100825580_prevalence_distribution_and_impact_of_mild_cognitive_impairment_in_latin_america_china_and_india_a_1066_population_based_study.docx

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Prevalence, distribution and impact of mild cognitive impairment in Latin America,

China and India – a 10/66 population-based study

Brief title: Mild cognitive impairment in LAMIC settings

Authors

Ana Luisa Sosa;

1†

Emiliano Albanese;

2†

Blossom CM Stephan;

Michael Dewey;

Daisy Acosta;

Cleusa P Ferri;

; Mariella Guerra;

Yueqin Huang;

KS Jacob;

Ivonne Z. Jiménez-Velázquez;

Juan J Llibre Rodriguez;

Aquiles Salas;

Joseph Williams;

Isaac Acosta;

Maribella González-

Viruet ;

Milagros A. Guerra Hernandez;

Li Shuran;

Martin J Prince

and Robert Stewart*

*Corresponding author

†

These authors contributed equally to this manuscript.

Affiliations

National Institute of Neurology and Neurosurgery, Autonomous National University of Mexico,

Mexico City, Mexico (AL Sosa, I Acosta);

Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda

MD, USA 20892 (E Albanese);

University of Cambridge, UK (BCM Stephan);

King’s College London (Institute of Psychiatry), London, UK (M Dewey; CP Ferri; M Prince; R

Stewart)

Universidad Nacional Pedro Henriquez Ureña (UNPHU), Internal Medicine Department,

Geriatric Section, Santo Domingo, Dominican Republic (D Acosta);

Universidad Peruana Cayetano Heredia, Instituto de la Memoria y Desordenes Relacionados,

Peru (M Guerra);

Peking University, Institute of Mental Health, Beijing, China (Y Huang, L Shuran);

Christian Medical College, Vellore, India (KS Jacob);

UPR, School of Medicine, San Juan, Puerto Rico (I Z Jiménez-Velázquez);

Medical University of Havana, Cuba (JJ Llibre Rodriguez);

Medicine Department, Caracas University Hospital, Faculty of Medicine, Universidad Central

de Venezuela, Caracas, Venezuela (A Salas);

Institute of Community Health, Voluntary Health Services, Chennai, India (J Williams);

Psy D Program

Carlos Albizu University, San Juan, Puerto Rico (M González-Viruet);

Policlinico Universitario 27 de Noviembre, Havana, Cuba (CMA Guerra Hernandez).

Abstract

Background Rapid demographic ageing is a growing public health issue in many low and middle

income countries (LAMICs). Mild cognitive impairment (MCI) is a construct frequently used to

define groups of people who may be at risk of developing dementia, crucial for targeting

preventative interventions. However, little is known about the prevalence or impact of MCI in

LAMIC settings.

Methods and findings Data were analysed from cross-sectional surveys carried out in Cuba, Dominican

Republic, Peru, Mexico, Venezuela, Puerto Rico, China and India on 15,376 individuals aged 65+

without dementia. Standardised assessments of mental and physical health, and cognitive function

were carried out including informant interviews. An algorithm was developed to define Mayo Clinic

amnestic MCI (a-MCI). Disability (WHO-DAS) and informant-reported neuropsychiatric

symptoms (NPI-Q) were measured. After adjustment, a-MCI was associated with disability,

anxiety, apathy and irritability (but not depression); between-country heterogeneity in these

associations was only significant for disability. The crude prevalence of a-MCI ranged from 0.8%

in China to 4.3% in India. Country differences changed little (range: 0.6-4.6%) after standardization

for age, gender and education level. In pooled estimates, a-MCI was modestly associated with male

gender and fewer assets but was not associated with age or education. There was no significant

between-country variation in these demographic associations.

Conclusions An algorithm-derived diagnosis of a-MCI showed few socio-demographic associations

but was consistently associated with higher disability and neuropsychiatric symptoms in addition

to showing substantial variation in prevalence across LAMIC populations. Longitudinal data are

needed to confirm findings – in particular, to investigate the predictive validity of a-MCI in these

settings and risk/protective factors for progression to dementia; however, the large number

affected has important implications in these rapidly ageing settings.

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Prevalence, distribution and impact of mild cognitive impairment in Latin America, China and India – a 10/66 population-based study Brief title: Mild cognitive impairment in LAMIC settings Authors Ana Luisa Sosa;1† Emiliano Albanese;2† Blossom CM Stephan;3 Michael Dewey;4 Daisy Acosta;5 Cleusa P Ferri;4; Mariella Guerra;6 Yueqin Huang;7 KS Jacob;8 Ivonne Z. Jiménez-Velázquez;9 Juan J Llibre Rodriguez;10Aquiles Salas;11 Joseph Williams;12 Isaac Acosta;1 Maribella González-Viruet ; 13Milagros A. Guerra Hernandez; 14 Li Shuran;7 Martin J Prince4 and Robert Stewart*4 *Corresponding author †These authors contributed equally to this manuscript. Affiliations 1National Institute of Neurology and Neurosurgery, Autonomous National University of Mexico, Mexico City, Mexico (AL Sosa, I Acosta); 2 Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda MD, USA 20892 (E Albanese); 3University of Cambridge, UK (BCM Stephan); 4 King’s College London (Institute of Psychiatry), London, UK (M Dewey; CP Ferri; M Prince; R Stewart) 5Universidad Nacional Pedro Henriquez Ureña (UNPHU), Internal Medicine Department, Geriatric Section, Santo Domingo, Dominican Republic (D Acosta); 6Universidad Peruana Cayetano Heredia, Instituto de la Memoria y Desordenes Relacionados, Peru (M Guerra); 7Peking University, Institute of Mental Health, Beijing, China (Y Huang, L Shuran); 8Christian Medical College, Vellore, India (KS Jacob); 9UPR, School of ...
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