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Yang Z, Cieza B, Reyes-Dumeyer D, Montesinos R, Soto-Añari M, Custodio N, Tosto G. A benchmark study on current GWAS models in admixed populations. Brief Bioinform 2023; 25:bbad437. [PMID: 38037235 PMCID: PMC10689347 DOI: 10.1093/bib/bbad437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 12/02/2023] Open
Abstract
OBJECTIVE The performances of popular genome-wide association study (GWAS) models have not been examined yet in a consistent manner under the scenario of genetic admixture, which introduces several challenging aspects: heterogeneity of minor allele frequency (MAF), wide spectrum of case-control ratio, varying effect sizes, etc. METHODS We generated a cohort of synthetic individuals (N = 19 234) that simulates (i) a large sample size; (ii) two-way admixture (Native American and European ancestry) and (iii) a binary phenotype. We then benchmarked three popular GWAS tools [generalized linear mixed model associated test (GMMAT), scalable and accurate implementation of generalized mixed model (SAIGE) and Tractor] by computing inflation factors and power calculations under different MAFs, case-control ratios, sample sizes and varying ancestry proportions. We also employed a cohort of Peruvians (N = 249) to further examine the performances of the testing models on (i) real genetic and phenotype data and (ii) small sample sizes. RESULTS In the synthetic cohort, SAIGE performed better than GMMAT and Tractor in terms of type-I error rate, especially under severe unbalanced case-control ratio. On the contrary, power analysis identified Tractor as the best method to pinpoint ancestry-specific causal variants but showed decreased power when the effect size displayed limited heterogeneity between ancestries. In the Peruvian cohort, only Tractor identified two suggestive loci (P-value $\le 1\ast{10}^{-5}$) associated with Native American ancestry. DISCUSSION The current study illustrates best practice and limitations for available GWAS tools under the scenario of genetic admixture. Incorporating local ancestry in GWAS analyses boosts power, although careful consideration of complex scenarios (small sample sizes, imbalance case-control ratio, MAF heterogeneity) is needed.
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Affiliation(s)
- Zikun Yang
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA
| | - Basilio Cieza
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA
| | - Dolly Reyes-Dumeyer
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital, 710 West 168th Street, New York, NY 10032, USA
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - Marcio Soto-Añari
- Instituto de Neurociencia Cognitiva, Arequipa, Perú
- Laboratorio de Neurociencia, Universidad Católica San Pablo, Arequipa, Perú
| | - Nilton Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - Giuseppe Tosto
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital, 710 West 168th Street, New York, NY 10032, USA
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Herrera-Perez E, Custodio N, Diaz M, Montesinos R, Chang A, Villafuerte M, Lanata S. Epidemiology of neurocognitive disorders in adults from urban-marginalized areas: a door-to-door population-based study in Puente Piedra, Lima, Peru. Front Public Health 2023; 11:1228008. [PMID: 37927880 PMCID: PMC10622761 DOI: 10.3389/fpubh.2023.1228008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
Background In Latin America (LA), the prevalence of dementia is expected to triple to 150 million people by 2050. The 2020 Lancet Commission report identified several modifiable dementia risk factors, yet few social and environmental factors, most relevant to vulnerable regions of LA, were highlighted in this report. We sought to assess the epidemiology of neurocognitive disorders (NCD) in Puente Piedra, one of the most socially and economically vulnerable districts of Lima, the capital of Peru. Methodology This was a cross-sectional door-to-door observational study that used two-stage household sampling. One young adult (30-59 years) and one older adult (>60 years) per household were enrolled. We collected demographic, clinical, and neurocognitive data. Addenbrooke's Cognitive Examination (young adults) and the RUDAS-PE (older adults) were used, classifying participants as cognitively normal, possible mild NCD, or possible major NCD. Results We enrolled 247 participants (median age 46 years; 67% female). One-fourth had not completed secondary school and more than 50% completed only secondary school. Most participants were housewives (46%) and 21% did not have health insurance. The overall prevalence of possible NCD was 30% (25.6 and 41.8% among younger adults and older adults, respectively). Among younger adults, those ages 55-59 years more frequently had NCD (70%) compared to younger age ranges. Among older adults, only 3 subjects (4.5%) had major NCD. Conclusion We found a high frequency of possible NCDs in a socially and economically vulnerable community in Lima, Peru, with younger adults showing levels of NCD higher than expected. Our findings support the need for health systems to incorporate cognitive screenings programs for NCD in younger ages. Future research on NCD would include younger populations, particularly in vulnerable communities.
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Affiliation(s)
- Eder Herrera-Perez
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Centro de Excelencia en Biotecnología e Investigación Traslacional, Lima, Peru
| | - Nilton Custodio
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - Monica Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Rosa Montesinos
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Alexandra Chang
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | | | - Serggio Lanata
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, San Francisco, CA, United States
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Custodio N, Malaga M, Montesinos R, Chambergo-Michilot D, Baca F, Carbajal JC, Huilca JC, Herrera-Perez E, Lira D, Diaz MM, Lanata S. The Memory Alteration Test Is Correlated with Clinical, Cerebrospinal Fluid, and Brain Imaging Markers of Alzheimer Disease in Lima, Peru. Dement Geriatr Cogn Disord 2023; 52:309-317. [PMID: 37827146 DOI: 10.1159/000534157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/04/2023] [Indexed: 10/14/2023] Open
Abstract
INTRODUCTION As disease-modifying therapies become available for Alzheimer's disease (AD), detection of AD in early stages of illness (mild cognitive impairment [MCI], early dementia) becomes increasingly important. Biomarkers for AD in low- and middle-income countries (LMICs) are costly and not widely available; hence, it is important to identify cognitive tests that correlate well with AD biomarker status. In this study, we evaluated the memory alteration test (M@T) to detect biomarker-proven AD and quantify its correlation with neurodegeneration and cerebrospinal fluid (CSF) AD biomarkers in a cohort of participants from Lima, Peru. METHODS This is a secondary analysis of a cohort of 185 participants: 63 controls, 53 with amnestic MCI (aMCI), and 69 with dementia due to AD. Participants underwent testing with M@T and a gold standard neuropsychological battery. We measured total tau (t-tau), phosphorylated tau (p-tau), and beta-amyloid (β-amyloid) in CSF, and evaluated neurodegeneration via medial temporal atrophy score in MRI. We used receiver-operator curves to determine the discriminative capacity of the total M@T score and its subdomains. We used the Pearson coefficient to correlate M@T score and CSF biomarkers. RESULTS The M@T had an area under the curve (AUC) of 0.994 to discriminate between controls and cognitively impaired (aMCI or AD) patients, and an AUC of 0.98 to differentiate between aMCI and AD patients. Free-recall and cued recall had the highest AUCs of all subdomains. Total score was strongly correlated with t-tau (-0.77) and p-tau (-0.72), and moderately correlated with β-amyloid (0.66). The AUC for discrimination of neurodegeneration was 0.87. CONCLUSION The M@T had excellent discrimination of aMCI and dementia due to AD. It was strongly correlated with CSF biomarkers and had good discrimination of neurodegeneration. In LMICs, the M@T may be a cost-effective screening tool for aMCI and dementia caused by AD.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
| | - Marco Malaga
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru,
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, California, USA,
- Grupo de Investigación Neurociencia Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Peru,
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Diego Chambergo-Michilot
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - Fiorella Baca
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru
| | - Juan Carlos Carbajal
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Jose Carlos Huilca
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Monica M Diaz
- Department of Neurology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Serggio Lanata
- Department of Neurology, Memory and Aging Center, UCSF Weill Institute for Neurosciences, University of California, San Francisco, California, USA
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Crivelli L, Calandri IL, Kimie Suemoto C, Salinas RM, Velilla LM, Yassuda MS, Caramelli P, Lopera F, Nitrini R, Sevlever GE, Sosa AL, Acosta D, Baietti AMC, Cusicanqui MI, Custodio N, De Simone SD, Derio CD, Duque-Peñailillo L, Duran JC, Jiménez-Velázquez IZ, Leon-Salas JM, Bergamo Y, Clarens MF, Damian A, Demey I, Helou MB, Márquez C, Martin ME, Martin MDGM, Querze D, Surace EI, Acosta-Egea S, Aguirre-Salvador E, de Souza LC, Cançado GHDCP, Brucki SMD, Friedlaender CV, Gomes KB, Gutierrez M, Ríos CL, Galindo JGM, Montesinos R, Nuñez-Herrera A, Ospina-Henao S, Rodríguez G, Masson VR, Sánchez M, Schenk CE, Soto L, Barbosa MT, Tosatti JAG, Vicuña Y, Espeland M, Hakansson K, Kivipelto M, Baker L, Snyder H, Carrillo M, Allegri RF. Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS): Study design and harmonization. Alzheimers Dement 2023; 19:4046-4060. [PMID: 37204054 PMCID: PMC11021182 DOI: 10.1002/alz.13101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 03/02/2023] [Accepted: 03/08/2023] [Indexed: 05/20/2023]
Abstract
INTRODUCTION Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm-FINGERS) is the first non-pharmacological multicenter randomized clinical trial (RCT) to prevent cognitive impairment in Latin America (LA). Our aim is to present the study design and discuss the strategies used for multicultural harmonization. METHODS This 1-year RCT (working on a 1-year extension) investigates the feasibility of a multi-domain lifestyle intervention in LA and the efficacy of the intervention, primarily on cognitive function. An external harmonization process was carried out to follow the FINGER model, and an internal harmonization was performed to ensure this study was feasible and comparable across the 12 participating LA countries. RESULTS Currently, 1549 participants have been screened, and 815 randomized. Participants are ethnically diverse (56% are Nestizo) and have high cardiovascular risk (39% have metabolic syndrome). DISCUSSION LatAm-FINGERS overcame a significant challenge to combine the region's diversity into a multi-domain risk reduction intervention feasible across LA while preserving the original FINGER design.
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Affiliation(s)
- Lucia Crivelli
- Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina
| | | | | | - Rosa María Salinas
- Laboratorio de Demencias del Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - Lina Marcela Velilla
- Neuroscience Group of Antioquia Medical School, Antioquia University, Medellín, Colombia
| | - Mônica Sanches Yassuda
- Cognitive and Behavioral Neurology Unit, Department of Neurology, University of Såo Paulo School of Medicine, Såo Paulo, Brazil
- Gerontology, School of Arts, Sciences, and Humanities, University of Såo Paulo, Såo Paulo, Brazil
| | - Paulo Caramelli
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Francisco Lopera
- Neuroscience Group of Antioquia Medical School, Antioquia University, Medellín, Colombia
| | - Ricardo Nitrini
- Cognitive and Behavioral Neurology Unit, Department of Neurology, University of Såo Paulo School of Medicine, Såo Paulo, Brazil
| | | | - Ana Luisa Sosa
- Laboratorio de Demencias del Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - Daisy Acosta
- Internal Medicine Department, Universidad Nacional Pedro Henriquez Urena (UNPHU), Santo Domingo, Dominican Republic
| | - Ana María Charamelo Baietti
- Clínica de la Memoria-Hospital Británico, Montevideo, Uruguay
- Departamento de Neuropsicología, Facultad de Medicina-Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | | | - Nilton Custodio
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
| | - Sergio Dansilio De Simone
- Departamento de Neuropsicología, Facultad de Medicina-Hospital de Clínicas, Universidad de la República, Montevideo, Uruguay
| | - Carolina Delgado Derio
- Unidad de Cerebro Saludable, Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago de Chile, Chile
| | | | | | - Ivonne Z. Jiménez-Velázquez
- Centro de Investigación en Geriatría, Departamento de Medicina Interna, Recinto de Ciencias Médicas, Universidad de Puerto Rico, San Juan, Puerto Rico
| | - Jorge Mario Leon-Salas
- Departamento de Investigación Clínica, Life Science Research Institute, Hospital Clínica Bíblica, San José, Costa Rica
| | - Yanina Bergamo
- Department of Diagnostic Imaging, Fleni, Buenos Aires, Argentina
| | | | - Andrés Damian
- CUDIM Centro Uruguayo de Imagenología Molecular, Montevideo, Uruguay
| | - Ignacio Demey
- Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina
| | | | - Carlos Márquez
- Instituto de Nutricion y Tecnología de los Alimentos, Universidad de Chile, Santiago de Chile, Chile
| | | | | | - Diego Querze
- Department of Neurology, Fleni, Buenos Aires, Argentina
| | | | - Sabrina Acosta-Egea
- Departamento de Investigación Clínica, Life Science Research Institute, Hospital Clínica Bíblica, San José, Costa Rica
| | | | - Leonardo Cruz de Souza
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Sonia Maria Dozzi Brucki
- Cognitive and Behavioral Neurology Unit, Department of Neurology, University of Såo Paulo School of Medicine, Såo Paulo, Brazil
| | | | - Karina Braga Gomes
- Faculdade de Farmícia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Myriam Gutierrez
- Unidad de Cerebro Saludable, Departamento de Neurociencia, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | | | - Joyce Graciela Martinez Galindo
- Laboratorio de Demencias del Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Ciudad de México, México
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
| | | | - Sebastián Ospina-Henao
- Facultad de Medicina, Universidad de Ciencias Médicas, Instituto de Investigación en Ciencias Médicas, San José, Costa Rica
| | - Guillermina Rodríguez
- Department of Demography and Biostatistics, Ministry of Public Health, Santo Domingo, Dominican Republic
| | | | - Mónica Sánchez
- Cognitive Disorders Unit–Neuromedicenter, Quito, Ecuador
| | - Christian E. Schenk
- Neurology Division, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Ligia Soto
- Cognitive Disorders Unit–Neuromedicenter, Quito, Ecuador
| | - Maira Tonidandel Barbosa
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Jéssica Abdo Gonçalves Tosatti
- Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Yosselin Vicuña
- Inbiomed (Instituto de Investigacion en Biomedicina), Universidad Central del Ecuador, Quito, Ecuador
| | - Mark Espeland
- Departments of Internal Medicine and Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Krister Hakansson
- Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Miia Kivipelto
- Division of Clinical Geriatrics, Centre for Alzheimer Research, Karolinska Institutet and Theme Inflammation and Aging, Karolinska University Hospital, 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, UK
| | - Laura Baker
- Departments of Internal Medicine, Neurology, and Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | | | | | - Ricardo Francisco Allegri
- Department of Cognitive Neurology, Fleni, Buenos Aires, Argentina
- Department of Neurosciences, Universidad de la Costa (CUC), Barranquilla, Colombia
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Yang Z, Huaman BC, Reyes-Dumeyer D, Montesinos R, Soto-Añari M, Custodio N, Tosto G. A benchmark study on current GWAS models in admixed populations. bioRxiv 2023:2023.04.27.538299. [PMID: 37163101 PMCID: PMC10168347 DOI: 10.1101/2023.04.27.538299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Objective The performances of popular Genome-wide association study (GWAS) models haven't been examined yet in a consistent manner under the scenario of genetic admixture, which introduces several challenging aspects such as heterogeneity of minor allele frequency (MAF), a wide spectrum of case-control ratio, and varying effect sizes etc. Methods We generated a cohort of synthetic individuals (N=19,234) that simulates 1) a large sample size; 2) two-way admixture [Native American-European ancestry] and 3) a binary phenotype. We then examined the inflation factors produced by three popular GWAS tools: GMMAT, SAIGE, and Tractor. We also computed power calculations under different MAFs, case-control ratios, and varying ancestry percentages. Then, we employed a cohort of Peruvians (N=249) to further examine the performances of the testing models on 1) real genetic data and 2) small sample sizes. Finally, we validated these findings using an independent Peruvian cohort (N=109) included in 1000 Genome project (1000G). Results In the synthetic cohort, SAIGE performed better than GMMAT and Tractor in terms of type-I error rate, especially under severe unbalanced case-control ratio. On the contrary, power analysis identified Tractor as the best method to pinpoint ancestry-specific causal variants, but showed decreased power when no adequate heterogeneity of the true effect sizes was simulated between ancestries. The real Peruvian data showed that Tractor is severely affected by small sample sizes, and produced severely inflated statistics, which we replicated in the 1000G Peruvian cohort. Discussion The current study illustrates the limitations of available GWAS tools under different scenarios of genetic admixture. We urge caution when interpreting results under complex population scenarios.
