Social determinants of health but not global genetic ancestry predict dementia prevalence in Latin America.

INTRODUCTION: Leveraging the nonmonolithic structure of Latin America, which represents a large variability in social determinants of health (SDoH) and high levels of genetic admixture, we aim to evaluate the relative contributions of SDoH and genetic ancestry in predicting dementia prevalence in Latin American populations. METHODS: Community-dwelling participants aged 65 and older (N = 3808) from Cuba, Dominican Republic, Mexico, and Peru completed the 10/66 protocol assessments. Dementia was diagnosed using the cross-culturally validated 10/66 algorithm. Multivariate linear regression models adjusted for SDoH were used in the main analysis. This study used cross-sectional data from the 1066 population-based study. RESULTS: Individuals with higher proportions of Native American (>70%) and African American (>70%) ancestry were more likely to exhibit factors contributing to worse SDoH, such as lower educational levels (p < 0.001), lower socioeconomic status (p < 0.001), and higher frequency of vascular risk factors (p < 0.001). After adjusting for measures of SDoH, there was no association between ancestry proportion and dementia probability, and ancestry proportions no longer significantly accounted for the variance in cognitive performance (African predominant p = 0.31 [-0.19, 0.59] and Native predominant p = 0.74 [-0.24, 0.33]). DISCUSSION: The findings suggest that social and environmental factors play a more crucial role than genetic ancestry in predicting dementia prevalence in Latin American populations. This underscores the need for public health strategies and policies that address these social determinants to effectively reduce dementia risk in these communities. HIGHLIGHTS: Countries in Latin America express a large variability in social determinants of health and levels of admixture. After adjustment for downstream societal factors linked to SDoH, genetic ancestry shows no link to dementia. Population ancestry profiles alone do not influence cognitive performance. SDoH are key drivers of racial disparities in dementia and cognitive performance.

Prevalence and impact of neuropsychiatric symptoms in normal aging and neurodegenerative syndromes: A population-based study from Latin America.

BACKGROUND: Neuropsychiatric symptoms (NPSs) are common in neurodegenerative diseases; however, little is known about the prevalence of NPSs in Hispanic populations. METHODS: Using data from community-dwelling participants age 65 years and older enrolled in the 10/66 study (N = 11,768), we aimed to estimate the prevalence of NPSs in Hispanic populations with dementia, parkinsonism, and parkinsonism-dementia (PDD) relative to healthy aging. The Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to assess NPSs. RESULTS: NPSs were highly prevalent in Hispanic populations with neurodegenerative disease; approximately 34.3%, 56.1%, and 61.2% of the participants with parkinsonism, dementia, and PDD exhibited three or more NPSs, respectively. NPSs were the major contributor to caregiver burden. DISCUSSION: Clinicians involved in the care of elderly populations should proactively screen for NPSs, especially in patients with parkinsonism, dementia, and PPD, and develop intervention plans to support families and caregivers. Highlights Neuropsychiatric symptoms (NPSs) are highly prevalent in Hispanic populations with neurodegenerative diseases. In healthy Hispanic populations, NPSs are predominantly mild and not clinically significant. The most common NPSs include depression, sleep disorders, irritability, and agitation. NPSs explain a substantial proportion of the variance in global caregiver burden.

Race, Genetic Admixture, and Cognitive Performance in the Cuban Population.

BACKGROUND: Population aging will lead to a dramatic increase in dementia prevalence, which will disproportionally affect racial minorities. The presence of racial differences in dementia prevalence has been widely reported in United States, but there are no relevant studies on this topic in low- and middle-income countries. METHODS: In a cross-sectional survey, 2944 older Cubans were recruited at a community-based level aimed to identify the effects of self-identified race and genetic admixture on cognitive performance. Dementia diagnosis was established using 10/66 Dementia and DSM-IV criteria. APOE-ε4 genotype was determined in 2511 (85%) and genetic admixture was completed for all dementia cases and in a randomly selected sample of cognitive healthy participants (218 dementia cases and 367 participants without dementia). RESULTS: The overall prevalence of dementia was 8.7%, without large or statistically significant differences on dementia prevalence (p = .12) by self-identified race. Mean cognitive scores were similar across racial groups (p = .46). After controlling for age, sex, and education, greater proportion of African ancestry was not associated with cognitive performance (p = .17). CONCLUSIONS: We found no evidence of an independent effect of self-identified race and/or population ancestry on dementia prevalence or cognitive performance. This suggests that observed differences in dementia prevalence among diverse populations may be driven primarily by social determinants of health.

