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Introduction: Rabies virus infection can cause fatal brain disease in mammals. Any species is susceptible to infection. Any effort aimed at recognizing infected animals and performing first actions in the event of transmission is mandatory., Objective: To determine knowledge, attitudes, and practice profiles regarding rabies, or hydrophobia, in a municipality of Colombia, using a multiple correspondence analysis., Materials and Methods: A descriptive observational study involving 71 pet owners was carried out in the municipality of Ibagué (Tolima). A questionnaire-based survey collected data on rabies knowledge, attitudes, practices, and demographic information. The survey was conducted between October and November 2021, and the data analysis involved descriptive statistics and multiple correspondence analysis., Results: The study revealed a commendable level of rabies awareness among the urban residents in the study municipality. However, there are causes of concern as they allow stray animals to enter their homes and are not aware of the importance of notifying dead animals. The respondents demonstrated a humane approach to bite management and emphasized the importance of wound cleaning. Additionally, they expressed a strong desire for more information to enhance their knowledge and awareness of the disease., Conclusion: The findings of this study provide valuable insights for improving rabies prevention efforts and promoting public health. Health education, evidence-based strategies, and community participation are essential for successful disease control and educational gaps addressing related to sociocultural factors.

Background: Hospital-acquired bacterial infections are associated with high morbidity and mortality rates in patients with systemic lupus erythematosus (SLE). This study aimed to develop and validate predictive models for the risk of hospital-acquired bacterial infections in patients with SLE., Methods: A historical cohort study was designed for development, and another bidirectional cohort study was used for external validation. The risk of bacterial infection was assessed upon admission and after 5 days of hospitalization. Predictor selection employed the least absolute shrinkage and selection operator (LASSO) techniques. Multiple imputations were used to handle missing data. Logistic regression models were applied, and the properties of discrimination, calibration, and decision curve analysis were evaluated., Results: The development cohort comprised 1686 patients and 237 events (14.1%) from 3 tertiary hospitals. The external validation cohort included 531 patients and 84 infection outcomes (15.8%) from 10 hospital centers in Colombia (secondary and tertiary level). The models applied at admission and after 120 hours of stay exhibited good discrimination (AUC > 0.74). External validation demonstrated good performance among patients from the same tertiary institutions where the models were developed. However, geographic validation at other institutions has been suboptimal., Conclusions: Two predictive models for nosocomial bacterial infections in patients with SLE are presented. All infection prevention recommendations should be maximized in patients at moderate/high risk. Further validation studies in diverse contexts, as well as clinical impact trials, are necessary before potential applications in research and clinical care., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: Several studies have demonstrated an association between frailty and worse outcomes in patients with acute coronary syndrome (ACS); however, there is a lack of evidence from Colombia. This study aims to evaluate the association between frailty and the risk of adverse outcomes in patients over 65 years old diagnosed with ACS., Materials and Methods: A prospective cohort study was conducted, including patients over 65 years old who underwent coronary angiography due to an ACS diagnosis at a hospital in Medellín, Colombia. Frailty was assessed using the FRAIL scale. The primary outcome was all-cause mortality at 30 days. Secondary outcomes included length of hospital stay and a composite outcome of in-hospital or 30-day mortality, contrast-induced nephropathy (CIN), acute heart failure, cardiogenic shock, hemorrhagic complications, and vascular complications., Results: A total of 112 patients were included. Frail patients (n=35, 31.3%) were older, had a lower socioeconomic status, higher GRACE scores, and more severely compromised coronary vessels. A significant association was observed between frailty and 30-day mortality (relative risk [RR] 19.00, 95% confidence interval [CI]: 5.04-72.61; p<0.001), the composite outcome (RR 4.57, 95% CI: 2.56-8.34; p<0.001), and longer hospital stays (9 days vs. 5 days in the non-frail group)., Conclusions: A considerable number of patients over 65 years old with ACS were frail. Frailty was associated with adverse in-hospital and 30-day outcomes., Competing Interests: Conflictos de interés: Ninguno

Background: Variants in APOE and PSEN1 (encoding apolipoprotein E and presenilin 1, respectively) alter the risk of Alzheimer's disease. We previously reported a delay of cognitive impairment in a person with autosomal dominant Alzheimer's disease caused by the PSEN1 E280A variant who also had two copies of the apolipoprotein E3 Christchurch variant ( APOE3 Ch ). Heterozygosity for the APOE3 Ch variant may influence the age at which the onset of cognitive impairment occurs. We assessed this hypothesis in a population in which the PSEN1 E280A variant is prevalent., Methods: We analyzed data from 27 participants with one copy of the APOE3 Ch variant among 1077 carriers of the PSEN1 E280A variant in a kindred from Antioquia, Colombia, to estimate the age at the onset of cognitive impairment and dementia in this group as compared with persons without the APOE3 Ch variant. Two participants underwent brain imaging, and autopsy was performed in four participants., Results: Among carriers of PSEN1 E280A who were heterozygous for the APOE3 Ch variant, the median age at the onset of cognitive impairment was 52 years (95% confidence interval [CI], 51 to 58), in contrast to a matched group of PSEN1 E280A carriers without the APOE3 Ch variant, among whom the median age at the onset was 47 years (95% CI, 47 to 49). In two participants with the APOE3 Ch and PSEN1 E280A variants who underwent brain imaging, 18 F-fluorodeoxyglucose positron-emission tomographic (PET) imaging showed relatively preserved metabolic activity in areas typically involved in Alzheimer's disease. In one of these participants, who underwent 18 F-flortaucipir PET imaging, tau findings were limited as compared with persons with PSEN1 E280A in whom cognitive impairment occurred at the typical age in this kindred. Four studies of autopsy material obtained from persons with the APOE3 Ch and PSEN1 E280A variants showed fewer vascular amyloid pathologic features than were seen in material obtained from persons who had the PSEN1 E280A variant but not the APOE3 Ch variant., Conclusions: Clinical data supported a delayed onset of cognitive impairment in persons who were heterozygous for the APOE3 Ch variant in a kindred with a high prevalence of autosomal dominant Alzheimer's disease. (Funded by Good Ventures and others.)., (Copyright © 2024 Massachusetts Medical Society.)

Over the past decade, research using virtual reality and serious game-based instruments for assessing spatial navigation and spatial memory in at-risk and AD populations has risen. We systematically reviewed the literature since 2012 to identify and evaluate the methodological quality and risk of bias in the analyses of the psychometric properties of VRSG-based instruments. The search was conducted primarily in July-December 2022 and updated in November 2023 in eight major databases. The quality of instrument development and study design were analyzed in all studies. Measurement properties were defined and analyzed according to COSMIN guidelines. A total of 1078 unique records were screened, and following selection criteria, thirty-seven studies were analyzed. From these studies, 30 instruments were identified. Construct and criterion validity were the most reported measurement properties, while structural validity and internal consistency evidence were the least reported. Nineteen studies were deemed very good in construct validity, whereas 11 studies reporting diagnostic accuracy were deemed very good in quality. Limitations regarding theoretical framework and research design requirements were found in most of the studies. VRSG-based instruments are valuable additions to the current diagnostic toolkit for AD. Further research is required to establish the psychometric performance and clinical utility of VRSG-based instruments, particularly the instrument development, content validity, and diagnostic accuracy for preclinical AD screening scenarios. This review provides a straightforward synthesis of the state of the art of VRSG-based instruments and suggests future directions for research., (© 2024. The Author(s).)

Objectives: Investigate the factors influencing life space utilization in older Afro-descendant adults residing in Tumaco, Colombia - a marginalized region of the country., Design: This cross-sectional study included 388 Afro-descendant older adults. The study assessed living space using the Life Space Assessment (LSA) scale and collected demographic data. Cognitive levels were measured with the Mini-Mental State Examination (MMSE), and depressive symptoms were assessed using the Yesavage scale. Socio-emotional indicators were determined with the Medical Outcomes Study (MOS). The research employed linear and logistic regression models for data analysis., Results: On average, participants scored 27.0 on the LSA scale. A lack of perceived income resulted in a 10.44-point decrease on the LSA scale. For each unit increase in the MOS-Instrumental Dimension score, the LSA score increased by 0.52 points (95% CI 0.17-0.87). As for cognitive performance (MMSE scale), each one-point increase resulted in a 0.69 decrease in the LSA score (95% CI -1.25 to -0.12)., Conclusion: Socioeconomic disadvantages limit living space utilization, particularly in the Afro-descendant population. Yet, social support can enhance living space use despite environmental and economic constraints.

Background: The largest identified kindred worldwide with a single mutation causing autosomal-dominant Alzheimer's disease (ADAD) is a family from Antioquia, Colombia, carrying the Presenilin-1 (PSEN1) E280A (Paisa) mutation. The majority of mutation carriers develop dementia, typically commencing in their late 30 s, with a median onset age of 49 years. Cognitive decline is a hallmark feature., Objective: This review synthesizes the existing literature on neuropsychological assessments in PSEN1 E280A mutation carriers throughout their lifespan. We provide a comprehensive overview of cognitive outcomes in this unique population., Methods: We reviewed and integrated the published research, analyzing studies on neuropsychological assessments in PSEN1 E280A carriers. Our focus was on measures of verbal, semantic, episodic, and spatial memory, and encompassed other cognitive domains such as language, attention, visuospatial memory, and executive functioning., Results: Verbal, semantic, episodic, and spatial memory emerged as the most sensitive indicators of preclinical changes in PSEN1 E280A carriers. Inconsistencies were noted in findings from tests assessing language, attention, visuospatial memory, and executive functioning, suggesting potential limitations in detecting early cognitive changes in PSEN1 mutation carriers. Specific cognitive tasks developed for this population proved effective but underutilized., Conclusions: The review underscores the importance of continued test development tailored to detect early cognitive changes in PSEN1 E280A carriers, potentially enhancing ADAD screening. Furthermore, investigating ADAD mutations in children may identify early changes in AD and enhance our understanding of neuropsychological functioning across the lifespan. This synthesis provides valuable insights for researchers, clinicians, and policymakers engaged in the study and management of ADAD.

