Brain health index as a predictor of possible vascular dementia in the Mexican health and aging study 2012-2015.

To determine the burden of disease among subjects at risk of developing stroke or dementia, brain health indexes (BHI) tend to rely on anatomical features. Recent definitions emphasize the need of a broader perspective that encompasses cardiovascular risk factors (CVRFS) and lifestyle components which can be considered partial contributors to optimal brain health. In this study, we aimed to establish the association and risk detected by a Brain Health Index and the risk of possible vascular dementia (PVD) using data from the Mexican Health and Aging Study (MHAS) 2012-2015. The MHAS is a longitudinal study of adults aged ≥ 50 years. We analyzed the data obtained between 2012 and 2015. CVRFS included in the index were diabetes mellitus, hypertension, myocardial infarction, depression, obesity, physical inactivity, and smoking history. A PVD diagnosis was established when scores in the Cross-Cultural Cognitive Examination were below reference norms and limitations in ≥1 instrumental activities of daily living and a history of stroke were present. A multinomial regression model was developed to determine the association between BHI scores and PVD. In 2015, 75 PVD cases were identified. Mean age was 67.1 ±13.2 years, 35.8% were female, and the mean educational level was 5.8 ±5.5 years. In cases with a higher score in the BHI, the model revealed a hazards ratio of 1.63 (95% CI: 1.63-1.64, p< 0.001) for PVD. In this longitudinal study, with the use of a feasible multifactorial BHI in the Mexican population, a greater score was associated with a 1.63-fold risk of developing PVD during the 3-year follow-up, while the risk for stroke was 1.75. This index could potentially be used to predict the risk of PVD in adults with modifiable CVRFS.

The Influence of Education and Occupation Type on Birth Cohort Differences in Cognitive Function of Mexican Older Adults.

OBJECTIVES: Mexico's population aging is occurring in the context of social changes such as increased educational attainment and occupational shifts from agriculture to service and industry. The current study compares cognitive function between two birth cohorts of Mexican adults aged 60-76 to determine if population-level changes in education and occupation type contribute to cohort differences in cognitive function. METHODS: We used the Mexican Health and Aging Study to examine adults aged 60-76 in 2001 (men: 2,309; women: 2,761) and 2018 (men: 2,842; women: 3,825). Global cognition was calculated from five measures. Five main lifetime occupation types were created: no main job; agriculture; service; professional; and industrial. Ordinary least squares regression and structural equation models (SEM) were used to examine cohort differences in cognitive functioning. RESULTS: Ordinary least squares models that adjusted for age, community size, and marital status indicated that men and women had higher global cognition in 2018 than 2001 (men: b = 0.44, p < .01; women: b = 0.54, p < .01). These differences were reduced after adjusting for education and occupation type (men: b = 0.27, p < .01; women: b = 0.37, p < .01). Results from SEM indicated that the indirect effects of education on cognitive functioning were larger than occupation type for men (education: b = 0.18, p < .05; occupation: b = 0.001, p = .91) and women (education: b = 0.18, p < .05; occupation: b = 0.002, p = .22). DISCUSSION: Cognitive functioning is higher among more recent birth cohorts of older adults in Mexico. These cohort differences are partially mediated by education but not main lifetime occupation. Additional factors may contribute to cohort differences in cognitive function for older adults in Mexico.

The Mex-Cog cognitive assessment battery: discriminant analysis of the cognitive performance profile in older adults.

OBJECTIVE: To analyze the cognitive profile of a clinical sample using the Mex-Cog cognitive battery and establish which cognitive measures and domains contribute most to group separation. MATERIALS AND METHODS: A group of 145 older adults previously diagnosed with dementia (n= 47), mild cognitive impairment MCI (n= 47), or as cognitively normal (n= 51) were assessed with the Mex-Cog cognitive battery. Six linear discriminant analyses (LDA) were estimated to compare dementia vs. cognitively normal, MCI vs. cognitively normal, and MCI vs. dementia, using ten individual measures and six cognitive domains. We used a leave-one-out cross-validation procedure to evaluate the predictive capacity of LDA models. RESULTS: Discriminant functions using individual measures and domains distinguished correctly 100% of dementia and cognitively normal groups showing a memory and executive function profile. The predictive group membership for MCI versus cognitively normal varied between 82 and 85%, with a cognitive profile associated with attention-executive function followed by memory. Group separation between MCI and dementia was between 80 and 87%, characterized by orientation, memory, and visuospatial abilities. CONCLUSIONS: The Mex-Cog cognitive battery is useful for identifying cognitive impairment in older adults.