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Affiliation(s)
- Zikun Yang
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University. 630 West 168 Street, New York, NY 10032, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University. 630 West 168 Street, New York, NY 10032, USA
| | - Basilio Cieza Huaman
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University. 630 West 168 Street, New York, NY 10032, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University. 630 West 168 Street, New York, NY 10032, USA
| | - Dolly Reyes-Dumeyer
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University. 630 West 168 Street, New York, NY 10032, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University. 630 West 168 Street, New York, NY 10032, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital. 710 West 168 Street, New York, NY 10032, USA
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - Marcio Soto-Añari
- Instituto de Neurociencia Cognitiva, Arequipa, Perú
- Laboratorio de Neurociencia, Universidad Católica San Pablo, Arequipa, Perú
| | - Nilton Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - Giuseppe Tosto
- Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, College of Physicians and Surgeons, Columbia University. 630 West 168 Street, New York, NY 10032, USA
- The Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University. 630 West 168 Street, New York, NY 10032, USA
- Department of Neurology, College of Physicians and Surgeons, Columbia University and the New York Presbyterian Hospital. 710 West 168 Street, New York, NY 10032, USA
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Custodio N, Malaga M, Montesinos R, Chambergo D, Baca F, Castro S, Carlos Carbajal J, Herrera E, Lira D, Diaz M, Lanata S. Impact of Covid-19 Mandatory Lockdown Measures on Cognitive and Neuropsychiatric Symptoms in Persons With Alzheimer's Disease in Lima, Peru. Curr Alzheimer Res 2023:CAR-EPUB-131009. [PMID: 37073648 DOI: 10.2174/1567205020666230417103216] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 04/20/2023]
Abstract
BACKGROUND Neuropsychiatric symptoms (NPS) in patients with Alzheimer's disease (AD) worsened during the COVID-19 lockdowns, but their progression thereafter is unknown. We present the first longitudinal study tracking them before, during, and after restrictions. OBJECTIVES To describe the effect of the COVID-19 mandatory lockdowns on Cognitive and Neuropsychiatric symptoms in patients with Mild Cognitive Impairment (MCI) and Alzheimer's Disease (AD) METHODS: Cohort of 48 patients with amnestic MCI and 38 with AD in Lima, Peru. They received three rounds of cognitive (RUDAS, CDR, M@T), behavioral (NPI), and functional (ADCS-ADL) assessments. We assessed the change in score means across the time points and for each domain of NPS and tracked the changes in individual patients. RESULTS RUDAS declined 0.9 (SD 1.0) from baseline to lockdown and 0.7 (SD 1.0) after restrictions. M@T declined 1.0 (SD 1.5) from baseline to lockdown and 1.4 (SD 2.0) after restrictions. CDR worsened in 72 patients (83.72%) from baseline to post-lockdown. NPI worsened by 10 (SD 8.3) from baseline to lockdown but improved by 4.8 (SD 6.4) after restrictions. Proportionally, 81.3% of all patients had worsened NPS during the lockdowns, but only 10.7% saw an increase thereafter. Improvement was statistically significant for specific NPS domains except hallucinations, delusions, and appetite changes. Anxiety, irritability, apathy, and disinhibition returned to baseline levels. CONCLUSION Following confinement, cognition continued to decline, but NPS demonstrated either stability or improvement. This highlights the role modifiable risk factors may have on the progression of NPS.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
| | - Marco Malaga
- Instituto Peruano de Neurociencias Unidad de Investigacion Lima Peru
| | - Rosa Montesinos
- Instituto Peruano de Neurociencias, Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Lima, Peru
| | - Diego Chambergo
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Fiorella Baca
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - Sheila Castro
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - Juan Carlos Carbajal
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - Eder Herrera
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - David Lira
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - Monica Diaz
- Department of Neurology, the University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Serggio Lanata
- Memory and Aging Center, Department of Neurology, UCSF Weill Institute for Neurosciences, University of California. San Francisco. USA
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Reyes‐Dumeyer D, Montesinos R, Caipa MP, Ore‐Gomez MF, RIVERA‐FERNANDEZ CLAUDIA, Soto‐Añari M, Custodio N, Tosto G. Collection of genetic data in ethnic‐based studies across Aymaras, Quechuas and Mestizos: the challenges of the Genetics of Alzheimer’s in Peruvian Population (GAPP) study. Alzheimers Dement 2022. [DOI: 10.1002/alz.062559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Dolly Reyes‐Dumeyer
- Columbia University New York NY USA
- Columbia University Irving Medical Center New York NY USA
| | - Rosa Montesinos
- Instituto Peruano de Neurociencias Lima Peru
- Research unit, Instituto Peruano de Neurociencias Lima Peru
| | - Maritza Pintado Caipa
- Instituto Peruano de Neurociencias Lima Peru
- Global Brain Health Institute San Francisco CA USA
- Unidad de Diagnóstico de Deterioro Cognitivo y prevención de demencia, Instituto Peruano de Neurociencias Lima Peru
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California of San Francisco San Francisco CA USA
- Global Brain Health Institute at University of California of San Francisco San Francisco CA USA
| | | | | | | | - Nilton Custodio
- Instituto Peruano de Neurociencias Lima Peru
- Research unit, Instituto Peruano de Neurociencias Lima Peru
- Cognitive impairment diagnosis and dementia prevention unit, Instituto Peruano de Neurociencias Lima Peru
| | - Giuseppe Tosto
- Columbia University New York NY USA
- Columbia University Irving Medical Center New York NY USA
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Cornejo‐Olivas M, Rajabli F, Kushch NA, Mena PR, Illanes‐Manrique M, Adams LD, Whitehead PL, Hamilton‐Nelson KL, Milla‐Neyra K, Marca V, Sarapura‐Castro E, Manrique‐Enciso C, Mejía KK, Isasi R, Castro‐Suarez S, Araujo‐Aliaga I, Custodio N, Montesinos R, Griswold AJ, Dalgard CL, Beecham GW, Cuccaro ML, Vance JM, Pericak‐Vance MA. Exploring effect of known Alzheimer disease genetic loci in the Peruvian population. Alzheimers Dement 2022. [DOI: 10.1002/alz.068028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Mario Cornejo‐Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas Lima Peru
- Center for Global Health, Universidad Peruana Cayetano Heredia Lima Peru
| | - Farid Rajabli
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine Miami FL USA
| | - Nicholas A. Kushch
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Pedro Ramon Mena
- John P. Hussman Institute for Human Genomics, University of Miami Miami FL USA
| | | | - Larry D. Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine Miami FL USA
| | - Patrice L. Whitehead
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Kara L. Hamilton‐Nelson
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Karina Milla‐Neyra
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas Lima Peru
| | - Victoria Marca
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas Lima Peru
| | | | - Carla Manrique‐Enciso
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas Lima Peru
| | - Koni K. Mejía
- Daniel Alcides Carrion National Hospital Callao Peru
| | - Rosario Isasi
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Sheila Castro‐Suarez
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas Lima Peru
- Atlantic Senior Fellow for Equity in Brain Health at University of California San Francisco. San Francisco CA USA
| | - Ismael Araujo‐Aliaga
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurologicas Lima Peru
| | | | | | - Anthony J. Griswold
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | | | - Gary W. Beecham
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Michael L. Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Jeffery M. Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Margaret A. Pericak‐Vance
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
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Custodio N, Failoc‐Rojas VE, Chambergo‐Michilot D, Malaga D, Ore‐Gomez MF, RIVERA‐FERNANDEZ CLAUDIA, Soto‐Añari M, Reyes‐Dumeyer D, Casavilca‐Zambrano S, Montesinos R, Tosto G. Hearing loss and dementia in Peruvian populations. Alzheimers Dement 2022. [DOI: 10.1002/alz.066033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nilton Custodio
- Cognitive impairment diagnosis and dementia prevention unit, Instituto Peruano de Neurociencias Lima Peru
| | | | | | | | | | | | | | | | | | | | - Giuseppe Tosto
- Columbia University Irving Medical Center New York NY USA
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10
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Montesinos R, Chambergo‐Michilot D, Malaga D, Ore‐Gomez MF, RIVERA‐FERNANDEZ CLAUDIA, Soto‐Añari M, Reyes‐Dumeyer D, Failoc‐Rojas VE, Casavilca‐Zambrano S, Custodio N, Tosto G. Association between nutritional status and dementia staging among Alzheimer’s disease patients in Peru: Preliminary results of the Genetic of Alzheimer’s Disease in Peruvian Population Study. Alzheimers Dement 2022. [DOI: 10.1002/alz.065928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nilton Custodio
- Instituto Peruano de Neurociencias Lima Peru
- Cognitive impairment diagnosis and dementia prevention unit, Instituto Peruano de Neurociencias Lima Peru
| | - Giuseppe Tosto
- Columbia University Irving Medical Center New York NY USA
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11
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Cubas‐Montecino D, Rajabli F, Illanes‐Manrique M, Kushch NA, Mena PR, Whitehead PL, Hamilton‐Nelson KL, Milla‐Neyra K, Marca V, Sarapura‐Castro E, Manrique‐Enciso C, Mejía KK, Isasi R, Castro‐Suarez S, Araujo‐Aliaga I, Custodio N, Montesinos R, Griswold AJ, Dalgard CL, Beecham GW, Cuccaro ML, Vance JM, Cornejo‐Olivas M, Pericak‐Vance MA. Admixed ancestral composition with Amerindian predominance at the Peruvian Alzheimer Disease Initiative (PeADI). Alzheimers Dement 2022. [DOI: 10.1002/alz.068155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Diana Cubas‐Montecino
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas Lima Peru
| | - Farid Rajabli
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine Miami FL USA
| | | | - Nicholas A. Kushch
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Pedro Ramon Mena
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Patrice L. Whitehead
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Kara L. Hamilton‐Nelson
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
| | - Karina Milla‐Neyra
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas Lima Peru
| | - Victoria Marca
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas Lima Peru
| | | | - Carla Manrique‐Enciso
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas Lima Peru
| | - Koni K. Mejía
- Daniel Alcides Carrion National Hospital Callao Peru
| | - Rosario Isasi
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Sheila Castro‐Suarez
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas Lima Peru
- Atlantic Senior Fellow for Equity in Brain Health at University of California San Francisco San Francisco CA USA
| | - Ismael Araujo‐Aliaga
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas Lima Peru
| | | | | | - Anthony J. Griswold
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | | | - Gary W. Beecham
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Michael L. Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
| | - Jeffery M. Vance
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
- John P. Hussman Institute for Human Genomics, University of Miami Miami FL USA
| | - Mario Cornejo‐Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas Lima Peru
- Center for Global Health, Universidad Peruana Cayetano Heredia Lima Peru
| | - Margaret A. Pericak‐Vance
- John P. Hussman Institute for Human Genomics, Miller School of Medicine, University of Miami Miami FL USA
- Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine Miami FL USA
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12
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Custodio N, Montesinos R, Chambergo‐Michilot D, Herrera‐Perez E, Caipa MP, Seminario G W, Cuenca J, Mesia L, Failoc‐Rojas VE, Diaz MM. Evaluation of a functional assessment tool in patients with mild cognitive impairment or Alzheimer’s disease in Lima, Peru. Alzheimers Dement 2022. [DOI: 10.1002/alz.063245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | | | | | - Eder Herrera‐Perez
- Instituto Peruano de Neurociencias Lima Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola Lima Peru
| | - Maritza Pintado Caipa
- Instituto Peruano de Neurociencias Lima Peru
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California of San Francisco San Francisco CA USA
| | | | - José Cuenca
- Instituto Peruano de Neurociencias Lima Peru
| | - Laura Mesia
- Instituto Peruano de Neurociencias Lima Peru
| | - Virgilio E Failoc‐Rojas
- Instituto Peruano de Neurociencias Lima Peru
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola Lima Peru
| | - Monica M Diaz
- University of North Carolina at Chapel Hill School of Medicine Chapel Hill NC USA
- Universidad Peruana Cayetano Heredia Lima Peru
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Custodio N, Soto‐Añari M, Montesinos R, Caipa MP, Ore‐Gomez MF, RIVERA‐FERNANDEZ CLAUDIA, Reyes‐Dumeyer D, Tosto G. Native American Ancestry is associated with lower risk of Alzheimer’s Disease: results from the Genetic of Alzheimer’s disease in Peruvian Populations (GAPP) study. Alzheimers Dement 2022. [DOI: 10.1002/alz.066002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nilton Custodio
- Cognitive impairment diagnosis and dementia prevention unit, Instituto Peruano de Neurociencias Lima Peru
| | | | | | - Maritza Pintado Caipa
- Cognitive impairment diagnosis and dementia prevention unit, Instituto Peruano de Neurociencias Lima Peru
| | | | | | | | - Giuseppe Tosto
- Columbia University Irving Medical Center New York NY USA
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Custodio N, Malaga D, Chambergo‐Michilot D, Ore‐Gomez MF, RIVERA‐FERNANDEZ CLAUDIA, Soto‐Añari M, Reyes‐Dumeyer D, Failoc‐Rojas VE, Casavilca‐Zambrano S, Montesinos R, Tosto G. IMPACT OF THE COVID‐19 PANDEMIC IN ADRD PATIENTS AND CAREGIVERS IN A LATIN‐AMERICAN COUNTRY. Alzheimers Dement 2022. [DOI: 10.1002/alz.066200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Nilton Custodio
- Cognitive impairment diagnosis and dementia prevention unit, Instituto Peruano de Neurociencias Lima Peru
| | | | | | | | | | | | | | | | | | | | - Giuseppe Tosto
- Columbia University Irving Medical Center New York NY USA
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15
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Custodio N, Malaga M, Chambergo-Michilot D, Montesinos R, Moron E, Vences MA, Huilca JC, Lira D, Failoc-Rojas VE, Diaz MM. Combining visual rating scales to identify prodromal Alzheimer's disease and Alzheimer's disease dementia in a population from a low and middle-income country. Front Neurol 2022; 13:962192. [PMID: 36119675 PMCID: PMC9477244 DOI: 10.3389/fneur.2022.962192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Many low- and middle-income countries, including Latin America, lack access to biomarkers for the diagnosis of prodromal Alzheimer's Disease (AD; mild cognitive impairment due to AD) and AD dementia. MRI visual rating scales may serve as an ancillary diagnostic tool for identifying prodromal AD or AD in Latin America. We investigated the ability of brain MRI visual rating scales to distinguish between cognitively healthy controls, prodromal AD and AD. Methods A cross-sectional study was conducted from a multidisciplinary neurology clinic in Lima, Peru using neuropsychological assessments, brain MRI and cerebrospinal fluid amyloid and tau levels. Medial temporal lobe atrophy (MTA), posterior atrophy (PA), white matter hyperintensity (WMH), and MTA+PA composite MRI scores were compared. Sensitivity, specificity, and area under the curve (AUC) were determined. Results Fifty-three patients with prodromal AD, 69 with AD, and 63 cognitively healthy elderly individuals were enrolled. The median age was 75 (8) and 42.7% were men. Neither sex, mean age, nor years of education were significantly different between groups. The MTA was higher in patients with AD (p < 0.0001) compared with prodromal AD and controls, and MTA scores adjusted by age range (p < 0.0001) and PA scores (p < 0.0001) were each significantly associated with AD diagnosis (p < 0.0001) but not the WMH score (p=0.426). The MTA had better performance among ages <75 years (AUC 0.90 [0.85–0.95]), while adjusted MTA+PA scores performed better among ages>75 years (AUC 0.85 [0.79–0.92]). For AD diagnosis, MTA+PA had the best performance (AUC 1.00) for all age groups. Conclusions Combining MTA and PA scores demonstrates greater discriminative ability to differentiate controls from prodromal AD and AD, highlighting the diagnostic value of visual rating scales in daily clinical practice, particularly in Latin America where access to advanced neuroimaging and CSF biomarkers is limited in the clinical setting.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Peru
- *Correspondence: Nilton Custodio
| | - Marco Malaga
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- San Martin de Porres University, Lima, Peru
| | - Diego Chambergo-Michilot
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Universidad Científica del Sur, Lima, Peru
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Elizabeth Moron
- Departamento de Radiología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru
- Servicio de Radiología, Centro de Diagnóstico por Imagen-DPI, Lima, Peru
| | - Miguel A. Vences
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Departamento de Neurología, Hospital Nacional Edgardo Rebagliati Martins, EsSalud, Lima, Peru
| | - José Carlos Huilca
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neurología, Hospital Guillermo Kaelin de La Fuente, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Virgilio E. Failoc-Rojas
