Prevalence of dementia in Latin America: a collaborative study of population-based cohorts

Background: Dementia is becoming a major public health problem in Latin America (LA), yet epidemiological information on dementia remains scarce in this region. This study analyzes data from epidemiological studies on the prevalence of dementia in LA and compares the prevalence of dementia and its causes across countries in LA and attempts to clarify differences from those of developed regions of the world. Methods: A database search for population studies on rates of dementia in LA was performed. Abstracts were also included in the search. Authors of the publications were invited to participate in this collaborative study by sharing missing or more recent data analysis with the group. Results: Eight studies from six countries were included. The global prevalence of dementia in the elderly (≥65 years) was 7.1% (95% CI: 6.8–7.4), mirroring the rates of developed countries. However, prevalence in relatively young subjects (65–69 years) was higher in LA studies The rate of illiteracy among the elderly was 9.3% and the prevalence of dementia in illiterates was two times higher than in literates. Alzheimer’s disease was the most common cause of dementia. Conclusions: Compared with studies from developed countries, the global prevalence of dementia in LA proved similar, although a higher prevalence of dementia in relatively young subjects was evidenced, which may be related to the association between low educational level and lower cognitive reserve, causing earlier emergence of clinical signs of dementia in the LA elderly population

Epidémiologie comparée de la Sclérose Latérale Amyotrophique en Limousin, Franc - Uruguay

LIMOGES-BU Médecine pharmacie (870852108) / SudocSudocFranceUruguayFRU

Incidencia de ataque cerebrovascular en el departamento de Cerro Largo, Uruguay. Diagnóstico de situación previo al desarrollo de una Unidad de ACV

Los ataques cerebrovasculares (ACV) constituyen la tercera causa de muerte en Uruguay. Las unidades de ACV han demostrado disminuir la morbimortalidad asociada al ACV. El desarrollo de estas unidades es reciente en Uruguay, y la regionalización es fundamental, dadas las limitantes temporales para la eficacia de algunos tratamientos. Con el objetivo de conocer la epidemiología del ACV en el departamento de Cerro Largo, para la creación de una Unidad de ACV local, se realizó un estudio descriptivo, prospectivo, de cohorte única constituida por los habitantes del departamento de Cerro Largo.  Se obtuvo una tasa de incidencia de 161,75/100.000 habitantes/año, 137 casos, de los cuales 73 (53.3%) eran mujeres. Un 4.3% (6 pacientes) fueron ataques isquémicos transitorios, 78.9% (108) infartos cerebrales y 16.8% (23) hemorragias cerebrales. La mortalidad temprana global fue de 21.9%, y se asoció a naturaleza hemorrágica. De los pacientes con ACV isquémico, 38 consultaron durante las primeras tres horas y 7 entre 3 - 4,5 horas después de iniciados los síntomas. Combinando criterios temporales y de severidad del déficit según NIHSS, 30% de los casos de infarto cerebral hubieran podido beneficiarse del uso de trombolíticos. La incidencia de ACV, global y por naturaleza, fue similar a otros estudios nacionales e internacionales. Este estudio mostró una realidad epidemiológica y clínica con margen para el impacto de políticas de prevención primaria, y un comportamiento de la población en cuanto a la consulta precoz favorable para la instrumentación y desarrollo de una Unidad de ACV y el uso de trombolíticos en el departamento de Cerro Largo

Pronostic de la sclérose amyotrophique en Limousin (France) et en Uruguay. Etude comparative.

International audienc

Pronostic de la sclérose amyotrophique en Limousin (France) et en Uruguay.

International audienc

Disease progression and survival in ALS: first multi-state model approach.

Although several prognostic factors have been identified in ALS, there remains some discordance concerning the prognostic significance of the age and clinical form at onset. In order to clarify these findings, we have analysed already known prognostic factors using a multi-state model. Two hundred and twenty-two sporadic ALS patients were followed. A simple unidirectional three-states model was used to summarize clinical course of ALS. States 1 and 2 reflected the progression of neurological impairment and state 3 represented the end of follow-up (tracheotomy or death). Gender, diagnostic delay, body mass index (BMI) and slow vital capacity (SVC) were also recorded. A time-inhomogeneous Markov model with piecewise constant transition intensities was used to estimate the effect of the covariates in each transition. The bulbar form at onset was only correlated with a more rapid clinical progression between state 1 and state 2. In contrast, an advanced age at diagnosis affected only survival from state 2. This methodological approach suggests that these two factors have a different prognostic significance: age at onset is related to patient's survival and the clinical form at onset predicts the progression of motoneuronal impairment in different regions

Prognosis of ALS: Comparing data from the Limousin referral centre, France, and a Uruguayan population.

International audienceOur objective was to compare clinical features and survival in two groups of ALS patients from countries in opposite hemispheres. The study took place at an ALS referral centre in the Limousin region of France (LIM) and in Uruguay (UY). All consecutive patients diagnosed with ALS between 1 January 2002 and 31 December 2004 were enrolled. Data from a total of 187 ALS patients were analysed: 84 from LIM and 103 from UY. Mean ages at onset and diagnosis were significantly higher in LIM (66 vs. 61 years). UY patients demonstrated more advanced disease at the time of diagnosis. The proportions of definite forms were 82% in UY versus 10% in LIM (p<0.001), and median manual muscle testing (MMT) and ALSFRS scores were significantly lower in LIM. This observed difference was not directly explained by a longer diagnostic delay in UY (10 vs. 9 months). Median survival from time of diagnosis was significantly shorter in UY patients (19 vs. 28 months; log-rank test, p = 0.030). In conclusion, survival of ALS patients in UY is nine months shorter than in LIM, probably due to the heterogeneity of medical care and the absence of an ALS referral centre

A Delphi consensus to identify the key screening tests/questions for a digital neurological examination for epidemiological research

Background: Most neurological diseases have no curative treatment; therefore, focusing on prevention is key. Continuous research to uncover the protective and risk factors associated with different neurological diseases is crucial to successfully inform prevention strategies. eHealth has been showing promising advantages in healthcare and public health and may therefore be relevant to facilitate epidemiological studies.Objective: In this study, we performed a Delphi consensus exercise to identify the key screening tests to inform the development of a digital neurological examination tool for epidemiological research.Methods: Twelve panellists (six experts in neurological examination, five experts in data collection-two were also experts in the neurological examination, and three experts in participant experience) of different nationalities joined the Delphi exercise. Experts in the neurological examination provided a selection of items that allow ruling out neurological impairment and can be performed by trained health workers. The items were then rated by them and other experts in terms of their feasibility and acceptability.Results: Ten tests and seven anamnestic questions were included in the final set of screening items for the digital neurological examination. Three tests and five anamnestic questions were excluded from the final selection due to their low ratings on feasibility.Conclusion: This work identifies the key feasible and acceptable screening tests and anamnestic questions to build an electronic tool for performing the neurological examination, in the absence of a neurologist.<br/