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.

Prevalence of Dementia and Alzheimer's Disease in a Havana Municipality: A Community-Based Study among Elderly Residents.

Introduction Approximately 24.2 million persons throughout the world suffer dementia with 4.6 million new cases reported annually. Only 10% of dementia and Alzheimer's disease studies are conducted in developing countries where 66% of sufferers live. Cuba, a developing country, exhibits health indicators similar to those of developed nations. Its population of 11.6 million is aging rapidly: by the year 2020 it is estimated that persons aged ≥65 years will comprise 25% of the population, making Cuban society the "oldest" in Latin America. Objectives Ascertain and characterize behavior of dementia, its etiologies and risk factors in persons aged ≥65 years in the Havana City municipality of Playa. Methods A two-phase, cross-sectional, door-to-door study was conducted in the municipality targeting all persons aged ≥65 years, achieving a 96.4% response rate (n=18,351). Folstein Mini Mental State Examination (MMSE), Hughes Clinical Dementia Rating (CDR) and a structured interview on risk factors were applied. DSM-IV, NINCDS-ADRDA and NINDS-AIREN criteria were used to determine dementia diagnosis, as well as other criteria for diagnosing Alzheimer's and other specific forms of dementia. Results Dementia prevalence was 8.2% of adults aged ≥65 years, with a slight predominance in males. The most frequent cause of dementia was Alzheimer's disease, followed by mixed dementias. Dementia-associated risk factors were: history of stroke, hypertension, depression, skull-brain trauma, family history of dementia, low educational level and advanced age. Conclusions This study corroborates that dementia and Alzheimer's disease constitute an important and growing health problem for our country due to the accelerated aging of the Cuban population. It also underlines the importance of early diagnosis and proper treatment of hypertension and other vascular risk factors, as well as the need for a national public health program for the prevention and early diagnosis of dementia and Alzheimer's disease, targeting elderly and at-risk populations.

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.

Dementia and Other Chronic Diseases in Older Adults in Havana and Matanzas: The 10/66 Study in Cuba

INTRODUCTION Chronic non-communicable diseases are the leading cause of death worldwide, except in Sub-Saharan Africa. Nonetheless, one of these conditions, dementia, is the major contributor to disability-adjusted life years in people aged ≥60 years. Few epidemiological studies exist of the prevalence and impact of dementia and selected chronic diseases in older adults in Latin America.OBJECTIVE Describe prevalence of dementia, other chronic vascular diseases and cardiovascular risk factors, as well as resulting disabilities and care needs generated in adults aged ≥65 years in Havana City and Matanzas provinces, Cuba. METHODS The 10/66 study is a prospective longitudinal study involving a cohort of 3015 adults aged ≥65 years in municipalities of Havana City and Matanzas provinces, divided into two phases: a cross-sectional door-to-door study conducted in 2003–2006, and a follow-up and assessment phase in 2007–2010. This article reports findings from the first phase. Hypertension diagnosis was based on criteria from the International Society for Hypertension; diabetes mellitus on American Diabetes Association criteria; stroke according to WHO definitions; and dementia according to criteria of the American Psychiatric Society's Diagnostic and Statistical Manual of Mental Disorders DSM-IV and the 10/66 International Dementia Research Group. Ischemic heart disease was defined by self-report of previous physician diagnosis. Study variables included age, sex, educational level, substance use (alcohol, tobacco) and dietary habits. A structured physical and neurological exam, including blood pressure measurement, was performed on all participants. Laboratory tests included complete blood count, fasting blood glucose, total cholesterol and lipoprotein fractions, triglycerides and apolipoprotein E genotype. Prevalence and standardized morbidity ratios (crude and adjusted) were calculated for chronic diseases studied with 95% confidence intervals, using a Poisson...(AU)

Repercusión psicosocial del huracán Wilma en la comunidad del consejo popular Miramar, del municipio Playa / Psychosocial repercussion caused by Wilma hurricane in the community of Miramar Popular Council of Playa municipality

Se realizó un estudio descriptivo, observacional y retrospectivo, auxiliándonos de diversas técnicas cuanticualitativas (cuestionario y grupos focales) con el propósito de describir las afectaciones más frecuentes sufridas por los vecinos del Consejo Popular Miramar, del municipio Playa, víctimas de la penetración del mar que provocó el huracán Wilma en esta localidad costera, e identificar las fortalezas y debilidades que exhibe esta comunidad para enfrentar las nefastas consecuencias derivadas de eventos de tal naturaleza. Predominaron las afectaciones de orden material, seguidas de los daños a la salud mental, entre los que se destacan: las crisis nerviosas o de ansiedad, el estado de ánimo abatido y los trastornos del sueño. Las fortalezas identificadas fueron la voluntad política del Estado y del Gobierno de la localidad, quienes garantizaron una eficaz estructura organizativa para el enfrentamiento de estas situaciones, la existencia de un mapa de riesgo en el municipio en el que se destacan las zonas más sensibles, la efectividad de los medios masivos de comunicación en la difusión de los partes meteorológicos seguidos por todo nuestro pueblo, y entre las amenazas más notorias, el mal estado de los desagües y de viviendas, así como la pobre percepción de riesgo de la población y la insuficiente preparación de vecinos y líderes comunitarios informales(AU)

