INTRODUCTION:This study aimed to determine the associations between parkinsonism and Parkinson's disease (PD) with cognitive impairment and dementia in a multi-country cohort in Latin America, using data from the 10/66 Dementia Research Group. METHODS:This population-based prospective cohort study was conducted in six Latin American countries, including 11,321 participants 65 years of age or older living in urban and rural areas. RESULTS:At baseline, the prevalence of cognitive impairment in people with parkinsonism and PD was 33% and 26%, respectively. Parkinsonism (odds ratio [OR] 2.2 [95% confidence interval [CI] 1.9-2.6] and PD (OR 1.9 [95% CI 1.4-2.4]) were individually associated with baseline cognitive impairment and incident dementia. The pooled sub-hazard ratios for dementia in fixed-effect meta-analysis were 1.5 (95% CI 1.2-1.9) for parkinsonism and 1.5 (95% CI 1.0-2.2) for PD. DISCUSSION:Parkinsonism and PD were cross-sectionally associated with cognitive impairment and prospectively associated with incident dementia. These findings underscore the importance of routine screening for cognitive impairment in individuals with parkinsonism and PD, to facilitate early detection and intervention strategies that mitigate adverse outcomes. HIGHLIGHTS:The present study is one of the first longitudinal investigations into the association of parkinsonism and Parkinson's disease (PD) with cognitive impairment and dementia incidence in Latin America. Parkinsonism and PD showed strong cross-sectional associations with cognitive impairment, with consistent estimates across countries, independent of demographic factors. Parkinsonism and PD were linked to a significantly higher incidence of dementia over a 4-year follow-up period. Findings emphasize the need for routine cognitive screening in Parkinsonism and PD.

Background: There is rapid growth of older people in Low-and Middle-Income Countries (LMICs). The aim of this review was to assess the literature on prevalence of anxiety and depression in this demographic, which to our knowledge, has not yet been conducted. Methods: Databases including Medline, PsychInfo, Embase, Scielo and African Journals Online were searched for terms including "mental disorders", "neurotic disorders", "mood disorders" and "anxiety disorders". Studies published between 1990 and 2020 providing data on older people (>= 50 years) in LMICs (defined by World Bank Criteria) were included and quality-assessed. Meta-analysis was conducted on a subset of higher-quality studies to derive pooled prevalence estimates of depression. Results: One hundred and forty relevant studies were identified, of which thirty-two were included in meta-analysis. One hundred and fifteen studies reported depression prevalence only, 19 reported both depression and anxiety, and six reported anxiety only. In all studies identified, depression prevalence ranged from 0.5 % to 62.7 %, and Generalised Anxiety Disorder prevalence ranged from 0.2 % to 32.2 %. The pooled prevalence of depression on meta-analysis was 10.5 % (95 % CI, 8.9 % -11.2 %). Reported prevalence rates of depression were significantly different in studies using ICD-10 compared with DSM criteria, and between community and clinical settings. Limitations: The search strategy contained bias towards English language papers and high income country (HIC) publications. There is significant heterogeneity within the meta-analysis. Discussion: A wide range of methodologies and clinical criteria are used in prevalence studies of depression and anxiety in older people. Studies using screening tools found higher prevalence rates; clinicians and researchers should ensure diagnosis is made with gold-standard clinical criteria. Meta-analysis data suggest that rates of depression are similar in older people in LMICs compared to HICs but mental healthcare resources are limited, suggesting a large potential treatment gap.

