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In these studies, incidence was similar [17,19] or higher in LA countries than in Western countries [18]. Besides age, other risk factors included markers of low cognitive reserve [18], poor cardiovascular health [20], and being a carrier of at least one APOE-ϵ 4 allele [19]. Joint efforts of clinicians and epidemiologists would be essential to improve the quality of epidemiological data on dementia in LA. Besides the high overall prevalence of dementia reported in most studies, prevalence among younger elderly (ie, 65-69 years) was found to be 2.4%, exactly twice the rate reported by a systematic review of 21 studies conducted in Europe [8]. [...]low education might increase dementia risk by limiting adequate diagnosis and treatment of comorbidities, particularly cardiovascular diseases and diabetes mellitus, as well as being commonly associated with impaired nutritional status. [...]low educational attainment is also associated with low cognitive reserve [21], thus possibly leading to the earlier manifestation of dementia symptoms. [...]the illiteracy rate among the elderly population is high, currently at 21%. [...]at least in Brazil, there is an unequal distribution of literacy rates, with lower figures in specific regions (North and Northeast) and rural areas of the country.

The relationship between alcohol consumption and cognition is still controversial. This is a cross-sectional population-based study conducted in Caeté (MG), Brazil, where 602 individuals aged 75+ years, 63.6% female, and with a mean education of 2.68 years, were submitted to thorough clinical assessments and categorized according to the number of alcoholic beverages consumed weekly. The prevalence rates of previous and current alcohol consumption were 34.6% and 12.3%, respectively. No association emerged between cognitive diagnoses and current/previous alcohol consumption categories. Considering current alcohol intake as a dichotomous variable, the absence of alcohol consumption was associated with dementia (OR = 2.34; 95%CI: 1.39–3.90) and worse functionality (p = 0.001). Previous consumption of cachaça (sugar cane liquor) increased the risk of dementia by 2.52 (95%CI: 1.25–5.04). The association between the consumption of cachaça and dementia diagnosis has not been described before. La rélation entre l’alcool et la cognition est encore controversée. II s’agit d’une étude transversale populationnelle menée au Caeté (MG), Brésil où 602 personnes âgées de 75+ ans, 63.6% femmes et avec une éducation moyenne de 2.68 ans, ont été soumises à des évaluations cliniques détaillées et classées face au nombre de boissons alcooliques consommées par semaine. Les prévalences de consommation d’alcool antérieure/actuelle étaient de 34.6% et 12.3%, respectivement. Aucune association n’a émergé entre les diagnostics cognitifs et la consommation d’alcool. L’absence de consommation actuelle d’alcool était associée à la démence (OR = 2.34; IC à 95%: 1.39–3.90) et à une pire fonctionnalité (p = 0.001). La consommation antérieure de cachaça (liqueur de canne à sucre) a augmenté la chance du diagnostic de démence de 2.52 (IC à 95%: 1.25–5.04). Cette association entre la consommation de cachaça et démence n’a pas été registré auparavant.

Background Parkinsonism is strongly associated with ageing, and many studies have suggested that parkinsonian signs may affect up to half of older adults and is associated with a wide range of adverse health outcomes. We compared clinical and functional characteristics of oldest-old community-dwelling individuals with parkinsonism (parkinsonian group [PG]) to individuals without parkinsonism (non-parkinsonian group [NPG]. Methods The Pietà study is a population-based study conducted in Caeté, southeast Brazil, involving 607 individuals aged 75 + years submitted to an extensive clinical evaluation. A subset of 65 PG individuals (61.5% women, median age of 82 years) was compared to 542 NPG individuals (64.8% women, median age of 80 years). Results PG individuals had significantly more functional impairment, clinical comorbidities (including number of falls, loss of bladder control and dysphagia) and major depression. Multivariate analysis revealed that older age, higher UPDRSm scores, lower category fluency test (animals/minute) and delayed recall memory scores were associated with PG. This group was also more cognitively impaired, with lower performance than NPG individuals in the Mini-Mental State Examination, category fluency test (animals/minute), clock drawing and in delayed recall (p < 0.001 for all tests). UPDRSm scores were the most contributing factor to cognition that independently explained variability in functionality of the entire sample. Conclusion Individuals aged 75 + years with parkinsonism were significantly more clinically and functionally impaired in this population-based sample. Cognitive dysfunction explained most of the loss of functionality in these patients. UPDRS-m scores contributed independently to explain variability in functionality in the whole sample.