Prevalence of parkinsonism and Parkinson disease in urban and rural populations from Latin America: A community based study.

Background: Age and gender specific prevalence rates for parkinsonism and Parkinson's disease (PD) are important to guide research, clinical practice, and public health planning; however, prevalence estimates in Latin America (LatAm) are limited. We aimed to estimate the prevalence of parkinsonism and PD and examine related risk factors in a cohort of elderly individuals from Latin America (LatAm). Methods: Data from 11,613 adults (65+ years) who participated in a baseline assessment of the 10/66 study and lived in six LatAm countries were analyzed to estimate parkinsonism and PD prevalence. Crude and age-adjusted prevalence were determined by sex and country. Diagnosis of PD was established using the UK Parkinson's Disease Society Brain Bank's clinical criteria. Findings: In this cohort, the prevalence of parkinsonism was 8.0% (95% CI 7.6%-8.5%), and the prevalence of PD was 2.0% (95% CI 1.7%-2.3%). PD prevalence increased with age from 1.0 to 3.5 (65-69vs. 80 years or older, p < 0.001). Age-adjusted prevalence rates were lower for women than for men. No significant differences were found across countries, except for lower prevalence in urban areas of Peru. PD was positively associated with depression (adjusted prevalence ratio [aPR] 2.06, 95% CI 1.40-3.01, I 2 = 56.0%), dementia (aPR 1.57, 95% CI 1.07- 2.32, I 2 = 0.0%) and educational level (aPR 1.14, 95% CI 1.01- 1.29, I 2 = 58.6%). Interpretation: The reported prevalence of PD in LatAm is similar to reports from high-income countries (HIC). A significant proportion of cases with PD did not have a previous diagnosis, nor did they seek any medical or neurological attention. These findings underscore the need to improve public health programs for populations currently undergoing rapid demographic aging and epidemiological transition. Funding: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Leg length, skull circumference, and the prevalence of dementia in low and middle income countries: a 10/66 population-based cross sectional survey.

BACKGROUND: Adult leg length is influenced by nutrition in the first few years of life. Adult head circumference is an indicator of brain growth. There is a limited literature linking short legs and small skulls to an increased risk for cognitive impairment and dementia in late life. METHODS: One phase cross-sectional surveys were carried out of all residents aged over 65 years in 11 catchment areas in China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru (n = 14,960). The cross-culturally validated 10/66 dementia diagnosis, and a sociodemographic and risk factor questionnaire were administered to all participants, and anthropometric measures taken. Poisson regression was used to calculate prevalence ratios for the effect of leg length and skull circumference upon 10/66 dementia, controlling for age, gender, education and family history of dementia. RESULTS: The pooled meta-analyzed fixed effect for leg length (highest vs. lowest quarter) was 0.82 (95% CI, 0.68-0.98) and for skull circumference 0.75 (95% CI, 0.63-0.89). While point estimates varied between sites, the proportion of the variability attributable to heterogeneity between studies as opposed to sampling error (I2) was 0% for leg length and 22% for skull circumference. The effects were independent and not mediated by family history of dementia. The effect of skull circumference was not modified by educational level or gender, and the effect of leg length was not modified by gender. CONCLUSIONS: Since leg length and skull circumference are said to remain stable throughout adulthood into old age, reverse causality is an unlikely explanation for the findings. Early life nutritional programming, as well as neurodevelopment may protect against neurodegeneration.

The use of prolonged administration of low-dose intravenous lipid emulsion to treat ivermectin toxicosis in goats.

