Prevalence of Alzheimer's disease and vascular dementia: association with education. The Rotterdam study.

OBJECTIVE--To estimate the prevalence of dementia and its subtypes in the general population and examine the relation of the disease to education. DESIGN--Population based cross sectional study. SETTING--Ommoord, a suburb of Rotterdam. SUBJECTS--7528 participants of the Rotterdam study aged 55-106 years. RESULTS--474 cases of dementia were detected, giving an overall prevalence of 6.3%. Prevalence ranged from 0.4% (5/1181 subjects) at age 55-59 years to 43.2% (19/44) at 95 years and over. Alzheimer''s disease was the main subdiagnosis (339 cases; 72%); it was also the main cause of the pronounced increase in dementia with age. The relative proportion of vascular dementia (76 cases; 16%), Parkinson''s disease dementia (30; 6%), and other dementias (24; 5%) decreased with age. A substantially higher prevalence of dementia was found in subjects with a low level of education. The association with education was not due to confounding by cardiovascular disease. CONCLUSIONS--The prevalence of dementia increases exponentially with age. About one third of the population aged 85 and over has dementia. Three quarters of all dementia is due to Alzheimer''s disease. In this study an inverse dose-response relation was found between education and dementia--in particular, Alzheimer''s disease.     

Depression in Persons with Diabetes by Age and Antidiabetic Treatment: A Cross-Sectional Analysis with Data from the Hordaland Health Study

BackgroundPersons with diabetes have increased risk of depression, however, studies addressing whether the risk varies by age and type of antidiabetic treatment have yielded conflicting results. The aim of this study was to investigate if the association between diabetes and depression varied by type of antidiabetic treatment in a large community based sample of middle-aged (40–47 years) and older adults (70–72 years).MethodsData from 21845 participants in the Hordaland Health Study (HUSK) were analyzed in a cross-sectional design. Diabetes was assessed by self-report and classified as un-medicated, treated by oral antidiabetic agents or by insulin. Depression was defined as a score ≥8 on the depression subscale of the Hospital Anxiety and Depression Scale and/or self-reported use of antidepressant agents. Associations between diabetes and depression were estimated using logistic regression.ResultsPersons in their forties with diabetes had a doubled prevalence of depression (OR: 1.96 (95% C.I.: 1.35, 2.83)) compared to persons without diabetes, while a lower and non-significant association was found among persons in their seventies. Persons in their forties with orally treated diabetes had about three times higher prevalence of depression (OR: 2.92 (95% C.I.: 1.48, 5.77)) after adjustment for gender, BMI, physical activity, alcohol consumption and education, compared to non-diabetic persons in the same age-group. No association between depression and insulin or un-medicated diabetes was found.ConclusionsClinicians should be aware that persons in their forties with orally treated diabetes are at a marked increased risk of depression.     

The association between mild geriatric depression and reproductive history--a Darwinian approach

The well described trend of population ageing results in a dramatic increase in the number of elderly, reporting symptoms of depression, the most common mood disorder today. Various intrinsic and extrinsic factors are discussed to be responsible for this increase of mood disorders. In the present study the association patterns between mild geriatric depression and the individual reproductive history are analyzed. 264 subjects, 167 females and 97 males, ageing between 60 and 95 years (mean 72.3, SD 8.1 yrs) were enrolled in the present study. The prevalence of depression was tested by mean of the geriatric depression scale (GDS), additionally reproductive history was documented. It turned out, that with increasing number of offspring the depression score decreased. Childless women exhibited the highest prevalence of mild depression and the highest mean depression score. These association patterns between reproductive history and depressive disorders during old age were discussed by means of Darwinian psychiatry. A low number of offspring or childlessness and a lack of social networks for support are new in the evolutionary history of Homo sapiens. Mild geriatric depression may be interpreted as a result of a mismatch or dysregulation because the recent social environment of elderly is completely different from that in which Homo sapiens evolved. The occurrence of geriatric depression may be an adaptation to this new situation.     

Low blood pressure and dementia in elderly people: the Kungsholmen project.