Gender, Personality, and Cognitive Resilience Against Early-Life Disadvantage.

OBJECTIVES: Early-life disadvantage (ELD) relates to lower late-life cognition. However, personality factors, including having an internal locus of control (LOC) or a conscientious personality, relate to resilience and effective stress coping. We explore whether personality factors convey resilience against the negative effects of ELD on cognition, by gender, in Mexico. METHODS: Using the 2015 Mexican Health and Aging Study, we estimated expected cognition using multiple ELD markers to identify a subsample in the lowest quartile of expected cognition given ELD (n = 2,086). In this subsample, we estimated cross-sectional associations between personality and having above-median observed cognitive ability (n = 522) using logistic regression. RESULTS: Among those in the lowest quartile of expected cognition, a more internal LOC (ß = 0.32 [men] and ß = 0.44 [women]) and conscientious personality (ß = 0.39 [men] and ß = 0.17 [women]) were significantly associated with having above-median cognitive ability in models adjusted for demographic confounders. Larger benefits of conscientiousness were observed for men than women. Associations between personality and having above-median cognitive ability remained statistically significant after further adjustment for health, stress, and cognitive stimulation variables, regardless of gender. DISCUSSION: Personality factors may convey resilience among individuals who experienced ELD, potentially breaking the link between ELD and worse late-life cognition. Structural factors and gender roles may affect how much women benefit from personality factors.

Living Arrangements and Dementia Among the Oldest Old: A Comparison of Mexicans and Mexican Americans.

Background and Objectives: The growing population of adults surviving past age 85 in the United States and Mexico raises questions about the living arrangements of the oldest old and those living with dementia. This study compares Mexican and Mexican American individuals aged 85 and older to identify associations with cognitive status and living arrangements in Mexico and the United States. Research Design and Methods: This study includes 419 Mexican Americans in 5 southwestern states (Hispanic Established Population for the Epidemiologic Studies of the Elderly) and 687 Mexicans from a nationally representative sample (Mexican Health and Aging Study). It examines characteristics associated with living alone using logistic regression and describes the living arrangements of older adults with probable dementia in each country. Results: Older adults with dementia were significantly less likely to live alone than with others in the United States while there were no relationships between dementia and living arrangements in Mexico. However, a substantial proportion of older adults with dementia lived alone in both nations: 22% in the United States and 21% in Mexico. Among Mexican Americans with dementia, those living alone were more likely to be women, childless, reside in assisted living facilities, and less likely to own their homes. Similarly, Mexican individuals with dementia who lived alone were also less likely to be homeowners than those living with others. Discussion and Implications: Contextual differences in living arrangements and housing between the United States and Mexico pose different challenges for aging populations with a high prevalence of dementia.

Midlife Vascular Factors and Prevalence of Mild Cognitive Impairment in Late-Life in Mexico.

OBJECTIVE: To estimate the prevalence of mild cognitive impairment (MCI) and its subtypes and investigate the impact of midlife cardiovascular risk factors on late-life MCI among the aging Mexican population. METHOD: Analyses included a sample of non-demented adults over the age of 55 living in both urban and rural areas of Mexico (N = 1807). MCI diagnosis was assigned based on a comprehensive cognitive assessment assessing the domains of memory, executive functioning, language, and visuospatial ability. The normative sample was selected by means of the robust norms approach. Cognitive impairment was defined by a 1.5-SD cut-off per cognitive domain using normative corrections for age, years of education, and sex. Risk factors included age, education, sex, rurality, depression, insurance status, workforce status, hypertension, diabetes, stroke, and heart disease. RESULTS: The prevalence of amnestic MCI was 5.9%. Other MCI subtypes ranged from 4.2% to 7.7%. MCI with and without memory impairment was associated with older age (OR = 1.01 [1.01, 1.05]; OR = 1.03 [1.01, 1.04], respectively) and residing in rural areas (OR = 1.49 [1.08, 2.06]; OR = 1.35 [1.03, 1.77], respectively). Depression (OR = 1.07 [1.02, 1.12]), diabetes (OR = 1.37 [1.03, 1.82]), and years of education (OR = 0.94 [0.91, 0.97]) were associated with MCI without memory impairment. Midlife CVD increased the odds of MCI in late-life (OR = 1.76 [1.19, 2.59], which was driven by both midlife hypertension and diabetes (OR = 1.70 [1.18, 2.44]; OR = 1.88 [1.19, 2.97], respectively). CONCLUSIONS: Older age, depression, low education, rurality, and midlife hypertension and diabetes were associated with higher risk of late-life MCI among older adults in Mexico. Our findings suggest that the causes of cognitive impairment are multifactorial and vary by MCI subtype.

