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      Dementia caregiving across Latin America and the Caribbean and brain health diplomacy

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      , , , , , , , , , on behalf of the Multi-Partner Consortium to Expand Dementia Research in Latin America
      The Lancet. Healthy longevity

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          Abstract

          The prevalence of dementia in Latin America and the Caribbean is growing rapidly, increasing the burden placed on caregivers. Exacerbated by fragile health-care systems, unstable economies, and extensive inequalities, caregiver burden in this region is among the highest in the world. We reviewed the major challenges to caregiving in Latin America and the Caribbean, and we propose regional and coordinated actions to drive future change. Current challenges include the scarcity of formal long-term care, socioeconomic and social determinants of health disparities, gender-biased burdens, growing dementia prevalence, and the effect of the current COVID-19 pandemic on families affected by dementia. Firstly, we propose local and regional short-term strategic recommendations, including systematic identification of specific caregiver needs, testing of evidence-based local interventions, contextual adaptation of strategies to different settings and cultures, countering gender bias, strengthening community support, provision of basic technology, and better use of available information and communications technology. Additionally, we propose brain health diplomacy (ie, global actions aimed to overcome the systemic challenges to brain health by bridging disciplines and sectors) and convergence science as frameworks for long-term coordinated responses, integrating tools, knowledge, and strategies to expand access to digital technology and develop collaborative models of care. Addressing the vast inequalities in dementia caregiving across Latin America and the Caribbean requires innovative, evidence-based solutions coordinated with the strengthening of public policies.

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          Dementia prevention, intervention, and care

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            The global prevalence of dementia: a systematic review and metaanalysis.

            The evidence base on the prevalence of dementia is expanding rapidly, particularly in countries with low and middle incomes. A reappraisal of global prevalence and numbers is due, given the significant implications for social and public policy and planning. In this study we provide a systematic review of the global literature on the prevalence of dementia (1980-2009) and metaanalysis to estimate the prevalence and numbers of those affected, aged ≥60 years in 21 Global Burden of Disease regions. Age-standardized prevalence for those aged ≥60 years varied in a narrow band, 5%-7% in most world regions, with a higher prevalence in Latin America (8.5%), and a distinctively lower prevalence in the four sub-Saharan African regions (2%-4%). It was estimated that 35.6 million people lived with dementia worldwide in 2010, with numbers expected to almost double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050. In 2010, 58% of all people with dementia lived in countries with low or middle incomes, with this proportion anticipated to rise to 63% in 2030 and 71% in 2050. The detailed estimates in this study constitute the best current basis for policymaking, planning, and allocation of health and welfare resources in dementia care. The age-specific prevalence of dementia varies little between world regions, and may converge further. Future projections of numbers of people with dementia may be modified substantially by preventive interventions (lowering incidence), improvements in treatment and care (prolonging survival), and disease-modifying interventions (preventing or slowing progression). All countries need to commission nationally representative surveys that are repeated regularly to monitor trends. Copyright © 2013 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.
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              World-Wide FINGERS Network: A global approach to risk reduction and prevention of dementia

              Reducing the risk of dementia can halt the worldwide increase of affected people. The multifactorial and heterogeneous nature of late-onset dementia, including Alzheimer’s disease (AD), indicates a potential impact of multidomain lifestyle interventions on risk reduction. The positive results of the landmark multidomain Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) support such an approach. The World-Wide FINGERS (WW-FINGERS), launched in 2017 and including over 25 countries, is the first global network of multidomain lifestyle intervention trials for dementia risk reduction and prevention. WW-FINGERS aims to adapt, test, and optimize the FINGER model to reduce risk across the spectrum of cognitive decline—from at-risk asymptomatic states to early symptomatic stages—in different geographical, cultural, and economic settings. WW-FINGERS aims to harmonize and adapt multidomain interventions across various countries and settings, to facilitate data sharing and analysis across studies, and to promote international joint initiatives to identify globally implementable and effective preventive strategies.
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                Author and article information

                Journal
                101773309
                50162
                Lancet Healthy Longev
                Lancet Healthy Longev
                The Lancet. Healthy longevity
                2666-7568
                5 November 2021
                31 March 2021
                April 2021
                16 November 2021
                : 2
                : 4
                : e222-e231
                Affiliations
                Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA (Prof A Ibáñez PhD, S D Pina-Escudero MD, K L Possin PhD, F A Peres MS, Prof B L Miller MD); Global Brain Health Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland (Prof A Ibáñez, S D Pina-Escudero, K L Possin, F A Peres, Prof B L Miller); Latin American Brain Health Institute, Universidad Adolfo Ibáñez, Santiago, Chile (Prof A Ibáñez); Cognitive Neuroscience Center, Universidad San Andres, Buenos Aires, Argentina (Prof A Ibáñez); CONICET, Buenos Aires, Argentina (Prof A Ibáñez); Department of Neurology, Memory and Aging Center, University of California San Francisco, San Francisco, CA, USA (S D Pina-Escudero, K L Possin, Prof B L Miller); Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA (Y T Quiroz PhD); Geroscience Center for Brain Health and Metabolism, Memory and Neuropsychology Clinic, Neuropsychology and Clinical Neuroscience Laboratory, Physiopathology Department, and Neuroscience and East Neuroscience Department, Faculty of Medicine, University of Chile, Santiago, Chile (Prof A Slachevsky PhD); Neurology Service, Department of Medicine, Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago, Chile (Prof A Slachevsky); National Institute of Neurology and Neurosurgery Manuel Velasco Suaréz, Mexico City, Mexico (Prof A L Sosa PhD); Cognitive and Behavioral Neurology Unit, University of São Paulo, São Paulo, Brazil (Prof S M D Brucki PhD)
                Author notes

                Contributors

                AI designed the proposal. AI, SDP-E, KLP, and BLM wrote the first drafts, discussed contributions from all co-authors, and approved the final version. All authors participated in the elaboration of non-text elements. All authors searched the literature, participated in discussing the contents of the paper, contributed to editing, and approved the submission of the final version of the article.

                [*]

                Joint first authors

                [†]

                Equal senior contribution

                Correspondence to: Prof Agustin Ibáñez, Global Brain Health Institute, University of California San Francisco, San Francisco, CA 94143, USA, agustin.ibanez@ 123456gbhi.org
                Article
                NIHMS1753665
                10.1016/s2666-7568(21)00031-3
                8594860
                34790905
                21691f95-88ea-4e93-a2a9-9168dac15847

                This is an Open Access article under the CC BY-NC-ND 4.0 license.

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