OBJECTIVE--To examine the relation between blood pressure and dementia in elderly people. DESIGN--Cross sectional, population based study. SETTING: Kungsholmen district of Stockholm, Sweden. SUBJECTS-- 1642 subjects aged 75-101 years. MAIN OUTCOME MEASURES--Prevalence and adjusted odds ratio of dementia by blood pressure. RESULTS--People with systolic pressure < or = 140 mm Hg were more often diagnosed as demented than those with systolic pressure >140 mm Hg: odds ratios (95% confidence interval) adjusted for age, sex, and education were 2.98 (2.17 to 4.08) for all dementias, 2.91 (1.93 to 4.38) for Alzheimer''s disease, 2.00 (1.09 to 3.65) for vascular dementia, and 5.07 (2.65 to 9.70) for other dementias. Similar results were seen in subjects with diastolic pressure < or = 75 mm Hg compared with those with higher diastolic pressure. When severity and duration of dementia were taken into account, only moderate and severe dementia were found to be significantly related to relatively low blood pressure, and the association was stronger in subjects with longer disease duration. Use of hypotensive drugs and comorbidity with cardiovascular disease did not modify the results for all dementias, Alzheimer''s disease, and other dementias but slightly reduced the association between vascular dementia and diastolic blood pressure. CONCLUSIONS--Both systolic and diastolic blood pressure were inversely related to prevalence of dementia in elderly people. We think that relatively low blood pressure is probably a complication of the dementia process, particularly Alzheimer''s disease, although it is possible that low blood pressure may predispose a subpopulation to developing dementia.     

Prevalence of congenital hereditary sensorineural deafness in Australian Cattle Dogs and associations with coat characteristics and sex

Background

Congenital hereditary sensorineural deafness (CHSD) occurs in many dog breeds, including Australian Cattle Dogs. In some breeds, CHSD is associated with a lack of cochlear melanocytes in the stria vascularis, certain coat characteristics, and potentially, abnormalities in neuroepithelial pigment production. This study investigates phenotypic markers for CHSD in 899 Australian Cattle Dogs.

Results

Auditory function was tested in 899 Australian Cattle Dogs in family groups using brainstem auditory evoked response testing. Coat colour and patterns, facial and body markings, gender and parental hearing status were recorded. Deafness prevalence among all 899 dogs was 10.8% with 7.5% unilaterally deaf, and 3.3% bilaterally deaf, and amongst pups from completely tested litters (n = 696) was 11.1%, with 7.5% unilaterally deaf, and 3.6% bilaterally deaf. Univariable and multivariable analyses revealed a negative association between deafness and bilateral facial masks (odds ratio 0.2; P ?? 0.001). Using multivariable logistic animal modelling, the risk of deafness was lower in dogs with pigmented body spots (odds ratio 0.4; P = 0.050). No significant associations were found between deafness and coat colour. Within unilaterally deaf dogs with unilateral facial masks, no association was observed between the side of deafness and side of mask. The side of unilateral deafness was not significantly clustered amongst unilaterally deaf dogs from the same litter. Females were at increased risk of deafness (odds ratio from a logistic animal model 1.9; P = 0.034) after adjusting for any confounding by mask type and pigmented body spots.

Conclusions

Australian Cattle Dogs suffer from CHSD, and this disease is more common in dogs with mask-free faces, and in those without pigmented body patches. In unilaterally deaf dogs with unilateral masks, the lack of observed association between side of deafness and side of mask suggests that if CHSD is due to defects in molecular pigment pathways, the molecular control of embryonic melanoblast migration from ectoderm to skin differs from control of migration from ectoderm to cochlea. In Australian Cattle Dogs, CHSD may be more common in females.     

La depresión: un predictor de demencia

Many studies suggest that in 10-25% of cases of Alzheimer's, the most common dementia in our society, can be prevented with the elimination of some risk factors. Barnes and Yaffe found that one-third of Alzheimer's cases are attributable to depression, but in the scientific literature it is not clear if it has a real causal effect on the development of dementia. The purpose of this study is to analyse the scientific evidence on the hypothesis that depression increases the risk of developing dementia.A systematic review and a meta-analysis were performed on the scientific literature published up until the present day, searching articles that were published between 1990 and 2014. Ten of the studies found met the selection criteria –similar to a) size and characteristics of the sample (origin, age…), b) process of gathering data c) method of studying the relationship (within and/or between group comparison), and d) statistical analysis of the results– and the previously established quality.The value of odds ratio varied from 1.72 to 3.59, and the hazard ratio from 1,72 to 5.44. This indicates that the subjects with a history of depression have a higher risk of developing dementia than others who did not suffer depression.     