Prevalence and incidence of possible vascular dementia among Mexican older adults: Analysis of the Mexican Health and Aging Study.

INTRODUCTION: Vascular dementia is the second most common cause of dementia. Physical disability and cognitive impairment due to stroke are conditions that considerably affect quality of life. We estimated the prevalence and incidence of possible vascular dementia (PVD) in older adults using data from the Mexican Health and Aging Study (MHAS 2012 and 2015 waves). METHODS: The MHAS is a representative longitudinal cohort study of Mexican adults aged ≥50 years. Data from 14, 893 participants from the 2012 cohort and 14,154 from the 2015 cohort were analyzed to estimate the prevalence and incidence of PVD. Self-respondents with history of stroke were classified as PVD if scores in two or more cognitive domains in the Cross-Cultural Cognitive Examination were ≥ 1.5 standard deviations below the mean on reference norms and if limitations in ≥ 1 instrumental activities of daily living were present. For proxy respondents with history of stroke, we used a score ≥3.4 on the Informant Questionnaire on Cognitive Decline in the Elderly. Crude and standardized rates of prevalent and incident PVD were estimated. RESULTS: Prevalence of PVD was 0.6% (95% CI, 0.5-0.8) (0.5 with age and sex- standardization). Rates increased with age reaching 2.0% among those aged 80 and older and decreased with educational attainment. After 3.0 years of follow-up, 87 new cases of PVD represented an overall incident rate of 2.2 (95% CI, 1.7-2.6) per 1,000 person-years (2.0 with age and sex- standardization). Incidence also increased with advancing age reaching an overall rate of 9.4 (95% CI, 6.3-13.6) per 1,000 person-years for participants aged >80 years. Hypertension and depressive symptoms were strong predictors of incident PVD. CONCLUSION: These data provide new estimates of PVD prevalence and incidence in the Mexican population. We found that PVD incidence increased with age. Males aged 80 years or older showed a greater incidence rate when compared to females, which is comparable to previous estimates from other studies.

Effect of Demographic and Health Dynamics on Cognitive Status in Mexico between 2001 and 2015: Evidence from the Mexican Health and Aging Study.

Sources of health disparities such as educational attainment, cardiovascular risk factors, and access to health care affect cognitive impairment among older adults. To examine the extent to which these counteracting changes affect cognitive aging over time among Mexican older adults, we examine how sociodemographic factors, cardiovascular diseases, and their treatment relate to changes in cognitive function of Mexican adults aged 60 and older between 2001 and 2015. Self and proxy respondents were classified as dementia, cognitive impairment no dementia (CIND), and normal cognition. We use logistic regression models to examine the trends in dementia and CIND for men and women aged 60 years or older using pooled national samples of 6822 individuals in 2001 and 10,219 in 2015, and sociodemographic and health variables as covariates. We found higher likelihood of dementia and a lower risk of CIND in 2015 compared to 2001. These results remain after adjusting for sociodemographic factors, cardiovascular diseases, and their treatment. The improvements in educational attainment, treatment of diabetes and hypertension, and better access to health care in 2015 compared to 2001 may not have been enough to counteract the combined effects of aging, rural residence disadvantage, and higher risks of cardiovascular disease among older Mexican adults.

Socioeconomic Disparities and Gender Inequalities in Dementia: a Community-Dwelling Population Study from a Middle-Income Country.