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Centro de Investigación en Medicina Traslacional, Universidad Privada Norbert Wiener, Lima, Peru
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
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Custodio N, Montesinos R, Cruzado L, Alva-Díaz C, Failoc-Rojas VE, Celis V, Cuenca-Alfaro J, Lira D. Comparative study of the word capacity and episodic memory of patients with degenerative dementia. Rev Colomb Psiquiatr (Engl Ed) 2022; 51:8-16. [PMID: 35210208 DOI: 10.1016/j.rcpeng.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/03/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Although the absence of memory impairment was considered among the diagnostic criteria to differentiate Alzheimer's disease (AD) from Behavioural Variant of Frontotemporal Dementia (bvFTD), current and growing evidence indicates that a significant percentage of cases of bvFTD present with episodic memory deficits. In order to compare the performance profile of the naming capacity and episodic memory in patients with AD and bvFTD the present study was designed. METHODS Cross-sectional and analytical study with control group (32 people). The study included 42 people with probable AD and 22 with probable bvFTD, all over 60 years old. Uniform Data Set instruments validated in Spanish were used: Multilingual Naming Test (MINT), Craft-21 history and Benson's complex figure, among others. RESULTS A higher average age was observed among the patients with AD. The naming capacity was much lower in patients with bvFTD compared to patients with AD, measured according to the MINT and the nouns/verbs naming coefficient. All patients with bvFTD, 73.81% of those with AD and only 31.25% of the control group failed to recognise Benson's complex figure. All differences were statistically significant (p < 0.001). RESULTS This study confirms the amnesic profile of patients with AD and reveals the decrease in naming capacity in patients with bvFTD, an area of language that is typically affected early on with executive functions, according to recent findings. CONCLUSIONS Patients with AD perform worse in verbal and visual episodic memory tasks, while patients with bvFTD perform worse in naming tasks. These findings open the possibility of exploring the mechanisms of prefrontal participation in episodic memory, typically attributed to the hippocampus.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru; Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru; Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru; Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru; Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Lizardo Cruzado
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru; Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru; Servicio de Psiquiatría, Instituto Peruano de Neurociencias, Lima, Peru; Sección Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Carlos Alva-Díaz
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru; Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Peru; Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Peru
| | - Virgilio E Failoc-Rojas
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru; Universidad San Ignacio de Loyola, Lima, Peru
| | - Violeta Celis
- Servicio de Neurología, Hospital Belén, Trujillo, Peru
| | - José Cuenca-Alfaro
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru; Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru; Facultad de Ciencias de la Salud, Departamento de Psicología, Universidad Privada del Norte, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru; Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru; Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
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Custodio N, Montesinos R, Chambergo-Michilot D, Herrera-Perez E, Pintado-Caipa M, Seminario G W, Cuenca J, Mesía L, Failoc-Rojas VE, Diaz MM. A Functional Assessment Tool to Distinguish Controls From Alzheimer's Disease in Lima, Peru. Am J Alzheimers Dis Other Demen 2022; 37:15333175221104354. [PMID: 35656899 PMCID: PMC10581136 DOI: 10.1177/15333175221104354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The Alzheimer's Disease Cooperative Study-Activities of Daily Living (ADCS-ADL) scale is a versatile functional assessment tool for patients with Alzheimer's disease (ad). We evaluated its performance in controls, Peruvians with MCI or AD. METHODS A cross-sectional study of older adults attending a neurology institute in Lima (Peru) with mild cognitive impairment (MCI), ad or cognitively healthy. Test-retest reliability (intraclass correlation coefficient, ICC; internal consistency, Cronbach's alpha) and validity were assessed. RESULTS We enrolled 276 individuals (ad: 113, MCI: 68, controls: 95) with no age, sex, educational level, and depressive symptom differences. Reliability was ideal (ICC: .996), and Cronbach's alpha was adequate (.937). The ADCS-ADL could not differentiate MCI from controls but did differentiate ad severity. The ADCS-ADL correlated highly with nearly all tools. CONCLUSIONS The ADCS-ADL scale is reliable in a population with ad in Lima, Peru. Future work may validate a tool for Peruvians with lower educational levels.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Perú
| | | | - Eder Herrera-Perez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Grupo de Investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, USA
| | - Wendy Seminario G
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - José Cuenca
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de La Salud, Universidad Privada Del Norte, Lima, Perú
| | - Laura Mesía
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Virgilio E Failoc-Rojas
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Salud Mental, Universidad Privada Norbert Wiener, Lima, Perú
| | - Monica M Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
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18
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Montesinos R, Parodi JF, Diaz MM, Herrera-Perez E, Valeriano-Lorenzo E, Soto A, Delgado C, Slachevsky A, Custodio N. Validation of Picture Free and Cued Selective Reminding Test for Illiteracy in Lima, Peru. Am J Alzheimers Dis Other Demen 2022; 37:15333175221094396. [PMID: 35465730 PMCID: PMC10581140 DOI: 10.1177/15333175221094396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Dementia in Latin America is a crucial public health problem. Identifying brief cognitive screening (BCS) tools for the primary care setting is crucial, particularly for illiterate individuals. We evaluated tool performance characteristics and validated the free and total recall sections of the Free and Cued Selective Reminding Test-Picture version (FCSRT-Picture) to discriminate between 63 patients with early Alzheimer's disease dementia (ADD), 60 amnestic mild cognitive impairment (aMCI) and 64 cognitively healthy Peruvian individuals with illiteracy from an urban area. Clinical, functional, and cognitive assessments were performed. FCSRT-Picture performance was assessed using receiver operating characteristic curve analyses. The mean ± standard deviation scores were 7.7 ± 1.0 in ADD, 11.8 ± 1.6 in aMCI, and 29.5 ± 1.8 in controls. The FCSRT-Picture had better performance characteristics for distinguishing controls from aMCI compared with several other BCS tools, but similar characteristics between controls and early ADD. The FCSRT-Picture is a reliable BCS tool for illiteracy in Peru.
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Affiliation(s)
- Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Jose F. Parodi
- Centro de Investigación del Envejecimiento, Facultad de Medicina, Universidad de San Martín de Porres, Lima, Perú
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Eder Herrera-Perez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Grupo de Investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
| | - Elizabeth Valeriano-Lorenzo
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Ambar Soto
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Carolina Delgado
- Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile, Santiago, Chile
- Departamento de neurociencia, Facultad de medicina Universidad de Chile, Santiago, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, ICBM, Neurosciences and East Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile
- Geroscience Center for Brain Health and Metabolism (GERO), University of Chile School of Medicine, Santiago, Chile
- Memory and Neuropsychiatric Clinic (CMYN), Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile
- Neurology Unit, Department of Medicine, Alemana Clinic, Universidad del Desarrollo, Santiago, Chile
| | - Nilton Custodio
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Lima, Perú
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Custodio N, Montesinos R, Alva-Diaz C, Pacheco-Barrios K, Rodriguez-Calienes A, Herrera-Pérez E, Becerra-Becerra Y, Castro-Suárez S, Pintado-Caipa M, Cruz Del Castillo R, Cuenca J, Lira D. Diagnostic accuracy of brief cognitive screening tools to diagnose vascular cognitive impairment in Peru. Int J Geriatr Psychiatry 2022; 37. [PMID: 33682923 DOI: 10.1002/gps.5531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION To evaluate the diagnostic accuracy of three brief cognitive screening (BCS) tools, Peruvian version of Addenbrooke's Cognitive Examination (ACE-Pe), of INECO Frontal Screening (IFS-Pe) and of the Mini-Mental State Examination (MMSE-Pe), for the diagnosis of vascular cognitive impairment (VCI) and its non-dementia stages (VCI-ND) and vascular dementia (VD) in patients with cerebral stroke in Lima-Peru. MATERIALS AND METHODS A cohort analysis to evaluate the diagnostic accuracy of three BCS for VCI. RESULTS Two hundred and four patients were evaluated: 61% Non-VCI, 30% VCI-ND and 9% VD. To discriminate patients with VCI from controls, the area under the curve (AUC) of ACE-Pe, IFS-Pe and MMs-Pe were 0.99 (95% confidence interval [CI] 0.98-0.99), 0.99 (95%CI 0.98-0.99) and 0.87 (95%CI 0.82-0.92), respectively. Of the three BCS, the IFS-Pe presented a larger AUC to discriminate VCI-ND from VD (AUC = 0.98 [95%CI 0.95-1]) compared to ACE-Pe (AUC = 0.84 [95%CI 0.74-0.95]) and MMSE-Pe (0.92 [95%CI 0.86-0.99]). The IFS-Pe presented a higher sensitivity (S), specificity (Sp), and positive (+LR) and negative likelihood ratios (-LR) (S = 96.72%, Sp = 89.47%, +LR = 9.1 and -LR = 0.03) than ACE-Pe (S = 96.72%, Sp = 63.16%, +LR = 2.62 and -LR = 0.05) and MMSE-Pe (S = 90.16%, Sp = 78.95%, +LR = 4.28 and -LR = 0.12). In the multiple regression analysis, the IFS-Pe was not affected by age, sex or years of schooling. CONCLUSION The IFS-Pe has the best diagnostic accuracy for detecting VCI and discriminating between pre-dementia (VCI-ND) and dementia (VD) stages.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Carlos Alva-Diaz
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Perú.,Grupo de Investigación Neurociencia, Efectividad Clínica y Salud Pública, Universidad Científica del Sur, Lima, Perú
| | - Kevin Pacheco-Barrios
- Red de Eficacia Clínica y Sanitaria, REDECS, Callao, Perú.,Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Perú
| | - Aaron Rodriguez-Calienes
- Red de Eficacia Clínica y Sanitaria, REDECS, Callao, Perú.,Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú.,Grupo Estudiantil de Investigación en Neurociencias, Sociedad de Estudiantes de Medicina Humana de la Facultad de Medicina Humana de la Universidad de San Martin de Porres, Lima, Perú
| | - Eder Herrera-Pérez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Grupo de Investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
| | - Yahaira Becerra-Becerra
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Servicio de Geriatría, Hospital Geriátrico Militar, Lima, Perú
| | - Sheila Castro-Suárez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Servicio de Neurología de la conducta y Neuro-inmunología clínica, Instituto Nacional de Ciencias Neurológicas, Lima, Perú
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Rossana Cruz Del Castillo
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Servicio de Geriatría, Programa de Atención Domiciliaria-PADOMI, EsSalud, Lima, Perú
| | - José Cuenca
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.,Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Perú.,Carrera de Psicología, Facultad de Ciencias de la Salud. Universidad Privada del Norte, Lima, Perú
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
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Castro‐Suarez S, Failoc‐Rojas VE, del Castillo RC, Montesinos R, Herrera‐Perez E, Custodio N. Behavioral and psychological symptoms of Alzheimer’s disease during the COVID‐19 pandemic in underserved settings. Alzheimers Dement 2021. [PMCID: PMC9011720 DOI: 10.1002/alz.054780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Background The behavioral and psychological symptoms of dementia (BPSD) are characterized by disturbances in perceptions, thought contents, moods, and behaviors. The causes for these symptoms are connected to factors related to the people with dementia (PWD), his/her caregivers, and environmental factors as well as the interrelationship between these three. Disruptions of routine due to confinements during the COVID‐19 pandemic has led to the onset/worsening of BPSD, thereby increasing distress levels in caregivers, and risks of self‐injury, hospitalization, and death for PWD. Our aim is to describe the onset/ worsening of BPSD during COVID‐19 pandemic confinement. Method This is a longitudinal study in patients and caregivers of people with Alzheimer’s disease from the Instituto Peruano de Neurociencias in Lima, Perú. A structured confinement interview was delivered to caregivers exploring how the caregiver's activities have been affected or modified by the confinement measures. All patients have neuropsychological, neuropsychiatric, and functional assessments performed six months before the onset of the confinement. BPSD was assessed using the neuropsychiatric inventory questionnaire (NPI). Result A total of 91 patients with Alzheimer’s disease and caregivers participated in the study. The average age of the patients was 73.4 years. Most patients had a CDR score of 0.5‐1. Caregivers reported that the pandemic affected their mood by 74%. Percentage of time spent caring increased from 15% to 25% (p<0.001). Worsening and new onset of behavioral and psychological symptoms were reported. The NPI (Fig 1.) and ADCS_ADL scores increased significantly during quarantine from baseline (6.6 and 10, respectively) (p<0.001). Delusions (75%), sleep disorder (71.7%), and hallucinations were the most frequently reported worsening symptoms. Sleep disorder (71.1%), agitation (68.6%) and depression (53.3%) were the most frequently reported new symptoms (p<0.001) (Table 1). Profile of BPSD did not vary according to the CDR score. Conclusion Quarantine induces increases in behavioral and psychological symptoms in patients with early stages of Alzheimer’s disease. Caregivers spent more time with the patient with AD and their emotions were affected by the pandemic. We need to plan for strategies in order to address these needs.
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Affiliation(s)
- Sheila Castro‐Suarez
- Research Unit, Instituto Peruano de Neurociencias Lima Peru
- Atlantic Senior Fellow for Equity in Brain Health at University of California San Francisco San Francisco CA USA
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurologicas Lima Peru
| | | | - Rossana Cruz del Castillo
- Research unit, Instituto Peruano de Neurociencias Lima Peru
- Programa de Asistencia Domiciliaria (PADOMI), EsSalud Lima Peru
| | - Rosa Montesinos
- Research Unit, Instituto Peruano de Neurociencias Lima Peru
- Instituto Peruano de Neurociencias Lima Peru
| | | | - Nilton Custodio
- Research Unit, Instituto Peruano de Neurociencias Lima Peru
- Cognitive Impairment Diagnosis and Dementia Prevention Unit, Instituto Peruano de Neurociencias Lima Peru
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21
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Diaz MM, Custodio N, Montesinos R, Lira D, Herrera-Perez E, Pintado-Caipa M, Cuenca-Alfaro J, Gamboa C, Lanata S. Thyroid Dysfunction, Vitamin B12, and Folic Acid Deficiencies Are Not Associated With Cognitive Impairment in Older Adults in Lima, Peru. Front Public Health 2021; 9:676518. [PMID: 34552900 PMCID: PMC8450418 DOI: 10.3389/fpubh.2021.676518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 08/12/2021] [Indexed: 01/27/2023] Open
Abstract
Background: Reversible etiologies of cognitive impairment are common and treatable, yet the majority of mild cognitive impairment (MCI) and dementia research in Latin America has focused on irreversible, neurodegenerative etiologies. Objective: We sought to determine if thyroid dysfunction and vitamin B12 and folate deficiencies are associated with cognitive disorders among older adults with memory complaints in Lima, Peru. Methods: This was a retrospective review of patients who presented for cognitive evaluations to a multidisciplinary neurology clinic in Lima, Peru from January 2014 to February 2020. We included individuals aged ≥60 years, native Spanish-speakers, with at least a primary school educational level and a complete clinical assessment. Patients had either subjective cognitive decline (SCD), MCI, or dementia. One-way ANOVA and multiple logistic regression analyses were performed. Results: We included 720 patients (330 SCD, 154 MCI, and 236 dementia); the dementia group was significantly older [mean age SCD 69.7 ± 4.1, dementia 72.4 ± 3.7 (p = 0.000)] and had lower folate levels than SCD patients. The MCI group had higher free T3 levels compared with SCD patients. Those with lower TSH had greater dementia risk (OR = 2.91, 95%CI: 1.15-6.86) but not MCI risk in unadjusted models. B12 deficiency or borderline B12 deficiency was present in 34% of the dementia group, yet no clear correlation was seen between neuropsychological test results and B12 levels in our study. There was no association between MCI or dementia and thyroid hormone, B12 nor folate levels in adjusted models. Conclusion: Our findings do not support an association between metabolic and endocrine disorders and cognitive impairment in older Peruvians from Lima despite a high prevalence of B12 deficiency. Future work may determine if cognitive decline is associated with metabolic or endocrine changes in Latin America.