Type 2 Diabetes with Comorbid Depression in Relation to Cognitive Impairment: an Opportunity for Prevention?

Studies show poor glycemic control is associated with increased risk of dementia among patients with Type 2 diabetes, indicating potential for prevention of dementia with improved glycemia. Emerging evidence suggests that a relationship between short-term glycemic control and cognitive function exists in Type 2 diabetes. However, detailed mechanisms relating diabetic dementia are lacking, as other concurrent conditions, such as depression, may also increase the risk of dementia in Type 2 diabetes. We examined the effects of glycemic control and depression on cognitive function in 88 patients (mean age, 67 ± 4 years) whose A1c (glycosylated hemoglobin) levels, comorbid depression, mini-mental state examination (MMSE) scores were recorded at baseline. Seventeen patients had depression; 14 agreed on anti-depressants. In 6 months, 69 patients reached A1c goal of < 7% (A1c from 9.7 ± 0.8 to 6.4 ± 0.3) while cognition improved significantly (MMSE scored from 20.2 ± 3.5 to 26.2 ± 2.1, p < 0.05). Cognitive increment in controlled diabetes was more consistently observed if their underlying depression was effectively treated (n ? 14). Nineteen patients did not reach A1c goal of < 7% (A1c from 9.6 ± 0.9 to 8.9 ± 0.9) while cognitive increment was minimal (MMSE scored from 20.6 ± 4.9 to 21.3 ± 5.1, p > 0.05). Cognitive decrements were observed among depressed diabetics who refused anti-depressants. Multivariate analysis adjusted for age, education, alcohol use, and other variables yielded similar results. We found controlled glycemia and depression prevent cognitive decline. Further research into mechanisms of cognitive impairment in diabetes may allow us to challenge the concept of dementia in those patients as an irremediable disease.     

Midlife obesity and dementia: Meta‐analysis and adjusted forecast of dementia prevalence in the united states and china

Objective:

Obesity is a risk factor of dementia. Current forecasts of dementia prevalence fail to take the rising obesity prevalence into account.

Design and Methods:

Embase and Medline were searched for observational studies on the association between overweight (BMI 25‐30 kg/m²) or obesity (BMI > 30 kg/m²) and dementia and pooled the effect sizes by meta‐analysis. The population attributable risk (PAR) was calculated for different time points and adjusted them for confounders. Based on current prevalence rates of dementia and demographic forecasts, patient numbers were calculated and adjusted by the growth rates of PAR.

Results:

Compared to normal weight, midlife obesity increases the risk of dementia later in life (BMI 25‐30: RR = 1.34 [95% CI 1.08, 1.66], BMI > 30: RR = 1.91 [1.4, 2.62]). If obesity is included into forecast models, the prevalence of dementia is estimated to be 7.1 million (6.9, 7.3) and 11.3 million (10.9, 11.7) for the United States in 2030 and 2050, respectively. In China, the estimate is 13.1 million (12.8, 13.3) in 2030 and 26.2 million (25.1, 27.4) in 2050. These figures are 9% and 19% higher for the United States and China, respectively, than forecasts that rely solely on the demographic change.

Conclusion:

The past and ongoing increase in midlife obesity prevalence will contribute significantly to the future prevalence of dementia and public health measures to reduce midlife obesity are simultaneously primary prevention measures to reduce the risk of dementia.     

Hand osteoarthritis in the Abkhazian population

The aim of the study was to evaluate the prevalence and pattern of radiographic hand osteoarthritis (OA) in an Abkhazian community-based sample and its association with age, sex, body mass index (BMI) and place of residence.The study sample was comprised of 542 males with a mean age of 43.9, sd 15.6 years and 463 females with a mean age of 44.9, sd 13.9 years. OA was evaluated for 14 joints of the left hand according to the Kellgren and Lawrence grading scheme. Statistical analyses included prevalence estimation, multiple regression analysis and χ² tests.In the entire Abkhazian sample the average prevalence of hand OA was 33.6% for males and 35.4% for females. After age 65, the prevalence of hand OA was 87.5% for males and 83.3% for females. No sex differences were found in the prevalence or number of affected hand joints. Statistically significant association was found between the number of affected joints and BMI, but not between the prevalence of hand OA and BMI. Different prevalences of radiographic hand OA were found in individuals from different villages, after adjustment for age, sex and BMI.Additional studies are needed to explore the possible reasons for such differences.     

