ABSTRACT Aging and Alzheimer is a prospective, longitudinal cohort study involving 2944 adults aged ≥65 years from selected areas in Cuba’s Havana and Matanzas Provinces. This door-to-door study, which began in 2003, includes periodic assessments of the cohort based on an interview; physical exam; anthropometric measurements; and diagnosis of dementia and its subtypes, other mental disorders, and other chronic non-communicable diseases and their risk factors. Information was gathered on sociodemographic characteristics; disability, dependency and frailty; use of health services; and characteristics of care and caregiver burden. The first assessment also included blood tests: complete blood count, blood glucose, and liver function, lipid profile and ApoE4 genotype (a susceptibility marker). In 2007–2011, the second assessment was done of 2010 study subjects aged ≥65 years who were still alive. The study provides data on prevalence and incidence of dementia and its risk factors, and of related conditions that affect the health of older adults. It also contributes valuable experiences from field work and interactions with older adults and their families. Building on lessons learned, a third assessment to be done in 2016–2018 will incorporate a community intervention strategy to respond to diseases and conditions that predispose to dementia, frailty and dependency in older adults.

Background: cerebrovascular disease is the third cause of death in elder adults of the entire world. Aim: to characterize the epidemiologic, clinical behavior, aspects of the management and the association with atherogenic risk factors of the vascular focal cerebral dysfunction in elder adults. Materials and Methods: we carried out a cross-sectional study, on a “door-to-door” population basis in two directions: one descriptive for determining the prevalence, risk factors, clinical subtypes and management aspects of the Vascular Focal Cerebral Dysfunction (VFCD), and another, cases and controls analytical direction for establishing the risk association in 901 elder people aged 65 years and more who live in a selected area of the Teaching Polyclinic “José Jacinto Milanés” of Matanzas, in the period from January 2003 to November 2006, as part of the international research project 10/66. Outcomes: the obtained prevalence index of vascular focal cerebral dysfunction was 12,9 (116 elder people/43 transitory ischemic stroke and 73 ictus), predominating this affection in women, aged more than 80 years and the clinical subtypes athero- thrombotic ischemic ictus and carotidal transitory ischemic stroke (TIS). Only 29,3 % of the vascular focal cerebral dysfunctions were assessed by a physician during the first 24 hours after the event; in the cardioembolic ictus and hemorrhagic ictus subtypes the percentage increased to 83,3 % and 100 % respectively. The totality of the hemorrhagic ictus, 40, 5 % of the ischemic ictus and only 2,3 % (1 case) of the transitory ischemic seizures were cause of admission. The arterial hypertension (OR-2.56; IC 95 % 1.209-4.815), the associated cardiac disease (OR-2.18; IC 95 % 1.195-4.012), the previous transitory ischemic stroke (OR-50,1; IC 95 % 24,037-104,542) and physical inactivity (OR-2,66; IC 95 % 1,023-6,945) were the main risk factors for the development of an ischemic ictus in the studied group.

Introducción: la enfermedad cerebrovascular constituye la tercera causa de muerte en adultos mayores de todo el mundo. Objetivo: caracterizar el comportamiento clínico, epidemiológico, aspectos del manejo y la asociación con factores de riesgo aterogénicos de la disfunción cerebral focal Vascular en adultos mayores. Materiales y Métodos: se realizó un estudio transversal, de base poblacional “puerta a puerta” en dos vertientes: una descriptiva para determinar la prevalencia, los factores de riesgo, subtipos clínicos y aspectos del manejo de la Disfunción cerebral focal vascular (DCFV) y otra vertiente analítica de casos y controles para establecer la asociación de riesgo en 901 ancianos de 65 años y más que viven en un área seleccionada del Policlínico Universitario “José Jacinto Milanés” de la ciudad de Matanzas, en el periodo comprendido de enero del 2003 a noviembre del 2006, como parte del proyecto de investigación internacional 10/66. Resultados: se obtuvo una tasa de prevalencia de DCFV de 12,9 % (116 ancianos/ 43 ATI y 73 ictus), predominando esta afección en las mujeres, las mayores de 80 años y los subtipos clínicos de ictus isquémico aterotrombótico y ataque transitorio de isquemia (ATI) carotideo. Solo el 29,3 % de las DCFV fueron valoradas por un médico en las primeras 24 h del evento; en los subtipos de ictus cardioembólico e ictus hemorrágico este por ciento se elevó a 83,3 % y 100 % respectivamente. Motivaron ingreso la totalidad de los ictus hemorrágicos, el 40,5 % de los ictus isquemicos y solo el 2,3 % (1 caso) de ATI. La HTA (OR-2.56; IC 95 % 1.209-4.815) la enfermedad cardiaca asociada (OR-2.18; IC 95 % 1.195-4.012), el ATI previo (OR-50,1; IC 95 % 24,037-104,542) y la inactividad física (OR-2,66; IC 95 % 1,023-6,945) constituyeron factores de riesgo para el desarrollo de un ictus isquémico en el grupo estudiado.