Introduction: Mild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients' subjective cognitive and communicative difficulties has not been explored., Objective: We aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints., Methods: We included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted., Results: PD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores., Conclusions: HRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD., (Copyright © 2021 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Studies that have compared the cognitive alterations of the children of parents with bipolar disorder (CPBD) versus the children of control parents (CCP), present heterogeneous results due to the studies' methodological differences, the age of the population studied, and the lack of standardisation of the measures used for the different neurocognitive domains. The objective was to compare the neurocognitive profile of CPBD versus CCP to observe if there are differences that could be proposed as possible endophenotypes of BD., Results: A total of 107 individuals (51 CPBD, and 56 CCP) with ages between 6 and 16 (mean, 12.2±2.80) years of age were evaluated. Seventy-four point five percent of the CPBD group had some disorder compared to 67.9% of the CCP group. Tests such as letter-F phonemic verbal fluency, letter-S phonemic verbal fluency, overall F-A-S phonemic verbal fluency, story recall and retrieval, and Wisconsin perseverative errors showed a difference with a small effect size, but with a high degree of uncertainty., Conclusions: The CPBD did not have differences in their neurocognitive profile in comparison with CCP. Both groups have a high prevalence of psychopathology, which is a factor that could explain the lack of differences in neurocognitive performance., (Copyright © 2021 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: To classify the staff of two reference institutions for COVID-19 care in Antioquia according to the intensity of anxiety and depression symptoms, and to determine the factors associated with these classes., Methods: Cross-sectional study in which the GAD-7, PHQ-9, fear of COVID-19, and the Copenhagen Burnout scale were used. Latent class analysis was performed to identify the classes, and the factors associated with these were determined using multinomial logistic regression., Results: 486 people participated. The three-class model had the best fit: class I with low scores on the scales; class II with mild degrees of anxiety and depression, and intermediate levels of fear of COVID-19 and perceived stress; and class III with moderate and severe degrees of anxiety, depression, and perceived stress. The factors associated with belonging to class III were age (OR = 0.94; 95%CI, 0.91-0.96), change of residence to avoid exposing relatives (OR = 4.01; 95%CI, 1.99-8.09), and a history of depressive disorder (OR = 3.10; 95%CI, 1.27-7.56), and anxiety (OR = 5.5; 95%CI, 2.36-12.90). Factors associated with class II were age (OR = 0.97; 95%CI, 0.95-0.99), history of depressive disorder (OR = 3.41; 95%CI, 1.60-7.25), living with someone at risk of death from COVID-19 (OR = 1.86; 95%CI, 1.19-2.91), family member being healthcare staff (OR = 1.58; 95%CI, 1.01-2.47), and change of residence to avoid exposing relatives (OR = 1.99; 95%CI, 1.11-3.59)., Conclusions: Three classes of participants were obtained, two of them with anxiety and depression symptoms. Younger age and a history of mental disorder were factors associated with the two classes of symptomatic patients; other factors may be causes or consequences of the symptoms., (Copyright © 2021 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Objective: We aimed to identify the predictive factors of hospital-acquired bacterial infections in patients with systemic lupus erythematosus (SLE)., Methods: This chart review study included patients with SLE who were hospitalized between 2009 and 2020 for reasons other than infection. The outcome was defined as any infection confirmed using any bacterial isolation method or diagnosed by treating physicians and required treatment with intravenous antibiotics. For statistical analysis, logistic regression analyses were performed., Results: In total, 1678 patients (87.6% women) were included. The median age was 33 years (interquartile range, 24-47 years). The incidence of hospital-acquired infections was 13.9% (233 infections). Age, Systemic Lupus Erythematosus Disease Activity Index score, Systemic Lupus International Collaborating Clinics damage score, blood urea nitrogen and C-reactive protein levels, dosage of steroid in the previous month, recent use of 1 or more immunosuppressants, admission with a central venous catheter (or dialysis catheter), and use of central venous catheter or bladder catheter in the first 5 days were the predictive factors of nosocomial infections., Conclusion: The patients' infection risk profile should be assessed to accurately determine the risk-benefit balance of any therapeutic intervention, minimize exposure to steroids and immunosuppressants, and maintain a low threshold for the early diagnosis of infections. Further studies should assess whether the modification of some identified factors could reduce the incidence of nosocomial infections., Competing Interests: The authors declare no conflict of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: We aim to determine the prevalence of mental disorders in siblings of children with attention deficit hyperactivity disorder (ADHD), and to determine how psychosocial adversity factors relate to this psychopathology, in a low-middle income country (Colombia)., Methods: We evaluated subjects with ADHD diagnosed according to the DSM-5 criteria, one of their parents and one of their siblings (ages 8-19). We used the ADHD rating scale and a set of instruments to assess the presence of mental disorders as well as psychosocial adversity., Results: We evaluated 74 trios formed by the index case with ADHD, one sibling and one of the parents. We found that 24.3% of the participating siblings also met the criteria for ADHD and another 24.3% for other psychiatric disorders. The risk of these siblings having ADHD increased further when one of the parents reported a history of ADHD. We also found that 28.3% of the families faced high levels of psychosocial adversity as per their scores in the Rutter Adversity Index., Conclusions: Siblings of subjects with ADHD showed a significant risk for ADHD and other mental disorders. That risk increased if a parent reported a history of ADHD and also when two or more psychosocial adversity factors were present. This study supports the importance of early detection in efforts to decrease the risk for other siblings., (Copyright © 2021 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Background: Acute decompensated heart failure (ADHF) is one of the most frequent causes of emergency department (ED) visits. Point-of-Care Ultrasound (POCUS) is a reliable, easy-to-use, and available tool for an accurate diagnosis of ADHF. We aimed to analyze the impact of introducing POCUS as an additional tool to clinical standard diagnosis in clinical times of hospitalized heart failure patients., Methods: Retrospective cohort study comparing patients consulting to ED for heart failure acute decompensation previous to the rutinary use of POCUS versus patients who received an ultrasound-guided diagnosis at entrance. Ultrasound evaluation was additional to standard diagnosis (which included natriuretic peptides, images, etc). Cumulative incidence functions were calculated for time to treatment, time to disposition decision, and time to discharge. We used a flexible parametric model for estimate the time ratio (TR) in order to reflect the effect of POCUS., Results: A total of 149 patients were included. The most frequent comorbid condition was hypertension (71.8%) followed by type 2 diabetes (36.2%). B type natriuretic peptide (BNP) was over 500 ng/ml. Most patients had Stevenson B profile (83.9%) at admission. In the cumulative incidence model (Fig. A), the TR (time ratio) for the outcome time to treatment was 1.539 (CI 95% 0.88 to 2.69). The TR for the outcome time to disposition decision was 0.665 (CI 95% 0.48 to 0.99). The TR for the outcome time to discharge (hospital length of stay) was 0.663 (CI 95% 0.49 to 0.90)., Conclusion: In our study, the introduction of POCUS to ADHF patients decreases time to disposition decision and total length of hospital stay. Conversely, time to treatment augments. There is need for the evaluation of ultrasound as an intervention in clinical trials to confirm these findings., Competing Interests: Declaration of Competing Interest The authors declare no conflict of interest. We have not received any funding., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The SARS-CoV2 global pandemic impacted participants in the Alzheimer's Prevention Initiative (API) Autosomal Dominant Alzheimer's Disease (ADAD) clinical trial, who faced three stressors: 1) fear of developing dementia; 2) concerns about missing treatment; and 3) risk of SARS-CoV2 infection., Objective: To describe the frequency of psychological disorders among the participants of the API ADAD Colombia clinical study, treated by a holistic mental health team during the COVID-19 pandemic. The extent of use of mental health team services was explored considering different risk factors, and users and non-users of these services were compared., Methods: Participants had free and optional access to psychology and psychiatry services, outside of the study protocol. Descriptive statistics was used to analyze the frequency of the mental health difficulties. A multivariable logistic regression model has been used to assess associations with using this program., Results: 66 participants were treated by the Mental Health Team from March 1, 2020, to December 31, 2020. Before and after the start of the pandemic, the most common psychological problems were anxiety (36.4% before, 63.6% after) and depression (34.8% before, 37.9% after). 70% of users assisted by psychology and 81.6% of those assisted by psychiatry felt that the services were useful for them. Female sex, depression, and anxiety before the pandemic were positively associated with being assisted by either psychology or psychiatry, while the association with hyperlipidemia was negative., Conclusions: A holistic mental health program, carried out in the context of a study, could mitigate psychopathology during pandemics such as COVID-19.

