ABSTRACT Introduction: COVID-19 has increased social distancing and the isolation of elderly people, which brings adverse effects to their physical and mental health. Objective: to study the influence of feelings of loneliness on Cuban elderly people’s mental health (depression, anxiety and sleep disorders) during the COVID-19 pandemic. Method: Observational study of 585 65 year old people and older ones included in the Aging and Alzheimer Longitudinal Study. The interviews were conducted from October 1 to November 30, 2020, during phase 3 of pandemic recovery in Havana province. The geriatric mental state (GMS) was used to identify feelings of loneliness, depression, anxiety and sleep disorders. Results: Was found a high prevalence of feelings of loneliness (29,7 %), depression (37,9 %), anxiety (20,9 %), and insomnia (28,9 %). Loneliness increased the probability of depression, OR= 5,37 (IC 95 % from 3,66 to 7,89), anxiety 0R = 3,60 (IC 95 % from 2,38 to 5,46) and insomnia OR = 2,88 (IC 95 %; from 1,97 to 4,22), the connection remaining significantly in the multivariate analysis. Conclusions. Social distancing and restriction measures during the COVID-19 pandemic have brought negative consequences on elderly people’s mental health and well-being. Further studies are necessary to identify risk factors and develop procedures to reduce the effects of social distancing on elderly people’s mental health in situations like the pandemic and also in periods of normalcy.

RESUMEN Introducción: La COVID-19 ha incrementado el distanciamiento social y el confinamiento de las personas mayores, lo cual tiene efectos adversos para su salud física y mental. Objetivo: estudiar la influencia sobre la salud mental (depresión, ansiedad y trastornos del sueño) de los sentimientos de soledad durante la actual pandemia por la COVID-19 en personas mayores cubanas. Métodos: Estudio observacional en 585 personas de 65 años y más procedentes del Estudio longitudinal Envejecimiento y Alzheimer. Las entrevistas se realizaron del 1 de octubre al 30 de noviembre del 2020, durante la fase 3 de recuperación de la pandemia en la provincia de La Habana. El estado mental geriátrico (GMS), se utilizó en la identificación de sentimientos de soledad, depresión, ansiedad y trastornos del sueño. Resultados: Se encontró una elevada prevalencia de sentimientos de soledad 29,7 %, depresión 37,9 %, ansiedad 20,9 % e insomnio 28,9 %. La soledad incrementó la probabilidad de depresión, OR = 5,37 (IC 95 % de 3,66 a 7,89), ansiedad OR = 3,60 (IC 95 % de 2,38 a 5,46) e insomnio OR = 2,88 (IC 95 %; de 1,97 a 4,22), manteniéndose la asociación de forma significativa en el análisis multivariado. Conclusiones: El aislamiento social y las medidas de restricción durante la pandemia por la COVID-19 han tenido consecuencias negativas en la salud mental y el bienestar de las personas mayores; se necesita continuar estudios que permitan identificar sus factores de riesgo y desarrollar intervenciones para disminuir los efectos del aislamiento social en la salud mental de las personas mayores en situaciones como la actual pandemia y en periodos de normalidad.

ABSTRACT Introduction: The existence of the SARS-CoV-2 coronavirus (COVID-19) represents an unprecedented health problem around the world, including people with dementia, their families and caregivers. Objectives: To study the characteristics of caregivers and care recipients as well as the burden among caregivers of people with dementia during the COVID-19 pandemic. Material and Methods: Prospective observational study. The universe comprised 3000 people aged 65 years who were selected by simple random sampling without replacement from the population based study of Aging and Alzheimer's Disease. Of them, 160 participants from Havana were evaluated at two different moments: in 2016 - 2018 and from October 1 to November 30, 2020. Results: The caregivers who were evaluated during the pandemic presented higher levels of stress or higher Zarit burden Interview scores (p=0,017) as well as a greater morbidity as measured by the General Health Questionnaire (p<0,0001) in relation to the study conducted in 2016-2018. Stress among caregivers was associated with the presence and severity of behavioral and psychological symptoms, OR = 1,02 (95 % CI 1.00-1.03); stages of dementia, OR = 1,61 (95 % CI, 1.45-1.76); greater care needs, OR = 1,56 (95 % CI, 1.14-2.77); fear of getting sick from COVID-19, OR = 1,52 (95 % CI, 1.11-4.12); insecurity about the future, OR = 1,26 (95 % CI, 1.04 -2.53) and job abandonment due to care, OR = 1,19 (95 % CI, 1.01-2.12). Conclusions: Our findings confirm that there is greater stress and burden among caregivers of people living with dementia during the COVID-19 pandemic and that there is a need to achieve coordinated actions in the national health system strategies aimed at supporting people with dementia and caregivers.