Abstract Introduction Evidence on the incidence and risk factors of frailty in low- and middle-income countries is very limited. We aimed to compare the incidence of frailty and explore its determinants in rural and urban areas in six Latin American countries and China. Methods The 10/66 is a multi-site cohort study in older adults. We conducted baseline and follow-up surveys in 2003-2006, and 2007-2010. We assessed frailty using a modified Fried frailty phenotype criterion, and adjudicated frailty (yes/no) when two or more of the following indicators were present: exhaustion, low physical activity, slow gait speed, and weight loss. We excluded frail participants at baseline and calculated person-years as the time interval between baseline and follow-up for frailty-free people who were survived and reinterviewed or the midpoint of it for incident frailty cases. We used Poisson and Cox regressions to model the incidence of frailty and its risk factors. Results We included 9,747 participants (≥65 years) for the analysis of frailty risk factors. Of whom, 8,212 were reinterviewed with an average of 4.0 years of follow-up, the incidence of frailty was lowest in Venezuela (21.9 per 1000 person-years) and rural Peru (24.3 per 1000 person-years), highest in rural Mexico (110.5 per 1000 person-years) and urban Peru (84.0 per 1000 person-years). In the overall Cox regression, we found significant prospective associations of incident frailty with living in rural areas (HR: 1.97, 95% CI: 1.69, 2.29), dementia (HR: 1.76, 95% CI: 1.42, 2.18), depression (HR: 1.69, 95% CI: 1.49, 1.93), comorbidity, female gender, older age, disability, hearing, and vision problems. Higher arm circumference was associated with a lower frailty risk (HR: 0.97, 95% CI: 0.96, 0.98). Conclusions The incidence of frailty varied substantially in Latin America and China, and between urban and rural areas. The identified risk factors could be potential intervention targets to decrease the global burden of frailty. Key messages • In Latin America and China, the incidence of frailty varied from 21.9 to 110.5 cases per 1000 person-years. • We identified 9 risk factors and 1 protective factor for developing frailty, and the most relevant risk factors were living in the rural area, dementia, and depression.

Background: Current estimates of the prevalence of depression in later life mostly arise from studies carried out in Europe, North America and Asia. In this study we aimed to measure the prevalence of depression using a standardised method in a number of low and middle income countries (LMIC).Methods: A one-phase cross-sectional survey involving over 17,000 participants aged 65 years and over living in urban and rural catchment areas in 13 sites from 9 countries (Cuba, Dominican Republic, Puerto Rico, Mexico, Venezuela, Peru, China, India and Nigeria). Depression was assessed and compared using LCD-10 and EURO-D criteria.Results: Depression prevalence varied across sites according to diagnostic criteria. The lowest prevalence was observed for LCD-10 depressive episode (0.3 to 13.8%). When using the EURO-D depression scale, the prevalence was higher and ranged from 1.0% to 38.6%. The crude prevalence was particularly high in the Dominican Republic and in rural India. LCD-10 depression was also associated with increased age and being female.Limitations: Generalisability of findings outside of catchment areas is difficult to assess.Conclusions: Late life depression is burdensome, and common in LMIC. However its prevalence varies from culture to culture; its diagnosis poses a significant challenge and requires proper recognition of its expression. (C) 2015 The Authors. Published by Elsevier B.V.

INDEP study, using both a quantitative and a qualitative approach.

Background There is relative little information about the prevalence and risk factors of co-morbid anxiety and depression in later life. These disorders are often associated with worse response to treatment than either condition alone, and researching its epidemiology in diverse settings is vital to policy makers. We therefore investigated the co-occurrence of anxiety and depressive syndromes among older adults living in developing countries and measured the separate and joint effect of these two disorders on levels of associated disability. Method The 10/66 study carried out cross-cultural surveys of all residents aged 65 or over (n=15 021) in 11 sites in seven countries (China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru). Anxiety was measured by using the Geriatric Mental State Examination (GMS) and the AGECAT diagnostic system. Depression was assessed according to ICD-10 and EURO-DEP criteria. Disability was measured by using the WHO-Disablement Assessment Scale Version II (WHODAS-II). Negative binomial regression models (ZINBs) were used to investigate the association between common mental disorders and disability. Results Co-morbid anxiety and depression was high (range %: 14.4–26.8) in the Latin American and Indian sites. Gender, socio-economic status, urbanicity and physical co-morbidities were associated with the different co-morbid states. Having both disorders was linked to higher disability scores than having anxiety or depression alone. Conclusions Given the close association of co-morbid anxiety and depression with disability, new policies to improve prevention, recognition and treatment will be needed to adapt to ageing populations and their mental health needs.