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Affiliation(s)
- Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Peru
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Atlantic Fellow, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Jose Cuenca-Alfaro
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Serggio Lanata
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
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22
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Custodio N, Montesinos R, Cruzado L, Herrera-Perez E, Failoc-Rojas VE, Pintado-Caipa M, Seminario G W, Cuenca J, Gamboa C, Diaz MM. Social Cognition and Behavioral Assessments Improve the Diagnosis of Behavioral Variant of Frontotemporal Dementia in Older Peruvians With Low Educational Levels. Front Neurol 2021; 12:704109. [PMID: 34552551 PMCID: PMC8450322 DOI: 10.3389/fneur.2021.704109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 07/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The behavioral variant of frontotemporal dementia (bvFTD), characterized by early behavioral abnormalities and late memory impairment, is a neurodegenerative disorder with a detrimental impact on patients and their caregivers. bvFTD is often difficult to distinguish from other neurodegenerative diseases, such as Alzheimer's disease (AD), using brief cognitive tests. Combining brief socio-cognitive and behavioral evaluations with standard cognitive testing could better discriminate bvFTD from AD patients. We sought to evaluate the diagnostic accuracy of brief socio-cognitive tests that may differentiate bvFTD and AD patients with low educational levels. Methods: A prospective study was performed on 51 individuals over the age of 50 with low educational levels, with bvFTD or AD diagnosed using published criteria, and who were receiving neurological care at a multidisciplinary neurology clinic in Lima, Peru, between July 2017 and December 2020. All patients had a comprehensive neurological evaluation, including a full neurocognitive battery and brief tests of cognition (Addenbrooke's Cognitive Examination version III, ACE-III), social cognition (Mini-social Cognition and Emotional Assessment, Mini-SEA), and behavioral assessments (Frontal Behavioral Inventory, FBI; Interpersonal Reactivity Index-Emphatic Concern, IRI-EC; IRI-Perspective Taking, IRI-PT; and Self-Monitoring Scale-revised version, r-SMS). Receiver operating characteristic (ROC) analysis to calculate the area under the curve (AUC) was performed to compare the brief screening tests individually and combined to the gold standard of bvFTD and AD diagnoses. Results: The AD group was significantly older than the bvFTD group (p < 0.001). An analysis of the discriminatory ability of the ACE-III to distinguish between patients with AD and bvFTD (AUC = 0.85) and the INECO Frontal Screening (IFS; AUC = 0.78) shows that the former has greater discriminatory ability. Social and behavioral cognition tasks were able to appropriately discriminate bvFTD from AD. The Mini-SEA had high sensitivity and high moderate specificity (83%) for discriminating bvFTD from AD, which increased when combined with the brief screening tests ACE-III and IFS. The FBI was ideal with high sensitivity (83%), as well as the IRI-EC and IRI-PT that also were adequate for distinguishing bvFTD from AD. Conclusions: Our study supports the integration of socio-behavioral measures to the standard global cognitive and social cognition measures utilized for screening for bvFTD in a population with low levels of education.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lizardo Cruzado
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Instituto Nacional de Salud Mental “Honorio Delgado—Hideyo Noguchi”, Lima, Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Virgilio E. Failoc-Rojas
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Atlantic Fellow, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - Wendy Seminario G
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
| | - José Cuenca
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención De Demencia, Instituto Peruano de Neurociencias, Lince, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lince, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
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23
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Custodio N, Montesinos R, Diaz MM, Herrera-Perez E, Chavez K, Alva-Diaz C, Reynoso-Guzman W, Pintado-Caipa M, Cuenca J, Gamboa C, Lanata S. Performance of the Rowland Universal Dementia Assessment Scale for the Detection of Mild Cognitive Impairment and Dementia in a Diverse Cohort of Illiterate Persons From Rural Communities in Peru. Front Neurol 2021; 12:629325. [PMID: 34305773 PMCID: PMC8292605 DOI: 10.3389/fneur.2021.629325] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 06/14/2021] [Indexed: 12/05/2022] Open
Abstract
Background: The accurate diagnosis of neurocognitive disorders in illiterate Peruvian populations is challenging, largely owing to scarcity of brief cognitive screening tools (BCST) validated in these diverse populations. The Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) is a BCST that relies minimally on educational attainment and has shown good diagnostic accuracy in an urban illiterate population in Peru, yet its psychometric properties in illiterate populations in rural settings of the country have not been previously investigated. Objectives: To establish the diagnostic accuracy of the RUDAS-PE compared to expert clinical diagnosis using the Clinical Dementia Rating (CDR) Scale in healthy and cognitively impaired illiterate persons living in two culturally and geographically distinct rural communities of Peru. Methods: A cross-sectional, population-based study of residents ≥ 50 years of age living in the Peruvian rural communities of Santa Clotilde and Chuquibambilla. A total of 129 subjects (76 from Santa Clotilde and 53 from Chuquibambilla) were included in this study. Gold standard diagnostic neurocognitive evaluation was based on expert neurological history and examination and administration of the CDR. Receiver operating characteristics, areas under the curve (AUC), and logistic regression analyses were conducted to determine the performance of RUDAS-PE compared to expert gold standard diagnosis. Results: Compared to gold standard diagnosis, the RUDAS-PE was better at correctly discriminating between MCI and dementia than discriminating between MCI and controls in both sites (97.0% vs. 76.2% correct classification in Chuquibambilla; 90.0% vs. 64.7% in Santa Clotilde). In Chuquibambilla, the area under the curve (AUC) of the RUDAS to discriminate between dementia and MCI was 99.4% (optimal cutoff at <18), whereas between MCI and controls it was 82.8% (optimal cutoff at <22). In Santa Clotilde, the area under the curve (AUC) of the RUDAS to discriminate between dementia and MCI was 99.1% (optimal cutoff at <17), whereas between MCI and controls it was 75.5% (optimal cutoff at <21). Conclusions: The RUDAS-PE has acceptable psychometric properties and performed well in its ability to discriminate MCI and dementia in two cohorts of illiterate older adults from two distinct rural Peruvian communities.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Monica M. Diaz
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Unidad de epidemiología, ITS y VIH, Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Peru
| | - Kristhy Chavez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Carlos Alva-Diaz
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
| | - Willyams Reynoso-Guzman
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Atlantic Fellow, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - José Cuenca
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Serggio Lanata
- Department of Neurology, University of California, San Francisco, San Francisco, CA, United States
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
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24
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Marca-Ysabel MV, Rajabli F, Cornejo-Olivas M, Whitehead PG, Hofmann NK, Illanes Manrique MZ, Veliz Otani DM, Milla Neyra AK, Castro Suarez S, Meza Vega M, Adams LD, Mena PR, Rosario I, Cuccaro ML, Vance JM, Beecham GW, Custodio N, Montesinos R, Mazzetti Soler PE, Pericak-Vance MA. Dissecting the role of Amerindian genetic ancestry and the ApoE ε4 allele on Alzheimer disease in an admixed Peruvian population. Neurobiol Aging 2021; 101:298.e11-298.e15. [PMID: 33541779 PMCID: PMC8122013 DOI: 10.1016/j.neurobiolaging.2020.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/29/2020] [Accepted: 10/01/2020] [Indexed: 01/21/2023]
Abstract
Alzheimer disease (AD) is the leading cause of dementia in the elderly and occurs in all ethnic and racial groups. The apolipoprotein E (ApoE) ε4 is the most significant genetic risk factor for late-onset AD and shows the strongest effect among East Asian populations followed by non-Hispanic white populations and has a relatively lower effect in African descent populations. Admixture analysis in the African American and Puerto Rican populations showed that the variation in ε4 risk is correlated with the genetic ancestral background local to the ApoE gene. Native American populations are substantially underrepresented in AD genetic studies. The Peruvian population with up to ~80 of Amerindian (AI) ancestry provides a unique opportunity to assess the role of AI ancestry in AD. In this study, we assess the effect of the ApoE ε4 allele on AD in the Peruvian population. A total of 79 AD cases and 128 unrelated cognitive healthy controls from Peruvian population were included in the study. Genome-wide genotyping was performed using the Illumina Global screening array v2.0. Global ancestry and local ancestry analyses were assessed. The effect of the ApoE ε4 allele on AD was tested using a logistic regression model by adjusting for age, gender, and population substructure (first 3 principal components). Results showed that the genetic ancestry surrounding the ApoE gene is predominantly AI (60.6%) and the ε4 allele is significantly associated with increased risk of AD in the Peruvian population (odds ratio = 5.02, confidence interval: 2.3-12.5, p-value = 2e-4). Our results showed that the risk for AD from ApoE ε4 in Peruvians is higher than we have observed in non-Hispanic white populations. Given the high admixture of AI ancestry in the Peruvian population, it suggests that the AI genetic ancestry local to the ApoE gene is contributing to a strong risk for AD in ε4 carriers. Our data also support the findings of an interaction between the genetic risk allele ApoE ε4 and the ancestral backgrounds located around the genomic region of ApoE gene.
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Affiliation(s)
| | - Farid Rajabli
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mario Cornejo-Olivas
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Center for Global Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patrice G Whitehead
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Natalia K Hofmann
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Diego Martin Veliz Otani
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Fogarty Northern Pacific Global Health Fellows Program, Lima, Peru; Fogarty Interdisciplinary Cerebrovascular Diseases Training Program in South America, Lima, Peru
| | | | - Sheila Castro Suarez
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; Atlantic Fellow of Global Brain Health Institute, San Francisco, CA, USA
| | - Maria Meza Vega
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Larry D Adams
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Pedro R Mena
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Isasi Rosario
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael L Cuccaro
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jeffery M Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Gary W Beecham
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | - Pilar E Mazzetti Soler
- Neurogenetics Research Center, Instituto Nacional de Ciencias Neurológicas, Lima, Peru; School of Medicine, Universidad Nacional Mayor de San Marcos, Lima, Peru
| | - Margaret A Pericak-Vance
- John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA; Dr. John Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, FL, USA.
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25
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Parra MA, Baez S, Sedeño L, Gonzalez Campo C, Santamaría‐García H, Aprahamian I, Bertolucci PHF, Bustin J, Camargos Bicalho MA, Cano‐Gutierrez C, Caramelli P, Chaves MLF, Cogram P, Beber BC, Court FA, de Souza LC, Custodio N, Damian A, de la Cruz M, Diehl Rodriguez R, Brucki SMD, Fajersztajn L, Farías GA, De Felice FG, Ferrari R, de Oliveira FF, Ferreira ST, Ferretti C, Figueredo Balthazar ML, Ferreira Frota NA, Fuentes P, García AM, Garcia PJ, de Gobbi Porto FH, Duque Peñailillo L, Engler HW, Maier I, Mata IF, Gonzalez‐Billault C, Lopez OL, Morelli L, Nitrini R, Quiroz YT, Guerrero Barragan A, Huepe D, Pio FJ, Suemoto CK, Kochhann R, Kochen S, Kumfor F, Lanata S, Miller B, Mansur LL, Hosogi ML, Lillo P, Llibre Guerra J, Lira D, Lopera F, Comas A, Avila‐Funes JA, Sosa AL, Ramos C, Resende EDPF, Snyder HM, Tarnanas I, Yokoyama J, Llibre J, Cardona JF, Possin K, Kosik KS, Montesinos R, Moguilner S, Solis PCL, Ferretti‐Rebustini REDL, Ramirez JM, Matallana D, Mbakile‐Mahlanza L, Marques Ton AM, Tavares RM, Miotto EC, Muniz‐Terrera G, Muñoz‐Nevárez LA, Orozco D, Okada de Oliveira M, Piguet O, Pintado Caipa M, Piña Escudero SD, Schilling LP, Rodrigues Palmeira AL, Yassuda MS, Santacruz‐Escudero JM, Serafim RB, Smid J, Slachevsky A, Serrano C, Soto‐Añari M, Takada LT, Grinberg LT, Teixeira AL, Barbosa MT, Trépel D, Ibanez A. Dementia in Latin America: Paving the way toward a regional action plan. Alzheimers Dement 2021; 17:295-313. [PMID: 33634602 PMCID: PMC7984223 DOI: 10.1002/alz.12202] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 12/12/2022]
Abstract
Across Latin American and Caribbean countries (LACs), the fight against dementia faces pressing challenges, such as heterogeneity, diversity, political instability, and socioeconomic disparities. These can be addressed more effectively in a collaborative setting that fosters open exchange of knowledge. In this work, the Latin American and Caribbean Consortium on Dementia (LAC-CD) proposes an agenda for integration to deliver a Knowledge to Action Framework (KtAF). First, we summarize evidence-based strategies (epidemiology, genetics, biomarkers, clinical trials, nonpharmacological interventions, networking, and translational research) and align them to current global strategies to translate regional knowledge into transformative actions. Then we characterize key sources of complexity (genetic isolates, admixture in populations, environmental factors, and barriers to effective interventions), map them to the above challenges, and provide the basic mosaics of knowledge toward a KtAF. Finally, we describe strategies supporting the knowledge creation stage that underpins the translational impact of KtAF.