Handgrip strength is a robust indicator of the biological health of children and adolescents. Objecti ves: to identify the anthropometric characteristics and body composition related to handgrip stren gth, and to describe the main characteristics of the protocols used for its evaluation., Methodology: A scoping review was developed; the search was carried out in 1.) Medline; 2.) Web of Science; 3.) Science Direct; 4.) Scielo; and 5.) EBSCO's Sportdiscus. Original investigations were included if they have handgrip strength data, anthropometric characteristics, and body composition., Results: 59 reports published between 2005 and 2020 were selected. Among them, nutritional classification was the most studied characteristic (n = 25; 42.3%), followed by body mass index (n = 23; 38.9%). In 47.5% (28 reports), the number of tests performed on each individual to estimate the handgrip strength value was not clear. The dynamometer brand Takei Scientific Instrument Co. Ltd. was the most used, with 49.2 %. The most widely used indicator was absolute handgrip (86.4%, 51 reports)., Conclusions: There is a wide variety of protocols used for handgrip strength assessment with va riations in body position, arm and hand selection, number of repetitions, and intervals between measurements. A proportional pattern of values was found between absolute handgrip strength and body mass index, Σ skinfolds, however, when adjusted by mass (relative handgrip strength), the relationship is inverse.

Background: Alzheimer's disease (AD) is a neurodegenerative disease that causes a gradual loss of cognitive functions and limits daily activities performance. Early diagnosis of AD is essential to start timely treatment. This study aimed to validate the Uniform Data Set neuropsychological battery version 3.0 (UDS 3.0) in a Colombian cohort., Methods: This study is a cross-sectional type, consecutive, incidental, with 143 persons, divided into two groups: 48 diagnosed AD cases and 95 healthy controls, between the ages of 50 and 80+, and between 1 and 19+ years of education., Results: The results indicate differences between the control group and the AD group in most battery tests. A significant correlation was found between the Montreal Cognitive Assessment (MoCA), Multilingual Naming Test (MINT), Craft Story, Benson Figure Test, P-word and F-word Phonemic Fluency Test, and their respective reference tests. Cutoff points were found based on the Youden index for each sub-test. The results indicate that all sub-tests are above the reference line of the ROC curve., Conclusion: The use of the UDS 3.0 in Colombia would help improving clinical diagnostic routes because of its high accuracy and high correlation with tests that measure general impairment; it has good sensitivity and specificity, and it can be a useful tool for AD.

Background: Self-Compassion is crucial for assessing how people relate to their suffering in moments of personal difficulty. The objective of this study was to check the psychometric properties of the Self-Compassion Scale (SCS) in a Colombian sample., Method: The Spanish version of the SCS was adapted to the Colombian context via a content validity technique. This version was administered to 751 Colombians from the general community. Psychometric analysis was performed using R studio packages., Results: 7 models were tested, the best fit was found for the bifactor ESEM model (χ2/df = 0.86, CFI = 1, TLI= 1, RMSEA= 0.00, SRMR= 0.01). This model produced optimal reliability indices (ωh = 0.83, FD= 0.93, H= 0.96)., Conclusions: The study produced initial psychometric evidence of the structure of the SCS in Colombia, with evidence of a general factor in the bifactor ESEM model. More research is needed to justify the complete usage of the SCS in the country.

Objective: The objective of this study is twofold: i) to estimate the normative values for handgrip strength and relative handgrip strength, specific to sex and age, for Colombian children and adolescents from 6 to 17 years of age using quantile regression models and ii) to compare the normative values for handgrip strength and relative handgrip strength in Colombian children and adolescents with those in children and adolescents in different countries., Method: This was a cross-sectional analysis of a sample of 2647 youngsters. Handgrip strength was evaluated with a TKK 5101 digital dynamometer (Takei Scientific Instruments Co., Ltd., Tokyo, Japan). The relative handgrip strength was estimated according to weight in kilograms. The normative values were estimated to handgrip strength and relative handgrip strength through quantile regression models for the percentiles P 5, P 10, P 25, P 50, P 75 , P 90, and P 95 developed independently for each sex. All analyses were adjusted for the expansion factor., Results: The values for handgrip strength were considerably higher in males than in females in all age ranges. Additionally, as age increased for both sexes, the values for handgrip strength increased. The percentiles by sex and age for relative handgrip strength show for males a proportional increase according to age; for females, this did not occur., Conclusions: When making comparisons with international studies, variability is observed in the methodologies used to evaluate handgrip strength and estimation methods, which could influence the discrepancies between the different reports., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: Subjective Cognitive Decline (SCD) may be an early indicator of risk for Alzheimer's disease (AD). Findings regarding sex differences in SCD are inconsistent. Studying sex differences in SCD within cognitively unimpaired individuals with autosomal-dominant AD (ADAD), who will develop dementia, may inform sex-related SCD variations in preclinical AD. We examined sex differences in SCD within cognitively unimpaired mutation carriers from the world's largest ADAD kindred and sex differences in the relationship between SCD and memory performance., Methods: We included 310 cognitively unimpaired Presenilin-1 (PSEN-1) E280A mutation carriers (51% females) and 1998 noncarrier family members (56% females) in the study. Subjects and their study partners completed SCD questionnaires and the CERAD word list delayed recall test. ANCOVAs were conducted to examine group differences in SCD, sex, and memory performance. In carriers, partial correlations were used to examine associations between SCD and memory performance covarying for education., Results: Females in both groups had greater self-reported and study partner-reported SCD than males (all p < 0.001). In female mutation carriers, greater self-reported ( p = 0.02) and study partner-reported SCD ( p < 0.001) were associated with worse verbal memory. In male mutation carriers, greater self-reported ( p = 0.03), but not study partner-reported SCD ( p = 0.11) was associated with worse verbal memory., Conclusions: Study partner-reported SCD may be a stronger indicator of memory decline in females versus males in individuals at risk for developing dementia. Future studies with independent samples and preclinical trials should consider sex differences when recruiting based on SCD criteria.