The proportion of the world's older adults and of its dementia cases is increasing in low and middle-income countries. This is particularly true in Colombia. There, the number of individuals with dementia may increase five-fold by 2050. Yet research is lacking on dementia in such settings. This work estimates the prevalence of dementia in a community-dwelling population in Colombia. It also assesses how gender-based differences in cardiovascular conditions and socioeconomic disparities affect dementia. This work analyzes data on 2000 respondents at least 60 years of age in the Health, Well-Being, And Aging (SABE) study in Bogota. Respondents with dementia are those who have cognitive impairment and at least two limitations in instrumental activities of daily living. The SABE study finds 8.4% of respondents have dementia. Age, cardiovascular risks, and socioeconomic disparities contributed to higher odds of dementia. The contributors to dementia can differ for men and women. For example, socioeconomic disparities were a larger contributor to dementia for women than men. The findings support the cognitive reserve hypothesis on dementia. This holds that pre-existing cognitive processes and compensatory mechanisms influence dementia. Women in Latin America are more likely to suffer from socioeconomic disparities that limit their cognitive reserve. This research points to several policy implications that can help offset these disparities and reduce the prevalence of dementia.

Health and social correlates of dementia in oldest-old Mexican-origin populations.

INTRODUCTION: Substantial gaps in research remain across oldest-old ethnic populations while the burden of dementia increases exponentially with age among Mexican and Mexican American older adults. METHODS: Prevalence and correlates of dementia among individuals ≥82 years of age were examined using two population-based cohort studies: The Mexican Health and Aging Study (MHAS, n = 1078, 2012) and the Hispanic Established Populations for the Epidemiologic Study of the Elderly (HEPESE, n = 735, 2012-2013). The analytic MHAS and HEPESE samples had an average age of 86.4 and 88.0 years, 1.2 and 1.8 women to men, and 2.7 and 5.1 average years of education, respectively. RESULTS: We identified 316 (29.2%) and 267 (36.3%) cases of likely dementia in the MHAS and HEPESE cohorts, respectively. For Mexicans but not Mexican Americans, age-adjusted prevalence rates of likely dementia were higher in women than men. For both populations prevalence rates increased with age and decreased with education for Mexican Americans but not for Mexicans. In both populations, odds of likely dementia increased with age. Health insurance for the low-income was significantly associated with higher odds of likely dementia for Mexican American men and women and Mexican women but not men. Living in extended households increased the odds of likely dementia in women, but not in men for both studies. Multiple cardiovascular conditions increased the odds of likely dementia for Mexicans but not for Mexican Americans. DISCUSSION: Our study provides evidence of the high burden of dementia among oldest-old Mexicans and Mexican Americans and its association with health and social vulnerabilities.

The Mexican Cognitive Aging Ancillary Study (Mex-Cog): Study Design and Methods.

OBJECTIVE: Describe the protocol sample and instruments of the Cognitive Aging Ancillary Study in Mexico (Mex-Cog). The study performs an in-depth cognitive assessment in a subsample of older adults of the ongoing Mexican Health and Aging Study (MHAS). The Mex-Cog is part of the Harmonized Cognitive Assessment Protocol (HCAP) design to facilitate cross-national comparisons of the prevalence and trends of dementia in aging populations around the world, funded by the National Institute on Aging (NIA). METHODS: The study protocol consists of a cognitive assessment instrument for the target subject and an informant questionnaire. All cognitive measures were selected and adapted by a team of experts from different ongoing studies following criteria to warrant reliable and comparable cognitive instruments. The informant questionnaire is from the 10/66 Dementia Study in Mexico. RESULTS: A total of 2,265 subjects aged 55-104 years participated, representing a 70% response rate. Validity analyses showed the adequacy of the content validity, proper quality-control procedures that sustained data integrity, high reliability, and internal structure. CONCLUSIONS: The Mex-Cog study provides in-depth cognitive data that enhances the study of cognitive aging in two ways. First, linking to MHAS longitudinal data on cognition, health, genetics, biomarkers, economic resources, health care, family arrangements, and psychosocial factors expands the scope of information on cognitive impairment and dementia among Mexican adults. Second, harmonization with other similar studies around the globe promotes cross-national studies on cognition with comparable data. Mex-Cog data is publicly available at no cost to researchers.

