Search

Objectives: Systematic review and meta-analysis to determine the effectiveness of interventions in reducing depressive symptoms in ethnic minority carers of people with dementia.Methods: We systematically searched EMBASE, CINAHL, MEDLINE, PsycINFO, PsycARTICLES, Applied Social Sciences Index and Abstracts (ASSIA), The Cochrane Central Register of Controlled Trials (CENTRAL), and Sociological Abstracts and Social Policy and Practices databases from 1990 to 2015, supplemented by a grey literature search, hand searches of bibliographies, and contacting authors. Study quality was assessed independently by two researchers using The Effective Public Health Practice Project Quality Assessment Tool, with an inter-rater reliability of Cohen's kappa of 0.72 (95% CI, 0.42-1.01). Narrative synthesis and meta-analysis were used to assess intervention effectiveness. Meta-regression was used to assess whether factors such as intervention type, peer support, and ethnicity accounted for hetereogeneity.Results: Thirteen studies were eligible for inclusion, with 1076 participants in control groups and 980 participants in intervention groups; 12 studies provided estimates for meta-analysis. All studies were from the United States. Interventions were associated with an overall mean reduction in depression in caregivers (SMD -0.17 (95% CI, -0.29 to -0.05; P = 0.005). Meta-regression did not indicate any potential sources of heterogeneity, although narrative synthesis suggested that interventions developed with the target ethnic minority group's preferred mode of engagement in mind alongside cultural adaptations may have enhanced effectiveness.Conclusions: Psychosocial interventions for depression in ethnic minority carers of people with dementia are effective and could be enhanced through cultural adaptations. High-quality studies targeting minority ethnic groups outside of the United States are needed. [ABSTRACT FROM AUTHOR]

Background: Population ageing will lead to a dramatic increase in dementia prevalence globally. Recent evidence suggest a decline in dementia incidence in High Income Countries due to increasing education levels and improvements in cardiovascular health. Although, most of the increase will occur in low and middle‐income countries (LMICs), there are no recent estimates of dementia prevalence and incidence in LMICs. The present study aimed to examine new trends on dementia prevalence and incidence in Latin‐America and associations of socioeconomic determinants and cardiovascular risk factors. Method: Sample size included older adults from Latin America (Cuba, Dominican Republic [DR], Puerto Rico [PR], and Mexico) drawn from the 10/66 Dementia Research Group study. We compare wave 1 (2003‐2006) with wave 3 (2016‐2019) of 10/66 studies. The main outcome was dementia prevalence relative to previous waves. Dementia diagnosis was determined according to 10/66 dementia criteria. All the 10/66 waves used the same standardized assessments and protocols. Result: Dementia prevalence is stable Cuba, standardized dementia prevalence rates was 12.4% in wave I and 10.1% in wave III. Relative to wave I, Dominican Republic (wave I 11.5% vs wave II 13.6%), Peru (wave I 9.2% vs wave II 16.8%) and Mexico (wave 1 8.3% vs wave 2 17.1%) experience a significant increase in dementia prevalence. Despite, improvements in levels of education, increases in dementia prevalence were associated with higher rates of cardiovascular disease and cardiovascular risk factors, including diabetes, hypertension, obesity and heart disease in the later‐born cohorts. Self‐reported stroke is also rising. Conclusion: The prevalence of dementia in the older Latin American and Caribbean population is high and increasing relative to the previous decade. These findings may inform health promotion efforts within dementia national plans adopted recently in some Latin American countries [ABSTRACT FROM AUTHOR]

Background: Latin America and the Caribbean (LAC) countries are experiencing unprecedentedly rapid demographic ageing. Growing evidence shows that cardiovascular health (CVH) is associated with brain health. Little is known about this topic among older adults in Latin America, where the number of people living with dementia is rising. The present study aimed to examine the prevalence, incidence and associations of socioeconomic determinants and cardiovascular risk factors with dementia across six LAC countries. Methods: The 10/66 Dementia Research Group has carried out population‐based catchment area surveys, using a common protocol, in six Latin‐American countries Cuba, Dominican Republic, Mexico, Peru, Puerto Rico and Venezuela of all over 65 year old (n = 12 704). An incidence wave was conducted 4 ‐5 years after cohort inception, 8 502 participants were reinter viewed, contributing 34 000 person‐years of follow‐up. The outcomes were 10/66 dementia and DSM IV dementia. An index of modifiable CVH factors (ranging from 0 to 14) was calculated. Incident dementia was modeled using competing risks regression to adjust for risk of death. Results: The prevalence of dementia varied widely across different countries, ranging from 4.8% in Peru and 11.7% in Puerto Rico and the Dominican Republic. Incidence of 10/66 dementia varied between 18.2 (95% CI 14.3‐23.0) per 1000 person‐years in Peru to 30.4 (25.5‐36.3) per 1000 person‐years in Mexico. Being male, having higher education and younger age were all protective of dementia. Specific cognitive tests including literacy, verbal fluency and motor sequencing had also similar protective associations with dementia, providing more supporting evidence for the cognitive reserve hypothesis. Compared to poor CVH, participants with moderate and ideal levels of CVH had a significantly lower risk of dementia both in the unadjusted (subhazard ratio for moderate: 0.77; ideal: 0.59) and adjusted models (moderate: 0.73; ideal: 0.66). Conclusions: The prevalence of dementia in the older Latin American and Caribbean population is high. Moderate and ideal levels of CVH in old age may protect against dementia incidence. These findings may inform health promotion efforts within dementia national plans adopted recently in some Latin American countries [ABSTRACT FROM AUTHOR]