Objective: The aim of the study was to evaluate the safety of high-intensity, low-volume interval training (HIIT-low volume) compared with moderate-intensity continuous aerobic training (MICT) in adults with metabolic syndrome., Methods: This is a controlled, randomized, clinical trial in patients without history of ischemic heart disease or diabetes, who underwent a supervised, 3 sessions/week, 12-week treadmill exercise program. The HIIT-low volume (n = 29) sessions consisted of 6 intervals with 1-minute, high-intensity phases at 90% of peak oxygen consumption (VO2peak). The MICT (n = 31) trained at 60% of VO2peak for 30 minutes. A new approach to record and classify all clinical events according to possible causality based on Naranjo's algorithm was developed., Results: Patients were 50.8 ± 6.0 years old, 70% women, with body mass index of 30.6 ± 4.0 kg/m2 and VO2peak of 29.0 ± 6.3 mL·kg-1·min-1. In total, 60 clinical events were recorded in the HIIT-low volume group and 48 in the MICT group, with 59.3% classified as general disease. Only 21 events were classified as adverse reactions possibly related to exercise, without any serious adverse reactions. Both interventions had a similar incidence of musculoskeletal events (incidence rate ratio, 1.1; 95% confidence interval, 0.6-1.8), but HIIT-low volume had a higher incidence of cardiovascular events (incidence rate ratio, 2.9; 95% CI, 0.4-22.8) after adjusting for age, sex, and body mass index (HIIT-low volume: chest pain [n = 1] and symptoms of venous insufficiency of lower limbs [n = 2]; MICT: chest pain [n = 1])., Conclusions: The HIIT-low volume and MICT are safe in patients with metabolic syndrome. We recommend a muscle-conditioning program prior to both and to avoid HIIT-low volume in treadmill in patients with venous insufficiency of the lower limbs.Trial registration number NCT03087721., Competing Interests: The authors disclose no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: Lithium treatment of bipolar disorder (BD) has been associated with less cognitive impairment and fewer changes in structural brain anatomy compared to other treatments. However, the studies are heterogeneous and few assess whether these effects are related. The objective of this study was to evaluate and relate cognitive performance and structural neuroanatomy in patients treated with and without lithium., Methods: Cross-sectional study that included 48 subjects with BD-I, of which 22 were treated with lithium and 26 without lithium. Performance was assessed on Wechsler III (WAIS III), TMT A and B (Trial Making Test) neuropsychological tests, California verbal learning test (CVLT), Rey complex figure test and Wisconsin card sorting test. Brain structures obtained by magnetic resonance imaging (MRI) were evaluated. The standardised mean difference (SMD) between both groups was calculated, adjusted for confounding variables using a propensity score, and the Spearman correlation coefficient (ρ) was used to assess the relationship between cognitive performance and neuroanatomical regions., Results: Compared to the group without lithium, the group with lithium had fewer perseverative errors in the Wisconsin test (SMD = -0.69) and greater left and right cortical areas (SMD = 0.85; SMD = 0.92); greater surface area in the left anterior cingulate (SMD = 1.32), right medial orbitofrontal cortex (SMD = 1.17), right superior frontal gyrus (SMD = 0.82), and right and left precentral gyrus (SMD = 1.33; SMD = 0.98); greater volume of the right amygdala (SMD = 0.57), right hippocampus (SMD = 0.66), right putamen (SMD = 0.87) and right thalamus (SMD = .67). In the lithium group, a correlation was found with these errors and the thickness of the left precentral gyrus (ρ = -0.78), the volume of the right thalamus (ρ = -0.44), and the right amygdala (ρ = 0.6)., Conclusions: The lithium group had better cognitive flexibility and greater dimension in some frontal and subcortical cortical regions. Furthermore, there was a moderate to high correlation between performance in this executive function and the thickness of the right precentral gyrus, and the volumes of the thalamus and the right amygdala. These findings could suggest a neuroprotective effect of lithium., (Copyright © 2020 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Purpose: We carried out a randomized, clinical trial in adults of both sexes with metabolic syndrome (MS) to assess the efficacy of high-intensity, low-volume interval training (HIIT) compared to moderate-intensity continuous training (MICT) on insulin resistance (IR), muscle mass, muscle activation, and serum musclin., Methods: Fasting glycemia, insulinemia, and glycated haemoglobin were determined by conventional methods, IR by Homeostatic model assessment (HOMA), lean mass by Dual-Energy X-ray Absorptiometry, muscle activation through carnosine by Proton Magnetic Resonance Spectroscopy, and musclin by Enzyme-Linked ImmunoSorbent Assay before and after a supervised, three-times/week, 12-week treadmill programme. HIIT (n = 29) consisted of six intervals with one-minute, high-intensity phases at 90% of peak oxygen consumption (VO 2peak ). MICT (n = 31) trained at 60% of VO 2peak for 30 min., Results: Patients had a mean age of 50.8 ± 6.0 years, body mass index of 30.6 ± 4.0 kg/m 2 , and VO 2peak of 29.0 ± 6.3 mL.kg -1 .min -1 . Compared to MICT, HIIT was not superior at reducing Ln HOMA-IR (adjusted mean difference: 0.083 [95%CI - 0.092 to 0.257]), carnosine or musclin or at increasing thigh lean mass. HIIT increased carnosine by 0.66 mmol/kg.ww (95% CI 0.08-1.24) after intervention. Both interventions reduced IR, body fat percentage and increased total lean mass/height 2 and VO 2peak . Musclin showed a non-significant reduction with a small effect size after both interventions., Conclusion: Compared to MICT, HIIT is not superior at reducing IR, carnosine or musclin or at increasing skeletal muscle mass in adults with MS. Both training types improved IR, muscle mass and body composition. NCT03087721, March 22nd, 2017., Trial Registration Number: NCT03087721. Registered March 22nd, 2017., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The offspring of bipolar parents (BO) is a high-risk population for inheriting the bipolar disorder (BD) and other early clinical manifestations, such as sleep disturbances., Objective: To compare the presence of psychiatric disorders and sleep disturbances of BO versus offspring of control parents (OCP)., Methods: A cross-sectional analytical study was conducted that compared BO versus OCP. The participants were assessed using valid tools to determine the presence of psychiatric symptoms or disorders. The "Sleep Evaluation Questionnaire" and "School Sleep Habits Survey" were used to determine sleep characteristics and associated factors. Sleep records (7-21 days) were also obtained by using an actigraphy watch., Results: A sample of 42 participants (18 BO and 24 OCP) was recruited. Differences were found in the presentation of the psychiatric disorder. The BO group showed a higher frequency of major depression disorder (MDD; P = .04) and Disruptive Mood Dysregulation Disorder (DMDD; P = .04). The OCP group showed a higher frequency of Attention Deficit and Hyperactivity Disorder (ADHD; P = .65), and Separation Anxiety Disorder (SAD; P = .46). Differences were also found in sleep by using subjective measurements. Compared to the OCP group, BO had a worse perception of quality of sleep (P = .02), a higher frequency of nightmares (P = .01), a shorter total sleep time, and a higher sleep latency. Nevertheless, no differences were found between groups in the actigraphy measurements., Conclusions: The BO group had a higher frequency of Mood Disorders, and at the same time a higher number of sleep disturbances in the subjective measurements. It is possible that there is an association between mood symptoms, sleep disturbances, and coffee intake. No differences were found in the sleep profile by using actigraphy., (Copyright © 2020 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Aging is a phenomenon that has increased worldwide as a result of a higher life expectancy, evidencing situations typical of this stage, which can impact the happiness of individuals, who deserve attention and approach from mental health and public health., Objective: to explore the association between sociodemographic characteristics, medical history and symptoms, emotional state, social support, cognitive performance, and functional dependence, in relation to happiness in older adults in a rural area of Túquerres, Nariño., Method: cross-sectional study of association. Results: There were 252 records in total, corresponding to the data of rural older adults. A multivariate linear regression was performed, finding an association with happiness in the variables of age ( β a = . 41; CI95% .09 - .73), socioeconomic level ( β a = -.22; CI95% -.58 - .13), education level ( β a = . 41; CI95% . 68 - 1.49), occupation ( β a = . 59; CI95% -.48 - 1.67), having chronic disease ( β a = . 42; CI95% .12 - .73), breathing difficulties ( β a = -.25; CI95% -.51 - .02), joint pain ( β a = . 55; CI95% .26 - .83), depression symptoms ( β a = -.21; CI95% -.48 - .06]) or anxiety ( β a = . 40; CI95% .72 - .07), and social support ( β a = -.27; CI95% -.52 - -.02)., Discussion: this population has unfavorable socioeconomic and health conditions that impact their perception of happiness. Conclusion: happiness is a multicausal phenomenon that in older adults is part of the result of the interaction of variables and historical decisions at a political, economic, and social level., Competing Interests: Conflict of interests: The authors have declared that there is no conflict of interest.

Background: Cigarette smoking is a known risk factor for Alzheimer's disease (AD). However, the association between neurodegeneration and other substances has not been fully determined. It is of vital importance to evaluate this relationship in populations at high risk of dementia. Since substance use possibly modifies the progression rate of cognitive decline, we studied this association in a unique and well-phenotyped cohort from the University of Antioquia: carriers of the PSEN1-E280A genetic variant., Objective: To determine the association between substance use and cognitive decline in carriers of the PSEN1-E280A genetic variant., Methods: A retrospective cohort study was conducted with 94 carriers and 69 noncarriers recruited between January 2019 and April 2020. A psychiatrist interviewed the participants using the Consumption of Alcohol, Cigarettes and other Substances questionnaire. The participants were also submitted to cognitive evaluation. The relationship between cognitive decline and substance use was explored through a mixed effects regression model., Results: There was an association between cigarettes and better performance on tasks related to perceptual organization, verbal fluency, and memory in carriers. Alcohol had a positive or negative effect on memory according to the type of alcoholic beverage. Results on marijuana use were no conclusive. Coffee was associated with progressive improvements in executive function and verbal fluency., Conclusion: Cigarette and alcohol were associated with an improvement of some cognitive assessments, possibly by a survival bias. In addition, coffee was related to improvements in executive function and language; therefore, its short-term neuroprotective potential should be studied.