No Association between Antenatal Common Mental Disorders in Low-Obstetric Risk Women and Adverse Birth Outcomes in Their Offspring: Results from the CDS Study in Ghana and C?te D'Ivoire

Background

Evidence linking common mental disorders (CMD) in pregnant women to adverse birth outcomes is inconsistent, and studies often failed to control for pregnancy complications. This study aimed to explore the association between antenatal depression and anxiety symptoms and birth outcomes in a low-obstetric risk sample of mother/child dyads in Ghana and Côte d’Ivoire.

Methods

In 2010-2011, a prospective cohort of 1030 women in their third trimester in Ghana and Côte d’Ivoire was enrolled. Depression and anxiety were assessed in the third trimester using the Patient Health Questionnaire depression module and the 7-item Generalized Anxiety Disorder scale. 719 mother/child dyads were included in the analysis. We constructed multivariate regression models to estimate the association between CMD and low birth weight (LBW), and preterm birth (PTB) to control for potential confounders.

Results

The prevalence of depression and anxiety symptoms were 28.9% and 14.2% respectively. The mean birth weight was 3172.1g (SD 440.6) and the prevalence of LBW was 1.7%. The mean gestational age was 39.6 weeks and the proportion of PTB was 4%. Multivariate linear regression revealed no significant association between maternal depression (B=52.2, 95% CI -18.2 122.6, p=0.15) or anxiety (B=17.1, 95% CI -74.6 108.7, p=0.72) and birth weight. Yet, low socio-economic status, female sex of the child, and younger maternal age were associated with lower birth weight. Multivariate logistic regression suggested no significant association between maternal depression (OR: 2.1, 95% CI 0.8 5.6, p=0.15) or anxiety (OR: 1.8, 95% CI 0.6 5.5, p=0.29) with PTB.

Conclusions

Our data suggests that depression and/or anxiety in the 3^rd trimester of pregnancy are not independent predictors of adverse birth outcomes in low obstetric risk women. The role of pregnancy complications as confounders or effect modifiers in studies of maternal CMD and their impact on birth outcomes should be investigated.     

帕金森病抑郁的相关因素分析

目的:探讨抑郁在帕金森病中(Parkinson’s disease,PD)的发生率及其影响因素。方法:对确诊的PD患者,采用汉密尔顿抑郁量表(Hamilt depression scale,HAMD)、简易精神状态检查量表(Mini-Mental State Examination,MMSE)及Webster功能评分量表进行评定,分析抑郁的发生情况和相关影响因素。结果:PD伴发抑郁者32例,抑郁的发生率为49.2%,病程、文化程度、Webster评分、MMSE评分与帕金森抑郁的发生均有统计学意义(P<0.05),年龄、性别、婚姻状况、经济情况与帕金森抑郁的发生均无统计学意义(P>0.05)。回归分析发现病程和病情严重程度是PD患者抑郁的危险因素。结论:PD患者有较高的抑郁发生率,抑郁的发生可能是社会心理、神经生物学多种因素作用的结果。     

Statins Reduces the Risk of Dementia in Patients with Late-Onset Depression: A Retrospective Cohort Study

Objective

Patients with late-onset depression (LOD) have been reported to run a higher risk of subsequent dementia. The present study was conducted to assess whether statins can reduce the risk of dementia in these patients.

Methods

We used the data from National Health Insurance of Taiwan during 1996–2009. Standardized Incidence Ratios (SIRs) were calculated for LOD and subsequent dementia. The criteria for LOD diagnoses included age ≥65 years, diagnosis of depression after 65 years of age, at least three service claims, and treatment with antidepressants. The time-dependent Cox proportional hazards model was applied for multivariate analyses. Propensity scores with the one-to-one nearest-neighbor matching model were used to select matching patients for validation studies. Kaplan-Meier curve estimate was used to measure the group of patients with dementia living after diagnosis of LOD.

