Carlos A. Chavez

Building capacity for dementia care in Latin America and the Caribbean

Latin America and the Caribbean (LAC) have limited facilities and professionals trained to diagnose, treat, and support people with dementia and other forms of cognitive impairment. The situation for people with dementia is poor, and worsening as the proportion of elderly in the general population is rapidly expanding. We reviewed existing initiatives and provided examples of actions taken to build capacity and improve the effectiveness of individuals, organizations, and national systems that provide treatment and support for people with dementia and their caregivers. Regional barriers to capacity building and the importance of public engagement are highlighted. Existing programs need to disseminate their objectives, accomplishments, limitations, and overall lessons learned in order to gain greater recognition of the need for capacity-building programs.

Incidence of dementia in elderly Latin Americans: Results of the Maracaibo Aging Study

There are few longitudinal studies of dementia in developing countries. We used longitudinal data from the Maracaibo Aging Study to accurately determine the age‐ and sex‐specific incidence of dementia in elderly Latin Americans.

INCIDENCE OF ALZHEIMER’S DISEASE IN HISPANICS: ROLE OF APOLIPOPROTEIN E GENOTYPES AND AMBULATORY BLOOD PRESSURE MONITORING

gender, education, chronic disease count, social network index, anticholinergic cognitive burden (ACB) score, Apoε4 status and antipsychotic drug use. Results: The best fitting model contained two classes; class 1 was the largest (N1⁄4389, 76%) and showed the slowest progression on both MMSE and ADL (figures 1 and 2; blue curves). Individuals in class 2 (N1⁄4123, 24%) demonstrated more rapid worsening on both outcomes (red curves), often followed by death within 5 years after dementia diagnosis (N1⁄494). Significant predictors of membership in the rapidly declining class 2, relative to class 1, were higher ACB score (OR1⁄41.35, 95%-CI: 1.01-1.81) and higher age (OR1⁄41.10, 95%-CI: 1.00-1.20). Conclusions: Our study shows that most individuals were members of a class with relatively slow disease progression. This presents a more optimistic prospect for the majority of patients as compared to the mean progression rate of the entire sample. This is important for informing newly diagnosed dementia patients and their caregivers about the course of the disease. The observed relationship between ACB and rapid decline in cognition and functioning urges caution in prescribing anticholinergic drugs and polypharmacy for individuals with dementia. This is especially relevant given that most antipsychotics used in dementia have a high ACB score.

BLOOD PRESSURE INDICES ARE ASSOCIATED WITH INCREASED REDUCED HIPPOCAMPAL VOLUME AND WHITE MATTER HYPERINTENSITIES IN HISPANIC ADULTS: THE MARACAIBO AGING STUDY

on days1, 5 and 9, respectively. However, there was no significant difference in SBP with the PDE4 inhibitor treatment in both hypertensive models. Rats with repeated treatment of rolipram before acquisition trial (T1) explored the object significantly more than the familiar one during discrimination trial (T2) respectively, showing an increase in memory retention. These effects of repeated administration of centrally acting anti-hypertensive drug were qualitatively similar to those obtained with the hypertensive control rats. Further, HT significantly down regulated the protein expression of pCREB and BDNF in the hippocampus. Repeated treatment with PDE4 inhibitors showed up regulation of pCREB as well as BDNFwhen compared to the vehicle treated group. On the contrary, pCREB and BDNF expressions were further down regulated during treatment with clonidine. Conclusions:These results suggest that rolipram ameliorate HT-induced impairment of learning and memory functions despite no changes in BP. However treatment with clonidine does not alleviate HT-inducedmemory loss despite reduction in BP because of a negative impact on cAMP/PK/CREB signaling. This caveat may be important in designing treatments for memory disorders associated with HT as they are not linked to a single pathophysiological mechanism.

Blood pressure variability as predictor of cognitive impairment in elderly subjects: Findings from the maracaibo aging study

association of healthy diet pattern with impairment in executive function, episodic memory and global cognition in the community-based EAS cohort.Methods:Cross-sectional analyses included 549 non-demented EAS participants who completed the Rapid Eating and Activity Assessment for Patients (REAP) between 2006-2007. The REAP is a previously-validated assessment based on Healthy People 2010 guidelines. REAP scores were dichotomized as less healthy diet (< median) or more healthy diet ( median). EAS assessments included: Free and Cued Selective Reminding TestFree Recall; WMS-R Logical Memory I subtest; Category Fluency; WAIS-III Digit Symbol Substitution, Digit Span and Block Design; Trail-Making Tests A and B ; and Phonemic Fluency. These were combined into 3 factors using principle components analysis; episodic memory, executive function, and global cognition. Domain scores were calculated for each by averaging z-scores of all tasks that loaded 0.5 within a factor. Impaired function in each domain was defined as 2 standard deviations below the mean on any task or a domain score 1.5 SD below the mean. Logistic regression was used to assess the association of diet with cognitive impairment, adjusting for age, education, sex, race, and cardiovascular comorbidities. Results: The sample was 60% female, 70% white, 24% black, mean age 80.2 years, and mean education 14 years. Healthy diet was associated with reduced odds of impaired executive function (OR1⁄40.65, 95%CI1⁄40.39-1.08, p1⁄40.09), but not with the other cognitive domains. In race stratified analyses, among whites, healthy diet was associated with reduced odds of impaired executive function (OR1⁄40.47, 95%CI1⁄40.22-0.98, p1⁄40.04), as were more healthy scores on sub-scales for total and saturated fat (OR1⁄40.48, 95% CI1⁄40.24-0.99, p1⁄40.05, and OR1⁄40.34, 95%CI1⁄40.16-0.70, p1⁄40.003, respectively). Among blacks, REAP scores were not associated with any cognitive domains. Conclusions: Healthy diet pattern was associated with a reduced risk of executive dysfunction. Diet is a promising target for prevention of cognitive decline. Observed race differences may be due to increased vascular burden among Blacks, or to differences in generalizability of the REAP.