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Dementia prevalence in a population at high vascular risk: the Trinidad national survey of ageing and cognition.

ABSTRACT: OBJECTIVE:To investigate the dementia prevalence in a country with high levels of cardiovascular risk factors DESIGN AND METHODS: Older people in Trinidad are recognised to have particularly high levels of cardiovascular risk factors. We carried out a survey in a nationally representative sample of people aged ?70 years using household enumeration. Dementia status was ascertained using standardised interviews and algorithms from the 10/66 schedule and age-specific prevalence were compared with identically defined output from the 10/66 surveys of 16?536 residents in eight other low-income and middle-income countries. RESULTS:Of 1832 participants (77.0% response rate), dementia was present in 442 (23.4%). Prevalences were 12.0% in persons aged 70-74 years, 23.5% at 75-79, 25.8% at 80-84, 41.3% at 85-89 and 54.0% in those aged ?90 years. Prevalence ratios compared with averages from 10/66 surveys in these age groups were 2.2, 2.6, 1.6, 1.7 and 1.6, respectively, and were 2.7, 2.8, 1.7, 1.4 and 0.8, respectively, compared with previously published consensus estimates for the Latin American region. Dementia was significantly associated with reported stroke and diabetes in logistic regression models adjusted for sociodemographic status and other vascular risk factors (OR (95%?CI) 4.40 (2.70 to 7.19) and 1.56 (1.20 to 2.03), respectively). Projected national numbers of people with dementia (18 206) were 70%-100%?higher than those estimated using most recent regional consensus prevalences. CONCLUSION:In a nation with high levels of vascular risk, dementia prevalence is higher than expected, particularly at the lower end of the 70+ age?range. International prevalence projections may need to take into account risk status as well as age structures.

SUBMITTER: Davis G

PROVIDER: S-EPMC5855448 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Dementia prevalence in a population at high vascular risk: the Trinidad national survey of ageing and cognition.

Davis Gershwin G Baboolal Nelleen N Mc Rae Amanda A Stewart Robert R

BMJ open 20180222 2

<h4>Objective</h4>To investigate the dementia prevalence in a country with high levels of cardiovascular risk factors DESIGN AND METHODS: Older people in Trinidad are recognised to have particularly high levels of cardiovascular risk factors. We carried out a survey in a nationally representative sample of people aged ≥70 years using household enumeration. Dementia status was ascertained using standardised interviews and algorithms from the 10/66 schedule and age-specific prevalence were compare ...[more]

PMID: 29472257

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Project description:Humans require a plethora of higher cognitive skills to perform executive functions, such as reasoning, planning, language and social interactions, which are regulated predominantly by the prefrontal cortex. The prefrontal cortex comprises the lateral, medial and orbitofrontal regions. In higher primates, the lateral prefrontal cortex is further separated into the respective dorsal and ventral subregions. However, all these regions have variably been implicated in several fronto-subcortical circuits. Dysfunction of these circuits has been highlighted in vascular and other neurocognitive disorders. Recent advances suggest the medial prefrontal cortex plays an important regulatory role in numerous cognitive functions, including attention, inhibitory control, habit formation and working, spatial or long-term memory. The medial prefrontal cortex appears highly interconnected with subcortical regions (thalamus, amygdala and hippocampus) and exerts top-down executive control over various cognitive domains and stimuli. Much of our knowledge comes from rodent models using precise lesions and electrophysiology readouts from specific medial prefrontal cortex locations. Although, anatomical disparities of the rodent medial prefrontal cortex compared to the primate homologue are apparent, current rodent models have effectively implicated the medial prefrontal cortex as a neural substrate of cognitive decline within ageing and dementia. Human brain connectivity-based neuroimaging has demonstrated that large-scale medial prefrontal cortex networks, such as the default mode network, are equally important for cognition. However, there is little consensus on how medial prefrontal cortex functional connectivity specifically changes during brain pathological states. In context with previous work in rodents and non-human primates, we attempt to convey a consensus on the current understanding of the role of predominantly the medial prefrontal cortex and its functional connectivity measured by resting-state functional MRI in ageing associated disorders, including prodromal dementia states, Alzheimer's disease, post-ischaemic stroke, Parkinsonism and frontotemporal dementia. Previous cross-sectional studies suggest that medial prefrontal cortex functional connectivity abnormalities are consistently found in the default mode network across both ageing and neurocognitive disorders such as Alzheimer's disease and vascular cognitive impairment. Distinct disease-specific patterns of medial prefrontal cortex functional connectivity alterations within specific large-scale networks appear to consistently feature in the default mode network, whilst detrimental connectivity alterations are associated with cognitive impairments independently from structural pathological aberrations, such as grey matter atrophy. These disease-specific patterns of medial prefrontal cortex functional connectivity also precede structural pathological changes and may be driven by ageing-related vascular mechanisms. The default mode network supports utility as a potential biomarker and therapeutic target for dementia-associated conditions. Yet, these associations still require validation in longitudinal studies using larger sample sizes.