RESUMEN Introducción: La existencia del SARS-CoV-2 coronavirus (COVID-19) representa un problema de salud sin precedentes en todo el mundo, incluidas las personas con demencia, sus familias y cuidadores. Objetivo: Estudiar las características del cuidado y el grado de sobrecarga en cuidadores de personas con demencia durante la pandemia causada por la COVID-19. Material y Métodos: Estudio observacional prospectivo. El universo comprendió 3000 personas de 65 años seleccionadas por un muestreo aleatorio simple sin reposición procedentes del estudio poblacional Envejecimiento y Alzheimer, de ellas 160 participantes, residentes en La Habana fueron evaluados en dos momentos diferentes; 2016 - 2018 y del 1 de octubre al 30 de noviembre de 2020. Resultados: Los cuidadores evaluados durante la pandemia presentaron mayor estrés o sobrecarga según la escala de Zarit (p=0,017) y mayor morbilidad según el cuestionario general de salud (p<0,0001) en relación con el estudio realizado en 2016-2018. El estrés en los cuidadores se asoció con la presencia y severidad de los síntomas psicológicos y conductuales, OR=1.02 (IC 95 % 1,00-1,03), el estadio de la demencia OR= 1,61 (IC 95 %, 1,45-1,76), mayores necesidades de cuidados OR=1.56 (IC 95 %, 1.14-2.77), temor a enfermar por la COVID-19 OR= 1.52 (IC 95 %, 1.11-4.12), inseguridad en el futuro OR= 1,26 (IC 95 %, 1,04-2,53) y el abandono del trabajo por el cuidado OR= 1,19 (IC 95 %, 1,01-2,12). Conclusiones: Nuestros hallazgos confirman mayor estrés y sobrecarga en cuidadores de personas que viven con demencia durante la pandemia y la necesidad de una acción coordinada en las estrategias del sistema nacional de salud, dirigida a las personas con demencias y los cuidadores.

ABSTRACT INTRODUCTION Age-related cognitive disorders, including Alzheimer disease, are among the main causes of disability and dependence in older adults worldwide. High blood homocysteine levels (hyperhomocysteinemia) are a risk factor for diseases whose metabolism involves different B vitamins. Antioxidant vitamins provide a protective effect by mitigating oxidative stress generated by these diseases. Epidemiological studies have presented varying results on the relationships between blood levels of these vitamins and such cognitive disorders. OBJECTIVE Evaluate the association of vitamin and homocysteine levels with mild cognitive impairment and Alzheimer disease in a group of Cuban older adults. METHODS A cross-sectional study was conducted in Havana, Cuba, of 424 persons aged ≥65 years: 43 with Alzheimer disease, 131 with mild cognitive impairment, and 250 with no signs of cognitive impairment. Dementia was diagnosed using criteria of the International 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM IV), and mild cognitive impairment was diagnosed using Petersen’s criteria. Blood levels of vitamins (thiamine, B-2, folate, B-12, C and A) and homocysteine were measured by standard procedures. Analysis of variance for continuous variables and percentage comparison tests for dichotomous variables were used to compare groups. RESULTS Persons with Alzheimer disease presented significantly lower levels of vitamins B-2, C and A than healthy participants (p <0.05). Homocysteine levels were significantly higher in those with Alzheimer disease and mild cognitive impairment than in participants with no cognitive impairment (p <0.05). Statistically, levels of thiamine, folic acid, and vitamin B-12 were not significantly different across groups. Compared with those without cognitive impairment, prevalence rates (PR) in the Alzheimer group were significantly higher for hyperhomocysteinemia (PR = 3.26; 1.84–5.80) and deficiency of all B vitamins: thiamine (PR = 1.89; 1.04–3.43), B-2 (PR = 2.85; 1.54–5.26), folate (PR = 3.02; 1.53–5.95), B-12 (PR = 2.21; 1.17–4.19), vitamin C (PR = 3.88; 2.12–7.10) and A (PR = 5.47; 3.26–9.17). In mild cognitive impairment, prevalence rates were significantly higher for hyperhomocysteinemia (PR = 1.42; 1.08–1.87), vitamin B-2 deficiency (PR = 1.70; 1.24–2.32) and vitamin A deficiency (PR =1.88; 1.05–3.38). CONCLUSIONS Hyperhomocysteinemia and various vitamin deficiencies are related to Alzheimer disease and mild cognitive impairment. Longitudinal studies are needed to further elucidate the relationship between different nutritional biomarkers and dementia. A better understanding of this relationship could provide a basis for therapeutic and preventive strategies.