Spanish validation and cultural adaptation of the Five-Word Test for the detection of the neurocognitive disorder in older adults / Adaptación cultural y validación al español de la Prueba de Cinco Palabras para detectar el trastorno neurocognitivo en adultos mayores

Abstract Introduction "Episodic" memory problems are common in people with cognitive impairment due to Alzheimer's disease and related disorders. Dubois et al. developed the Five-Word Test (5WT) to evaluate episodic memory, which has proved to be an easy and valid test for identifying cognitive disorders. However, its validation and cultural adaptation from French to Spanish has not been undertaken and its usefulness in Mexican population is unknown. Objective Validation and cultural adaptation of the 5WT for screening minor and major neurocognitive disorder (ND) in Mexican older adults with probable Alzheimer's disease. Method Two hundred and fifteen participants (70 cognitively healthy subjects, 73 with minor ND and 72 with major ND were included). The cognitive status (gold standard) was determined using current clinical criteria and neuropsychological evaluation. The Spearman coefficient, ROC curve, and multinomial logistic regression models were used to determine the concurrent validity of the 5WT. Results The correlation between the 5WT and the Mini-Mental State Exam (MMSE) was .58, whereas for the clock face test it was -.37 (p < .001). The area under the 5WT curve was .97 (95% CI [.94, .99]), with a cut-off point of ≤ 16/20 for the diagnosis of major ND (89% sensitivity, 98% specificity) and .77 (95% CI [.70, .85]) for minor ND with a cut-off point of ≤ 18/20 (66% sensitivity, 77% specificity). Discussion and conclusion Since the 5WT is a simple, valid instrument for the identification of neurocognitive disorders like Alzheimer's disease, it could be a practical screening test.

Resumen Introducción Los problemas de la memoria "episódica" son comunes en las personas con deterioro cognitivo tipo Alzheimer. Dubois et al. desarrollaron la Prueba de Cinco Palabras (P5P) para evaluar la memoria episódica, la cual ha demostrado ser sencilla y válida para identificar trastornos cognitivos. Sin embargo, su validación y adaptación cultural del francés al español no se ha realizado y se desconoce su utilidad en población mexicana. Objetivo Validación y adaptación cultural de la P5P para el tamizaje del trastorno neurocognitivo (TNC) menor y mayor en adultos mayores mexicanos con probable enfermedad de Alzheimer. Método Participaron 215 participantes (70 cognitivamente sanos, 73 con TNC menor y 72 con TNC mayor. El estado cognitivo (estándar de oro) se determinó mediante los criterios clínicos vigentes y de evaluación neuropsicológica. El coeficiente de Spearman, la curva ROC y modelos de regresión logística multinomial se utilizaron para determinar la validez concurrente de la P5P. Resultados La correlación entre la P5P y el MMSE fue de .58, mientras que para la prueba de reloj fue de -.37 (p < .001). El área bajo la curva de la P5P fue .97 (IC 95% [.94, .99]), con un punto de corte ≤ 16/20 para el diagnóstico del TNC mayor (sensibilidad: 89%, especificidad: 98%) y de .77 (IC 95% [.70, .85]) para el TNC menor con un punto de corte ≤ 18/20 (sensibilidad: 66%, especificidad: 77%). Discusión y conclusión La P5P es un instrumento válido y simple para identificar de trastornos neurocognitivos de tipo Alzheimer por lo que podría ser una prueba práctica para uso en el tamizaje.

Type 2 Diabetes as a Risk Factor for Dementia in Women Compared With Men: A Pooled Analysis of 2.3 Million People Comprising More Than 100,000 Cases of Dementia.

