Prevalence, incidence and risk factors of dementia in Cuban admixed population.
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1 Prevalence, incidence and risk factors of dementia in Cuban admixed population. Authors: J. J. Llibre Rodriguez, J. C. Llibre Guerra, A. Valhuerdi, M. Guerra Hernandez, C. Ferri, M. Prince. Medical University. of Havana Institute of Pschiatry, KCL London 10/66 Dementia Research Group.
2 Proportion of older adults Crecimiento por 1000 habitantes , Porcentaje de esperanza de vida al nacer 78,97 AÑOS FEMALE SURVIVAL 4.02 AÑOS ANUARIO ESTADÍSTICO,2013
3 The Cuban Dementia and Alzheimer Study Playa Municipality, Havana & Santa Clara, Villa Clara Total Municipalities Population Studied Over 65 years old approximately inhabitants
4 10/66 Protocol Door knocking Cognitive test Clinical interview Socio-demographic and risk factor interview Physical/ neurological examination Blood test Informant interview 10/66 Dementia diagnosis DSM IV Dementia DSM IV/ ICD10 Depression Esperanza Aged 104 years! Prince M, Ferri CP, Acosta D, et al. The protocols for the 10/66 Dementia Research Group population-based research programme. BMC Public Health 2007,7:165.
5 The Havana and Matanzas prevalence and incident study sample. Cross sectional study ( ) (Baseline sample n=3015) Follow up (Median=4.5 years) Deceased: 608 (21.6%) (Verbal autopsy) Refused 20 (0,7%) Untraceable 178 (6,3% Incident cohort at follow-up ( ) (n=2 517) Diagnosed with 10/66 or DSM-IV (n=320) Incident cases (n=171)
6 PREVALENCE OF DEMENTIA BY AGE Prevalence (%) Cuba - 10/66 Cuba - DSM IV EURODEM Age (years) Llibre Rodríguez J.J, Valhuerdi A., Sanchez I.I., Guerra M.A, et al. The prevalence, correlates and impact of dementia in Cuba. Neuroepidemiology 2008.
7 INCIDENCE OF DEMENTIA BY SEX AND AGE. AGING AND ALZHEIMER STUDY. CUBA Sex Cases Incidence CI 95% Female ( ) Male ( ) By age ( ) ( ) ( ) ( ) ALL ( ) * Incidence rate/ 1000 pyr
8 Associations with Incidence dementia. Hazard ratio (HR and 95 % CI) Risk associations HR (CI 95 %) Stroke 1.61 ( ) Vascular score 1.09 ( ) APOE ( ) Older age, per 5 year group 1.64 ( ) Hypertension in middle age 1.35 ( ) More assets, (per assets) 1.17 ( ) Higher education per level 0.77 ( ) Sex, (men vs women) 0.87 ( ) Lower occupational attainment 0.98 ( ) Animal naming per word 0.92 ( ) Smoking 0.82 ( )
9 Does African Ancestry Protect Against Dementia? A Population Based Casecontrol Study Univ. de Ciencias Medicas - Habana, Matanzas Cuba Centro Nacional de Genetica, Centre for Public Mental Health, KCL, UK Interactions between genetic admixture, ethnic identity, APOE genotype and dementia prevalence in an admixed Cuban sample; a cross-sectional population survey and nested case-control study. BMC Medical Genetics 2011,
10 Admixture studies Design Populations of mixed African and Caucasian ancestry Genotype to measure ancestry directly in individuals (60 markers of admixture) Hypothesis Higher levels of African ancestry associated with lower risk of dementia
11 Association of APOE genotype with dementia Dementia N 273 (%) No dementia N 2247 (%) Crude PR (95% CI) PR (95% CI)* 1 or 2 ApoE4 alelles 87 (31.9) 329 (14.6) 2.4 ( ) 2.6 ( ) Number of ApoE4 alelles (68.1) 1918 (85.4) 1.00 (ref.) 1.00 (ref.) 1 79 (28.9) 300 (13.4) 2.36 ( ) 2 8 (2.9) 29 (1.3) 2.45 ( ) 2.6 ( ) 2.9 ( ) *Adj. age, sex and education
12 Mean admixture proportion by APOE allele status (case control subsample) APOE genotype Admixture proportions No APOE allele N= 445 One APOE allele N=119 Two APOE allele N=20 P value African mean 95% CI 0.15 ( ) 0.19 ( ) 0.35 ( ) P = 0.01 European mean 95% CI 0.82 ( ) 0.78 ( ) 0.62 ( ) P = Native american P = 0.65 ( ) ( ) ( ) *
13 Age and the incidence of dementia for persons with Apo E4 compared with persons without an Apo E4 allele.
14 Conclusions Dementia is at least as common in Cuba as in developed countries. APOE genotype is strongly associated with ancestry. The study shows that the relationship between APOE e4 and incident dementia is stronger in younger old persons than in older old persons and that this change must be taken into account in models of dementia. In this community-based population longitudinal study, some well-known risk factors for dementia, are confirmed but not others. New cohort studies are needed to study the effect of cardiocascular risk factors from mid- to late-life.
15 PROYECTO ALZHEIMER LA HABANA Dra. Ana M. López Medina Dra.Marina Calvo Rodriguez Dra. Isis I. Sanchez Gil Dra.Milagros A. Guerra Dra. Lisseth Noriega Fdez Dra.Milagros A.G. Klibanski Dra. Beatriz Marcheco Teruel Dra. Carmen Moreno Carbonell AGRADECIMIENTOS Universidad Médica de La Habana Policlinicos de Ciudad Habana y Matanzas Centro Nacional de Genética Médica Institute of Psychiatry, London MATANZAS Dr.Adolfo Valhuerdi Cepero Dra. Ruthbeskia Porto Lic. Francis Arencibia
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