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.

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.

Introduction: The high blood pressure accounts for the 80% of death from cardiovascular and cerebrovascular disease in persons aged 65 and over. Objective: To determine the prevalence of the high blood pressure, the adherence to treatment and its control in elderly patients. Methods: A cross-sectional, descriptive and observational study was conducted in 1 216 elderly in four health areas selected from the Marianao and La Lisa municipalities from September, 2008 to September, 2009. Results: The adjusted high blood pressure prevalence was of 74,3% (95% CI 71,7-76,9) greater in female patients. The early detection of high blood pressure was higher to 70% in all polyclinics selected, but the adherence to treatment fluctuates between 47 and 68% and les than half of hypertensive ones were under control. Conclusions: To strength the primary health care to improve the high blood pressure care and control is the key in reduction of morbidity and mortality from cardiovascular diseases.

Introducción: La hipertensión arterial contribuye al 80 % de las muertes por enfermedad cardiovascular y cerebrovascular en la población de 65 años y más. Objetivo: Determinar la prevalencia de hipertensión arterial, adhesión al tratamiento y su control en adultos mayores. Métodos: Se realizó un estudio observacional descriptivo de corte transversal en 1 216 adultos mayores de 4 áreas de salud seleccionadas pertenecientes a los municipios Marianao y La Lisa, en el período de septiembre de 2008 a septiembre de 2009. Resultados: La prevalencia de hipertensión arterial ajustada fue de 74,3 (IC 95 % 71,7-76,9), con mayor prevalencia en las mujeres. La detección previa de hipertensión arterial resultó superior al 70 % en todos los policlínicos seleccionados, pero la adhesión al tratamiento osciló entre 47 y 68 %, y menos de la mitad de los hipertensos se encontraban controlados. Conclusiones: Fortalecer la atención primaria de salud para mejorar la atención y el control de la hipertensión arterial es clave en la reducción de la morbilidad y la mortalidad por enfermedades cardiovasculares.

During the 10/66 Study " Prevalence and risk factors of Dementia Syndrome and Alzheimer's Disease" in the policlinic Ana Betancourt of Playa Municipality, Havana city; we conducted a study based in the population which included 307 persons older than 65 years, selected by intentional randomized sampling; with the aim to estimate the prevalence of cognitive disorders and depression. The DSM IV, NINCDS, and ADRDA criteria were applied by the diagnostic algorithm 10/66, having, as a result, a low prevalence of minimal cognitive deterioration and Major Depression and High prevalence of demential Syndrome.

Durante el Estudio 10/66 "Prevalencia y factores de riesgo del Síndrome Demencial y la Enfermedad de Alzheimer "en el Policlínico Ana Betancourt del Municipio Playa en Ciudad de La Habana, se realizó una investigación basada en la población que incluyó una muestra comunitaria de 307 adultos, mayores de 65 años, seleccionados por muestreo intencional, con el objetivo de estimar la prevalencia del deterioro cognitivo y de depresión. Se aplicaron los criterios del DSM IV, del NINCDS y de la ADRDA mediante el algoritmo diagnostico 10/66, y se obtuvo como resultado una prevalencia baja de Trastorno Cognitivo Mínimo y de depresión Mayor y alta del Síndrome Demencial en la población estudiada.