Bipolar disorder (BD) has a large hereditary component. It is a disorder that begins in early adulthood, but about which it has been described a premorbid period preceding the onset of BD. During this herald expression psychiatric disorders and symptoms, such as depressive, manic, psychotic, anxious and others, may appear., Objective: To determine the psychopathological profile of a Bipolar Offspring (BO) group compared with the Community Control Offspring (CCO) group, and its evolution over time, including subthreshold symptoms and mental disorders., Methods: We conducted an observational mixed cohort study, with a prospective design. We included subjects from six to 30 years of age, from the region of Antioquia, Colombia. A total of 131 subjects from the risk group BO and 150 subjects from the CCO group were evaluated through validated psychiatric diagnostic interviews (K-SADS-PL and DIGS) at baseline and at 4 years follow up. All interviews were carried out by a staff blind to parent diagnoses. Follow-up assessment were complete in 72% of the offspring. Forty-two subjects were excluded as they surpassed the age of 30 years, and only 46 subjects were not followed (change of address or did not consent to participate)., Results: Compared with the CCO group, the BO group had a higher frequency of affective disorder, psychotic disorder, externalizing disorders and use of the psychoactive substances during both assessments at time 1 and 2. The magnitude of the differences between the groups increased when they reach time 2. The BO group had a greater risk for presenting subthreshold symptoms and definitive psychiatric disorders, such as affective disorders, psychotic disorders and externalizing disorders. In addition, the BO group had a younger age of onset for psychoactive substances consumption., Conclusion: During the follow-up period, the BO group had a higher risk of presenting mental disorders compared with the CCO group. The most relevant symptoms and disorders that could precede the onset of BD were depressive, bipolar not otherwise specified, psychotic and substance use., (Copyright © 2020 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: Studies that have compared the cognitive alterations of the children of parents with bipolar disorder (CPBD) versus the children of control parents (CCP), present heterogeneous results due to the studies' methodological differences, the age of the population studied, and the lack of standardisation of the measures used for the different neurocognitive domains. The objective was to compare the neurocognitive profile of CPBD versus CCP to observe if there are differences that could be proposed as possible endophenotypes of BD., Results: A total of 107 individuals (51 CPBD, and 56 CCP) with ages between 6 and 16 (mean, 12.2±2.80) years of age were evaluated. Seventy-four point five percent of the CPBD group had some disorder compared to 67.9% of the CCP group. Tests such as letter-F phonemic verbal fluency, letter-S phonemic verbal fluency, overall F-A-S phonemic verbal fluency, story recall and retrieval, and Wisconsin perseverative errors showed a difference with a small effect size, but with a high degree of uncertainty., Conclusions: The CPBD did not have differences in their neurocognitive profile in comparison with CCP. Both groups have a high prevalence of psychopathology, which is a factor that could explain the lack of differences in neurocognitive performance., (Copyright © 2021 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Cortical thinning is a marker of neurodegeneration in Alzheimer's disease (AD). We investigated the age-related trajectory of cortical thickness across the lifespan (9-59 years) in a Colombian kindred with autosomal dominant AD (ADAD)., Methods: Two hundred eleven participants (105 presenilin-1 [ PSEN1 ] E280A mutation carriers, 16 with cognitive impairment; 106 non-carriers) underwent magnetic resonance imaging. A piecewise linear regression identified change-points in the age-related trajectory of cortical thickness in carriers and non-carriers., Results: Unimpaired carriers exhibited elevated cortical thickness compared to non-carriers, and thickness more negatively correlated with age and cognition in carriers relative to non-carriers. We found increased cortical thickness in child carriers, after which thickness steadied compared to non-carriers prior to a rapid reduction in the decade leading up to the expected age at cognitive impairment in carriers., Discussion: Findings suggest that cortical thickness may fluctuate across the ADAD lifespan, from early-life increased thickness to atrophy proximal to clinical onset., Competing Interests: Mr. Fox‐Fuller was supported by the National Institute on Aging (NIA F31AG062158) and was the member‐at‐large for the International Neuropsychological Society's Student Liaison Committee. Dr. Quiroz was supported by grants from the National Institutes of Health (NIH) Office of the Director (DP5OD019833), the NIA (R01 AG054671]), the Alzheimer's Association, and Massachusetts General Hospital Executive Committee on Research (ECOR). Mr. d'Oleire Uquillas was supported by the National Science Foundation, NSF GRFP (disbursed to institution) and the Ford Foundation National Academies of Sciences, Medicine and Engineering Predoctoral Fellowship (disbursed to institution). Dr. Kewei Chen was supported by the NIH (to the institute State of Arizona and to the institute) and was a paid consultant (unrelated to this manuscript) to the following: Green Valley Pharmaceutical, Shanghai, China; Beijing Normal University, Beijing, China; and The sixth people's hospital, Shanghai, China. In addition, Dr. Kewei Chen holds a patent regarding use of multi‐modal linkage (multi‐modal partial least square) to link and co‐analyze multi‐modal data (https://patents.google.com/patent/US20060074290). Dr. Su was supported on this work by R01AG055444 (funding was made to Banner Health) and was also supported by the following grants: NIH/NIA R01AG069453, NIH/NIA R21AG065942, NIH/NIA R42AG053149, NIH/NIA P30AG019610, NIH/NIA R01AG031581, NIH/NIA U19AG024904, NIH/NIBIB R21EB024366 BrightFocus ADR A2017272S, Alzheimer's Association AARG‐17‐532945 State of Arizona All grants were made to institution. Dr. Su is also a paid consultant (unrelated to this work) to Green Valley Pharmaceutical LLC. Dr. Jacobs received support (unrelated to this work) from the following: NIA‐NIH R01 AG 062559, R01 AG 068062‐01A1, and from Alzheimer Nederland (the Netherlands): AN‐19021. In addition, Dr. Jacobs is vice‐chair of the Neuromodulatory Subcortical Systems professional interest area of International Society to Advance Alzheimer's Research and Treatment (ISTAART; Alzheimer's Association). Dr. Guzmán‐Vélez was supported by funding from the National Institute on Aging (NIA) K23AG061276, the Massachusetts General Hospital ECOR Fund for Medical Discovery Clinical Fellowship Award, and the NIH Research Supplement for Diversity (DP5OD019833); she also received honoraria for a presentation at a Missouri University of Science and Technology departmental colloquium (unrelated to this work). Dr. Vila‐Castelar is supported by a grant from the Alzheimer's Association (2019A005859) and serves as co‐chair for the Sex Differences Special Interest Group, Diversity and Disparities Professional Interest Area‐PIA of ISTAART. Dr. Reiman has received support from the following grants: NIH grants R01 AG069453, R01 AG031581, P30 AG019610, R01 AG055444, R01 AG054671, R01 AG058468, U01 NS093334, OT2 OD026549, PO1 AG052350, U19 AG024904, U54 MD000507, U01 AG0169765 and AG016976, and R01 AG054671; Arizona Department of Health Services; and Banner Alzheimer's Foundation, Flinn Foundation, Anonymous Foundations, NOMIS Foundation, Alzheimer's Association, and GHR Foundation. Dr. Reiman's institution has received consulting fees for his work with: Alkahest, Alzheon, Aural Analytics, Denali, Green Valley, Retromer Therapeutics, and Vaxxinity. Dr. Reiman is an inventor, with a patent issued to Banner Health, related to biomarker strategies involved in the accelerated evaluation of AD prevention therapies. Dr. Reiman is on the Board of Directors, Flinn Foundation, and is a Member of the National Advisory Council on Aging (NACA). Dr. Reiman is also Cofounder and shareholder of ALZPath. Dr. Sperling was supported by the following grants: R01AG058825 from the NIH, payment made to Brigham and Women's Hospital (BWH); R01AG063689 from NIH, payment made to BWH R01AG053184; from NIH, payment made to BWH; P01AG036694 from NIH, payment made to Massachusetts General Hospital (MGH); R01AG063689 from NIH (subcontract with USC), payment made to MGH R01AG061848; from NIH, payment made to MGH R01AG058468; from NIH (subcontract with Banner Alzheimer's Institute), payment made to MGH; from a research grant from the Alzheimer's Association, payment made to MGH ; and research funding Eisai, Eli Lilly, Janssen, clinical research funding. Dr. Sperling received Honorarium payments (unrelated to this work) made directly to her from: Shionogi, Genentech, Oligomerix, Inc., Cytox, Prothena, Acumen, JOMDD, Renew, Alnylam Pharmaceuticals, Neuraly, Janssen, Neurocentria, AC Immune, Biogen, Eisai, Roche, and Takeda. Dr. Sperling also reports a financial relationship for my spouse Dr. Keith Johnson regarding the following: Cerveau, Janssen, AC Immune, Novartis (these are all honorarium consulting payments). Dr. Sperling received the following additional honoraria (unrelated to this work): 2018 Duke Lectureship; 2018 UCLA Talk; 2018 Alzheimer Research Roundtable; 2018 ADRC Talk; 2019 ACTC Scottdale; 2019 ADPD Symposium; 2019 University of Tokyo Roundtable; 2019 Biogen: ARIA State of the Art Meeting; 2019 University of Pittsburgh Distinguished Scientist Lecture; 2019 University of Cincinnati Lurie Lecture; 2019 CTAD San Diego; 2019 CT Research Academy Talk; 2020 UC Irvine Distinguished Lecture on the Brain; 2020 Virtual Rhode Island IDeA Symposium; 2020 IMPACT‐AD Course; 2020 University of Chicago DOM Weekly Grand Rounds Seminar Series; 2020 Adler Foundation Symposium; San Diego 2020 ACTC; and San Diego 2020 UC Irvine Lecture. Dr. Sperling has also received travel support for the following conferences (unrelated to this work): 2018 ACTC Atlanta; 2018 CTAD Spain; 2018 Harvard HUBWeek Panel; 2018 Japan JSNM; 2019 Palm Beach Reversing the Tide of Alzheimer's Fundraiser; 2019 HAI Meeting; 2019 ACTC Philadelphia; 2019 GHR Board of Directors in DC; 2019 Marr Family Race; 2019 ACTC St. Louis; 2019 FDA Type C Meeting; 2019 Marc Diamond UT Southwestern Symposium; and 2020 HAI Miami. Dr. Sperling reports the following leadership positions: 2014‐2018 National Institute on Aging, Standing Council Member; National Advisory Council on Aging 2018‐2019 Chair, Division of Neuroscience Review Committee; National Institute on Aging 2018‐Present Journal of Prevention of Alzheimer's Disease; Editorial Board 2020‐2021 Chair, Preclinical Alzheimer's Disease Biomarker Disclosure Workshop Committee, National Academies of Science, Engineering and Medicine. Dr. Lopera reports support from the COLBOS project to himself and his Institution and received funds from an NIH Subcontract with Massachusetts General Hospital. Dr. Lopera reports receiving funds from NIH to participate in various Alzheimer's‐related conferences. Dr. Keith Johnson reports research support from NIH (unrelated to this work) and received personal consulting fees from Novartis. Dr. Brad Dickerson reports research support from NIA, NIDCD, and NIMH, as well as royalties/licenses with Oxford University Press, Cambridge University Press, and Elsevier. Dr. Dickerson reports personal consulting fees received from: Acadia, Alector, Arkuda, Biogen, Novartis, Takeda, and Wave. Dr. Dickerson received honoraria from InTouch Medical and Biogen and was on the Data Safety/Advisory Boards for: Acadia, Alector, Arkuda, Biogen, Novartis, Takeda, and Wave. Dr. Dickerson is also Chair elect of the Association for FTD., (© 2021 The Authors. Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring published by Wiley Periodicals, LLC on behalf of Alzheimer's Association.)