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Affiliation(s)
- Mario Alfredo Parra
- School of Psychological Sciences and HealthGraham Hills BuildingGlasgow, G1 1QE, UK, Universidad Autónoma del CaribePrograma de PsicologíaUniversity of StrathclydeBarranquillaColombia
| | | | - Lucas Sedeño
- Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET)Buenos AiresArgentina
| | - Cecilia Gonzalez Campo
- Cognitive Neuroscience Center (CNC)Universidad de San AndresConsejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET)Buenos AiresArgentina
| | - Hernando Santamaría‐García
- Pontificia Universidad JaverianaMedical School, Physiology and Psychiatry DepartmentsMemory and Cognition Center IntellectusHospital Universitario San IgnacioBogotáColombia
| | - Ivan Aprahamian
- Department of Internal MedicineFaculty of Medicine of JundiaíGroup of Investigation on Multimorbidity and Mental Health in Aging (GIMMA)JundiaíState of São PauloBrazil
| | - Paulo HF Bertolucci
- Department of Neurology and NeurosurgeryEscola Paulista de MedicinaFederal University of São Paulo ‐ UNIFESPSão PauloBrazil
| | - Julian Bustin
- INECO FoundationInstitute of Cognitive and Translational Neuroscience (INCYT)Favaloro UniversityBuenos AiresArgentina
| | | | - Carlos Cano‐Gutierrez
- Medical SchoolGeriatric Unit, Memory and Cognition Center‐IntellectusAging InstituteHospital Universitario San IgnacioPontificia Universidad JaverianaBogotáColombia
| | - Paulo Caramelli
- Faculdade de MedicinaUniversidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Marcia L. F. Chaves
- Neurology ServiceHospital de Clínicas de Porto Alegre e Universidade Federal do Rio Grande do SulBrazil
| | - Patricia Cogram
- Laboratory of Molecular NeuropsychiatryINECO FoundationNational Scientific and Technical Research CouncilInstitute of Cognitive and Translational Neuroscience (INCyT)Favaloro UniversityBuenos AiresArgentina
| | - Bárbara Costa Beber
- Department of Speech and Language PathologyAtlantic Fellow for Equity in Brain HealthFederal University of Health Sciences of Porto Alegre (UFCSPA)Porto AlegreBrazil
| | - Felipe A. Court
- Center for Integrative BiologyFaculty of SciencesFONDAP Center for GeroscienceBrain Health and Metabolism, Santiago, Chile, The Buck Institute for Research on AgingUniversidad Mayor, ChileNovatoCAUSA
| | | | - Nilton Custodio
- Unit Cognitive Impairment and Dementia PreventionCognitive Neurology CenterPeruvian Institute of NeurosciencesLimaPerú
| | - Andres Damian
- Centro Uruguayo de Imagenología Molecular (CUDIM)Centro de Medicina Nuclear e Imagenología MolecularHospital de ClínicasUniversidad de la RepúblicaMontevideoUruguay
| | - Myriam de la Cruz
- Global Brain Health Institute, University of CaliforniaSan FranciscoUSA
| | - Roberta Diehl Rodriguez
- Behavioral and Cognitive Neurology UnitDepartment of Neurology and LIM 22University of São PauloSão PauloBrazil
| | | | - Lais Fajersztajn
- Laboratory of Experimental Air Pollution (LIM05)Department of PathologySchool of MedicineGlobal Brain Health Institute, University of CaliforniaSan Francisco (UCSF)University of São PauloSão PauloSao PauloBrazil
| | - Gonzalo A. Farías
- Department Neurology and Neurosurgery North/Department of NeurosciencesCenter for Advanced Clinical Research (CICA)Faculty of MedicineUniversidad de ChileSantiagoChile
| | | | - Raffaele Ferrari
- Department of Neurodegenerative DiseaseUniversity College LondonLondonESUK
| | - Fabricio Ferreira de Oliveira
- Department of Neurology and NeurosurgeryEscola Paulista de MedicinaFederal University of São Paulo ‐ UNIFESPSão PauloBrazil
| | - Sergio T. Ferreira
- Institute of Medical Biochemistry Leopoldo de Meis & Institute of Biophysics Carlos Chagas FilhoFederal University of Rio de JaneiroRio de JaneiroRJBrazil
| | - Ceres Ferretti
- Division of NeurologyUniversity of São PauloSão PauloBrazil
| | | | | | - Patricio Fuentes
- Geriatrics Section Clinical Hospital University of Chile, Santos Dumont 999 IndependenciaSantiagoChile
| | - Adolfo M. García
- Cognitive Neuroscience Center (CNC)Faculty of EducationNational University of Cuyo (UNCuyo)Universidad de San Andres. National Scientific and Technical Research Council (CONICET)MendozaArgentina
| | | | - Fábio Henrique de Gobbi Porto
- Laboratory of Psychiatric Neuroimaging (LIM‐21)Instituto de PsiquiatriaHospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloSao PauloSao PauloBrazil
| | | | | | | | - Ignacio F. Mata
- Department of Genomic MedicineLerner Research InstituteCleveland ClinicOHUSA
| | - Christian Gonzalez‐Billault
- Center for GeroscienceBrain Health and Metabolism (GERO), Santiago, Chile, and Department of Biology, Faculty of SciencesUniversity of ChileSantiagoChile
| | - Oscar L. Lopez
- Alzheimer's Disease Research CenterUniversity of PittsburghPittsburghPAUSA
| | - Laura Morelli
- Fundacion Instituto Leloir‐IIBBA‐CONICET. AveArgentina
| | - Ricardo Nitrini
- Department of NeurologyUniversity of São Paulo Medical SchoolSão PauloBrazil
| | | | - Alejandra Guerrero Barragan
- Trinity College Dublin, Dublin, Departamento de Neurologia Hospital Occidente de KennedyGlobal Brain Health InstituteUniversidad de la SabanaBogotaColombia
| | - David Huepe
- Center for Social and Cognitive Neuroscience (CSCN)School of PsychologyUniversidad Adolfo IbañezSantiagoChile
| | - Fabricio Joao Pio
- Department of NeurologyHospital Governador Celso RamosFlorianopolisBrazil
| | | | - Renata Kochhann
- Graduate Program in PsychologySchool of Health SciencesHospital Moinhos de VentoPontifical Catholic University of Rio Grande do Sul—PUCRS and Researcher OfficePorto AlegreBrazil
| | - Silvia Kochen
- Neurosciences and Complex Systems Unit (EnyS), CONICET, Hosp, El Cruce “N. Kirchner”, Univ. National A, Jauretche (UNAJ), F. Varela, Prov. Buenos Aires. Fac. MedicineUniv Nacional de Buenos Aires (UBA)Buenos AiresArgentina
| | - Fiona Kumfor
- Brain and Mind Centre and School of PsychologyUniversity of SydneySydneyNSWAustralia
| | - Serggio Lanata
- UCSF Department of NeurologyMemory and Aging CenterUCSFSan FranciscoCaliforniaUS
| | - Bruce Miller
- UCSF Department of NeurologyMemory and Aging CenterUCSFSan FranciscoCaliforniaUS
| | | | - Mirna Lie Hosogi
- Behavioral and Cognitive Unit of Department of NeurologyUniversity of São Paulo School of MedicineSao PauloBrazil
| | - Patricia Lillo
- Geroscience Center for Brain Health and Metabolism, Santiago, Chile, Departamento de Neurología Sur/Departamento de Neurociencia, Facultad de MedicinaUniversidad de ChileSantiagoChile
| | | | - David Lira
- Unit Cognitive Impairment and Dementia PreventionCognitive Neurology CenterPeruvian Institute of NeurosciencesLimaPerú
| | - Francisco Lopera
- Neuroscience Research GroupUniversidad de AntioquiaMedellínColombia
| | - Adelina Comas
- Department of Health Policy at the London School of Economics and Political ScienceLondonUK
| | | | - Ana Luisa Sosa
- Instituto Nacional de Neurología y NeurocirugíaCiudad de MéxicoMéxico
| | - Claudia Ramos
- Global Brain Health Institute, University of California, San Francisco (UCSF)San FranciscoUSA
| | | | | | - Ioannis Tarnanas
- Global Brain Health Institute, University of CaliforniaSan FranciscoUSA
- Altoida Inc.HoustonTexasUSA
| | - Jenifer Yokoyama
- UCSF Department of NeurologyMemory and Aging CenterUCSFSan FranciscoCaliforniaUS
| | | | | | - Kate Possin
- UCSF Department of NeurologyMemory and Aging CenterUCSFSan FranciscoCaliforniaUS
| | - Kenneth S. Kosik
- Neuroscience Research Institute and Dept of Molecular Cellular and Developmental BiologyUniversity of California SantaBarbaraCaliforniaUSA
| | - Rosa Montesinos
- Unit Cognitive Impairment and Dementia PreventionCognitive Neurology CenterPeruvian Institute of NeurosciencesLimaPerú
| | - Sebastian Moguilner
- Global Brain Health Institute, University of California, San Francisco (UCSF)San FranciscoUSA
| | - Patricia Cristina Lourdes Solis
- Neurosciences and Complex Systems Unit (EnyS), CONICET, Hosp, El Cruce “N. Kirchner”, Univ. National A, Jauretche (UNAJ), F. Varela, Prov. Buenos Aires. Fac. MedicineUniv Nacional de Buenos Aires (UBA)Buenos AiresArgentina
| | | | - Jeronimo Martin Ramirez
- Departamen de Admision Continua Adultos Hospital General La Raza Instituto Mexicano del Seguro SocialGlobal Brain Health Institute, Trinity College Dublin, DublinCiudad de MexicoMexico
| | - Diana Matallana
- Medical SchoolAging Institute and Psychiatry DepartmentPontificia Universidad Javeriana. Memory and Cognition Center‐IntellectusHospital Universitario San IgnacioBogotáColombia
| | - Lingani Mbakile‐Mahlanza
- Global Brain Health InstituteUniversity of California San Francisco, University of BotswanaGaboroneBotswana
| | | | | | - Eliane C Miotto
- Department of NeurologyUniversity of Sao PauloSao PauloBrazil
| | | | | | - David Orozco
- Cognitive Neuroscience Development LaboratoryAxis NeurocienciasUniversidad Nacional del Sur, Cognitive Impairment and Behavior Disorders UnitBahía BlancaArgentina
| | - Maira Okada de Oliveira
- Global Brain Health Institute, University of California, San Francisco (UCSF)San FranciscoUSA
| | - Olivier Piguet
- School of Psychology and Brain and Mind CentreUniversity of SydneyCamperdownNSWAustralia
| | - Maritza Pintado Caipa
- Global Brain Health Institute, University of California, San Francisco (UCSF)San FranciscoUSA
| | | | - Lucas Porcello Schilling
- Department of NeurologyPontificia Universidade Catolica do Rio Grande do Sul (PUCRS)Porto AlegreBrazil
| | - André Luiz Rodrigues Palmeira
- Santa Casa de Misericórdia de Porto Alegre, Serviço de Neurologia, Porto Alegre, BrazilHospital Ernesto DornellesServiço de Neurologia e NeurocirurgiaPorto AlegreBrazil
| | | | - Jose Manuel Santacruz‐Escudero
- Medical School and Psychiatry DepartmentMemory and Cognition Center‐ IntellectusPontificia Universidad JaverianaHospital Universitario San IgnacioBogotáColombia
| | | | - Jerusa Smid
- Department of NeurologyUniversity of Sao PauloSão PauloBrazil
| | - Andrea Slachevsky
- Neurology DepartmentGeroscience Center for Brain Health and Metabolism, Santiago, Chile, Laboratory of Neuropsychology and Clinical Neuroscience (LANNEC), Physiopathology Program‐ICBM, East Neurologic and Neurosciences Departments, Faculty of MedicineHospital del Salvador and Faculty of Medicine University of Chile. Servicio de NeurologíaDepartamento de MedicinaClínica Alemana—Universidad del DesarrolloUniversity of Chile, Neuropsychiatry and Memory Disorders clinic (CMYN)SantiagoChile
| | | | | | | | - Lea Tenenholz Grinberg
- Departments of NeurologyPathology and Global Brain Health InstituteUCSF ‐ USA, Department of PathologyUniversity of São Paulo Medical SchoolSão PauloBrazil
| | - Antonio Lucio Teixeira
- Laboratório Interdisciplinar de Investigação MédicaFaculdade de MedicinaAv. Alfredo Balena, 110Universidade Federal de Minas GeraisBelo HorizonteBrazil
| | - Maira Tonidandel Barbosa
- Faculdade de Medicina da Universidade Federal de Minas Gerais e Faculdade deCiências Médicas de Minas GeraisBelo HorizonteBrazil
| | - Dominic Trépel
- Global Brain Health Institute (GBHI)Trinity College DublinDublin
| | - Agustin Ibanez
- Cognitive Neuroscience Center (CNC) Buenos Aires, Argentina; Universidad Autonoma del Caribe, Barranquilla, Colombia; Global Brain Health Institute (GBHI), USUniversidad de San AndresCONICETUniversidad Autonoma del CaribeUniversidad Adolfo IbanezUCSFUSA
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Custodio N, Castro-Suárez S, Montesinos R, Failoc-Rojas VE, Cruz del Castillo R, Herrera-Perez E. Neuropsychiatric Symptoms in Patients With Alzheimer's Disease During SARS-COV-2 Pandemic in Peru. Am J Alzheimers Dis Other Demen 2021; 36:15333175211039089. [PMID: 34416114 PMCID: PMC10581147 DOI: 10.1177/15333175211039089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
To evaluate neuropsychiatric symptoms in patients with Alzheimer's disease (AD) and their association with cognition and functionality during lockdown of the COVID-19's first wave. We included 91 patients and caregivers of people with AD from a memory clinic. The RUDAS, M@T, and CDR were administered to patients and NPI/ADCS-ADL to caregivers. Baseline and lockdown measurements scales were analyzed to compare the frequencies at baseline versus lockdown and conditional Odds Ratio (ORc) was calculated for the neuropsychiatric symptoms. During the pandemic, significant increase in the number of cases was observed in depression (23%), agitation (36.8%), aberrant motor activity (12%), sleep disorders (26.3%), and appetite change (12.1%). In worsening of pre-existing symptoms, the most frequent were delusions (75%), followed by sleep disorders (71.7%). Lockdown induces a rapid increase of neuropsychiatric symptoms affecting cognitive symptoms and functionality of Peruvian patients with AD.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
| | - Sheila Castro-Suárez
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Atlantic Senior Fellow of Global Brain Health Institute, University of California, San Francisco, CA. USA
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Virgilio E. Failoc-Rojas
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Vicerrectorado de Investigación, Lima, Perú
| | - Rossana Cruz del Castillo
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- Servicio de Geriatría, Programa de Atención Domiciliaria-PADOMI, EsSalud, Lima, Perú
| | - Eder Herrera-Perez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Departamento de Investigación y docencia, Instituto Peruano de Neurociencias, Lima, Perú
- CBI en Demencias y Enfermedades Desmielinizantes del Sistema Nervioso, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
- Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
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27
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Parra MA, Custodio N, Montesinos R, Pintado Caipa M, Reynoso‐Guzman W, Slachevsky A. Cultural validity of cognitive markers for Alzheimer’s disease (AD): Evidence for global strategies. Alzheimers Dement 2020. [DOI: 10.1002/alz.045356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mario A. Parra
- Universidad Autónoma de Caribe Barranquilla Colombia
- University of Strathclyde Glasgow United Kingdom
| | | | | | - Maritza Pintado Caipa
- Global Brain Health Institute at University of California of San Francisco San Francisco CA USA
| | - Wylliams Reynoso‐Guzman
- Research Unity, Instituto Peruano de Neurociencias Lima Peru
- Cognitive Decline and Dementia Diagnostic and Prevention Services Unit, Instituto Peruano de Neurociencias Lima Peru
| | - Andrea Slachevsky
- Memory and Neuropsychiatric Clinic (CMYN) Neurology Department‐ Hospital del Salvador & University of Chile Santiago Chile
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28
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Caipa MP, Custodio N, Montesinos R. Validation of the RUDAS for the identification of dementia in illiterate and low‐educated older adults in Lima, Peru. Alzheimers Dement 2020. [DOI: 10.1002/alz.041967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Maritza Pintado Caipa
- Global Brain Health Institute at University of California of San Francisco San Francisco CA USA
- Global Brain Health Institute San Francisco CA USA
- Instituto Peruano de Neurociencias Lima Peru
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29
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Cornejo‐Olivas MR, Rajabli F, Veliz‐Otani DM, Whitehead PL, Hofmann NK, Hamilton‐Nelson KL, Illanes‐Manrique M, Milla‐Neyra K, Marca V, Sarapura‐Castro E, Rivera‐Valdivia A, Mejía KK, Adams LD, Mena PR, Vance JM, Isasi R, Cuccaro ML, Beecham GW, Meza‐Vega M, Castro‐Suarez S, Custodio N, Montesinos R, Mazzetti P, Pericak‐Vance MA. Exploring the role of Amerindian genetic ancestry and
ApoEε4
gene on Alzheimer disease in the Peruvian population. Alzheimers Dement 2020. [DOI: 10.1002/alz.045012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mario R. Cornejo‐Olivas
- Instituto Nacional de Ciencias Neurologicas Lima Peru
- Fundacion San Marcos Lima Peru
- Universidad Peruana Cayetano Heredia Lima Peru
| | - Farid Rajabli
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Diego M. Veliz‐Otani
- Instituto Nacional de Ciencias Neurologicas Lima Peru
- Fundacion San Marcos Lima Peru
- Fogarty Northern Pacific Global Health Fellows Program/Fogarty Interdisciplinary Cerebrovascular Diseases Training Program in South American Bethesda MD USA
| | - Patrice L. Whitehead
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Natalia K. Hofmann
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Kara L. Hamilton‐Nelson
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | | | - Karina Milla‐Neyra
- Instituto Nacional de Ciencias Neurologicas Lima Peru
- Fundacion San Marcos Lima Peru
| | - Victoria Marca
- Instituto Nacional de Ciencias Neurologicas Lima Peru
- Fundacion San Marcos Lima Peru
| | | | | | | | - Larry D. Adams
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Pedro Ramon Mena
- John P. Hussman Institute for Human Genomics University of Miami Miller School of Medicine Miami FL USA
| | - Jeffery M. Vance
- Dr. John T. Macdonald Department of Genetics University of Miami Miller School of Medicine Miami FL USA
| | | | - Michael L. Cuccaro
- Dr. John T. Macdonald Foundation Department of Human Genetics University of Miami Miller School of Medicine Miami FL USA
| | - Gary W. Beecham
- Dr. John T. Macdonald Foundation Department of Human Genetics University of Miami Miller School of Medicine Miami FL USA
| | - Maria Meza‐Vega
- Instituto Nacional de Ciencias Neurologicas Lima Peru
- Universidad Nacional Mayor de San Marcos Lima Peru
| | - Sheila Castro‐Suarez
- Instituto Nacional de Ciencias Neurologicas Lima Peru
- Atlantic Fellow for Equity in Brain Health at University of California San Francisco San Francisco CA USA
| | | | | | - Pilar Mazzetti
- Instituto Nacional de Ciencias Neurologicas Lima Peru
- Fundacion San Marcos Lima Peru
- Universidad Nacional Mayor de San Marcos Lima Peru
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30
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Custodio N, Montesinos R, Cruzado L, Alva-Díaz C, Failoc-Rojas VE, Celis V, Cuenca-Alfaro J, Lira D. Comparative Study of the Word Capacity and Episodic Memory of Patients with Degenerative Dementia. Rev Colomb Psiquiatr (Engl Ed) 2020; 51:S0034-7450(20)30083-4. [PMID: 33735000 DOI: 10.1016/j.rcp.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/03/2020] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Although the absence of memory impairment was considered among the diagnostic criteria to differentiate Alzheimer's disease (AD) from Behavioural Variant of Frontotemporal Dementia (bvFTD), current and growing evidence indicates that a significant percentage of cases of bvFTD present with episodic memory deficits. In order to compare the performance profile of the naming capacity and episodic memory in patients with AD and bvFTD the present study was designed. METHODS Cross-sectional and analytical study with control group (32 people). The study included 42 people with probable AD and 22 with probable bvFTD, all over 60 years old. Uniform Data Set instruments validated in Spanish were used: Multilingual Naming Test (MINT), Craft-21 history and Benson's complex figure, among others. RESULTS A higher average age was observed among the patients with AD. The naming capacity was much lower in patients with bvFTD compared to patients with AD, measured according to the MINT and the nouns/verbs naming coefficient. All patients with bvFTD, 73.81% of those with AD and only 31.25% of the control group failed to recognise Benson's complex figure. All differences were statistically significant (p <0.001). RESULTS This study confirms the amnesic profile of patients with AD and reveals the decrease in naming capacity in patients with bvFTD, an area of language that is typically affected early on with executive functions, according to recent findings. CONCLUSIONS Patients with AD perform worse in verbal and visual episodic memory tasks, while patients with bvFTD perform worse in naming tasks. These findings open the possibility of exploring the mechanisms of prefrontal participation in episodic memory, typically attributed to the hippocampus.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú; Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú; Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú.
