterol (mmol/L). Levels for each of these variables were defined within six 2-year time intervals over the 12 years prior to the index date.

MAIN OUTCOMES

Case-control differences in exposures of interest were modelled for each time period and adjusted for demographic and clinical factors (ischaemic/unspecified stroke, type 2 diabetes mellitus, acute myocardial infarction, hypertension diagnosis, antihypertensive medication, cholesterol-lowering medication). Coefficients and interactions with time period were meta-analysed across the six databases.

RESULTS

Mean BMI (coefficient -1.16 kg/m2; 95% CI -1.38 to 0.93) and SBP (-2.83 mm Hg; 95% CI -4.49 to -1.16) were lower in cases at diagnosis, and case-control differences were greater in more recent time periods, as indicated by significant case-x-time interaction and case-x-time-squared interaction terms. Time variations in coefficients for cholesterol levels were less consistent between databases and those for DBP were largely not significant.

CONCLUSION

Routine clinical data show emerging divergence in levels of BMI and SBP prior to the diagnosis of dementia but less evidence for DBP or total cholesterol levels. These divergences should receive at least some consideration in routine dementia risk screening, although underlying mechanisms still require further investigation.

The socio-economic determinants of multimorbidity among the elderly population in Trinidad and Tobago

OBJECTIVE

To estimate the prevalence of multimorbidity and investigate the socioeconomic factors that are associated with multimorbidity among persons 70 years and older in Trinidad and Tobago.

DESIGN AND METHODS

The data were obtained from a nationally representative comprehensive cross-sectional survey conducted in 2014 among elderly persons in the targeted age group. The prevalence of multimorbidity among the elderly population was estimated. A logit model was utilized to determine the socioeconomic characteristics that are associated with multimorbidity in the elderly.

RESULTS

The results of the study show that multimorbidity in the elderly population is strongly associated with age, ethnicity, lower education, smoking history, no physical activity and being female. An interesting finding is that elderly persons in the richest quintile are in general, more prone to multimorbidity.

CONCLUSION

The findings suggest that interventions to reduce multimorbidity among the elderly population must encourage greater levels of physical activity, provide education on the risk factors of multimorbidity, and discourage smoking.

Vascular, inflammatory and metabolic risk factors in relation to dementia in Parkinson's disease patients with type 2 diabetes mellitus

There are limited data on vascular, inflammatory, metabolic risk factors of dementia in Parkinson’s disease (PD) with type 2 diabetes mellitus (DM) (PD-DM). In a study of 928 subjects comprising of 215 PD with DM (including 31 PD-DM with dementia, PD-DMD), 341 PD without DM (including 31 PD with dementia, PDD) and 372 DM without PD (including 35 DM with dementia, DMD) patients, we investigated if vascular, inflammatory, metabolic, and magnetic resonance imaging (MRI) markers were associated with dementia in PD-DM. Lower fasting blood glucose (FBG<5mmol/L, OR=4.380; 95%CI: 1.748-10.975; p=0.002), higher homocysteine (HCY>15μmol/L, OR=3.131; 95%CI: 1.243-7.888; p=0.015) and hyperlipidemia (OR=3.075; 95%CI: 1.142-8.277; p=0.026), increased age (OR=1.043; 95%CI: 1.003-1.084; p=0.034) were the most significant risk factors in PDD patients. Lower low-density lipoprotein cholesterol (LDL-C<2mmol/L, OR=4.499; 95%CI: 1.568-12.909; p=0.005) and higher fibrinogen (>4g/L, OR=4.066; 95%CI: 1.467-11.274; p=0.007) were the most significant risk factors in PD-DMD patients. The area under the curve (AUC) for fibrinogen and LDL-C was 0.717 (P=0.001), with a sensitivity of 80.0% for the prediction of PD-DMD.

In summary, we identified several factors including LDL-C and fibrinogen as significant risk factors for PD-DMD and these may have prognostic and treatment implications.