OBJECTIVE: Type 2 diabetes confers a greater excess risk of cardiovascular disease in women than in men. Diabetes is also a risk factor for dementia, but whether the association is similar in women and men remains unknown. We performed a meta-analysis of unpublished data to estimate the sex-specific relationship between women and men with diabetes with incident dementia. RESEARCH DESIGN AND METHODS: A systematic search identified studies published prior to November 2014 that had reported on the prospective association between diabetes and dementia. Study authors contributed unpublished sex-specific relative risks (RRs) and 95% CIs on the association between diabetes and all dementia and its subtypes. Sex-specific RRs and the women-to-men ratio of RRs (RRRs) were pooled using random-effects meta-analyses. RESULTS: Study-level data from 14 studies, 2,310,330 individuals, and 102,174 dementia case patients were included. In multiple-adjusted analyses, diabetes was associated with a 60% increased risk of any dementia in both sexes (women: pooled RR 1.62 [95% CI 1.45-1.80]; men: pooled RR 1.58 [95% CI 1.38-1.81]). The diabetes-associated RRs for vascular dementia were 2.34 (95% CI 1.86-2.94) in women and 1.73 (95% CI 1.61-1.85) in men, and for nonvascular dementia, the RRs were 1.53 (95% CI 1.35-1.73) in women and 1.49 (95% CI 1.31-1.69) in men. Overall, women with diabetes had a 19% greater risk for the development of vascular dementia than men (multiple-adjusted RRR 1.19 [95% CI 1.08-1.30]; P < 0.001). CONCLUSIONS: Individuals with type 2 diabetes are at ∼60% greater risk for the development of dementia compared with those without diabetes. For vascular dementia, but not for nonvascular dementia, the additional risk is greater in women.

Normative and standardized data for cognitive measures in the Mexican Health and Aging Study.

OBJECTIVE: To describe the cognitive instrument used in the Mexican Health and Aging Study (MHAS) in Mexican individuals aged 60 and over and to provide normative values for the Cross Cultural Cognitive Examination test and its modified versions (CCCE). MATERIALS AND METHODS: The CCCE was administered to 5,120 subjects as part of a population-based sample free of neurologic and psychiatric disease from the MHAS 2012 survey. Normative data were generated by age and education for each test in the cognitive instrument as well as for the total cognition score. Pearson correlations and analysis of variance were used to examine the relationship of scores to demographic variables. RESULTS: Results present standardized normed scores for eight cognitive domains: orientation, attention, verbal learning memory, verbal recall memory, visuospatial abilities, visual memory, executive function, and numeracy in three education groups within three age groups. CONCLUSION: These findings highlight the need for population-based norms for the CCCE, which has been used in population-based studies. Demographic factors such as age and education must be considered when interpreting the cognitive measures.

Normative and standardized data for cognitive measures in the Mexican Health and Aging Study / Normalización y estandarización de las medidas cognitivas en el Estudio Nacional de Salud y Envejecimiento en México

Objective. To describe the cognitive instrument used in the Mexican Health and Aging Study (MHAS) in Mexican individuals aged 60 and over and to provide normative values for the Cross Cultural Cognitive Examination test and its modified versions (CCCE). Materials and methods. The CCCE was administered to 5 120 subjects as part of a population-based sample free of neurologic and psychiatric disease from the MHAS 2012 survey. Normative data were generated by age and education for each test in the cognitive instrument as well as for the total cognition score. Pearson correlations and analysis of variance were used to examine the relationship of scores to demographic variables. Results. Results present standardized normed scores for eight cognitive domains: orientation, attention, verbal learning memory, verbal recall memory, visuospatial abilities, visual memory, executive function, and numeracy in three education groups within three age groups. Conclusion. These findings highlight the need for population-based norms for the CCCE, which has been used in population-based studies. Demographic factors such as age and education must be considered when interpreting the cognitive measures.

Objetivo. Describir el instrumento cognitivo usado en el Estudio Nacional de Salud y Envejecimiento en México (Ena-sem) en personas mayores de 60 años,y proporcionar valores normativos para el Test Cognitivo Transcultural (CCCE, por sus siglas en inglés) y sus modificaciones. Material y métodos. Se administró el CCCE a 5 120 individuos mayores de 60 años, libres de enfermedad neurológica y psiquiátrica de la Enasem 2012. Los datos normativos se obtuvieron para la puntuación en cada test incluido en el CCCE y para la puntuación total estratificando por edad y escolaridad. Para analizar la relación con las variables demográficas, se aplicaron la correlación de Pearson y el análisis de varianza. Resultados. Los resultados presentan normas estandarizadas para ocho dominios cognitivos: orientación, atención, aprendizaje verbal, memoria de evocación, habilidades espaciales, memoria visual, función ejecutiva y numerología en tres grupos de educación dentro de tres grupos de edad. Conclusión. Estos resultados subrayan la importancia de contar con datos normativos para los tests cognitivos que, como el CCCE, han sido aplicados en estudios poblacionales. Los factores demográficos como la edad y, en particular, la escolaridad deben considerarse al momento de interpretar las medidas aplicadas.