CASE DESCRIPTION: 2 Nigerian Dwarf goats (a doe [goat 1] and a wether [goat 2]) with coughing and nasal discharge since they were purchased at an auction 6 days prior were empirically treated for suspected pneumonia and intestinal parasitism. An ivermectin dosing error (intended dose, 0.4 mg/kg, PO; administered dose, 10 mg/kg, PO) was retrospectively discovered, and the owner was urged to return the goats for hospitalization and treatment. CLINICAL FINDINGS: On admission 19 hours after iatrogenic ivermectin overdose, both goats had tachycardia, tachypnea, and absent menace responses. Goat 1 also had vomited in transit, was lethargic and febrile, had slow pupillary light reflexes, and walked into walls and obstacles. Goat 2 was quiet but responsive, not ataxic or febrile, and had pale mucous membranes and a prolonged capillary refill time. TREATMENT AND OUTCOME: Each goat received 20% IV lipid emulsion (2 mL/kg, IV bolus over 15 minutes, followed by 0.008 mL/kg/min, IV) and immediately improved. Activated charcoal was administered by orogastric tube, and 6 hours later, mineral oil was similarly administered. Goat 1 had complete resolution of signs and was discharged by 48 and 72 hours, respectively, after admission. Goat 2 improved but developed progressive respiratory distress after the second orogastric intubation and was euthanized. Necropsy findings were consistent with acute renal tubular necrosis, acute respiratory distress syndrome of unknown cause, ruminal tympany, and mesenteric caseous lymphadenitis. CLINICAL RELEVANCE: Results indicated that IV lipid emulsion could be used to successfully treat ivermectin toxicosis in goats. Treatment early in the course of ivermectin toxicosis is advisable to avoid severe clinical signs and secondary complications.

Black oil sunflower seed ingestion associated with renal azotemia, gastroesophageal ulceration, and a high mortality rate in four alpacas and two llamas.

CASE DESCRIPTION: 4 alpacas and 2 llamas (11 months to 11 years old) from 2 properties were examined for lethargy (6/6), salivation and regurgitation (4/6), and recumbency (3/6). Signs developed approximately 48 to 72 hours after accidental access to black oil sunflower seeds. CLINICAL FINDINGS: 3 alpacas died suddenly prior to treatment and were necropsied. One llama survived, and 1 alpaca and 1 llama died after days of medical treatment. All 3 treated animals had systemic inflammatory signs including tachycardia, fever, and hematologic changes. Biochemical anomalies included azotemia, hyperglycemia, hyponatremia, hypochloremia, and hypoalbuminemia. Necropsy identified numerous sunflower seeds in the gastrointestinal tract of all 5 animals that died, with pulmonary congestion (5/5 animals), mild centrilobular vacuolar hepatic degeneration (4/5), and erosions of the esophagus (3/5) and first (3/5) and third (1/5) compartments of the forestomach. Renal tubular necrosis was found in the 2 animals that died on day 4 of treatment. TREATMENT AND OUTCOME: One llama responded successfully to intensive medical management including supplemented IV fluid therapy, oral and partial parenteral nutrition, and administration of antimicrobials, furosemide, and insulin and was clinically normal with plasma biochemical analysis values within reference range 12 weeks later. Vitamin D, oxalates, heavy metals, and mycotoxins were excluded as the cause of clinical signs on the basis of screening of uneaten seeds and tissue samples and gastric content from the treated llama that died. CLINICAL RELEVANCE: Inadvertent large volume black oil sunflower seed ingestion resulted in a high mortality rate in camelids. A specific toxic principle was not identified. Feeding this product to camelids is not recommended to avoid the risk of accidental overingestion and subsequent disease.