Project description:BackgroundStudies have suggested that the prevalence of dementia is lower in developing than in developed regions. We investigated the prevalence and severity of dementia in sites in low-income and middle-income countries according to two definitions of dementia diagnosis.MethodsWe undertook one-phase cross-sectional surveys of all residents aged 65 years and older (n=14 960) in 11 sites in seven low-income and middle-income countries (China, India, Cuba, Dominican Republic, Venezuela, Mexico, and Peru). Dementia diagnosis was made according to the culturally and educationally sensitive 10/66 dementia diagnostic algorithm, which had been prevalidated in 25 Latin American, Asian, and African centres; and by computerised application of the dementia criterion from the Diagnostic and Statistical Manual of Mental Disorders (DSM IV). We also compared prevalence of DSM-IV dementia in each of the study sites with that from estimates in European studies.FindingsThe prevalence of DSM-IV dementia varied widely, from 0.3% (95% CI 0.1-0.5) in rural India to 6.3% (5.0-7.7) in Cuba. After standardisation for age and sex, DSM-IV prevalence in urban Latin American sites was four-fifths of that in Europe (standardised morbidity ratio 80 [95% CI 70-91]), but in China the prevalence was only half (56 [32-91] in rural China), and in India and rural Latin America a quarter or less of the European prevalence (18 [5-34] in rural India). 10/66 dementia prevalence was higher than that of DSM-IV dementia, and more consistent across sites, varying between 5.6% (95% CI 4.2-7.0) in rural China and 11.7% (10.3-13.1) in the Dominican Republic. The validity of the 847 of 1345 cases of 10/66 dementia not confirmed by DSM-IV was supported by high levels of associated disability (mean WHO Disability Assessment Schedule II score 33.7 [SD 28.6]).InterpretationAs compared with the 10/66 dementia algorithm, the DSM-IV dementia criterion might underestimate dementia prevalence, especially in regions with low awareness of this emerging public-health problem.

Project description:BackgroundCytopenia, a reduced count of blood cells manifesting as anemia, neutropenia, and/or thrombocytopenia is frequently associated with other medical conditions. However, a cytopenia may not be accompanied by a known determinant and in some of these cases, may be a precursor to pre-malignancies or hematologic cancers. Little is known about the prevalence of these unexplained cytopenias and their distribution in the population.Materials and methodsThe National Health and Nutrition Examination Survey (NHANES) from 1999 to 2002 was used to identify those with a cytopenia in the general population. Those without an identifiable determinant in the NHANES were classified as having unexplained cytopenia. Weighted frequencies were examined to assess the prevalence of unexplained cytopenia in the population. Distribution of blood counts comparing those with unexplained cytopenia to the general population was examined. Multivariable logistic regression was conducted to assess the association between unexplained cytopenia and demographic factors.ResultsOf the 7,962 people in the sample, 236 (2.0%) had any cytopenia and 86 (0.9%) had an unexplained cytopenia. Approximately 43% of all cytopenias were not accompanied by a clinical determinant. Unexplained cytopenia was more common in men (1.1%) than in women (0.7%) and in Non-Hispanic Black participants (3.4%). Among those with an unexplained cytopenia, the majority (74.8%) manifested as neutropenia. Compared to those with no cytopenia, those with unexplained cytopenia were significantly less likely to be female, have body mass index ≥30 kg/m2, and work in the service industry, and were significantly more likely to be non-Hispanic Black.ConclusionsThis is the first study to examine the prevalence of unexplained cytopenia in a nationally representative sample and may serve as a baseline for comparison with other populations. Future research to identify risk factors for development of malignant hematological disorders among those with unexplained cytopenia is warranted.

Dataset Information

Dementia prevalence in a population at high vascular risk: the Trinidad national survey of ageing and cognition.

Publications

Dementia prevalence in a population at high vascular risk: the Trinidad national survey of ageing and cognition.

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