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú; Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú; Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Perú
| | - Lizardo Cruzado
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú; Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú; Servicio de Psiquiatría, Instituto Peruano de Neurociencias, Lima, Perú; Sección Psiquiatría y Salud Mental, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Carlos Alva-Díaz
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú; Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Perú; Servicio de Neurología, Departamento de Medicina y Oficina de Apoyo a la Docencia e Investigación (OADI), Hospital Daniel Alcides Carrión, Callao, Perú
| | - Virgilio E Failoc-Rojas
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú; Universidad San Ignacio de Loyola, Lima, Perú
| | - Violeta Celis
- Servicio de Neurología, Hospital Belén, Trujillo, Perú
| | - José Cuenca-Alfaro
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú; Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú; Facultad de Ciencias de la Salud, Departamento de Psicología, Universidad Privada del Norte, Lima, Perú
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú; Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú; Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Perú
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31
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Custodio N, Duque L, Montesinos R, Alva-Diaz C, Mellado M, Slachevsky A. Systematic Review of the Diagnostic Validity of Brief Cognitive Screenings for Early Dementia Detection in Spanish-Speaking Adults in Latin America. Front Aging Neurosci 2020; 12:270. [PMID: 33101004 PMCID: PMC7500065 DOI: 10.3389/fnagi.2020.00270] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/04/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives: The aim of this study was to evaluate the validity of brief cognitive screening (BCS) tools designed to diagnose mild cognitive impairment (MCI) or dementia in Spanish-speaking individuals over the age of 50 years from Latin America (LA). Methods: A systematic search of titles and abstracts in Medline, Biomed Central, Embase, Scopus, Scirus, PsycINFO, LILACS, and SciELO was conducted. Inclusion criteria were papers written in English or Spanish involving samples from Spanish-speaking Latin American individuals published until 2018. Standard procedures were applied for reviewing the literature. The data related to the study sample, methodology, and procedures applied, as well as the performance obtained with the corresponding BCS, were collected and systematized. Results: Thirteen of 211 articles met the inclusion criteria. The studies primarily involved memory clinic-based samples, with the exception of two studies from an adult day-care center, one from a primary care clinic, and one from a community-based sample. All the studies originated from five of the 20 countries of LA and all used standardized diagnostic criteria for the diagnosis of dementia and MCI; however, the diagnostic protocols applied differed. Most studies reported samples with an average of 10 years of education and only one reported a sample with an average of <5 years of education. No publication to date has included an illiterate population. Although the Montreal cognitive assessment (MoCA) is the most widely-used BCS tool in LA, it is significantly influenced by education level. Conclusions: Although evidence is still limited, the findings from studies on LA populations suggest that MoCA requires cultural adaptations and different cutoff points according to education level. Moreover, the diagnostic validity of the INECO frontal screening (IFS) test should be evaluated in populations with a low level of education. Given the heterogeneity that exists in the levels of education in LA, more studies involving illiterate and indigenous populations are required.
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Affiliation(s)
- Nilton Custodio
- Research Unit, Instituto Peruano de Neurociencias, Lima, Peru.,Cognitive Decline and Dementia Diagnostic and Prevention Services Unit, Instituto Peruano de Neurociencias, Lima, Peru.,Neurology Department, Instituto Peruano de Neurociencias, Lima, Peru
| | | | - Rosa Montesinos
- Research Unit, Instituto Peruano de Neurociencias, Lima, Peru.,Cognitive Decline and Dementia Diagnostic and Prevention Services Unit, Instituto Peruano de Neurociencias, Lima, Peru
| | - Carlos Alva-Diaz
- Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Peru
| | - Martin Mellado
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, ICBM, Neurosciences and East Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), Physiopathology Department, ICBM, Neurosciences and East Neuroscience Departments, University of Chile School of Medicine, Santiago, Chile.,Geroscience Center for Brain Health and Metabolism (GERO), University of Chile School of Medicine, Santiago, Chile.,Memory and Neuropsychiatric Clinic (CMYN), Neurology Department, Del Salvador Hospital and University of Chile School of Medicine, Santiago, Chile.,Neurology Unit, Department of Medicine, Alemana Clinic, Universidad del Desarrollo, Santiago, Chile
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32
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Casavilca-Zambrano S, Custodio N, Liendo-Picoaga R, Cancino-Maldonado K, Esenarro L, Montesinos R, Bertani S, Fejerman L, Guerchet M, Vidaurre T. Depression in women with a diagnosis of breast cancer. Prevalence of symptoms of depression in Peruvian women with early breast cancer and related sociodemographic factors. Semin Oncol 2020; 47:293-301. [PMID: 33046263 DOI: 10.1053/j.seminoncol.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 11/11/2022]
Abstract
We sought to review literature on the prevalence of symptoms of depression in women with a diagnosis of breast cancer (BC) and in the Peruvian population determine the prevalence of symptoms of depression and to describe the association with sociodemographic characteristics. Descriptive cross-sectional analytical study of 254 patients from the National Cancer Institute of Peru (Instituto Nacional de Enfermedades Neoplásicas) with a diagnosis of clinical stage I or II BC. The patients included women aged between 26 and 67 years old. Symptoms of depression were monitored by the Beck Depression Inventory-II. Moreover, clinical features and patient sociodemographic characteristics were analyzed and their association with depression was assessed by logistic regression. The average age of the patients was 47.8 ± 9.2 years; 5.4% of the patients were postmenopausal at the time of the questionnaire. About 55% of women were from Lima, 58.3% had completed secondary education (11 ± 3.2 years), 45.7% were not working, and 46.5% were single. The prevalence of depression was 25.6% at the time of BC diagnosis. Of those patients with symptoms of depression, 16.9% showed symptoms of mild depression, 6.3% moderate, and 2.4% severe. A multivariable logistic regression model showed that in Peruvian women with a diagnosis of BC being married or employed significantly decreased the odds of presenting depressive symptoms (P = 0.029 and 0.017, respectively). Our main limitation was the lack of evaluation of depressive symptoms before the diagnosis, during or at the end of treatment. Another limitation was that the Beck Depression Inventory-II test could only identify depressive symptoms, but not depression as a disease. We have reviewed relevant literature on depression in women with a diagnosis of BC. The data presented suggests an association between both employment and marital status with depressive symptoms among Peruvian women with a diagnosis of BC. Pre-emptive support for women at risk could influence resilience and/or motivation for compliance with antineoplastic treatments.
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Affiliation(s)
- Sandro Casavilca-Zambrano
- Facultad de Psicología, University of Huanuco, Huanuco, Peru; Banco de Tejidos Tumorales, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru.
| | | | - Ruddy Liendo-Picoaga
- Banco de Tejidos Tumorales, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | - Loida Esenarro
- Departamento de Especialidades Medicas, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | | | | | - Laura Fejerman
- University of California San Francisco, San Francisco, CA
| | | | - Tatiana Vidaurre
- Departamento de Oncología Medica, Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
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Custodio N, Montesinos R, Lira D, Herrera-Perez E, Chavez K, Reynoso-Guzman W, Pintado-Caipa M, Cuenca J, Gamboa C, Metcalf T. Validation of the RUDAS for the Identification of Dementia in Illiterate and Low-Educated Older Adults in Lima, Peru. Front Neurol 2020; 11:374. [PMID: 32477248 PMCID: PMC7232574 DOI: 10.3389/fneur.2020.00374] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 04/14/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the performance of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) in discriminating between controls and patients with mild cognitive impairment (MCI) and dementia in an illiterate population with low-levels of education. Methods: We compared the cognitive performance of 187 elderly subjects who were illiterate (controls n = 60; MCI n = 64; dementia n = 63). Neuropsychological measures included the RUDAS-PE, Mini-Mental State Examination (MMSE), INECO Frontal Screening (IFS), and Pfeffer Functional Activities Questionnaire (PFAQ). The results were compared to a neuropsychological evaluation (gold standard), including use of Clinical Dementia Rating (CDR) scores. Results: We found a Cronbach's alpha was 0.65; Spearman's correlation coefficient was 0.79 (p < 0.01). The area under the receiver operating characteristics curve for the RUDAS to discriminate dementia from MCI was 98.0% with an optimal cut-off <19 (sensitivity 95%, specificity 97%); whereas, to differentiate MCI and controls was 98.0% with an optimal cut-off <23 (sensitivity 89%, specificity 93%). Conclusions: Based on its excellent psychometric properties, we find the RUDAS-PE suitable to aid in the opportune detection of dementia in a geriatric illiterate population with low-levels of education.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Grupo de investigación Molident, Universidad San Ignacio de Loyola, Lima, Peru
| | - Kristhy Chavez
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Willyams Reynoso-Guzman
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Maritza Pintado-Caipa
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Atlantic Fellow, Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
| | - José Cuenca
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru.,Carrera de Psicología, Facultad de Ciencias de la Salud, Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Tatiana Metcalf
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de diagnóstico de deterioro cognitivo y prevención de demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
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Custodio N, Herrera-Pérez E, Montesinos R, Lira D, Metcalf T. Brief cognitive tests validated in Peru for detection of cognitive impairment A systematic mapping of the scientific literature. Dement Neuropsychol 2020; 14:134-144. [PMID: 32595882 PMCID: PMC7304273 DOI: 10.1590/1980-57642020dn14-020006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/31/2020] [Indexed: 12/25/2022] Open
Abstract
Brief cognitive tests (BCTs) are necessary for early detection of cognitive impairment, particularly in primary care settings. OBJECTIVE This report describes a systematic review of BCTs evaluated in Peruvian populations. METHODS We used systematic mapping techniques to identify articles on screening tests for cognitive impairment involving Peruvian subjects. We included studies published in English and Spanish up to 2018. We reviewed 6 reference databases within the Virtual Health Library network, as well as the Web of Science, Scopus (MEDLINE), and EMBASE databases. RESULTS Ten out of 447 articles met the inclusion criteria. Studies included both outpatient (9) and community-based (2) samples. Eligibility criteria of the studies were similar. Although different protocols were applied, the diagnostic criteria were standardized. For discrimination between dementia and controls, IFS (AUC: 0.99) and ACE (AUC: 0.95 to 1.00) showed superior performance, as did the M@T (AUC: 1.00) and CDT-Mv (AUC: 0.94 to 1.00) for discriminating between Alzheimer's disease (AD) and controls. CONCLUSION The available evidence is limited. However, our analysis of national data suggests that the ACE may be a good choice whenever it can be applied to Peruvian patients. Alternatively, the M@T and IFS can be used for screening patients with suspected AD or FTD, respectively.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela de Postgrado, Universidad Católica San Pablo, Arequipa, Perú
| | - Eder Herrera-Pérez
- Unidad de Investigación de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación Molident, Universidad San Ignacio de Loyola, Lima, Perú
| | - Rosa Montesinos
- Unidad de Investigación de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela de Postgrado, Universidad Católica San Pablo, Arequipa, Perú
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias. Lima, Perú
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
- Escuela de Postgrado, Universidad Católica San Pablo, Arequipa, Perú
| | - Tatiana Metcalf
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
- Unidad de Investigación de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Perú
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Custodio N, Montesinos R, Lira D, Herrera-Perez E, Chavez K, Hernandez-Córdova G, Cuenca J, Gamboa C, Metcalf T. Validation of the RUDAS in Patients With a Middle-Level Education in Lima, Peru. Am J Alzheimers Dis Other Demen 2019; 34:513-522. [PMID: 31422688 PMCID: PMC10653366 DOI: 10.1177/1533317519869709] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To assess the psychometric properties of the Peruvian version of the Rowland Universal Dementia Assessment Scale (RUDAS-PE) to discriminate controls from patients with mild cognitive impairment (MCI) and early dementia (ED) in a population with a mid-level education. METHODS A total of 133 patients from a memory clinic were administered the RUDAS-PE, INECO Frontal Screening, Addenbrooke's Cognitive Examination, and Mini-Mental State Examination. Results were compared against a neuropsychological evaluation (gold standard). Validity measures, internal consistency, and concurrent validity were calculated. RESULTS Cronbach's α was 0.68; Pearson's ratio was 0.79 (P < .01). The area under the receiver-operating characteristics curve of the RUDAS to discriminate between ED and MCI was 89.0% (optimal cutoff at <21), whereas between MCI and controls, it was 99.0% (optimal cutoff at <24). CONCLUSIONS The RUDAS-PE has acceptable psychometric properties performing well in its ability to discriminate controls from patients with MCI and ED.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Rehabilitación, Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Dirección de investigación, Universidad San Ignacio de Loyola, Lima, Peru
- Consejo Nacional de Ciencia, Tecnología e Innovación (CONCYTEC), Lima, Peru
| | - Kristy Chavez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Gustavo Hernandez-Córdova
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Laboratorio de Investigación y Desarrollo, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - José Cuenca
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
- Carrera de Psicología, Facultad de Ciencias de la Salud. Universidad Privada del Norte, Lima, Peru
| | - Carlos Gamboa
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neuropsicología, Instituto Peruano de Neurociencias, Lima, Peru
| | - Tatiana Metcalf
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
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Zamora EB, Zavala G, López A, Cevada E, Montesinos R, Vázquez F, Flores C. Quantitative Structure-Activity Relationship (QSAR) analysis of functionalized triblock copolymers with applications as dehydrating agents of crude oil. J DISPER SCI TECHNOL 2019. [DOI: 10.1080/01932691.2019.1611439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Gerardo Zavala
- Instituto Mexicano del Petróleo, Ciudad de México, México
| | - Alfonso López
- Instituto Mexicano del Petróleo, Ciudad de México, México
| | - Enrique Cevada
- Escuela Superior de Ingeniería Química e Industrias Extractivas, Instituto Politécnico Nacional, Ciudad de México, México
| | | | - Flavio Vázquez
- Instituto Mexicano del Petróleo, Ciudad de México, México
| | - César Flores
- Instituto Mexicano del Petróleo, Ciudad de México, México
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Abstract
La esclerosis múltiple es una enfermedad inflamatoria, autoinmune y neurodegenerativa del sistema nervioso central caracterizada por pérdida de la función motora y sensitiva; es considerada una de las principales causas de discapacidad en el adulto joven. Recientemente, se le ha dado gran importancia al deterioro cognitivo, por ser un síntoma frecuente y discapacitante. Este deterioro está presente en un 40 a 65% de los pacientes y afecta la velocidad de procesamiento de información, atención compleja, memoria de trabajo, memoria visual y verbal, fluencia verbal y funciones ejecutivas. Se puede presentar en el síndrome radiológico aislado, en el síndrome clínico aislado y en las diferentes fases de la enfermedad; además, es el responsable de la dependencia de algunos pacientes y de las dificultades para mantener o conseguir empleo. Este déficit cognitivo se asocia a atrofia del tálamo y se ha observado una correlación con las medidas de atrofia y con el volumen lesional cerebral. Existen diferentes herramientas para su evaluación; hay pruebas de cribado breves de 5 minutos de duración, hasta baterías extensas de 90 minutos. Respecto al tratamiento de las alteraciones cognitivas, no existe un tratamiento farmacológico específico; sin embargo, se considera que los fármacos modificadores de la enfermedad podrían tener una influencia favorable en la función cognitiva por sus efectos en la reducción de la actividad inflamatoria y la atrofia cerebral. En cuanto a la estimulación cognitiva, no existen datos concluyentes por las diferentes técnicas empleadas y las distintas medidas utilizadas para evaluar los resultados de las intervenciones.