Disección espontánea de la arteria coronaria e infarto agudo de miocardio / Spontaneous coronary artery dissection and acute myocardial infarction

Resumen La disección espontánea de la arteria coronaria es una causa no aterosclerótica de infarto de miocardio, la cual es más común en mujeres jóvenes con pocos o ningún factor de riesgo cardiovascular. Es infrecuente, no se asocia a iatrogenia ni trauma, y se presenta por acumulación espontánea de sangre entre las capas de la pared arterial coronaria, por ruptura de la íntima; de ahí que genera una falsa luz que produce compresión externa del verdadero lumen arterial, con lo cual altera el flujo sanguíneo coronario y ocluye la arteria comprometida. Se expone el caso de una mujer de 31 años, sin factores de riesgo cardiovascular, quien ingresó a un servicio de urgencias con dolor torácico típico, de 2 horas de evolución. En el electrocardiograma se apreció elevación del segmento ST en las derivaciones de la cara anteroseptal e inferior, y troponina T de alta sensibilidad positiva, por lo que se realizó terapia trombolítica con tenecteplasa, sin obtener criterios de reperfusión. Se hizo angiografía coronaria, la cual mostró obstrucción total de la arteria coronaria descendente anterior en el tercio medio. El ultrasonido intravascular documentó flap de disección y hematoma en este segmento, los cuales confirmaron la disección coronaria espontánea. Se realizó angioplastia con implante de stent coronario y se restableció la circulación, observando mejoría de los síntomas.

Abstract Spontaneous coronary artery dissection is a non-atherosclerotic cause of myocardial infarction, more frequent in young women with few or no cardiovascular risk factors, it is infrequent, and it is not associated with iatrogenesis or trauma. It occurs due to spontaneous accumulation of blood between the layers of the coronary artery wall, due to rupture of the intima, generating a false lumen that produces external compression of the true arterial lumen, altering coronary blood flow, occluding the compromised artery. It is presented the case of a 31-year-old woman with no cardiovascular risk factors, who was admitted to an emergency department, with typical chest pain of 2 hours of evolution, showing ST-segment elevation in leads of anteroseptal and inferior face on the electrocardiogram and troponin T with high sensitivity positive. Therefore, thrombolytic therapy was performed with tenecteplase, without obtaining reperfusion criteria. Coronary angiography was performed that demonstrates total obstruction of the anterior descending coronary artery in the middle third. Intravascular ultrasound documents the dissection flap and hematoma in this segment that confirm spontaneous coronary dissection, performing angioplasty with implantation of a coronary stent, restoring circulation with improvement of symptoms.

Cuba's Aging and Alzheimer Longitudinal Study.

Aging and Alzheimer is a prospective, longitudinal cohort study involving 2944 adults aged ≥65 years from selected areas in Cuba's Havana and Matanzas Provinces. This door-to-door study, which began in 2003, includes periodic assessments of the cohort based on an interview; physical exam; anthropometric measurements; and diagnosis of dementia and its subtypes, other mental disorders, and other chronic non-communicable diseases and their risk factors. Information was gathered on sociodemographic characteristics; disability, dependency and frailty; use of health services; and characteristics of care and caregiver burden. The first assessment also included blood tests: complete blood count, blood glucose, kidney and liver function, lipid profile and ApoE4 genotype (a susceptibility marker). In 2007-2011, the second assessment was done of 2010 study subjects aged ≥65 years who were still alive. The study provides data on prevalence and incidence of dementia and its risk factors, and of related conditions that affect the health of older adults. It also contributes valuable experiences from field work and interactions with older adults and their families. Building on lessons learned, a third assessment to be done in 2016-2018 will incorporate a community intervention strategy to respond to diseases and conditions that predispose to dementia, frailty and dependency in older adults. KEYWORDS Dementia, Alzheimer disease, chronic disease, aging, chronic illness, frailty, dependency, cohort studies, Cuba.

Incidence of dementia and association with APOE genotype in older Cubans.