ObjectivesTo investigate the rates of diabetes mellitus (DM) and impaired fasting glucose (IFG) in a population-based sample of individuals aged 75 + years old and their associations with cognitive performance, depression, functionality, and quality of life (QoL).Study designOverall, 350 people participated in the study. Assessments of cognition, mood, functionality and QoL were performed using the mini-mental state examination (MMSE), clock-drawing, category fluency tests, the Mini-International Neuropsychiatric Interview, Pfeffer’s Functional Activities Questionnaire, and the WHO Quality of Life-Old (WHOQOL-OLD).ResultsIFG (ADA criteria) was identified in 42.1% of the sample, while the DM rate was 24.1%. Lack of knowledge of the DM diagnosis and lack of treatment occurred in 27% and 39% of the sample, respectively. Rates of dementia and depression, MMSE, category fluency scores, and previous cardiovascular events did not differ between the glycaemic groups. Individuals with DM performed worse on the clock-drawing test, functionality, and WHOQOL-OLD than the other participants. Individuals with IFG presented similar QoL and functionality when compared with the group without DM.ConclusionsIFG and DM were common in this population-based sample aged 75 + years old, as were inadequate diagnoses and treatments of DM. DM individuals presented poor performance in the executive function test, functionality, and QoL. Further studies are recommended to investigate the value of an IFG diagnosis among the most elderly population.

Abstract Introduction Late-life depression (LLD) is common, but remains underdiagnosed. Validated screening tools for use with the oldest-old in clinical practice are still lacking, particularly in developing countries. Objectives To evaluate the accuracy of a screening tool for LLD in a community-dwelling oldest-old sample. Methods We evaluated 457 community-dwelling elderly subjects, aged ≥75 years and without dementia, with the Geriatric Depression Scale (GDS-15). Depression diagnosis was established according to DSM-IV criteria following a structured psychiatric interview with the Mini International Neuropsychiatric Interview (MINI). Results Fifty-two individuals (11.4%) were diagnosed with major depression. The area under the receiver operating characteristic (ROC) curve was 0.908 (p<0.001). Using a cut-off score of 5/6 (not depressed/depressed), 84 (18.4%) subjects were considered depressed by the GDS-15 (kappa coefficient = 53.8%, p<0.001). The 4/5 cut-off point achieved the best combination of sensitivity (86.5%) and specificity (82.7%) (Youden's index = 0.692), with robust negative (0.9802) and reasonable positive predictive values (0.3819). Conclusion GDS-15 showed good accuracy as a screening tool for major depression in this community-based sample of low-educated oldest-old individuals. Our findings support the use of the 4/5 cut-off score, which showed the best diagnostic capacity. Resumo Introdução A depressão geriátrica (DG) é um transtorno prevalente que permanece sendo subdiagnosticado. Ferramentas validadas para rastreio de DG em idosos muito idosos na prática clínica são necessárias, especialmente em países em desenvolvimento. Objetivos Avaliar a acurácia diagnóstica da Escala de Depressão Geriátrica (Geriatric Depression Scale, GDS-15) em uma população de idosos muito idosos residentes na comunidade. Métodos Foram avaliados, com a GDS-15, 457 indivíduos nãodemenciados, residentes na comunidade, com idade ≥75 anos. O diagnóstico definitivo de depressão maior foi realizado através da entrevista semiestruturada Mini International Neuropsychiatric Interview (MINI), de acordo com os critérios do DSM-IV. Resultados Cinquenta e dois indivíduos (11,4%) foram diagnosticados com episódio depressivo maior. A área sob a curva receiver operating characteristic (ROC) foi de 0,908 (p<0,001). Utilizando-se o ponto de corte 5/6 (não-deprimido/deprimido), 84 (18,4%) indivíduos foram considerados deprimidos pela GDS-15 (coeficiente de kappa = 53,8%, p<0,001). O ponto de corte 4/5 atingiu a melhor combinação entre sensibilidade (86,5%) e especificidade (82,7%) (índice de Youden = 0,692), com valor preditivo negativo robusto (0,9802) e razoável valor preditivo positivo (0,3819). Conclusão A GDS-15 demonstrou boa acurácia para o rastreio de depressão maior nesta amostra de base populacional de idosos muito idosos com baixa escolaridade. Os resultados do presente estudo indicam que o ponto de corte 4/5 mostrou-se mais adequado para utilização nesta população.