Elderspeak to Resident Dementia Patients Increases Resistiveness to Care in Health Care Profession

Resistiveness to care is very common among patients of dementia as these patients do not take medicines, meals or bath very easily. Indeed, it is a very challenging task for health caregivers and there is a significant rise in time and cost involved in managing dementia patients. Amongst different factors, the type of communication between resident dementia patients and health caregivers is an important contributing factor in the development of resistiveness to care. Elderspeak (baby talk) is a type of communication in which health caregivers adjust their language and style while interacting with elderly and dependent patients. It involves the use of short sentences, simple grammar, slow and high pitch voice, repeating phrases to provide a comfortable and friendly environment to patients. Most of the time, caregivers tend to adapt elderspeak as they handle weak and fragile older patients for routine activities. Although elderspeak is meant to provide support, warmth and care to patients, yet patients perceive elderspeak as patronizing and it induces negative feelings about self-esteem. Scientists have found a correlation between the development of resistiveness to care and the extent of elderspeak in communication. Therefore, there have been strategies to develop alternative communication strategies by avoiding the use of elderspeak. Moreover, the beneficial effects of such communications have been documented as it improves the quality of life, reduces aggression, agitation and psychosocial symptoms. The present review discusses the scientific studies discussing the use of elderspeak in communication and development of resistiveness to care in resident patients of dementia.

A review of the 10/66 dementia research group

BACKGROUND

In this review we discuss how the study of dementia epidemiology in Low- and Middle-Income Countries (LMICs) has changed in the last 20 years, and specifically to review the evidence created by the 10/66 Dementia Research Group (DRG) and discuss future directions for research.

METHODS

We identified and collated all the papers related to the 10/66 Dementia Research Group, including papers from groups who adopted the 10/66 methodology, that have been published in peer-reviewed journals.

RESULTS

Over 200 papers including data from Africa, Asia, Europe and Latin America and the Caribbean were identified by this review. Many of the findings revolved around the epidemiology of dementia, mental health and non-communicable diseases, including the cross-cultural development and validation of measurement tools of cognition and functioning, need for care, care arrangements and mental health. Social ageing, care dependence and caregiver interventions were also topics that the group had published on.

DISCUSSION

A body of evidence has been generated that has challenged the view, prevalent when the group started, that dementia is comparatively rare in LMICs. The experience of the 10/66 DRG has shown that descriptive epidemiological research can be important and impactful, where few data exist. Monitoring population trends in the prevalence and incidence of dementia may be our best chance to confirm hypotheses regarding modifiable risk factors of dementia.

Comparisons between different elements of reported burden and common mental disorder in caregivers of ethnically diverse people with dementia in Trinidad

OBJECTIVE

Culture plays a significant role in determining family responsibilities and possibly influences the caregiver burden associated with providing care for a relative with dementia. This study was carried out to determine the elements of caregiver burden in Trinidadians regarding which interventions will provide the most benefit.

METHODS

Seventy-five caregivers of patients diagnosed with dementia participated in this investigation. Demographic data were recorded for each caregiver and patient. Caregiver burden was assessed using the Zarit Burden Interview (ZBI), and the General Health Questionnaire (GHQ) was used as a measure of psychiatric morbidity. Statistical analyses were performed using Stata and SPSS software. Associations between individual ZBI items and GHQ-28 scores in caregivers were analyzed in logistic regression models; the above-median GHQ-28 scores were used a binary dependent variable, and individual ZBI item scores were entered as 5-point ordinal independent variables.

RESULTS

The caregiver sample was composed of 61 females and 14 males. Caregiver burden was significantly associated with the participant being male; there was heterogeneity by ethnic group, and a higher burden on female caregivers was detected at borderline levels of significance. Upon examining the associations between different ZBI items and the above-median GHQ-28 scores in caregivers, the strongest associations were found with domains reflecting the caregiver's health having suffered, the caregiver not having sufficient time for him/herself, the caregiver's social life suffering, and the caregiver admitting to feeling stressed due to caregiving and meeting other responsibilities.

CONCLUSIONS

In this sample, with a majority of female caregivers, the factors of the person with dementia being male and belonging to a minority ethnic group were associated with a greater degree of caregiver burden. The information obtained through the association of individual ZBI items and above-median GHQ-28 scores is a helpful guide for profiling Trinidadian caregiver burden.