OBJECTIVE: In an admixed population of older Cubans, the incidence and association of APOE and sociodemographic risk factors with dementia incidence was estimated. METHODS: A single-phase survey (baseline) of all over 65-year-olds residing in seven catchment areas in Cuba (n=2944) was conducted between 2003 and 2007. Dementia diagnosis was established according to DSM-IV and 10/66 criteria. APOE genotype was determined in 2520 participants. An incidence wave was conducted 4.5 years after cohort inception in order to estimate incidence and associations with sociodemographic risk factors of the APOE ε4 genotype. RESULTS: The incidence rate of DSM IV dementia was 9.0 per 1000 person-years (95% CI 7.2-11.3) and of 10/66 dementia was 20.5 per 1000 person-years (95% CI, 17.6-23.5). Older age, a family history of dementia and APOE ε4 genotype were independent risk factors for incident 10/66 dementia. APOE genotype was associated cross-sectionally with dementia prevalence, but the effect on the incidence of dementia was attenuated, and only apparent among those in the youngest age group. CONCLUSION: The incidence of dementia in the older Cuban population is relatively high and similar to levels reported in Europe and North-America. The study showed that the relationship between APOE ε4 and incident dementia is stronger in the younger-old than the older-old and that this change must be taken into account in models of dementia.

OBJETIVO: Em uma população miscigenada de cubanos idosos, estimamos a incidência de demência e a associação entre o genótipo da APOE e os fatores de risco sociodemográficos na incidência de demência. MÉTODOS: Realizamos uma pesquisa de uma fase (linha de base) de todos os idosos com mais de 65 anos residentes em sete áreas de Cuba (n=2944), de 2003 a 2007. O diagnóstico de demência foi estabelecido de acordo com os critérios do DSM-IV e do 10/66. O genótipo APOE foi determinado em 2520 participantes. Avaliação da incidência foi conduzida 4,5 anos após a linha de base, a fim de estimar a incidência e associações com fatores de risco sociodemográficos e o genótipo APOE ε4. RESULTADOS: A taxa de incidência de demência foi de 9,0 por 1000 pessoas-ano (IC 95% 7,2-11,3) de acordo com o DSM-IV e de 20,5 por 1000 pessoas-ano (IC 95%, 17,6-23,5) de acordo com o 10/66. Idade avançada, história familiar de demência e genótipo APOE ε4 foram fatores de risco independentes para a incidência de demência de acordo com os critérios do 10/66. O genótipo APOE foi associado com a prevalência de demência em estudo transversal, mas o efeito sobre a incidência de demência foi atenuado, e apenas aparente entre aqueles na faixa etária mais jovem. CONCLUSÃO: A incidência de demência na população cubana mais velha é relativamente alta, semelhante às relatadas na Europa e América do Norte. O estudo mostra que a relação entre APOE ε4 incidente e demência é mais forte entre os idosos mais jovens e que esta alteração deve de ser considerada em modelos de demência.

Incidence of dementia and association with APOE genotype in older Cubans / Incidência de demência e associação com o genótipo APOE em idosos Cubanos

Objective: In an admixed population of older Cubans, the incidence and association of APOE and sociodemographic risk factors with dementia incidence was estimated. Methods: A single-phase survey (baseline) of all over 65-year-olds residing in seven catchment areas in Cuba (n=2944) was conducted between 2003 and 2007. Dementia diagnosis was established according to DSM-IV and 10/66 criteria. APOE genotype was determined in 2520 participants. An incidence wave was conducted 4.5 years after cohort inception in order to estimate incidence and associations with sociodemographic risk factors of the APOE ?4 genotype. Results: The incidence rate of DSM IV dementia was 9.0 per 1000 person-years (95% CI 7.2-11.3) and of 10/66 dementia was 20.5 per 1000 person-years (95% CI, 17.6-23.5). Older age, a family history of dementia and APOE e4 genotype were independent risk factors for incident 10/66 dementia. APOE genotype was associated cross-sectionally with dementiaprevalence, but the effect on the incidence of dementia was attenuated, and only apparent among those in the youngest age group. Conclusion: The incidence of dementia in the older Cuban population is relatively high and similar to levels reported in Europe and North-America. The study showed that the relationship between APOE e4 and incident dementia is stronger in the younger-old than the older-old and that this change must be taken into account in models of dementia.