Effect of social capital and personal autonomy on the incidence of depressive symptoms in the elderly: evidence from a longitudinal study in Mexico.

OBJECTIVES: To estimate the effect of social capital (SC) and personal autonomy (PA) on the depressive symptoms (DS) in older people living in poverty. METHOD: Longitudinal study of elderly participants in the impact evaluation study of a non-contributory pension program in Mexico. For this study we selected the group of older people without significant DS at baseline. PA, SC indicators and covariates were measured at baseline. Using the Geriatric Depression Scale, the incidence of DS was assessed at a follow-up interview after 11 months. The effect of SC and autonomy on the occurrence of DS was estimated by using a multilevel logistic regression model. RESULTS: Of the various indicators of PA, not being dependent in daily functioning, and being able to read/write were associated with lower risk of DS. A higher level of SC at baseline was associated with lower incidence of DS in women (odds ratio; OR = 0.73, p < 0.01), while for men there was no significant association (OR = 1.04, p = 0.69). CONCLUSIONS: PA and SC proved to be protective factors against the onset of DS in women. For men, only PA was a protective factor. Future studies need to explore in what ways that PA and SC may reduce risk of DS as well as the role of gender differences.

[Diabetes mellitus as a risk factor for dementia in the Mexican elder population]. / Diabetes mellitus como factor de riesgo de demencia en la población adulta mayor mexicana.

INTRODUCTION: Diabetes and dementia are growing problems throughout the world and especially in developing countries. AIM: To determine the risk of developing dementia in subjects with type 2 diabetes mellitus. PATIENTS AND METHODS: Diabetic elders free of dementia from the Mexican Health and Aging study, a prospective community-based cohort research were followed after two years. Socio-demographic factors, comorbid conditions and type of diabetes treatment were analyzed in subjects who become demented. RESULTS: At baseline, 749 participants (13.8%) had diabetes mellitus. During the follow-up period (mean: 2.02 years; range: 1-3 years), 306 of 749 persons with diabetes mellitus developed dementia, yielding a relative risk (RR) of 2.08 (95% confidence interval, 95% CI = 1.59-2.73). The effect was strongest in persons aged 80 years or older with a RR of 2.44 (95% CI = 1.46-4.08), men had a greater relative risk than women (RR = 2.25; 95% CI = 1.46-3.49 vs. RR = 1.98; 95% CI = 1.08-1.11) and subjects with low education (< 7 years of schooling) had a significant RR while those with higher education didn't. Individuals treated with insulin where at highest risk of dementia (RR = 2.83; 95% CI = 1.58-5.06). Hypertension (RR = 2.75; 95% CI = 1.86-4.06) and depression (RR = 3.78; 95% CI = 2.37-6.04) where the two comorbidities which increased the risk of dementia. CONCLUSIONS: Subjects with diabetes mellitus have an increased risk of developing dementia. Sociodemographic factors and other co-morbidities highly prevalent in the Mexican population contribute to the diabetes-dementia association.

Prevalence and incidence rates of dementia and cognitive impairment no dementia in the Mexican population: data from the Mexican Health and Aging Study.

OBJECTIVE: To estimate the prevalence and incidence of dementia and cognitive impairment without dementia (CIND) in the Mexican population. METHOD: The MHAS study is a prospective panel study of health and aging in Mexico with 7,000 elders that represent eight million participants nationally. Using measurements of cognition and activities of daily living of dementia cases and CIND were identified at baseline and follow-up. Overall incidence rates and specific rates for sex, age, and education were calculated. RESULTS: Prevalence was 6.1% and 28.7% for dementia and CIND, respectively. Incidence rates were 27.3 per 1,000 person-years for dementia and 223 per 1,000 persons-year for CIND. Rates of dementia and CIND increased with advancing age and decreased with higher educational level; sex had a differential effect depending on the age strata. Hypertension, diabetes, and depression were risk factors for dementia but not for CIND. DISCUSSION: These data provide estimates of prevalence and incidence of dementia and cognitive impairment in the Mexican population for projection of future burden.