Abstract: Background: We aimed to investigate the association between dementia severity and weight loss in countries with low and middle incomes, where most prevalent cases reside. Methods: Cross-sectional catchment area surveys were performed in Cuba, Mexico, Venezuela, Peru, Dominican Republic, Puerto Rico, China, and India. In 16,538 older adults (≥65 years of age), significant weight loss was self-reported and confirmed by an informant. We conducted neuropsychological testing and clinical and neurological assessments. Dementia severity was determined by applying a validated algorithm and was quantified by the Clinical Dementia Rating Scale. Results: The characteristics of those who reported weight loss varied across countries. In Poisson models, after controlling for relevant covariates and for waist and arm circumferences, dementia severity was associated with reported weight loss (pooled prevalence ratios [95% confidence intervals {CI}] 2.19 [1.98, 2.41]; 3.81 [3.35, 4.33]; and 5.18 [4.41, 6.10] for CDR 0.5, 1, and 2/3, respectively, compared with CDR 0). The association increased linearly through stages of dementia severity in all countries (P for trend < .001), and between-country heterogeneity was minimal. Conclusions: We found a strong gradient effect in the direct association between dementia severity and reported weight loss, homogeneous across sites from eight countries, consistent with mechanistic data on the role of neurodegenerative processes on energy balance and with dietary changes due to disease severity. Considering the well-recognized effect of weight loss on morbidity and mortality and the large number affected by dementia in less resourced countries, amelioration of weight loss in dementia patients should be considered with priority in these settings. [Copyright &y& Elsevier]

Anaemia among older people is increasingly recognized as a matter of public health concern. Data from low- and middle-income countries are sparse. We surveyed 10915 people aged 65 years and over (8423 with blood tests) in catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela and Mexico, to assess prevalence and correlates of anaemia and impact on disability. Prevalence varied widely between sites, from 6·4% in rural Mexico to 9·2% in urban Mexico, 9·8% in Venezuela, 19·2% in Cuba, 32·1% in Puerto Rico and 37·3% in Dominican Republic. Prevalence was higher in men and increased with age, but sociodemographic composition did not account for prevalence differences between sites. Standardized morbidity ratios indicated a much higher prevalence in Cuba (173), Puerto Rico (280) and Dominican Republic (332) compared with USA National Health and National Examination Surveys. Anaemia was associated with undernutrition, physical impairments, and serum creatinine. There was an association with greater African admixture in Dominican Republic but not in Cuba. African admixture is therefore unlikely to fully explain the high prevalence in the Caribbean islands, which may also arise from environmental, possibly dietary factors. Given an important independent contribution of anaemia to disability, more research is needed to identify preventable and treatable causes. [ABSTRACT FROM AUTHOR]