Introduction: Mild Cognitive Impairment (MCI) is common in Parkinson's Disease (PD). Few studies have compared the Health-Related Quality of Life (HRQoL) in patients with and without MCI due to PD (PD-MCI), and its correlation to patients' subjective cognitive and communicative difficulties has not been explored., Objective: We aimed to compare HRQoL in PD-MCI and PD without MCI (PD-nMCI), and explore its possible relationship to subjective cognitive and communicative complaints., Methods: We included 29 PD-nMCI and 11 PD-MCI patients. The HRQoL was assessed with the Parkinson's Disease Questionnaire-39 (PDQ-39): its Cognition dimension was used as a measure of subjective cognitive complaints, its Communication dimension for subjective communicative complaints, and the summary index (PDQ-39 SI) as an indicator of HRQoL. Non-parametric partial correlations between the Cognition and Communication dimensions, and the adjusted PDQ-39 SI were conducted., Results: PD-MCI patients had greater subjective cognitive and communicative complaints and worse HRQoL than PD-nMCI patients. In the PD-MCI group, both subjective cognitive and communicative complaints exhibited significant direct correlations with the adjusted HRQoL scores., Conclusions: HRQoL seems to be affected in PD-MCI, and it might be influenced by greater subjective cognitive and communicative complaints. Including patient-reported outcome measures of HRQoL, and providing cognitive and speech rehabilitation, as well as psychotherapeutic strategies to face these deficits can enhance the patient-centred approach in PD., (Copyright © 2021 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Importance: We previously reported that children with the autosomal dominant Alzheimer disease (ADAD) presenilin 1 (PSEN1) E280A variant had early life plasma biomarker findings consistent with amyloid β overproduction. However, the cognitive functioning of children with this variant has not been characterized vs those without the variant., Objective: To test whether cognitive functioning of children with and without the PSEN1 E280A variant in the same ADAD cohort differed by genetic status (ie, PSEN1 variant) and sex., Design, Setting, and Participants: This cohort study was conducted among 1354 children (including 265 children with the variant) aged 6 to 16 years recruited from the Alzheimer Prevention Initiative Colombia Registry. Participants from the city of Medellín and surrounding suburban areas traveled to the University of Antioquia to undergo all procedures. Participants were administered a Spanish version of the Wechsler Intelligence Scale for Children, Fourth Edition (WISC-IV) to measure general cognitive functioning. Data were analyzed from July through November 2020., Main Outcomes and Measures: Univariate general linear models were used to characterize differences on WISC-IV cognitive performance by genetic status, sex, and the interaction of genetic status with sex. Urbanity, socioeconomic status, and education were entered as covariates., Results: Among 1354 children with ADAD (695 [51.3%] girls; mean [SD] age, 11.64 [2.64] years), there were 265 children with the variant (19.6%) and 1089 children without the variant (80.4%). Children with and without the variant did not differ by demographic variables or performance on WISC-IV indices. Irrespective of genetic status, boys had statistically significantly decreased mean scores on indices for working memory (90.27 [95% CI, 89.21-91.34] vs 92.99 [95% CI, 91.98-93.99]; mean difference = -2.72; P < .001), perceptual reasoning (91.56 [95% CI, 90.47-92.65] vs. 93.27 [95% CI, 91.23-94.30]; mean difference = -1.71; P = .03), and verbal comprehension (88.69 [95% CI, 87.54-89.84] vs. 90.81 [95% CI, 89.73-91.90]; mean difference = -2.12; P = .009) compared with girls. In the interaction between sex and genetic status, boys with the variant had worse mean working memory index performance (88.78 [95% CI, 86.86-90.70]) than girls with the variant (93.75 [95% CI, 91.95-95.55]; mean difference = -4.97; P = .001), as well as boys (91.77 [95% CI, 90.85-92.70]; mean difference = -2.99; P = .04) and girls (92.22 [95% CI, 91.32-93.13]; mean difference = -3.44; P = .009) without the variant., Conclusions and Relevance: This study found that boys with the PSEN1 variant had decreased working memory abilities compared with girls with the variant and boys and girls without the variant, suggesting a sex-specific genetic risk in early life cognitive performance among individuals with the PSEN1 variant. This increased risk of future cognitive difficulties among boys with the variant may have important downstream implications for learning and academic achievement and could be associated with sex differences seen in adulthood on episodic memory measures.

Objective: We aim to determine the prevalence of mental disorders in siblings of children with attention deficit hyperactivity disorder (ADHD), and to determine how psychosocial adversity factors relate to this psychopathology, in a low-middle income country (Colombia)., Methods: We evaluated subjects with ADHD diagnosed according to the DSM-5 criteria, one of their parents and one of their siblings (ages 8-19). We used the ADHD rating scale and a set of instruments to assess the presence of mental disorders as well as psychosocial adversity., Results: We evaluated 74 trios formed by the index case with ADHD, one sibling and one of the parents. We found that 24.3% of the participating siblings also met the criteria for ADHD and another 24.3% for other psychiatric disorders. The risk of these siblings having ADHD increased further when one of the parents reported a history of ADHD. We also found that 28.3% of the families faced high levels of psychosocial adversity as per their scores in the Rutter Adversity Index., Conclusions: Siblings of subjects with ADHD showed a significant risk for ADHD and other mental disorders. That risk increased if a parent reported a history of ADHD and also when two or more psychosocial adversity factors were present. This study supports the importance of early detection in efforts to decrease the risk for other siblings., (Copyright © 2021 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Validate the Self Stigma Of Seeking Help (SSOSH) scale in a population of students of a medical school for its use in Colombia., Methods: We included 384 medical students from the city of Medellín. Initially, two direct translations were made, two back translation and one pilot test. The internal consistency, test-retest repeatability and structural, convergent, divergent and discriminative construct validity were then evaluated., Results: A easy-to-understand and to fill out Spanish version was obtained. The internal consistency of the scale was adequate (Cronbach's alpha=.80; 95%CI, .77-.83) as well as the test-retest repeatability (CCI=.77; 95%CI, .63-.86). The Confirmatory Factor Analysis showed a good fit with the one-dimensional structure (RMSEA=.073; IC90%, .056-.089; CFI=.968; TLI=.977; WRMR=.844). The convergent validity was supported by the correlation with the Public Stigma scales (ρ=.39) and Attitudes towards Seeking Help (ρ= -0.50) and the divergent validity with the Social Desirability scale (ρ=-0,05). When examining the discriminative validity, differences were found between the scores of those who would be willing to seek professional help when having a mental health problem and those who probably would not (Difference of means=4.9; 95%CI, 2.99-6.83)., Conclusions: The Colombian version of the SSOSH is valid, reliable and useful for the measurement of the Self-stigma associated with seeking professional help in the university population of the Colombian health sector. Its psychometric properties must be investigated in populations of other programs and outside universities., (Copyright © 2020 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: Validate the Self Stigma Of Seeking Help (SSOSH) scale in a population of students of a medical school for its use in Colombia., Methods: We included 384 medical students from the city of Medellín. Initially, two direct translations were made, two back translation and one pilot test. The internal consistency, test-retest repeatability and structural, convergent, divergent and discriminative construct validity were then evaluated., Results: A easy-to-understand and to fill out Spanish version was obtained. The internal consistency of the scale was adequate (Cronbach's alpha = .80; 95%CI, .77-.83) as well as the test-retest repeatability (CCI = .77; 95%CI, .63-.86). The Confirmatory Factor Analysis showed a good fit with the one-dimensional structure (RMSEA = .073; IC90%, .056-.089; CFI = .968; TLI = .977; WRMR = .844). The convergent validity was supported by the correlation with the Public Stigma scales (ρ = .39) and Attitudes towards Seeking Help (ρ = -0.50) and the divergent validity with the Social Desirability scale (ρ = -0,05). When examining the discriminative validity, differences were found between the scores of those who would be willing to seek professional help when having a mental health problem and those who probably would not (Difference of means = 4.9; 95%CI, 2.99-6.83)., Conclusions: The Colombian version of the SSOSH is valid, reliable and useful for the measurement of the Self-stigma associated with seeking professional help in the university population of the Colombian health sector. Its psychometric properties must be investigated in populations of other programs and outside universities., (Copyright © 2020 Asociación Colombiana de Psiquiatría. Published by Elsevier España, S.L.U. All rights reserved.)

Neuropsychologists continue to face challenges when assessing Spanish-speaking individuals due to limited availability of normative data. We developed comprehensive normative data stratified by age and education for a Spanish neuropsychological test battery used by the Grupo de Neurociencias de Antioquia (Colombia) and the Colombian Alzheimer's Prevention Initiative Registry, which have followed large families at risk for autosomal-dominant Alzheimer's disease (ADAD) since the 1990s. Approximately 75% of these individuals are cognitively-unimpaired and are not genetically predisposed to develop ADAD. We conducted a retrospective study on neuropsychological evaluations from 2,673 cognitively unimpaired individuals (56% female), with ages ranging from 18 to 86 years and education from 1 to 25 years. Neuropsychological measures included the Consortium to Establish a Registry for Alzheimer's Disease-Colombia, and other multidomain Spanish tests. We examined associations between age, education, and sex with cognitive performance. Norms stratified by age and education are presented. Cognitive performance showed small associations with age and education and was unrelated to sex. We provided population-based norms for Spanish tests targeting multiple cognitive domains using a large Colombian sample. These normative data may be helpful for the neuropsychological characterization of Spanish speakers from Latin America in clinical and research settings.

To determine the explanatory capacity of pain metacognitions and beliefs over the functionality, coping and pain intensity, following the Model of Self-Regulatory Executive Functions (S-REF) in a sample of women with fibromyalgia from Medellín and its Metropolitan Area. Method: Metacognitions Scale on Symptom Control, Pain Self-efficacy Questionnaire, Chronic Pain Catastrophizing Scale, Chronic Pain Coping Questionnaire, WHODAS 2.0 Scale, and Pain Intensity Numerical Scale. The sample was represented by 108 women between 24 and 60 years old with a diagnosis of fibromyalgia. A modeling process was carried out through an analysis of structural equations. Results: The final model fails to fit. Despite this, the analysis suggests that negative metacognitions and pain self-efficacy have an effect over the tendency to catastrophizing. The latter and the pain self-efficacy are the main mediators in the effects of functionality. The intensity of pain is not determined by the metacognitions related to it., Competing Interests: Conflict of interests:The authors have declared that there is no conflict of interest.