Background: Cognitive and functional decline are common problems in older adults, especially in those 75+ years old. Currently, there is no specific plasma biomarker able to predict this decline in healthy old-age people. Machine learning (ML) is a subarea of artificial intelligence (AI), which can be used to predict outcomes Aim: This study aimed to evaluate routine laboratory variables able to predict cognitive and functional impairment, using ML algorithms, in a cohort aged 75+ years, in a one-year follow-up study. Method: One hundred and thirty-two older adults aged 75+ years were selected through a community-health public program or from long-term-care institutions. Their functional and cognitive performances were evaluated at baseline and one year later using a functional activities questionnaire, Mini-Mental State Examination, and the Brief Cognitive Screening Battery. Routine laboratory tests were performed at baseline. ML algorithms—random forest, support vector machine (SVM), and XGBoost—were applied in order to describe the best model able to predict cognitive and functional decline using routine tests as features. Results: The random forest model showed better accuracy than other algorithms and included triglycerides, glucose, hematocrit, red cell distribution width (RDW), albumin, hemoglobin, globulin, high-density lipoprotein cholesterol (HDL-c), thyroid-stimulating hormone (TSH), creatinine, lymphocyte, erythrocyte, platelet/leucocyte (PLR), and neutrophil/leucocyte (NLR) ratios, and alanine transaminase (ALT), leukocyte, low-density lipoprotein cholesterol (LDL-c), cortisol, gamma-glutamyl transferase (GGT), and eosinophil as features to predict cognitive decline (accuracy = 0.79). For functional decline, the most important features were platelet, PLR and NLR, hemoglobin, globulin, cortisol, RDW, glucose, basophil, B12 vitamin, creatinine, GGT, ALT, aspartate transferase (AST), eosinophil, hematocrit, erythrocyte, triglycerides, HDL-c, and monocyte (accuracy = 0.92). Conclusions: Routine laboratory variables could be applied to predict cognitive and functional decline in oldest-old populations using ML algorithms.

According to the cognitive reserve theory, intellectual stimuli acquired during life can prevent against developing cognitive impairment. The underlying cognitive reserve mechanisms were underexplored in low-educated individuals. Because episodic memory impairment due to hippocampal dysfunction is a key feature of Alzheimer's dementia (AD), we sought to look at a possible cognitive reserve mechanism by determining whether few years of education moderated the relationship between the hippocampal volumes and the episodic-memory scores. The sample was composed by 183 older adults, 40.1% male, with the median age of 78[76,82] years and the median years of education of 4[2,10] who had undergone an episodic-memory test and a 3-Tesla MRI scan to access the hippocampal volumes. Overall, 112 were cognitively healthy, 26 had cognitive impairment-no dementia (CIND) and 45 had dementia. We used multiple linear regression to assess whether the interaction between years of education and each hippocampal volume significantly predicted the episodic-memory scores' variance, controlling for cognitive diagnosis and nuisance variables. The interaction term with the left hippocampus (ß = 0.2, = 0.043, CI = 1.0, 1.4), but not with the right (ß = 0.1, = 0.218, CI = 0.9, 1.2) significantly predicted the variation on memory scores. The mechanism by which the left hippocampus seems to play a more important role on memory processing in more educated individuals needs to be further investigated and might be associated with a better use of mnemonic strategies or higher hippocampal connectivity. Because the sample's median years of education was four, which corresponds to primary school, we may infer that this level might be sufficient to contribute for building cognitive reserve.

Background The Latin American Initiative for Lifestyle Intervention to Prevent Cognitive Decline (LatAm‐FINGERS) is the first multicenter, non‐pharmacological randomized clinical trial in the field of dementia developed in Latin America. The study aims to investigate the influence of a multidomain intervention on cognitive impairment in older adults with associated risk factors, including cognitive training, physical activity, clinical monitoring and changes in eating habits. Method Participants underwent dietary habit change interventions conducted by a nutrition team. Monthly, group discussions focused on topics presented in the “Food Guide for the Brazilian Population”. After 12 months of intervention, individualized consultations with a nutrition team were conducted to assess food intake using a 24‐hour recall method, obtaining data on the consumption of macronutrients, fiber, calcium, vitamins D and B12, and body composition based on weight and height measurements, as well as anthropometric measurements. The data were tabulated, and the results were presented as mean and standard deviation or relative frequency. Result Twenty‐two participants from the systematic group were evaluated, with a mean age of 69.4 ± 4.9 years, predominantly composed of women (54.5%). Regarding the assessment of food consumption, the average water intake was 1430 ± 529 ml, the average caloric intake was 1568.3 ± 501.3 calories, carbohydrate intake was 176.2 ± 64.8 grams, protein intake was 77.3 ± 37.9 grams, lipid intake was 60.9 ± 24.6 grams, and fiber intake was 18.0 ± 9.0 grams. In terms of micronutrients, the average calcium intake was 575.9 ± 267.7 mg, Vitamin D was 1.6 ± 2.1 μg, and Vitamin B12 was 1.9 ± 3.0 μg. For anthropometric markers, the mean weight of the participants was 71.4 ± 17.4 kg, body mass index (BMI) was 27.3 ± 5.4 kg/m2, neck circumference was 36.9 ± 4.0 cm, waist circumference was 90.7 ± 14.7 cm, arm circumference was 30.2 ± 4.3 cm, calf circumference was 37.3 ± 4.2 cm, waist‐to‐hip ratio was 0.9 ± 0.1, and waist‐to‐height ratio was 0.6 ± 0.1. Conclusion The results highlight the need for personalized nutritional interventions for older adults to improve the intake of critical micronutrients and macronutrients to reduce metabolic risks.