Introduction Pain is an important indicator of health mainly among older adults. The aim of the present study is to describe the prevalence of pain and to examine the relationship between pain and disability in elderly. Methods One-phase cross-sectional surveys of all residents aged 65 years and over (n=15 177) living in eight low- and middle-income countries. Pain was measured using three questions, about frequency, severity and extent of limitation associated with pain in the previous 4 weeks. Disability was assessed using the 12 item WHODAS 2.0. We calculated the crude and standardised prevalence of pain and used Poisson regression prevalence ratios, to estimate the association between pain and severe disability, and to generate population attributable prevalence fractions (PAPF). Results The overall prevalence of pain—defined as any type of pain in the last 4 weeks - ranged between 15.1% (China) and 46.0% (Peru) in urban sites and between 33.5% (Peru) and 58.8% (India) in rural sites. Pain was associated with severe disability, prevalence ratio pooled estimate was 1.49 (95% CI 1.21 to 1.78), adjusted for depression, number of impairments and chronic disease diagnoses. The adjusted PAPF showed that 39.2% of severe disability could be explained by pain. Conclusion The results show that the prevalence of pain in the elderly is high. Pain seems to be an important contributor to disability among older people. Pain in older people is an increasingly important health issue worldwide, and one that requires urgent worldwide attention from the public health and clinical perspectives.

BACKGROUND:There is relative little information about the prevalence and risk factors of co-morbid anxiety and depression in later life. These disorders are often associated with worse response to treatment than either condition alone, and researching their epidemiology in diverse settings is vital to policy makers. We therefore investigated the co-occurrence of anxiety and depressive syndromes amongst older adults living in developing countries and measured the separate and joint effect of these two disorders on levels of associated disability.METHOD:The 10/66 study carried out cross-cultural surveys of all residents aged 65 years or over (n=15021) in 11 sites in seven countries (People's Republic of China, India, Cuba, Dominican Republic, Venezuela, Mexico and Peru). Anxiety was measured by using the Geriatric Mental State Examination and the Automated Geriatric Examination for Computer Assisted Taxonomy diagnostic system. Depression was assessed according to International Classification of Diseases 10th revision (ICD-10) and EURO-D criteria. Disability was measured by using the World Health Organization's Disablement Assessment Scale Version II. Zero-inflated negative binomial regression models were used to investigate the association of common mental disorders and disability.RESULTS:The prevalence of co-occurring anxiety and depression (with the exclusion of subthreshold disorders) ranged between 0.9% and 4.2% across sites. Gender, socio-economic status, urbanicity and physical co-morbidities were associated with the different co-morbid states. Having both disorders was linked to higher disability scores than having anxiety or depression alone.CONCLUSIONS:Given the close association of co-morbid anxiety and depression with disability, new policies to improve prevention, recognition and treatment will be needed to adapt to ageing populations and their mental health needs.

Objective: Brief screening tools for dementia for use by non-specialists in primary care have yet to be validated in non-western settings where cultural factors and limited education may complicate the task. We aimed to derive a brief version of cognitive and informant scales from the Community Screening Instrument for Dementia (CSI-D) and to carry out initial assessments of their likely validity.Methods: We applied Mokken analysis to CSI-D cognitive and informant scale data from 15 022 participants in representative population-based surveys in Latin America, India and China, to identify a subset of items from each that conformed optimally to item response theory scaling principles. The validity coefficients of the resulting brief scales (area under ROC curve, optimal cutpoint, sensitivity, specificity and Youden's index) were estimated from data collected in a previous cross-cultural validation of the full CSI-D.Results: Seven cognitive items (Loevinger H coefficient 0.64) and six informant items (Loevinger H coefficient 0.69) were selected with excellent hierarchical scaling properties. For the brief cognitive scale, AUROC varied between 0.88 and 0.97, for the brief informant scale between 0.92 and 1.00, and for the combined algorithm between 0.94 and 1.00. Optimal cutpoints did not vary between regions. Youden's index for the combined algorithm varied between 0.78 and 1.00 by region.Conclusion: A brief version of the full CSI-D appears to share the favourable culture-and education-fair screening properties of the full assessment, despite considerable abbreviation. The feasibility and validity of the brief version still needs to be established in routine primary care. Copyright (C) 2010 John Wiley & Sons, Ltd.