Authors made a retrospective, observational and descriptive study using different quantitative and qualitative techniques (questionnaire and focal groups) to describe the more frequent affectations suffered by neighbors of Miramar Popular Council of Playa municipality, victims of sea penetration caused by Vilma hurricane in this coastal locality, and to identify the strengths and weakness exhibiting this community to confront the awful consequences derived from events like this. There was a predominance of affectation of material order, followed by damages to mental health which include nervous crises or of anxiety, dejected mood state, and sleep disorders. Strengths identified were the State and Government politic will of the locality, who guaranteed an efficient organization structure to confront of these situations, existence of a risk map in municipality in which be emphasized the more sensible zones, effectiveness of massive media of communication in the dissemination of meteriological reports followed by all our people, the poor conditions of drains and of the houses, as well as the poor risk perception from people, and the insufficient preparation of neighbors and informal community leaders(AU)

Repercusión psicosocial del huracán Wilma en la comunidad del consejo popular Miramar, del municipio Playa / Psychosocial repercussion caused by Wilma hurricane in the community of Miramar popular council of Playa municipality

Se realizó un estudio descriptivo, observacional y retrospectivo, auxiliándonos de diversas técnicas cuanticualitativas (cuestionario y grupos focales) con el propósito de describir las afectaciones más frecuentes sufridas por los vecinos del Consejo Popular Miramar, del municipio Playa, víctimas de la penetración del mar que provocó el huracán Wilma en esta localidad costera, e identificar las fortalezas y debilidades que exhibe esta comunidad para enfrentar las nefastas consecuencias derivadas de eventos de tal naturaleza. Predominaron las afectaciones de orden material, seguidas de los daños a la salud mental, entre los que se destacan: las crisis nerviosas o de ansiedad, el estado de ánimo abatido y los trastornos del sueño. Las fortalezas identificadas fueron la voluntad política del Estado y del Gobierno de la localidad, quienes garantizaron una eficaz estructura organizativa para el enfrentamiento de estas situaciones, la existencia de un mapa de riesgo en el municipio en el que se destacan las zonas más sensibles, la efectividad de los medios masivos de comunicación en la difusión de los partes meteorológicos seguidos por todo nuestro pueblo, y entre las amenazas más notorias, el mal estado de los desagües y de viviendas, así como la pobre percepción de riesgo de la población y la insuficiente preparación de vecinos y líderes comunitarios informales.

Authors made a retrospective, observational and descriptive study using different quantitative and qualitative techniques (questionnaire and focal groups) to describe the more frequent affectations suffered by neighbors of Miramar Popular Council of Playa municipality, victims of sea penetration caused by Vilma hurricane in this coastal locality, and to identify the strengths and weakness exhibiting this community to confront the awful consequences derived from events like this. There was a predominance of affectation of material order, followed by damages to mental health which include nervous crises or of anxiety, dejected mood state, and sleep disorders. Strengths identified were the State and Government politic will of the locality, who guaranteed an efficient organization structure to confront of these situations, existence of a risk map in municipality in which be emphasized the more sensible zones, effectiveness of massive media of communication in the dissemination of meteriological reports followed by all our people, the poor conditions of drains and of the houses, as well as the poor risk perception from people, and the insufficient preparation of neighbors and informal community leaders.

El funcionamiento cognitivo en la vejez: atención y percepción en el adulto mayor / The cognitive functioning in the elderly: attention and perception in the older adult

Hay que reconocer la importancia de la ejercitación de la atención y la percepción en el ambiente cotidiano del adulto mayor, ya que ambas funciones corticales superiores tienen una íntima relación con la capacidad psicológica de la memoria, además de considerarse que la afectación de dichas funciones puede provocar pérdida de validismo, dependencia y discapacidad, una vez que se ha iniciado el deterioro cognitivo. La sociedad necesita adultos mayores sanos, los profesionales de la Atención Primaria de Salud tenemos la responsabilidad social de desarrollar acciones de prevención y rehabilitación del deterioro mental en el adulto mayor, porque su salud y calidad de vida están muy relacionadas con un adecuado funcionamiento cognitivo(AU)

It is necessary to recognize the importance of exercising attention and perception in the daily environment of the older adult, since both higher cortical functions are closely related to the psychological capacity of memory. It is also considered that the affectation of such functions may cause loss of validism, dependence and disability, once the cognitive deterioration has started. Society needs healthy older adults and the professionals at the Primary Health Care level are socially responsible for developing actions of prevention and rehabilitation of mental deterioration in the older adult due to the fact that their health and quality of life are closely related to an adequate cognitive functioning(AU)

El funcionamiento cognitivo en la vejez: atención y percepción en el adulto mayor / The cognitive functioning in the elderly: attention and perception in the older adult

Hay que reconocer la importancia de la ejercitación de la atención y la percepción en el ambiente cotidiano del adulto mayor, ya que ambas funciones corticales superiores tienen una íntima relación con la capacidad psicológica de la memoria, además de considerarse que la afectación de dichas funciones puede provocar pérdida de validismo, dependencia y discapacidad, una vez que se ha iniciado el deterioro cognitivo. La sociedad necesita adultos mayores sanos, los profesionales de la Atención Primaria de Salud tenemos la responsabilidad social de desarrollar acciones de prevención y rehabilitación del deterioro mental en el adulto mayor, porque su salud y calidad de vida están muy relacionadas con un adecuado funcionamiento cognitivo.

It is necessary to recognize the importance of exercising attention and perception in the daily environment of the older adult, since both higher cortical functions are closely related to the psychological capacity of memory. It is also considered that the affectation of such functions may cause loss of validism, dependence and disability, once the cognitive deterioration has started. Society needs healthy older adults and the professionals at the Primary Health Care level are socially responsible for developing actions of prevention and rehabilitation of mental deterioration in the older adult due to the fact that their health and quality of life are closely related to an adequate cognitive functioning.