Perfil de seguridad y satisfacción con la combinación fija de memantina-donepezilo en pacientes con diagnóstico de Alzheimer moderado a severo / Safety and satisfaction profile with the fixed combination of memantine-donepezil in patients diagnosed with moderate to severe Alzheimer's disease

Introducción: La enfermedad de Alzheimer es un trastorno neurodegenerativo de inicio insidioso y progresión lenta. Epidemiológicamente representa 60% a 70% de los casos de demencia.Objetivo: Determinar el grado de satisfacción y seguridad con la combinación fija de memantina-donepezilo durante 6 meses.Material y métodos: Se llevó a cabo un estudio observacional, transversal y analítico con base a un diseño de Real World Evidence (RWE), para evaluar la satisfacción del tratamiento a través de preguntas con una escala de Likert para la valoración de la satisfacción de 31 pacientes que recibieron como parte de su tratamiento habitual la combinación fija de memantina + donepezilo una vez al día durante seis meses previos a la aplicación de la escala de satisfacción. La información se recopiló de febrero a noviembre del 2021. Resultados: 60% de los eventos adversos fueron leves, 40% moderados. La tolerabilidad luego de 3 meses fue percibida como muy buena o excelente por 81% de pacientes. A seis meses 87,1% calificó como muy bueno o excelente el tratamiento. Satisfacción con el tratamiento a 3 meses fue, "satisfecho en su mayoría" o "totalmente satisfecho" para el 87,1%. Discusión: Prevalencia en el género femenino de 77,4% mayor a la reportada para todo el país de 54,8%, comorbilidades reportadas similares a las descritas por la literatura. Tolerabilidad calificada como excelente en comparación con otros estudios que calificaron como buena tolerabilidad. Conclusión: La administración de la combinación fija de memantina 14 mg + donepezilo 10 mg o memantina 28 mg + donepezilo 10 mg, fue una opción segura y bien tolerada.

Introduction:Alzheimer's disease is a neurodegenerative disorder of insidious onset and slow progression. Epidemiologically it accounts for 60% to 70% of cases of dementia.Objective:Determine the degree of satisfaction and safety with the fixed combination of memantine-donepezil for 6 months.Materials and methods: A cross-sectional, observational, and analytical study was conducted based on a Real World Evidence (RWE) design to assess treatment satisfaction through Likert-scale questions of 31 patients who, as part of their regular treatment, received the fixed combination of memantine + donepezil once daily for six months before the administration of the satisfaction scale. Data collection took place from February to November 2021.Results: 60% of adverse events were mild, 40% moderate. Tolerability after 3 months was perceived as very good or excellent by 81% of patients. At six months 87,1% rated the treatment as very good or excellent. Satisfaction with treatment at 3 months was, "mostly satisfied" or "totally satisfied" for 87,1%. Discussion: Prevalence in the female gender of 77,4% higher than that reported for the whole country of 54,8%, reported comorbidities similar to those described in the literature. Tolerability rated as excellent compared to other studies which rated as good tolerability. Conclusions:Administration of the fixed combination of memantine 14 mg + donepezil 10 mg or memantine 28 mg + donepezil 10 mg was a safe and well-tolerated option.

Biomarkers for dementia in Latin American countries: Gaps and opportunities.

Limited knowledge on dementia biomarkers in Latin American and Caribbean (LAC) countries remains a serious barrier. Here, we reported a survey to explore the ongoing work, needs, interests, potential barriers, and opportunities for future studies related to biomarkers. The results show that neuroimaging is the most used biomarker (73%), followed by genetic studies (40%), peripheral fluids biomarkers (31%), and cerebrospinal fluid biomarkers (29%). Regarding barriers in LAC, lack of funding appears to undermine the implementation of biomarkers in clinical or research settings, followed by insufficient infrastructure and training. The survey revealed that despite the above barriers, the region holds a great potential to advance dementia biomarkers research. Considering the unique contributions that LAC could make to this growing field, we highlight the urgent need to expand biomarker research. These insights allowed us to propose an action plan that addresses the recommendations for a biomarker framework recently proposed by regional experts.

The impact of SARS-CoV-2 in dementia across Latin America: A call for an urgent regional plan and coordinated response.

The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we underscore the selective impact of SARS-CoV-2 on dementia among LACs, the specific strain on health systems devoted to dementia, and the subsequent effect of increasing inequalities among those with dementia in the region. Implementation of best practices for mitigation and containment faces particularly steep challenges in LACs. Based upon our consideration of these issues, we urgently call for a coordinated action plan, including the development of inexpensive mass testing and multilevel regional coordination for dementia care and related actions. Brain health diplomacy should lead to a shared and escalated response across the region, coordinating leadership, and triangulation between governments and international multilateral networks.

Systematic Review of the Diagnostic Validity of Brief Cognitive Screenings for Early Dementia Detection in Spanish-Speaking Adults in Latin America.

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.