Introduction: Predominant polarity (PP) has been proposed as a specifier of bipolar disorder (BD) due to its relationship with clinical and prognostic variables. It is possible that this is due to a different underlying neurobiology, in such a way that the changes found by structural nuclear magnetic resonance imaging (sMRI) in BD are different and specific., Objectives: To explore findings of structural neuroimaging in patients with BD type I (BD-I) according to PP., Methods: Cross-sectional study that evaluated 77 patients with BD-I using the DIGS interview. PP was established using the operative definition of two-thirds of all affective episodes throughout life to classify PP as manic (MPP), depressive (DPP) or indeterminate (IPP). MRIwas performed during the euthymia phase to measure intracranial structures. The data obtained was analysed using a linear regression model adjusted for confounding variables (drug use, alcohol use, psychoactive substance use) and were compared between the three groups finding the standardised mean difference (SMD)., Results: Differences with adequate effect size were found in three brain structures after adjusting for confounding variables, specifically in the right fusiform gyrus and the left lingual gyrus, which were greater in the DPP group than in the MPP group (SMD = 0.92; 95% CI = 0.34 to 1.49 and SMD = 0.78; 95% CI = 0.21 to 1.35). Likewise, in the right thalamus, it was shown to be greater in the IPP group compared to MPP group (SMD 0.89, 95% CI = 0.31 to 1.46)., Conclusions: A reduction in the thickness of the right fusiform gyrus and the left lingual gyrus, as well as the right thalamic volume was observed in patients with BD-I with PPM, which supports the hypothesis that PP has a plausible neurobiological correlate and could have potential utility as a BD specifier., (Copyright © 2020 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To explore the role of cardiovascular risk factors and the different NOTCH-3 mutations to explain the variability observed in the clinical presentation of CADASIL., Methods: This was a retrospective cohort study of 331 individuals, 90 were carriers of four mutations in the NOTCH3 gene. These four mutations are the ones identified in our region from the genetic evaluation of probands. Cox proportional hazards models were fitted to estimate the effect of genetic and cardiovascular factors on the onset of migraine, first stroke, and dementia. Competing risk regression models considered death as risk., Results: Noncarriers (healthy controls from the same families without NOTCH3 mutations) and NOTCH3 mutation carriers had similar frequencies for all cardiovascular risk factors. Diabetes (SHR 2.74, 95% CI 1.52-4.94) was associated with a younger age at onset of strokes among carriers. Additionally, a genotype-phenotype relationship was observed among C455R mutation carriers, with higher frequency of migraines (100%), younger age at onset of migraine (median age 7 years, IQR 8) and strokes (median age 30.5 years, IQR 26). Moreover, fewer carriers of the R141C mutation exhibited migraines (20%), and it was even lower than the frequency observed in the noncarrier group (44.8%)., Conclusions: This study characterizes extended family groups, allowing us a comparison in the genotype-phenotype. The results suggest a complex interplay of genetic and cardiovascular risk factors that may help explain the variability in the clinical presentation and severity of CADASIL., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: The offspring of bipolar parents (BO) is a high-risk population for inheriting the bipolar disorder (BD) and other early clinical manifestations, such as sleep disturbances., Objective: To compare the presence of psychiatric disorders and sleep disturbances of BO versus offspring of control parents (OCP)., Methods: A cross-sectional analytical study was conducted that compared BO versus OCP. The participants were assessed using valid tools to determine the presence of psychiatric symptoms or disorders. The "Sleep Evaluation Questionnaire" and "School Sleep Habits Survey" were used to determine sleep characteristics and associated factors. Sleep records (7-21 days) were also obtained by using an actigraphy watch., Results: A sample of 42 participants (18 BO and 24 OCP) was recruited. Differences were found in the presentation of the psychiatric disorder. The BO group showed a higher frequency of major depression disorder (MDD; P=.04) and Disruptive Mood Dysregulation Disorder (DMDD; P=.04). The OCP group showed a higher frequency of Attention Deficit and Hyperactivity Disorder (ADHD; P=.65), and Separation Anxiety Disorder (SAD; P=.46). Differences were also found in sleep by using subjective measurements. Compared to the OCP group, BO had a worse perception of quality of sleep (P=.02), a higher frequency of nightmares (P=.01), a shorter total sleep time, and a higher sleep latency. Nevertheless, no differences were found between groups in the actigraphy measurements., Conclusions: The BO group had a higher frequency of Mood Disorders, and at the same time a higher number of sleep disturbances in the subjective measurements. It is possible that there is an association between mood symptoms, sleep disturbances, and coffee intake. No differences were found in the sleep profile by using actigraphy., (Copyright © 2020 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Clinical practice guidelines (CPGs) are designed to improve the quality of care and reduce unjustified individual variation in clinical practice. Knowledge of the barriers and facilitators that influence the implementation of the CPG recommendations is the first step in creating strategies to improve health outcomes. The present systematic meta-review sought to explore the barriers and facilitators for the implementation of CPGs., Methods: A search was conducted in the PubMed, Embase, Cochrane, Health System Evidence and International Guideline Library (G-I-N) databases. Systematic reviews of qualitative, quantitative or mixed-methods studies that identified barriers or facilitators for the implementation of CPGs were included. The selection of the title and abstract, the evaluation of the full text, extraction of the data and the quality assessment were carried out by two independent reviewers. To summarise the evidence, we grouped the barriers and facilitators according to the following contexts: political and social, health organisational system, guidelines, health professionals and patients., Results: Overall, 25 systematic reviews were selected. The relevant barriers in the social-political context were the absence of a leader, difficulties with teamwork and a lack of agreement with colleagues. Relevant barriers in the health system were a lack of time, financial problems and a lack of specialised personnel. Barriers of the CPGs included a lack of clarity and a lack of credibility in the evidence. Regarding the health professional, a lack of knowledge about the CPG and confidence in oneself were relevant. Regarding patients, a negative attitude towards implementation, a lack of knowledge about the CPG and sociocultural beliefs played a role. Some of the most frequent facilitators were consistent leadership, commitment of the members of the team, administrative support of the institution, existence of multidisciplinary teams, application of technology to improve the practice and education regarding the guidelines., Conclusions: The barriers and facilitators described in this review are factors that influence the implementation of evidence in clinical practice. Knowledge of these factors should contribute to the development of a theoretical basis for the creation of CPG implementation strategies to improve professional practice and health outcomes for patients.

Background: The issue of lower extremity amputation has been in the Colombian political agenda for its relationship with the armed conflict and antipersonnel mines. In 2015 the Colombian Ministry of Health published a national clinical practice guideline (CPG) for amputee patients. However, there is a need to design implementation strategies that target end-users and the context in which the CPG will be used. This study aims to identify users' perceptions about the barriers and facilitators for implementing the guideline for the care of amputee patients in a middle-income country such as Colombia., Methods: Semi-structured interviews were conducted with 38 users, including patients, health workers, and administrative staff of institutions of the health system in Colombia. Individuals were purposively selected to ensure different perspectives, allowing a balance of individual positions., Results: According to participants' perceptions, barriers to implementation are classified as individual barriers (characteristics of the amputee patient and professionals), health system barriers (resource availability, timely care, information systems, service costs, and regulatory changes), and barriers related to clinical practice guidelines (utility, methodological rigour, implementation flexibility, and characteristics of the group developing the guidelines)., Conclusions: Our study advances knowledge on the perceived individual and health system barriers and facilitators for the implementation of the CPG for amputee patients in Colombia. Importantly, the governance, financial, and service delivery arrangements of the Colombian health system are determining factors in implementing CPGs. For example, the financial arrangements between the insurance companies and the health care provider institutions were identified as barriers for the implementation of recommendations related to the continuity and opportunity of care of patients with amputations. The design of implementation strategies that successfully address the individual behaviours and the contextual health systems arrangements may significantly impact the health care process for amputee patients in Colombia.

Bipolar disorder (BD) has a large hereditary component. It is a disorder that begins in early adulthood, but about which it has been described a premorbid period preceding the onset of BD. During this herald expression psychiatric disorders and symptoms, such as depressive, manic, psychotic, anxious and others, may appear., Objective: To determine the psychopathological profile of a Bipolar Offspring (BO) group compared with the Community Control Offspring (CCO) group, and its evolution over time, including subthreshold symptoms and mental disorders., Methods: We conducted an observational mixed cohort study, with a prospective design. We included subjects from six to 30 years of age, from the region of Antioquia, Colombia. A total of 131 subjects from the risk group BO and 150 subjects from the CCO group were evaluated through validated psychiatric diagnostic interviews (K-SADS-PL and DIGS) at baseline and at 4 years follow up. All interviews were carried out by a staff blind to parent diagnoses. Follow-up assessment were complete in 72% of the offspring. Forty-two subjects were excluded as they surpassed the age of 30 years, and only 46 subjects were not followed (change of address or did not consent to participate)., Results: Compared with the CCO group, the BO group had a higher frequency of affective disorder, psychotic disorder, externalizing disorders and use of the psychoactive substances during both assessments at time 1 and 2. The magnitude of the differences between the groups increased when they reach time 2. The BO group had a greater risk for presenting subthreshold symptoms and definitive psychiatric disorders, such as affective disorders, psychotic disorders and externalizing disorders. In addition, the BO group had a younger age of onset for psychoactive substances consumption., Conclusion: During the follow-up period, the BO group had a higher risk of presenting mental disorders compared with the CCO group. The most relevant symptoms and disorders that could precede the onset of BD were depressive, bipolar not otherwise specified, psychotic and substance use., (Copyright © 2020 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Psychological approaches to the study of armed conflict have focused on analyzing post-traumatic stress outcomes, and on evaluating the intensity of exposure to violent confrontation. Nevertheless, psychometrically valid tools required for measuring these traumatic experiences are scarce To validate the Extreme Experiences scale (EX 2 ) for armed conflict contexts for its use in Colombia, and to provide a framework for validation in conflict contexts around the world This Cross-sectional aims to validate the scale with 187 participants, study of validate with 187 participants, comprising population with high exposure to conflict (former combatants and a set of armed conflict victims) and low conflict-exposed individuals (control group). Structures of two domains and 18 items were confirmed: Direct Extreme Experiences (dEX 2 ) and Indirect Extreme Experiences (iEX 2 ); these dimensions were also validated by expert judgment, producing 14-item version. Good levels of internal consistency were found, with a KR-20 of 0.80 for the 18-item version, and 0.77 for the 14-item. The scale differentiates between population with 'high exposure to conflict' from population with 'low exposure' (d np  > 0.5 and area under the ROC >0.90). The scale scores have significant correlation with some mental health constructs. The EX 2 scale has good internal consistency, as well as structural validity with regard to exposed groups. This scale can be potentially validated for its use in countries with armed confrontation history. In future versions, the scale may include additional items in order to improve content validity.