Results

Totally 45,973 patients aged ≥65 years were enrolled. The prevalence of LOD was 12.9% (5,952/45,973). Patients with LOD showed to have a higher incidence of subsequent dementia compared with those without LOD (Odds Ratio: 2.785; 95% CI 2.619–2.958). Among patients with LOD, lipid lowering agent (LLA) users (for at least 3 months) had lower incidence of subsequent dementia than non-users (Hazard Ratio = 0.781, 95% CI 0.685–0.891). Nevertheless, only statins users showed to have reduced risk of dementia (Hazard Ratio = 0.674, 95% CI 0.547–0.832) while other LLAs did not, which was further validated by Kaplan-Meier estimates after we used the propensity scores with the one-to-one nearest-neighbor matching model to control the confounding factors.

Conclusions

Statins may reduce the risk of subsequent dementia in patients with LOD.     

Socio demographic and lifestyle factors of metabolic syndrome among adult rural indigenous Malaysian population from Perak State,Malaysia

Metabolic syndrome (MetS) is defined as a cluster of known disorders that increase the risk for morbidity and mortality from cardiovascular diseases (CVD) and type 2 diabetes mellitus. This cross sectional study was carried out to estimate the prevalence of MetS using Adult Treatment Panel 3 (ATP 3) classification and socio-demographic and lifestyle factors contributing to metabolic syndrome among rural indigenous Malaysian population from Perak state, Malaysia which included 148 rural Malay and 145 Orang Asli(OA) individuals. This community based cross-sectional study revealed that the prevalence of MetS was significantly higher among Malays (27.7%) as compared to Orang Aslis (13.8%). Overall Prevalence of Metabolic syndrome in the rural indigenous Malaysian population was 20.8%. Prevalence of abdominal obesity and high blood pressure were significantly higher among Malays as compared to OA population. Metabolic syndrome was significantly higher among those above 45 years of age group in overall rural indigenous Malaysian population and among OA. The prevalence of MetS was significantly higher among those who were obese and overweight and among Malays who were regularly taking snacks between meals. There was no significant association between other dietary risk factors, smoking, alcohol use or physical activity with metabolic syndrome.     

Low blood pressure and depression in older men: a population based study.

OBJECTIVE--To determine if an association exists between low blood pressure and depressive symptoms in older men living in the community. DESIGN--Cross sectional, population based study. SETTING--Town of Rancho Bernardo, California, United States. SUBJECTS--846 men aged 60-89 years. Comparisons between hypotensive, normotensive, and hypertensive groups were limited to 594 men not taking drugs for hypertension. MAIN OUTCOME MEASURES--Mean scores on Beck depression inventory and prevalence of scores > or = 13. RESULTS--Men with diastolic blood pressure < 75 mm Hg had significantly higher depression scores (mean scores 6.35 v 4.96; P < 0.001) and more categorical depression (7.6% v 1.8% with scores > or = 13; P < 0.01) than men with diastolic blood pressure levels between 75 and 85 mm Hg. Men with diastolic blood pressure levels > 85 mm Hg had higher depression scores than men with intermediate blood pressure levels (mean scores 5.85 v 4.96; P < 0.05). Men with diastolic hypotension scored significantly higher on both affective and somatic item subscales of the Beck depression inventory and on individual measures of fatigue, pessimism, sadness, loss of appetite, weight loss, and preoccupation with health. Low diastolic blood pressure was a significant predictor of both mean depression score and prevalence of categorical depression, independent of age and change in weight since the baseline visit. The presence of several chronic diseases was associated with depressed mood and higher blood pressure but not with low blood pressure. CONCLUSION--The association of relatively low diastolic blood pressure with higher depressive symptom scores and rates of categorical depression was independent of age or weight loss. Since fatigue is a prominent symptom of depression, any association of low blood pressure with fatigue could reflect depressive disorders or clinically important depression.     

Prevalence of Dementia and Subtypes in Valladolid,Northwestern Spain: The DEMINVALL Study

Objective

To describe the prevalence of dementia and subtypes in a general elderly population in northwestern Spain and to analyze the influence of socio-demographic factors.

Methods

Cross-sectional, two-phase, door-to-door, population-based study. A total of 870 individuals from a rural region and 2,119 individuals from an urban region of Valladolid, Spain, were involved. The seven-minute screen neurocognitive battery was used in the screening phase. A control group was included.