Motoric Cognitive Risk Syndrome (MCR) is a pre-dementia syndrome characterized by subjective memory complaints and slow gait speed. MCR is associated with increased risk of dementia and mortality. Studies on MCR remain scarce in low- and middle-income countries, particularly in Latin America. The aim of the present study was to investigate the prevalence of MCR in a community-sample in Brazil and its associations with sociodemographic and clinical factors. Cross-sectional study conducted in four public health/primary care settings in Belo Horizonte, Brazil. Sample size calculation indicated that 310 subjects aged 60+ years should be included. Sociodemographic, clinical, motor (Unified Parkinson's Disease Rating Scale-motor; UPDRSm) and cognitive (Addenbrooke' Cognitive Examination-revised; ACE-R) aspects were assessed. Gait evaluation was performed using the APDM Mobility Lab™ system. The final sample consisted of 355 individuals, with mean age of 71.4 years, 69.6% women. Prevalence of MCR was 11.3%. Univariate analysis showed that MCR diagnosis was associated with older age (OR 2.5, CI 1.1-5.9), lower education (OR 0.92, 95% CI 0.85-0.99), physical inactivity (OR 8.2, CI 3.1-21.5), history of falls in the past year (OR 24.5, CI 9.8-61.0), polypharmacy (OR 7.4, CI 3.4-16.1), depression (OR 2.9, CI 1.5-5.7), previous stroke (OR 4.3, CI 1.4-13.4), poor performance on ACE-R (OR 0.97, CI 0.95-0.99) and higher scores in subsection III of UPDRS (OR 1.2, CI 1.1-1.3). In multivariate logistic regression analysis, history of falls in the past year (OR 14.4, 95% CI 5.5-37.4), polypharmacy (OR = 4.3, 95% CI 1.8-10.3), and higher scores in UPDRS-III (OR = 1.1, 95% CI 1.03-1.17) remained significantly associated with MCR. The present study found a prevalence of 11.3% of MCR among older adults seen at primary care level in Belo Horizonte, Brazil. MCR was associated with polypharmacy, falls and parkinsonian signs. These findings are consistent with previous studies and may provide further insights into this pre-dementia syndrome, which is easily identifiable at low-cost at primary care/public health settings.

Background Motoric Cognitive Risk Syndrome (MCR) is a pre‐dementia syndrome characterized by subjective memory complaints and slow gait speed. MCR is associated with increased risk of dementia and mortality. Studies on MCR remain scarce in low‐ and middle‐income countries, particularly in Latin America. The aim of the present study was to investigate the prevalence of MCR in a community‐sample in Brazil and its associations with sociodemographic and clinical factors. Method Cross‐sectional study conducted in four public health/primary care settings in Belo Horizonte, Brazil. Sample size calculation indicated that 310 subjects aged 60+ years should be included. Sociodemographic, clinical, motor (Unified Parkinson’s Disease Rating Scale‐motor; UPDRSm) and cognitive (Addenbrooke’ Cognitive Examination‐revised; ACE‐R) aspects were assessed. Gait evaluation was performed using the APDM Mobility Lab™ system. Result The final sample consisted of 355 individuals, with mean age of 71.4 years, 69.6% women. Prevalence of MCR was 11.3%. Univariate analysis showed that MCR diagnosis was associated with older age (OR 2.5, CI 1.1–5.9), lower education (OR 0.92, 95% CI 0.85–0.99), physical inactivity (OR 8.2, CI 3.1–21.5), history of falls in the past year (OR 24.5, CI 9.8–61.0), polypharmacy (OR 7.4, CI 3.4–16.1), depression (OR 2.9, CI 1.5–5.7), previous stroke (OR 4.3, CI 1.4–13.4), poor performance on ACE‐R (OR 0.97, CI 0.95–0.99) and higher scores in subsection III of UPDRS (OR 1.2, CI 1.1–1.3). In multivariate logistic regression analysis, history of falls in the past year (OR 14.4, 95% CI 5.5–37.4), polypharmacy (OR = 4.3, 95% CI 1.8–10.3), and higher scores in UPDRS‐III (OR = 1.1, 95% CI 1.03–1.17) remained significantly associated with MCR. Conclusion The present study found a prevalence of 11.3% of MCR among older adults seen at primary care level in Belo Horizonte, Brazil. MCR was associated with polypharmacy, falls and parkinsonian signs. These findings are consistent with previous studies and may provide further insights into this pre‐dementia syndrome, which is easily identifiable at low‐cost at primary care/public health settings.