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Custodio N, Alva-Diaz C, Morán-Mariños C, Mejía-Rojas K, Lira D, Montesinos R, Herrera-Pérez E, Castro-Suárez S, Bardales Y. Factors associated with depression in patients with Parkinson's disease A multicenter study in Lima, Peru. Dement Neuropsychol 2018; 12:292-298. [PMID: 30425793 PMCID: PMC6200150 DOI: 10.1590/1980-57642018dn12-030010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/25/2018] [Indexed: 11/22/2022] Open
Abstract
The diagnosis and treatment of depression in patients with Parkinson's disease (PD) is inadequate, often contributing to a reduced quality of life, rapid disease progression, higher cognitive impairment, and an increased burden of care for family members of patients with PD. OBJECTIVE To determine the factors associated with depression in PD and to examine the frequency of depressive symptoms among patients with PD. METHODS This study was an observational, analytical, multicenter study of a cross-sectional cohort, conducted between July 2016 and May 2017. PD patients were recruited from neurology clinics in Lima, Peru. All statistical analyses were performed using descriptive statistics. Bivariate and multivariate logistic regression analyses were calculated using STATA. RESULTS Out of 124 patients (average age: 68.7 years; 58% males) included in the study 60.5% (75/124) presented with symptoms of depression; only 20% (25/124) received antidepressants. Factors associated with depression in PD included: unemployment, falls, freezing of gait, involuntary movements micrographia, stooped posture, hyposmia, movement disorders in sleep, rapid disease progression, and the use of MAOIs. Furthermore, statistically significant differences were found in disease duration, UPDRS and MMSE scores, Hoehn and Yahr (HY) stage, and length of time taking L-dopa between PD patients with and without depressive symptoms. CONCLUSION Factors associated with depressive symptoms in patients with PD were hyposmia, rapid progression of the disease, the use of L-dopa, and use of MAOIs. The frequency of depressive symptoms in patients with PD is high; early diagnosis and prompt treatment are needed to improve their quality of life and the family environment.
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Affiliation(s)
- Nilton Custodio
- Department of Neurology, Peruvian Institute of Neurosciences, Lima, Peru
- Diagnostic Unit for Cognitive Impairment and Dementia Prevention, International Clinic, Lima, Peru
- Research Unit, Peruvian Institute of Neurosciences, Lima, Peru
- Rehabilitation Medicine Department, Peruvian Institute of Neurosciences, Lima, Peru
- Department of Neurology of Human Behavior. National Institute of Neurological Sciences. Lima, Peru
| | - Carlos Alva-Diaz
- Research Unit, Peruvian Institute of Neurosciences, Lima, Peru
- Clinical and Healthcare Efficiency Network (REDECS). Lima, Peru
- Neurology Department, Hospital Nacional Daniel Alcides Carrión, Callao, Peru
- Research Center OADI, Hospital Nacional Daniel Alcides Carrión, Callao, Peru
| | - Cristian Morán-Mariños
- Research Unit, Peruvian Institute of Neurosciences, Lima, Peru
- Clinical and Healthcare Efficiency Network (REDECS). Lima, Peru
- Neurology Department, Hospital Nacional Daniel Alcides Carrión, Callao, Peru
- Peruvian Student Medical Scientific Society, Universidad Privada San Juan Bautista (SOCIEM - UPSJB). Lima, Peru
| | - Koni Mejía-Rojas
- Research Unit, Peruvian Institute of Neurosciences, Lima, Peru
- Neurology Department, Hospital Nacional Daniel Alcides Carrión, Callao, Peru
| | - David Lira
- Department of Neurology, Peruvian Institute of Neurosciences, Lima, Peru
- Diagnostic Unit for Cognitive Impairment and Dementia Prevention, International Clinic, Lima, Peru
- Research Unit, Peruvian Institute of Neurosciences, Lima, Peru
- Research and Teaching Unit. International Clinic. Lima, Peru
- Department of Neurology, International Clinic. Lima, Peru
| | - Rosa Montesinos
- Diagnostic Unit for Cognitive Impairment and Dementia Prevention, International Clinic, Lima, Peru
- Research Unit, Peruvian Institute of Neurosciences, Lima, Peru
- Rehabilitation Medicine Department, Peruvian Institute of Neurosciences, Lima, Peru
- Research and Teaching Unit. International Clinic. Lima, Peru
| | - Eder Herrera-Pérez
- Diagnostic Unit for Cognitive Impairment and Dementia Prevention, International Clinic, Lima, Peru
- Research Unit, Peruvian Institute of Neurosciences, Lima, Peru
- Research and Teaching Unit. International Clinic. Lima, Peru
| | - Sheila Castro-Suárez
- Department of Neurology, Peruvian Institute of Neurosciences, Lima, Peru
- Research Unit, Peruvian Institute of Neurosciences, Lima, Peru
- Rehabilitation Medicine Department, Peruvian Institute of Neurosciences, Lima, Peru
- Department of Neurology of Human Behavior. National Institute of Neurological Sciences. Lima, Peru
- Department of Neurology, International Clinic. Lima, Peru
| | - Yadira Bardales
- Diagnostic Unit for Cognitive Impairment and Dementia Prevention, International Clinic, Lima, Peru
- Research Unit, Peruvian Institute of Neurosciences, Lima, Peru
- Research and Teaching Unit. International Clinic. Lima, Peru
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Custodio N, Becerra-Becerra Y, Cruzado L, Castro-Suárez S, Montesinos R, Bardales Y, Fonseca J, Mar M, Ocampo H, Herrera-Pérez E, Lira D. Nivel de conocimientos sobre demencia frontotemporal en una muestra de médicos que evalúan regularmente a pacientes con demencia en Lima-Perú. ACTA ACUST UNITED AC 2018. [DOI: 10.4067/s0717-92272018000200077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Custodio N, Alva-Diaz C, Becerra-Becerra Y, Montesinos R, Lira D, Herrera-Pérez E, Castro-Suárez S, Cuenca-Alfaro J, Valeriano-Lorenzo E. [Performance of cognitive brief test in elderly patients with dementia in advanced stage living in an urban community of Lima, Peru]. ACTA ACUST UNITED AC 2018; 33:662-669. [PMID: 28327834 DOI: 10.17843/rpmesp.2016.334.2549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 10/26/2016] [Indexed: 11/06/2022]
Abstract
Objectives. Evaluate the performance of clock drawing test- Manos versión (PDR-M) and Mini Mental State Examination -Peruvian version (MMSE) to detect dementia in a sample based on urban community of Lima, Peru. Materials and methods. This study is a secondary analysis database, observational, analytical and cross-sectional, the gold standard was the clinical and the neuropsychological evaluations together. Performance testing individually and in combination were evaluated.. Data were obtained from prevalence study conducted in 2008 in Cercado de Lima. Results. MMSE performance for evaluation of patients with dementia of any kind showed sensitivity of 64,1%, specificity of 84,1%, PPV of 24.4%, NPV of 96.7%, PLR of 4,03 and NLR of 0,43. PDR-M showed sensitivity of 89,3%, specificity of 98,1%, PPV of 79.3%, NPV of 99.1%, PLR of 47,79 and NLR of 0,11. When both tests were applied, and at least one of them was positive, they showed sensitivity 98.1%, specificity 84.1%, PPV of 33.1%, NPV of 99.8%, PLR of 6,17 and NLR of 0,02. When performing separate analysis of Alzheimer-type dementia and non- Alzheimer dementia, the values of the parameters do not differ substantially from those obtained for dementia of any kind. Conclussions. The combination of MMSE and PDR-M show good discriminative ability to detect moderate and severe dementia in population living in urban community in Lima.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Neurología, Clínica Internacional. Lima, Perú
| | - Carlos Alva-Diaz
- Servicio de Neurología, Hospital Nacional Daniel Alcides Carrión. Callao, Perú.,Red de Eficacia Clínica y Sanitaria REDECS. Lima, Perú
| | - Yahaira Becerra-Becerra
- Servicio de Geriatría, Hospital Militar Geriátrico. Lima, Perú.,Red de Eficacia Clínica y Sanitaria REDECS. Lima, Perú
| | - Rosa Montesinos
- Unidad de Medicina de Rehabilitación, Instituto Peruano de Neurociencias. Lima, Perú
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Neurología, Clínica Internacional. Lima, Perú
| | - Eder Herrera-Pérez
- Unidad de Proyectos de Investigación, Instituto de Salud del Niño. Lima, Perú
| | - Sheila Castro-Suárez
- Servicio de Neurología, Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Neurología, Clínica Internacional. Lima, Perú.,Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas. Lima, Perú
| | - José Cuenca-Alfaro
- Unidad de Neuropsicología, Instituto Peruano de Neurociencias. Lima, Perú
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Custodio N, Montesinos R, Lira D, Herrera-Perez E, Bardales Y, Valeriano-Lorenzo L. Evolution of short cognitive test performance in stroke patients with vascular cognitive impairment and vascular dementia: Baseline evaluation and follow-up. Dement Neuropsychol 2017; 11:381-388. [PMID: 29354218 PMCID: PMC5769996 DOI: 10.1590/1980-57642016dn11-040007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
There is limited evidence about the progression of cognitive performance during the post-stroke stage.
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Affiliation(s)
- Nilton Custodio
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Peru.,Servicio de Neurología. Instituto Peruano de Neurociencias. Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Peru.,Servicio de Medicina de Rehabilitación. Instituto Peruano de Neurociencias. Lima, Peru
| | - David Lira
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Peru.,Servicio de Neurología. Instituto Peruano de Neurociencias. Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Peru.,Unidad de Diseño y Elaboración de Proyectos de Investigación. Instituto Nacional de Salud del Niño. Lima, Peru.,GESID. Lima, Peru
| | - Yadira Bardales
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Peru.,Unidad de Geriatría. Instituto Peruano de Neurociencias. Lima, Peru
| | - Lucia Valeriano-Lorenzo
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Peru.,Unidad de Neuropsicología. Instituto Peruano de Neurociencias. Lima. Peru
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Abstract
Mixed dementia is the coexistence of Alzheimer's disease and cerebrovascular disease (CVD) in the same demented patient. Currently, its diagnosis and treatment remains a challenge for practitioners. To provide an overview of the epidemiology, pathogenesis, natural history, diagnosis, and therapy of Mixed Vascular-Alzheimer Dementia (MVAD). The literature was reviewed for articles published between 1990-2016 by using the keywords linked to MVAD. Neuropathological studies indicate that MVAD is a very common pathological finding in the elderly with a prevalence about of 22%. The distinction between Alzheimer's dementia and vascular dementia (VD) is complex because their clinical presentation can overlap. There are international criteria for the MVAD diagnosis. The pharmacologic therapy shows modest clinical benefits that are similar among all drugs used in patients with Alzheimer's dementia and VD. The non-pharmacologic therapy includes the rigorous management of cardiovascular risk factors (especially hypertension) and the promotion of a healthy diet. The diagnosis and treatment of MVAD cannot be improved without further studies. Currently available medications provide only modest clinical benefits once a patient has developed MVAD. In subjects at risk, the antihypertensive therapy and healthy diet should be recommend for preventing or slowing the progression of MVAD.
