Prevalence of Dementia Among the Elderly in Latin America and the Caribbean: A Systematic Review and Meta-Analysis

Background Over the last decades, life expectancy in Latin America and the Caribbean showed a rapid increase, which led to a significant increase in the number of people with dementia. Moreover, 9% of the population in this part of the world are aged 65 or older, and by 2050 this percentage is projected to at least double. For this reason, it is essential to estimate the prevalence of dementia in LAC countries with the aim to determine suitable actions to enhance the quality of life of those affected. Methods Database searches for articles were conducted September 2020 throughout Pubmed, Web of knowledge, Scopus, Lilacs, and SciELO. The inclusion criteria comprised population- or community-based studies, published in English, Spanish, or Portuguese, reporting data on the prevalence of dementia collected in LAC countries. The complete data search retrieved 1719 non-duplicates. Results A total of 58 studies met the high-quality inclusion criteria, published 1991-2020, including participants in the following countries: Brazil, Mexico, Argentina, Colombia, Peru, Cuba, Dominican Republic, Venezuela, Ecuador, Trinidad and Tobago, and Jamaica. The most common form of dementia studied was Alzheimer’s disease with prevalence ranging from 5.9% to 23.4%. Estimates differed by age, gender, and education, with oldest, women, and lower-educated adults living in rural areas presenting higher dementia prevalence. Conclusion This is the first study giving a comprehensive overview of dementia prevalence in LAC countries, which is relevant to estimate care needs and economic costs related to dementia treatment and care.

Prevalence of MCI and Dementia Prior to Incarceration

As the number of older, incarcerated persons increases, prevalence of dementia and mild cognitive impairment (MCI) in this population will likely grow, with implications for healthcare costs and advance care planning within the prison setting. This study is the first to determine the prevalence of dementia or MCI in later-life adults prior to incarceration. We leveraged a national cohort of Veterans aged 50+ whose most recent incarceration was ≤10 years in length and who were released between 10/1/2012 and 9/30/2018 (N=17,962). We linked VA and CMS healthcare records to determine diagnosis of dementia or MCI within 3 years prior to incarceration. The overall sample had a mean age of 62.4 (±7.6) years at the start of their incarceration, were largely male (97%), and were 65% White and 30% Black. Before incarceration, 445 (2.5%) and 152 (0.8%) Veterans were diagnosed with dementia and MCI, respectively. Compared to those without a diagnosis of dementia or MCI prior to incarceration, those with dementia or MCI were older at incarceration start (66.1 [±8.3] vs. 62.3 [±7.9]), had more chronic medical conditions (4.0 [±2.2] vs. 2.2 [±1.9]), were more likely to experience homelessness (21.6% vs. 9.1%), have a TBI (24.5% vs. 9.1%), and have serious mental illness (81.7% vs. 49.1%). All comparisons were significant (p<.001). Our findings indicate that later-life adults with dementia or MCI are being incarcerated. Improved understanding of pathways linking cognitive impairment to later-life incarceration is needed to both prevent unnecessary incarceration and to help provide appropriate healthcare for this vulnerable group.

Dementia among older adults living in long-term care facilities: an epidemiological study

ABSTRACT Institutionalization has been associated with social isolation, psychological and cognitive changes, and decreased levels of physical activity in older adults. Objectives: The aim of this study was to estimate the prevalence of dementia, mild cognitive impairment (MCI), and functional dependence in older adults dwelling in two different Brazilian long-term care facilities (LTCFs). Methods: This is a cross-sectional study with 185 older people of both sexes, aged 60 years or over, residing in two LTCFs in the city of Montes Claros-MG, Brazil. The diagnosis of MCI and dementia was performed using the Diagnostic and Statistical Manual of Mental Disorders. Results: Prevalence rates of dementia, MCI, and functional dependence in institutionalized older participants were 62.3, 15.1, and 78.9%, respectively. There was a significant reduction of the Mini-Mental State Examination scores according to the increase of the institutionalization period in LCTFs and the age of older adults (p<0.001). Conclusions: Prevalence of dementia and functional dependence of older adults residing in LTCFs exhibited higher rates compared to the other older population worldwide. A higher institutionalization period is related to a greater cognitive decline.

Prevalence of Dementia in American Indian/ Alaska Native Medicare Beneficiaries

Given the increase in life expectancy for American Indians and Alaska Natives (AIANs) due to many positive changes in social and environmental factors, the number of AIAN older adults with dementia is expected to grow from 23,850 in 2010 to over 100,000 by 2050. However, there have been few studies on the prevalence of dementia that have included AIANs . The purpose of the current study was to estimate the prevalence of dementia among AIANs over 65 years compared to non-Hispanic Whites (NHWs), Non-Hispanic Blacks (NHBs), Hispanics. The current study used survey data from Round 5 of the National Health and Aging Trends Study (NHATS, 2015) (N=7,449), a nationally representative study of Medicare beneficiaries 65 years and older. We estimated the age and gender-adjusted prevalence of dementia and 95% confidence intervals for each race/ethnicity. The majority of participants were between 65 and 74 years old. Slightly more than half of them were female. AIAN Medicare beneficiaries showed a significantly higher prevalence of dementia than NHWs after adjusting for age and gender (4% greater or higher prevalence). We also observed a significantly lower prevalence of dementia in AIAN Medicare beneficiaries than NHBs, Hispanics. While previous research has reported that AIANs shave a similar or lower prevalence of dementia than NHWs, our findings indicate significant dementia disparities in AIAN Medicare beneficiaries. Future research should focus on dementia prevalence and risk factors within/between AIAN tribes.