Kuripacha Tituana

Introduction: Social determinants of health shape dementia risk in Latin America, particularly in rural and Indigenous populations. Methods: This cross-sectional study examined cognitive impairment and associated social factors in 75 adults aged 60 years or older in Cotacachi, Ecuador, identifying as Indigenous, Mestizo, or Other. Cognition was assessed with the RUDAS using education-adjusted cutoffs, alongside daily functioning and depression. Results: Cognitive impairment affected 22.7% and was more frequent among Indigenous participants. Limited early education emerged as a key social factor. In adjusted analyses, older age and depression were associated with impairment, whereas vascular conditions were not; ethnicity could not be disentangled from rurality. Discussion: These findings suggest that observed ethnic differences are embedded within structural inequalities, particularly educational and territorial disadvantage, supporting dementia prevention strategies addressing social inequities and mental health in rural Andean communities.

The rising prevalence of dementia, particularly in low-income and developing countries, highlights the urgent need for effective cognitive screening tools. However, the existing tools often fail to address the unique needs of low-educated and illiterate populations, leading to diagnostic disparities. This review aimed to evaluate cognitive screening tests and domains employed globally to detect mild cognitive impairment (MCI) and dementia in low-educated and illiterate older adults. Following the PRISMA guidelines, Searches were performed in Web of Science, Scopus, and PubMed, targeting studies from January 2000 to 2023 involving adults over 45 years old. Of 1611 studies identified, 27 met the inclusion criteria and underwent pair review. The results revealed that most studies preferred adapting the existing tools to local languages over developing culturally tailored instruments. Twelve cognitive tests specifically designed for low-educated populations were identified, with the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) being the most utilized, despite their educational biases. Adjusting the cutoff points improved detection (e.g., MoCA: sensitivity 82.5%, specificity 82%). Notably, the Rowland Universal Dementia Assessment Scale (RUDAS) demonstrated superior performance for low-educated groups (sensitivity 89% and specificity 93%). The findings underscore the critical need for region-specific cognitive batteries that integrate functional assessments, ensuring equitable and accurate diagnosis across diverse educational backgrounds.