OBJETIVO: Em uma população miscigenada de cubanos idosos, estimamos a incidência de demência e a associação entre o genótipo da APOE e os fatores de risco sociodemográficos na incidência de demência. MÉTODOS: Realizamos uma pesquisa de uma fase (linha de base) de todos os idosos com mais de 65 anos residentes em sete áreas de Cuba (n=2944), de 2003 a 2007. O diagnóstico de demência foi estabelecido de acordo com os critérios do DSM-IV e do 10/66. O genótipo APOE foi determinado em 2520 participantes. Avaliação da incidência foi conduzida 4,5 anos após a linha de base, a fim de estimar a incidência e associações com fatores de risco sociodemográficos e o genótipo APOE ε4. RESULTADOS: A taxa de incidência de demência foi de 9,0 por 1000 pessoas-ano (IC 95% 7,2-11,3) de acordo com o DSM-IV e de 20,5 por 1000 pessoas-ano (IC 95%, 17,6-23,5) de acordo com o 10/66. Idade avançada, história familiar de demência e genótipo APOE ε4 foram fatores de risco independentes para a incidência de demência de acordo com os critérios do 10/66. O genótipo APOE foi associado com a prevalência de demência em estudo transversal, mas o efeito sobre a incidência de demência foi atenuado, e apenas aparente entre aqueles na faixa etária mais jovem. CONCLUSÃO: A incidência de demência na população cubana mais velha é relativamente alta, semelhante às relatadas na Europa e América do Norte. O estudo mostra que a relação entre APOE ε4 incidente e demência é mais forte entre os idosos mais jovens e que esta alteração deve de ser considerada em modelos de demência.

OBJECTIVE: In an admixed population of older Cubans, the incidence and association of APOE and socio demographic risk factors with dementia incidence was estimated. METHODS: A single-phase survey (baseline) of all over 65-year-olds residing in seven catchment areas in Cuba (n=2944) was conducted between 2003 and 2007. Dementia diagnosis was established according to DSM-IV and 10/66 criteria. APOE genotype was determined in 2520 participants. An incidence wave was conducted 4.5 years after cohort inception in order to estimate incidence and associations with sociodemographic risk factors of the APOE ε4 genotype. RESULTS: The incidence rate of DSM IV dementia was 9.0 per 1000 person-years (95% CI 7.2-11.3) and of 10/66 dementia was 20.5 per 1000 person-years (95% CI, 17.6-23.5). Older age, a family history of dementia and APOE ε4 genotype were independent risk factors for incident 10/66 dementia. APOE genotype was associated cross-sectionally with dementia prevalence, but the effect on the incidence of dementia was attenuated, and only apparent among those in the youngest age group. CONCLUSION: The incidence of dementia in the older Cuban population is relatively high and similar to levels reported in Europe and North-America. The study showed that the relationship between APOE ε4 and incident dementia is stronger in the younger-old than the older-old and that this change must be taken into account in models of dementia.