Results

A total of 2,170 individuals aged 65 to 104 years (57% women) were assessed. There were 184 subjects diagnosed with dementia. The crude prevalence was 8.5% (95% CI: 7.3-9.7). Age- and sex-adjusted prevalence was 5.5 (95% CI: 4.5-6.5). Main subtypes of dementia were: Alzheimer’s disease (AD) 77.7%, Lewy Body disease, 7.6% and vascular dementia (VD) 5.9%. Crude prevalences were 6.6% (AD), 0.6% (Lewy Body disease), and 0.5% (VD). Dementia was associated with age (OR 1.14 for 1-year increase in age), female sex (OR 1.79) and the absence of formal education (OR 2.53 compared to subjects with primary education or more).

Conclusion

The prevalence of dementia in the study population was lower than the most recent estimates for Western Europe. There was a high proportion of AD among all dementia cases and very low prevalence of VD. Old age, female sex, and low education level were independent risk factors for dementia and AD.     

Associations between symptoms of irritable colon and psychological and social conditions and lifestyle.

In a survey of risk factors for coronary heart disease 14 102 middle aged men and women answered a questionnaire on lifestyle, diet, and health, including symptoms of functional abdominal disorders. The overall prevalence of reports of one or both of the abdominal symptoms of "bloating and rumbling" or "cramping abdominal pain" was 28% in men and 35% in women. Only a weak negative association between age and prevalence of reported pain was found in both sexes. Women reported abdominal symptoms, especially cramping abdominal pain, significantly more commonly than men. In a multiple regression analysis abdominal symptoms were much more strongly associated with symptoms of mental stress such as depression, sleeping difficulties, problems of coping, and the use of analgesics than with lifestyle, dietary, and social variables together. The association was stronger in subjects reporting both symptoms. This strong and consistent association between functional abdominal disorders and psychological and social problems suggests that action other than prescribing drugs, diets, or radiography is required.     

Prevalence Studies of Dementia in Mainland China,Hong Kong and Taiwan: A Systematic Review and Meta-Analysis

Background

Many studies have considered the prevalence of dementia in mainland China, Hong Kong and Taiwan. However, area level estimates have not been produced. This study examines area differences across mainland China, Hong Kong and Taiwan adjusting for the effect of methodological factors with the aim of producing estimates of the numbers of people with dementia in these areas.

Method and Findings

A search of Chinese and English databases identified 76 dementia prevalence studies based on samples drawn from mainland China, Hong Kong and Taiwan between 1980 and 2012. A pattern of significantly decreasing prevalence was observed from northern, central, southern areas of mainland China, Hong Kong and Taiwan. Area variations in dementia prevalence were not explained by differences in methodological factors (diagnostic criteria, age range, study sample size and sampling method), socioeconomic level or life expectancy between areas. The results of meta-analysis were applied to current population data to provide best estimate. Based on the DSM-IV diagnostic criteria, the total number of people aged 60 and over with dementia in mainland China, Hong Kong and Taiwan is 8.4 million (4.6%, 95% CI: 3.4, 5.8) and in northern, central and southern areas are 3.8 (5.1%, 95% CI: 4.1, 6.1), 3.2 (4.4%, 95% CI: 3.2, 5.6) and 1.2 (3.9%, 95% CI: 2.3, 5.4) million respectively. These estimates were mainly based on the studies existing in highly developed areas and potentially affected by incomplete and insufficient data.

Conclusions

The findings of this review provide a robust estimate of area differences in dementia prevalence. Application of the estimated prevalence to population data reveals the number of people with dementia is expected to double every 20 years, areas in mainland China will be facing the greatest dementia challenge.     

Prevalencia de demencia en adultos mayores de América Latina: revisión sistemática

Background and objectiveDementia is a growing public health problem. It involves the impairment of several cognitive functions, generating mental and physical disability, and therefore greater functional dependence. There is limited epidemiological information which reveals an approximate prevalence in older adults from Latin America. The objective of this study was to determine the prevalence of dementia in the older adult population of Latin America, and its distribution according to geographic area and gender.Materials and methodsA systematic review was carried out in databases: PubMed, Ovid, Lilacs, Cochrane, Scielo and Google Scholar, in order to identify studies that estimate the prevalence of dementia in urban and / or rural population over 65 years of age.ResultsOn February 2018, the literature search yielded 357 publications. The overall prevalence of dementia in the older adult population of Latin America was found to be 11%, prevailing more in female gender and urban people.ConclusionThe prevalence of dementia in Latin America is higher than registered previously, and even than in other continents.