Objetivo: Em uma população miscigenada de cubanos idosos, estimamos a incidência de demência e a associação entre o genótipo da APOE e os fatores de risco sociodemográficos na incidência de demência. Métodos: Realizamos uma pesquisa de uma fase (linha de base) de todos os idosos com mais de 65 anos residentes em sete áreas de Cuba (n=2944), de 2003 a 2007. O diagnóstico de demência foi estabelecido de acordo com os critérios do DSM-IV e do 10/66. O genótipo APOE foi determinado em 2520 participantes. Avaliação da incidência foi conduzida 4,5 anos após a linha de base, a fim de estimar a incidência e associações com fatores de risco sociodemográficos e o genótipo APOE 4. Resultados: A taxa de incidência de demência foi de 9,0 por 1000 pessoas-ano (IC 95% 7,2-11,3) de acordo com o DSM-IV e de 20,5 por 1000 pessoas-ano (IC95%, 17,6-23,5) de acordo com o 10/66. Idade avançada, história familiar de demência e genótipo APOE 4 foram fatores de risco independentes para a incidência de demência de acordo com os critérios do 10/66. O genótipo APOE foi associado com a prevalência de demência em estudo transversal, mas o efeito sobre a incidência de demência foi atenuado, e apenas aparente entre aqueles na faixa etária mais jovem. Conclusão: A incidência de demência na população cubana mais velha é relativamente alta, semelhante às relatadas na Europa e América do Norte. O estudo mostra que a relação entre APOE 4 incidente e demência é mais forte entre os idosos mais jovens e que esta alteração deve de ser considerada em modelos de demência.

[Surgical treatment of gastric cancer: results in 423 cases]. / Resultados del tratamiento quirúrgico del cáncer gástrico: Análisis de 423 casos.

BACKGROUND: Gastric cancer is the second cause of cancer death worldwide and the first cause in Chile. Management of this pathology is controversial. AIM: To report the results on morbidity, mortality, and long-term survival rates of surgical treatment of gastric cancer, and compare them with those reported in the literature. MATERIAL AND METHODS: Follow up of 423 patients (aged 16 to 88 years, 271 males) operated for a gastric adenocarcinoma between 1996 and 2002. Patients were staged with the 5th edition of TNM staging system, and the 2nd edition in English of the Japanese Classification of Gastric Cancer. Morbidity was assessed using the classification of the Memorial Kettering Cancer Center group. Kapplan-Meier method was used to assay survival, and Log rank Test to compare long-term survivals. RESULTS: Resectability of the lesions was 70.4%, and 88% of them corresponded to a curative-intended surgery. Seventy percent of patients were in stage TNM IIIA or higher at the moment of surgery. Mortality in curative intended operated patients was 4.2%, and morbidity was 33.7%. Overall five years survival rate was 33%: In the group with curative intended surgery it was 52%. Two years survival rate in the non intended curative group was 3.4%. CONCLUSIONS: The reported incidence of complications in our series is similar to that reported in the literature. Five year survival rates, morbidity and mortality were comparable to those reported abroad.

An audiotaped mental health evaluation tool for Hispanic immigrants with a range of literacy levels.

Debilitating mental illness is treatable if found. There is no validated self-administered mental illness evaluation tool for immigrant Hispanic farm workers with variable literacy levels. This study tested sensitivity and specificity of an audiotaped survey developed for low literacy levels compared with standard interview instruments. Subjects from 11 migrant camps completed a self-administered audiotaped survey in Spanish to diagnose major depression, substance abuse, panic and generalized anxiety, and domestic violence. Primary care clinics assisted in finding camps and provided follow-up treatment. For 154 men and 156 women, the audio tool was most sensitive for major depression and specific for anxiety disorder, alcohol abuse, and domestic violence. Seventy percent of those diagnosed with major depression received appropriate treatment. This study validated an inexpensive, self-administered audio tool to evaluate the mental health of immigrant Hispanic farm workers with a wide range of literacy levels.