Objectives To assess the association between tobacco consumption and dementia using the same methodology in seven developing countries, testing the specific hypotheses that higher exposure to tobacco is associated with a higher prevalence of dementia, that the association is limited to smoked tobacco and is stronger for vascular dementia compared to Alzheimer's disease. Methods Cross-sectional surveys conducted on individuals aged 65+. A total of 15 022 residents in specified catchment areas were assessed face-to-face using a standardised protocol, which included dementia diagnosis and detailed information on past and current tobacco consumption, and on important potential confounders of this association. Results A high proportion of participants were never smokers (52% in Dominican Republic to 83% in Peru), most of those who ever used tobacco in China and India were still smoking at age 65 and above (80% and 84%, respectively). There was a positive association between history of tobacco smoke exposure (pack years up to age 50) and dementia (pooled PR = 1.003; 95%CI 1.001-1.005), Alzheimer's disease (pooled PR = 1.007; 95% CI, 1.003-1.011) and Vascular Dementia (pooled PR = 1.003; 95% CI = 1.001-1.005). These associations were attenuated but remained significant if exposure after the age of 50 was included. In India there was no association between smokeless tobacco and dementia. Conclusions Dementia in developing countries appears to be positively associated with history of tobacco smoking but not smokeless tobacco use. Selective quitting in later life may bias estimation of associations. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We evaluated the psychometric properties of the 12-item interviewer-administered screener version of the World Health Organization Disability Assessment Schedule – version II (WHODAS II) among older people living in seven low- and middle-income countries. Principal component analysis (PCA), confirmatory factor analysis (CFA) and Mokken analyses were carried out to test for unidimensionality, hierarchical structure, and measurement invariance across 10/66 Dementia Research Group sites. PCA generated a one-factor solution in most sites. In CFA, the two-factor solution generated in Dominican Republic fitted better for all sites other than rural China. The two factors were not easily interpretable, and may have been an artefact of differing item difficulties. Strong internal consistency and high factor loadings for the one-factor solution supported unidimensionality. Furthermore, the WHODAS II was found to be a ‘strong’ Mokken scale. Measurement invariance was supported by the similarity of factor loadings across sites, and by the high between-site correlations in item difficulties. The Mokken results strongly support that the WHODAS II 12-item screener is a unidimensional and hierarchical scale confirming to item response theory (IRT) principles, at least at the monotone homogeneity model level. More work is needed to assess the generalizability of our findings to different populations. Copyright © 2010 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To describe the prevalence and determinants of dependence in older Nigerians and associations with informal care and health service utilization. DESIGN: A single-phase cross-sectional catchment area survey. SETTING: Dunukofia, a rural community in southeastern Nigeria. PARTICIPANTS: One thousand two hundred thirty-eight adults aged 65 and older, for whom full data were available on 914. MEASUREMENTS: The full 10/66 Dementia Research Group survey protocol was applied, including ascertainment of depression, cognitive impairment, physical impairments, and self-reported diagnoses. The interviewer rated dependence as not needing care, needing some care, or needing much care. The prevalence of dependence and the independent contribution of underlying health conditions were estimated. Sources of income, care arrangements, caregiver strain, and health service use are described according to level of dependence. RESULTS: The prevalence of dependence was 24.3% (95% confidence interval=22.1–26.5%), with a concentration in participants aged 80 and older. Only 1% of participants received a pension, and fewer than 7% had paid work. Those who were dependent were less likely than others to receive income from their family. Cognitive impairment, physical impairments, stroke, and depression were each independently associated with dependence. Depression made the largest contribution. Dependence was strongly associated with health service use (particularly private doctor and traditional healer services) and with high levels of out-of-pocket expenditure. CONCLUSION: In Nigeria, dependence is an important outcome given rapid demographic aging and increases in chronic disease prevalence in all developing regions. Enhancing the social protection of dependent older adults should be a policy priority. Cognitive and mental disorders are important contributors to disability and dependence; more attention should be given to their prevention, detection, and treatment. [ABSTRACT FROM AUTHOR]

Background . This study investigates the recent suggestion that some putative aetiological factors for depression, such as cerebral deterioration and social distress, may act differentially in the aetiology of depression in old age. Method . In a cross-sectional study, a community sample of 654 elderly subjects were interviewed with Short-CARE to assess the prevalence of depression and cognitive impairment. Information was collected for a variety of potential risk factors for depression such as exposure to social support deficit, threatening life events, impairment, disability and handicap. Results . The prevalence of depression was 17% and that of a broad concept of cognitive impairment 23.9%. This analysis found associations between depression and exposure to social support deficits and threatening life events in the year prior to interview. These associations were considerably stronger for those subjects with no cognitive impairment than for those with cognitive impairment. We also found a progressive lowering in the strength of these associations the higher the chance of cognitive impairment measured as a longitudinal variable using both the Dementia Diagnostic Scale (DDS) and the Organic Brain Syndrome Scale (OBS) included in Short-CARE. Conclusions . The results of this theory-driven analysis lend some support to the notion of at least two differential pathways to depression in the elderly, one via social distress factors and another mediated by cerebral deterioration clinically expressed as cognitive impairment. © 1997 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Most people with dementia live in Low and Middle Income Countries (LMICs), where little research on dementia risk prediction modelling has occurred. This study aimed to develop new models to simply predict all‐cause dementia, suitable for use in LMICs. Country‐specific models were expected, due to different risk profiles. Method: Data was from the 10/66 cohort study. Individuals aged ≥65 years without dementia at baseline (N=11,143) were recruited from Cuba, the Dominican Republic, Peru, Venezuela, Mexico, Puerto Rico and China. Dementia incidence was assessed over a mean follow‐up of 3.8 years (SD=1.3 years). Variables were selected to be tested that have been associated with dementia previously. Two Cox risk models were produced for each site, with and without objective cognitive variables. Predictive accuracy (c‐statistic) and calibration were tested. Result: 1,069 individuals progressed to dementia during follow‐up. The models had mostly moderate to good predictive accuracy. The models in the total sample performed moderately (cognitive model c‐statistic = 0.74; 95%CI: 0.72‐0.75; non‐cognitive model c‐statistic = 0.71; 95%CI: 0.70‐0.73). In each country, the cognitive models' c‐statistics ranged from 0.70 (95%CI: 0.67‐0.74) in China to 0.84 (95%CI: 0.80‐0.88) in Peru, and the non‐cognitive models' c‐statistics ranged from 0.67 (95%CI: 0.63‐0.71) in the Dominican Republic to 0.80 (95%CI: 0.74‐0.85) in Peru. There were no major noticeable patterns of variables included in each country‐specific model. Model calibration was however poor. Conclusion: Different prediction models were necessary for each country, most of which had moderate to good predictive accuracy. Further research is needed to improve calibration, and to determine whether risk prediction is cost‐effective, ethical and acceptable in LMICs. Dementia risk prediction is important so that individuals at high risk can be identified, and their risk factors addressed, to help decrease the burden of dementia. [ABSTRACT FROM AUTHOR]