INTRODUCTION Population aging translates into more people with chronic non-communicable diseases, disability, frailty and dependency. The study of frailty-a clinical syndrome associated with an increased risk of falls, disability, hospitalization, institutionalization and death-is important to improve clinical practice and population health indicators. OBJECTIVES In a cohort of older adults in Havana and Matanzas provinces, Cuba, estimate prevalence of frailty and its risk factors; determine incidence of dependency; estimate mortality risk and identify mortality predictors. METHODS A prospective longitudinal study was conducted door to door, from June 2003 through July 2011, in a cohort of 2813 adults aged ≥65 years living in selected municipalities of Havana and Matanzas provinces; mean followup time was 4.1 years. Independent variables included demographics, behavioral risk factors and socioeconomic indicators, chronic non-communicable diseases (hypertension, stroke, dementia, depression, diabetes, anemia), number of comorbidities, and APOE ε4 genotype. Dependent variables were frailty, dependency and mortality. Criteria for frailty were slow walking speed, exhaustion, weight loss, low physical activity and cognitive decline. Prevalence and frailty risk were estimated by Poisson regression, while dependency and mortality risks and their predictors were determined using Cox regression. RESULTS Frailty syndrome prevalence was 21.6% (CI 17.9%-23.8%) at baseline; it was positively associated with advanced age, anemia and presence of comorbidities (stroke, dementia, depression, three or more physically debilitating diseases). Male sex, higher educational level, married or partnered status, and more household amenities were inversely associated with frailty prevalence. In followup, dependency incidence was 33.1 per 1000 person-years (CI 29.1-37.6) and mortality was 55.1 per 1000 person-years. Advanced age, male sex, lower occupational status during productive years, dependency, frailty, dementia, depression, cerebrovascular disease and diabetes were all associated with higher risk of death. CONCLUSIONS Given the challenge for developing countries presented by demographic and epidemiologic transition; the high prevalence in older adults of frailty syndrome, dependency and chronic non-communicable diseases; and the association of all these with higher mortality, attention should be targeted to older adults as a risk group. This should include greater social protection, age-appropriate health services, and modification and control of cardiovascular risk factors.

INTRODUCTION: Chronic non-communicable diseases are the leading cause of death worldwide, except in Sub-Saharan Africa. Nonetheless, one of these conditions, dementia, is the major contributor to disability-adjusted life years in people aged >60 years. Few epidemiological studies exist of the prevalence and impact of dementia and selected chronic diseases in older adults in Latin America. OBJECTIVE: Describe prevalence of dementia, other chronic vascular diseases and cardiovascular risk factors, as well as resulting disabilities and care needs generated in adults aged >65 years in Havana City and Matanzas provinces, Cuba. METHODS: The 10/66 study is a prospective longitudinal study involving a cohort of 3015 adults aged >65 years in municipalities of Havana City and Matanzas provinces, divided into two phases: a cross-sectional door-to-door study conducted in 2003-2006, and a follow-up and assessment phase in 2007-2010. This article reports findings from the first phase. Hypertension diagnosis was based on criteria from the International Society for Hypertension; diabetes mellitus on American Diabetes Association criteria; stroke according to WHO definitions; and dementia according to criteria of the American Psychiatric Society's Diagnostic and Statistical Manual of Mental Disorders DSM-IV and the 10/66 International Dementia Research Group. Ischemic heart disease was defined by self-report of previous physician diagnosis. Study variables included age, sex, educational level, substance use (alcohol, tobacco) and dietary habits. A structured physical and neurological exam, including blood pressure measurement, was performed on all participants. Laboratory tests included complete blood count, fasting blood glucose, total cholesterol and lipoprotein fractions, triglycerides and apolipoprotein E genotype. Prevalence and standardized morbidity ratios (crude and adjusted) were calculated for chronic diseases studied with 95% confidence intervals, using a Poisson regression model and indirect standardization. RESULTS: The study assessed 2944 older adults (response rate 97.6%) and found high prevalence of vascular risk factors and of chronic non-communicable diseases: hypertension 73.0% (95% CI 71.4-74.7), diabetes mellitus 24.8% (95% CI 22.9-26.5), ischemic heart disease 14.1% (95% CI 12.9-15.4), dementia 10.8% (95% CI 9.7-12.0) and stroke 7.8% (95% CI 6.9-8.8). The majority of participants (85%) had more than one cardiovascular risk factor. The main cause of disability and dependency in the study population was dementia. CONCLUSION: The high prevalence of chronic diseases observed in the elderly-with the consequent morbidity, disability and dependency-highlights the need for prevention, early diagnosis and risk factor control, particularly given the demographic and epidemiologic transition faced by Cuba and other developing countries.