Introduction: The identification of pre-frailty and frailty syndrome in older adults is important due to its association with the development of disability. It is a priority problem for health systems and quality of life of older adults, caregivers, and relatives., Objective: To determine the prevalence and associated factors of pre-frailty and frailty syndrome in indigenous older adults from Colombia., Material and Method: A cross-sectional study was conducted that included 540 indigenous over 60 years of age who belong to the 13 sub-regions of the Obando province in Nariño, Colombia. The prevalence of frailty and pre-frailty syndrome was determined, we evaluated sociodemographic variables, cognitive deterioration, functionality, and the presence of different morbidities. Associations were estimated using multivariate multinomial logistic regression models., Results: The mean age was 70.68 (SD 6.86). The prevalence of frailty syndrome was 32.4%, and pre-frailty syndrome was 58.7%. Having depressive symptoms, those with altered functional dependence according to the Barthel index, and those who reported having arthrosis or arthritis, showed an association with frailty syndrome., Conclusion: This analysis shows a high prevalence of frailty syndrome in the population of indigenous older adults. This was similar to that reported in other countries. Frailty has a great impact on health due to its strong association with musculoskeletal diseases, depression, and disability., (Copyright © 2019 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: People with schizophrenia and bipolar disorder (BD) have a high risk of unwanted pregnancies and abortions, due to their condition of vulnerability or hypersexuality (common in BD). This is associated with difficulty in planning their actions and lack of sex education and counselling by medical personnel, and can lead to adverse obstetric outcomes and inability to care adequately for their children., Objective: To describe the characteristics in terms of sexual and reproductive health, and the use of contraception and counselling in psychiatric consultations, in a sample of patients with BD and schizophrenia in Medellin, Colombia., Methods: Observational cross-sectional study. We included the 160 participants from the clinical trial, "The effects of a multimodal intervention programme in patients with bipolar disorder and schizophrenia", who were recruited from the mood and psychosis disorders group clinic at Hospital Universitario de San Vicente Fundación in Medellin. They were contacted by phone by a third-year psychiatry resident, who applied a survey about the characteristics of their sex life, contraception and reproduction., Results: Almost all of the patients with schizophrenia were single, had no undergraduate studies and were unemployed. No significant differences were found regarding the age of starting sexual relations when comparing by diagnosis and gender. Almost all patients with schizophrenia and almost half of the patients with BD reported not having an active sexual life. Almost all of those who admitted to having an active sexual life claimed to always use contraception; in the BD group, only 48.8% of single women admitted to using contraception and a little over half of men stated that they used a condom when having sex. A quarter of the pregnancies were unplanned. Although the majority of the patients stated that they had never received information about family planning in the consultations with their psychiatrist, 57.4% of the patients with BD and 78.8% of those who had schizophrenia, considered themselves to be well informed on the subject., Conclusions: Patients with mental illness have cognitive and behavioural alterations that affect their sexual and reproductive lives. Psychiatrists should therefore address this issue, to ensure education in areas such as contraception, family planning and sexually transmitted diseases and help safeguard the safety and quality of life of their patients., (Copyright © 2018. Publicado por Elsevier España, S.L.U.)

Introduction: The prevalence and incidence of amyotrophic lateral sclerosis (ALS) is not fully established, and this varies depending on the studied population., Objective: To estimate the prevalence/incidence of ALS patients in Antioquia-Colombia., Methodology: Observational/descriptive study by reviewing clinical records from 2010 to 2014. Cases with possible, probable and definite ALS were included. To estimate the prevalence/incidence, capture-recapture method was used., Results: Point prevalence in December 2014 was 4.9/100,000 (95% CI 2.0-7.8), and the incidence was 1.4/100,000/year (95% CI 0.5-2.2). The median survival was 4 years. Spinal-onset was observed in 62.4% of the included patients., Conclusion: Prevalence, incidence and clinical presentation of ALS in Antioquia are similar to most studies reported worldwide. However, prevalence in Antioquia seems to be slightly higher than in other studies from Latin -American countries. This may derive from the inclusion criteria and case detection methodology adopted, but sociodemographic and genetic factors should be considered., (© 2019 S. Karger AG, Basel.)

Background: Dementia of the Alzheimer's type (DAT) impacts Hispanics disproportionately, with almost a twofold elevated risk of developing DAT, as well as earlier onset of the disease, than in non-Hispanic Whites. However, the role of main risk factors for DAT, such as APOE-ɛ4 and blood pressure (BP) levels, remains uncertain among Hispanics., Objective: To investigate the association of APOE-ɛ4 and BP levels, measures with 24-h ambulatory BP monitoring, with incidence of DAT in an elderly cohort of Hispanics., Methods: 1,320 participants from the Maracaibo Aging Study, free of dementia at the baseline, and with ambulatory BP measurements and APOE genotype available were included. Adjusted Cox proportional models were performed to examine 1) the incidence of DAT and 2) the relationship between BP levels and DAT according to APOE genotypes. Models were adjusted by competing risk of death before the onset of DAT. Model performance was assessed by likelihood test., Results: The average follow-up time was 5.3 years. DAT incidence was 5.8 per 1000 person-year. APOE-ɛ4 carriers had a higher risk of DAT. In unadjusted analyses, conventional, 24-h, and nighttime systolic BP levels were significantly higher in participants who developed DAT and of APOE-ɛ4 carriers (p < 0.05). After adjustment for competing risks, only higher nighttime systolic BP was associated with DAT incidence, but only among subjects carrying APOE-ɛ4., Conclusion: In this Hispanic population, both APOE-ɛ4 genotype and assessment of nocturnal systolic BP (rather than diurnal or office BP) were necessary to estimate DAT risk.

Introduction: Ethnicity in Latin America is a factor of poverty and social exclusion. Like in developed countries, demographic, medical, psychosocial, global cognitive, and functional variables interact in a complex relationship on the elderly population. Such interaction should be considered to determine cognitive and functional performance using screening tests. The aim of this study was to evaluate the demographic, medical, and psychosocial factors affecting global cognitive performance as well as functional activities., Methods: The study was conducted in a Colombian elderly indigenous population which included a sample of 518 adults. This research employed a structural model of latent factors to assess the effects of demographic, medical, and psychosocial factors on cognitive and functional performance. The model was estimated by least squares and used a maximum-likelihood procedure, and it was determined RMSEA, TLI, and CFI to assess the model's goodness of fit. The categorical variables used in the model were as follows: (1) demographics, (2) psychosocial factors, (3) medical condition, (4) global cognition, and (5) functional factors., Results: Demographics, in addition to medical and psychosocial factors, were related to global cognition and functional factors (RMSEA = 0.051, CI 90% 0.045-0.057, CFI = 0.901, and TLI = 0.881)., Conclusion: These results provide strong evidence about the complex relationships among demographics, medical conditions, and psychosocial factors and their influence on global cognition and functional performance in Colombian indigenous elderly population., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2019 Yenny Vicky Paredes-Arturo et al.)

Background: There are forms of Alzheimer's disease (AD) that have an autosomal dominant inheritance pattern; one of them is caused by the E280A mutation in the gene that codes for Presenilin-1 ( PSEN1 ). Studying families of people with this mutation allows the evaluation of characteristics of the subjects before cognitive decline begins., Objective: To determine whether having the mutation E280A in PSEN1 increases the risk of presenting mental disorders in adults under 30 years old who are in the preclinical stage of AD and may be eligible for primary prevention studies of AD., Methods: A psychiatric evaluation was made to 120 people belonging to families with a history of early onset AD. Of these, 62 carried the E280A mutation in PSEN1 . The occurrence of mental disorders between carriers and non-carriers of the mutation was compared., Results: No statistically significant differences were found in the frequency of any mental disorder between the group of carriers and non-carriers of the mutation (Hazard Ratio: 0.80, 95% CI 0.49 to 1.31); nor were differences observed when evaluating specific disorders., Conclusion: The E280A mutation does not increase the risk of mental disorders before the age of 30 in the relatives of people affected by familial AD. Studies with larger sample sizes are required to assess the risk of low incidence mental disorders., Competing Interests: A. Villalba, J. García, R. Cuastumal and D.C. Aguirre have nothing to disclosure. C. Ramos reports the following (pertinent for the last two years): grant and contract support from the NIA, Genentech/Roche, and an anonymous foundation to develop the Alzheimer’s Prevention Initiative Autosomal Dominant Alzheimer’s Disease - API ADAD - Registry since 2015 and she helps to conduct the API ADAD Trial in Colombia. D. Aguillón reports the following (pertinent for the last two years): grant and contract support from the National Institute on Aging - NIA -, Genentech/Roche, and an anonymous foundation to develop the API ADAD Registry since 2017 and he helps to conduct the API ADAD Trial in Colombia. L. Madrigal receives grant and contract support from the NIA, Genentech/Roche, and an anonymous foundation to develop the API ADAD Registry since 2013 and she helps to conduct the API ADAD Trial in Colombia. F. Lopera receives grand and contract support from the NIA, Genentech/Roche, and an anonymous foundation to develop the API ADAD Registry since 2013 and he is the principal investigator of the API ADAD Trial in Colombia., (© 2019 – IOS Press and the authors. All rights reserved.)