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Affiliation(s)
- Nilton Custodio
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Neurología. Instituto Peruano de Neurociencias. Lima, Perú
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Medicina de Rehabilitación. Instituto Peruano de Neurociencias. Lima, Perú
| | - David Lira
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Servicio de Neurología. Instituto Peruano de Neurociencias. Lima, Perú
| | - Eder Herrera-Pérez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Diseño y Elaboración de Proyectos de Investigación. Instituto Nacional de Salud del Niño. Lima, Perú.,GESID. Lima, Peru
| | - Yadira Bardales
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Geriatría. Instituto Peruano de neurociencias. Lima, Perú
| | - Lucía Valeriano-Lorenzo
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia. Instituto Peruano de Neurociencias. Lima, Perú.,Unidad de Neuropsicología. Instituto Peruano de Neurociencias. Lima. Perú
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Custodio N, Lira D, Herrera-Perez E, Montesinos R, Castro-Suarez S, Cuenca-Alfaro J, Valeriano-Lorenzo L. Memory Alteration Test to Detect Amnestic Mild Cognitive Impairment and Early Alzheimer's Dementia in Population with Low Educational Level. Front Aging Neurosci 2017; 9:278. [PMID: 28878665 PMCID: PMC5572224 DOI: 10.3389/fnagi.2017.00278] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 08/07/2017] [Indexed: 12/03/2022] Open
Abstract
Background/Aims: Short tests to early detection of the cognitive impairment are necessary in primary care setting, particularly in populations with low educational level. The aim of this study was to assess the performance of Memory Alteration Test (M@T) to discriminate controls, patients with amnestic Mild Cognitive Impairment (aMCI) and patients with early Alzheimer’s Dementia (AD) in a sample of individuals with low level of education. Methods: Cross-sectional study to assess the performance of the M@T (study test), compared to the neuropsychological evaluation (gold standard test) scores in 247 elderly subjects with low education level from Lima-Peru. The cognitive evaluation included three sequential stages: (1) screening (to detect cases with cognitive impairment); (2) nosological diagnosis (to determinate specific disease); and (3) classification (to differentiate disease subtypes). The subjects with negative results for all stages were considered as cognitively normal (controls). The test performance was assessed by means of area under the receiver operating characteristic (ROC) curve. We calculated validity measures (sensitivity, specificity and correctly classified percentage), the internal consistency (Cronbach’s alpha coefficient), and concurrent validity (Pearson’s ratio coefficient between the M@T and Clinical Dementia Rating (CDR) scores). Results: The Cronbach’s alpha coefficient was 0.79 and Pearson’s ratio coefficient was 0.79 (p < 0.01). The AUC of M@T to discriminate between early AD and aMCI was 99.60% (sensitivity = 100.00%, specificity = 97.53% and correctly classified = 98.41%) and to discriminate between aMCI and controls was 99.56% (sensitivity = 99.17%, specificity = 91.11%, and correctly classified = 96.99%). Conclusions: The M@T is a short test with a good performance to discriminate controls, aMCI and early AD in individuals with low level of education from urban settings.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,GESIDLima, Peru.,Instituto Nacional de Salud del NiñoLima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica InternacionalLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Servicio de Medicina de Rehabilitación, Instituto Peruano de NeurocienciasLima, Peru
| | - Sheila Castro-Suarez
- Servicio de Neurología, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias NeurológicasLima, Peru
| | - José Cuenca-Alfaro
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Neuropsicología, Instituto Peruano de NeurocienciasLima, Peru
| | - Lucía Valeriano-Lorenzo
- Unidad de Investigación, Instituto Peruano de NeurocienciasLima, Peru.,Unidad de Neuropsicología, Instituto Peruano de NeurocienciasLima, Peru
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Custodio N, Lira D, Herrera-Perez E, Montesinos R, Castro-Suarez S, Cuenca-Alfaro J, Cortijo P. Predictive model for falling in Parkinson disease patients. eNeurologicalSci 2016; 5:20-24. [PMID: 29430553 PMCID: PMC5803085 DOI: 10.1016/j.ensci.2016.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 10/05/2016] [Accepted: 11/01/2016] [Indexed: 11/17/2022] Open
Abstract
Background/aims Falls are a common complication of advancing Parkinson's disease (PD). Although numerous risk factors are known, reliable predictors of future falls are still lacking. The aim of this study was to develop a multivariate model to predict falling in PD patients. Methods Prospective cohort with forty-nine PD patients. The area under the receiver-operating characteristic curve (AUC) was calculated to evaluate predictive performance of the purposed multivariate model. Results The median of PD duration and UPDRS-III score in the cohort was 6 years and 24 points, respectively. Falls occurred in 18 PD patients (30%). Predictive factors for falling identified by univariate analysis were age, PD duration, physical activity, and scores of UPDRS motor, FOG, ACE, IFS, PFAQ and GDS (p-value < 0.001), as well as fear of falling score (p-value = 0.04). The final multivariate model (PD duration, FOG, ACE, and physical activity) showed an AUC = 0.9282 (correctly classified = 89.83%; sensitivity = 92.68%; specificity = 83.33%). Conclusions This study showed that our multivariate model have a high performance to predict falling in a sample of PD patients. In PD patients the fall rates doubles the reported rates in community welling older people without neurological disease, ranging from 35% to 90%. Falls have a negative psychosocial impact creating a spiral of increased fear of falling and reduced physical activity, and increased likelihood of nursing home admission. A multivariate model (PD duration, freezing of gait, Addenbrook's Cognitive Examination, and physical activity) to predict falling in our sample of PD patients showed a high performance.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Corresponding author at: Instituto Peruano de Neurociencias, – Bartolomé Herrera 161, Lima, Peru.Instituto Peruano de NeurocienciasBartolomé Herrera 161LimaPeru
| | - David Lira
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Unidad de Desarrollo de Investigación, Tecnologías y Docencia, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
- Centro de Investigación para el Desarrollo Integral y Sostenible (CIDIS), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Medicina Física y Rehabilitación, Clínica Internacional, Lima, Peru
| | - Sheila Castro-Suarez
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
- Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Jose Cuenca-Alfaro
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Patricia Cortijo
- Unidad de Diagnostico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
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Custodio N, Montesinos R, Alva-Diaz C, Mejía-Rojas K, Becerra-Becerra Y, Lira D. Nuevos términos clínicos, prevención y tratamiento del trastorno cognitivo vascular: revisión de literatura basada en la evidencia. ACTA ACUST UNITED AC 2016. [DOI: 10.20453/rnp.v79i3.2921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
El trastorno cognitivo vascular agrupa todas las instancias donde el compromiso cognitivo puede ser atribuido a enfermedad vascular cerebral, es mayor que el esperado para el envejecimiento normal y que, cuando llega a afectar las actividades de la vida diaria, se denomina demencia vascular. En esta revisión, se actualizan los términos relacionados a trastorno cognitivo vascular y se plantean estrategias de prevención y tratamiento basadas en revisionessistemáticas y meta-análisis. En la primera parte se definen diversos términos relacionados a trastorno cognitivo vascular; en la segunda, se plantea el tratamiento del trastorno cognitivo vascular/demencia vascular, que incluyeun manejo orientado a prevención primaria, controlando los factores de riesgo; un tratamiento secundario para prevenir la exacerbación o la extensión de las lesiones producidas por la injuria vascular cerebral y, finalmente,untratamiento terciario o sintomático de los problemas cognitivos y/o conductuales. Damos especial énfasis y se fundamenta la conveniencia y beneficios de los tratamientos primario y secundario.
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Custodio N, Herrera-Pérez E, Lira D, Montesinos R, Alva-Diaz C, Cortijo P, Cuenca-Alfaro J, Valeriano-Lorenzo E. Utilidad de la batería ejecutiva y cognición social de INECO en la evaluación de funciones ejecutivas de una serie de pacientes peruanos con demencia fronto-temporal, variante conductual. Rev Neuropsiquiatr 2015. [DOI: 10.20453/rnp.v78i4.2650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Los síntomas característicos de la demencia fronto-temporal, variante conductual reflejan disfunción del cortex prefrontal ventromedial, y no existe consenso respecto a las pruebas neuropsicológicas más sensibles y específicos para evaluarlos. Objetivos: El objetivo de este estudio fue detectar alteraciones específicas de funciones ejecutivas y de cognición social en pacientes con demencia fronto-temporal variante conductual. Material y Métodos: Evaluamos la batería ejecutiva y cognición social del Instituto de Neurología Cognitiva (INECO), la cual incluye pruebas de teoría de la mente (test de la mirada y test de metida de pata), tareas del hotel, tests de diligencias multiples-versión del hospital y el Iowa Gambling Test para toma de decisiones. Los pacientes fueron divididos en dos grupos según su desempeño en el Addenbrooke´s Cognitive Examination. Resultados: Pacientes del grupo de Addenbrooke´s Cognitive Examination Bajo mostró resultados significativamente menores, respecto a los controles en muchas de las tareas de la batería ejecutiva estándar y en la batería ejecutiva y cognición social de INECO. Pero, el grupo deAddenbrooke´s Cognitive Examination Alto no difirió de los controles en muchas de las tareas de la batería ejecutiva estándar, mientras que encontramos diferencias significativas en los pacientes con demencia fronto-temporal con Addenbrooke´s Cognitive Examination Alto y los controles en la mayoría de las tareas de la batería ejecutiva y cognición social. Conclusiones: La batería ejecutiva y cognición social de INECO es más sensible para detectar alteraciones ejecutivas y de cognición social en estadios precoces de demencia fronto-temporal, variante conductual que las tareas empleadas en la batería ejecutiva estándar.
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Lira D, Custodio N, Bujaico E, Núñez del Prado L, Castro-Suárez S, Montesinos R, Herrera-Pérez E. Perception of sleep after a polysomnography in a sleep laboratory. J Neurol Sci 2015. [DOI: 10.1016/j.jns.2015.08.624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Custodio N, Lira D, Herrera-Perez E, Del Prado LN, Parodi J, Guevara-Silva E, Castro-Suarez S, Montesinos R. Cost-of-illness study in a retrospective cohort of patients with dementia in Lima, Peru. Dement Neuropsychol 2015; 9:32-41. [PMID: 29213939 PMCID: PMC5618989 DOI: 10.1590/s1980-57642015dn91000006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Dementia is a major cause of dependency and disability among older persons, and
imposes huge economic burdens. Only a few cost-of-illness studies for dementia
have been carried out in middle and low-income countries.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Clínica Internacional, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología. Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Clínica Internacional, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología. Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Centro de Investigación para el Desarrollo Integral y Sostenible (CIDIS), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Liza Nuñez Del Prado
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología. Instituto Peruano de Neurociencias, Lima, Peru
| | - José Parodi
- Centro de Investigación del Envejecimiento, Facultad de Medicina Humana, Universidad San Martín de Porres, Lima, Peru
| | | | - Sheila Castro-Suarez
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología. Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Medicina Física y Rehabilitación, Clínica Internacional, Lima, Peru
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Custodio N, Lira D, Herrera-Perez E, Del Prado LN, Parodi J, Guevara-Silva E, Castro-Suarez S, Mar M, Montesinos R, Cortijo P. Informal caregiver burden in middle-income countries: Results from Memory Centers in Lima - Peru. Dement Neuropsychol 2014; 8:376-383. [PMID: 29213929 PMCID: PMC5619187 DOI: 10.1590/s1980-57642014dn84000012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective The aim of this study was to evaluate caregiver burden based on Zarit Burden Interview (ZBI) and depression in caregivers on the Beck Depression Inventory-II (BDI-II). Methods Literate individuals, 18 years or older, who spoke Spanish as their native language were included. Demographic characteristics: Age, sex, education, relationship to person with dementia, length of time caregiving, other sources of help for caring, impact on the household economy, family support, and perception of impaired health; and Clinical data on care-recipients: type of dementia, time since diagnosis, treatment, and Global Deterioration Scale (GDS); the ZBI and BDI-II. Descriptive and analytical statistics were employed to assess caregiver burden and predictors of higher burden in caregivers. Results A total of 92 informal caregivers were evaluated. Regarding care-recipients, 75% were 69 years old or over, 75% had at least one year since diagnosis, 73.9% had Alzheimer's disease, 84.8% received treatment, 75% scored 5 or over on the GDS. For caregivers, 75% were 55.5 years old or over, predominantly female (81.5%), married (83.7%), the spouse of care-recipients (60.87%), had at least 10 years of education (75.0%) and one year of caregiving (75%), reduced entertainment time (90.2%) and self-perception of impaired health (83.7%). Median score on the ZBI was 37.5 (minimum value = 3; and maximum value = 74). The coefficient of BDI was 1.38 (p-value <0.001). Conclusion This sample of Peruvian informal caregivers showed elevated ZBI values. Self-perception of worsened health, repercussion on the family economy and time caregiving were the main determinants of ZBI, although only BDI was a consistent predictor of ZBI.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Clínica Internacional, Lima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - David Lira
- Servicio de Neurología, Clínica Internacional, Lima, Peru.,Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Unidad de Diseño y Elaboración de Proyectos de Investigación, Lima, Peru.,Centro de Investigación para el Desarrollo Integral y Sostenible (CIDIS), Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Liza Nuñez Del Prado
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología. Clínica Maisson de Sante, Lima, Peru
| | - José Parodi
- Centro de Investigación del Envejecimiento, Facultad de Medicina Humana, Universidad San Martín de Porres, Lima, Peru
| | | | - Sheila Castro-Suarez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Marcela Mar
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Clínica Internacional, Lima, Peru.,Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru.,Servicio de Medicina Física y Rehabilitación, Clínica Internacional, Lima, Peru
| | - Patricia Cortijo
- Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru
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Custodio N, Lira D, Herrera-Perez E, Nuñez Del Prado L, Parodi J, Guevara-Silva E, Castro-Suarez S, Montesinos R, Cortijo P. The Memory Alteration Test Discriminates between Cognitively Healthy Status, Mild Cognitive Impairment and Alzheimer's Disease. Dement Geriatr Cogn Dis Extra 2014; 4:314-21. [PMID: 25298775 PMCID: PMC4176469 DOI: 10.1159/000365280] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background/Aims Dementia is a worldwide public health problem and there are several diagnostic tools for its assessment. The aim of this study was to evaluate the performance of the Memory Alteration Test (M@T) to discriminate between patients with early Alzheimer's disease (AD), patients with amnestic mild cognitive impairment (a-MCI), and subjects with a cognitively healthy status (CHS). Methods The discriminative validity was assessed in a sample of 90 patients with AD, 45 patients with a-MCI, and 180 subjects with CHS. Clinical, functional, and cognitive studies were independently performed in a blinded fashion and the gold standard diagnosis was established by consensus on the basis of these results. The test performance was assessed by means of a receiver operating characteristic curve analysis as area under the curve (AUC). Results M@T mean scores were 17.7 (SD = 5.7) in AD, 30.8 (SD = 2.3) in a-MCI, and 44.5 (SD = 3.1) in CHS. A cutoff score of 37 points had a sensitivity of 98.3% and a specificity of 97.8% to differentiate a-MCI from CHS (AUC = 0.999). A cutoff score of 27 points had a sensitivity of 100% and a specificity of 98.9% to differentiate mild AD from a-MCI and from CHS (AUC = 1.000). Conclusions The M@T had a high performance in the discrimination between early AD, a-MCI and CHS.
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Affiliation(s)
- Nilton Custodio
- Servicio de Neurología, Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Universidad Peruana Cayetano Heredia, Lima, Peru ; Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Universidad Peruana Cayetano Heredia, Lima, Peru ; Unidad de Investigación, Instituto Peruano de Neurociencias, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - David Lira
- Servicio de Neurología, Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Universidad Peruana Cayetano Heredia, Lima, Peru ; Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Universidad Peruana Cayetano Heredia, Lima, Peru ; Unidad de Investigación, Instituto Peruano de Neurociencias, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Eder Herrera-Perez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Universidad Peruana Cayetano Heredia, Lima, Peru ; Unidad de Diseño y Elaboración de Proyectos de Investigación, Universidad Peruana Cayetano Heredia, Lima, Peru ; Centro de Investigación para el Desarrollo Integral y Sostenible, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Liza Nuñez Del Prado
- Unidad de Investigación, Instituto Peruano de Neurociencias, Universidad Peruana Cayetano Heredia, Lima, Peru ; Servicio de Neurología, Clínica Maisson de Sante, Universidad San Martín de Porres, Lima, Peru
| | - José Parodi
- Centro de Investigación del Envejecimiento, Facultad de Medicina Humana, Universidad San Martín de Porres, Lima, Peru
| | - Erik Guevara-Silva
- Departamento de Medicina, Hospital de Chancay, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Sheila Castro-Suarez
- Unidad de Investigación, Instituto Peruano de Neurociencias, Universidad Peruana Cayetano Heredia, Lima, Peru ; Servicio de Neurología de la Conducta, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Rosa Montesinos
- Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Universidad Peruana Cayetano Heredia, Lima, Peru ; Servicio de Medicina Física y Rehabilitación, Clínica Internacional, Universidad Peruana Cayetano Heredia, Lima, Peru ; Unidad de Investigación, Instituto Peruano de Neurociencias, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Patricia Cortijo
- Unidad de Investigación, Instituto Peruano de Neurociencias, Universidad Peruana Cayetano Heredia, Lima, Peru
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