Carmen Paredes-Manrique

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.

Background:The Rowland Universal Dementia Assessment Scale (RUDAS) is a validated cognitive screening tool for illiterate and low-educated individuals, adaptable across languages and cultures. In Peru, we adapted it for Quechua speakers (Q-RUDAS) to assess cognitive status in older adults. Objective: We aimed to estimate the prevalence of neurocognitive disorders—mild cognitive impairment (MCI) and dementia—among Quechua-speaking older adults in one of the most socially vulnerable districts of Peru using the Quechua version of the Rowland Universal Dementia Assessment Scale (Q-RUDAS), a brief cognitive screening tool validated in Peru. Methods: We studied 511 participants from Puno a region in the southern Peruvian Andes (mean age 65.04 ± 6.73 years; 80.4% females), collecting sociodemographic data and Q-RUDAS scores. After excluding 18 individuals with medical conditions that could affect cognitive performance, such as neurological, psychiatric, or cerebrovascular disorders, 493 completed the test. Results: All Q-RUDAS items were well understood, although over 50% of participants struggled with visuospatial construction. The mean Q-RUDAS score was 26.01 ± 2.71. Of the participants, 446 (90.5%) scored within normal ranges (26.67 ± 1.92), 41 (8.3%) were classified as having mild cognitive impairment (MCI) (21.49 ± 1.92), and 6 (1.2%) as having dementia (17.00 ± 2.71) based on established Q-RUDAS cut-offs. Urban participants scored higher. The prevalence of MCI and dementia combined was 9.52%. Conclusions: The Q-RUDAS is a culturally sensitive tool that can support the identification of cognitive impairment in Indigenous populations. Our findings highlight the need for further cross-validation studies to refine diagnostic accuracy in Quechua-speaking populations.

Alzheimer’s disease (AD) is a leading cause of dementia, characterized by multifactorial interactions involving genetic, inflammatory, and metabolic dysregulation. Insulin-like growth factor 1 (IGF-I) plays a critical role in maintaining brain homeostasis through neurogenesis, synaptogenesis, and neuroprotection. However, disruptions in IGF-I signaling have been implicated in hallmark AD processes such as beta-amyloid accumulation, glucose metabolism disturbances, oxidative stress, chronic inflammation, and neuronal death. This review aims to comprehensively analyze the mechanisms by which IGF-I influences AD pathology, emphasizing its potential as both an early detection biomarker and a therapeutic target. By synthesizing clinical and preclinical study findings, we explore how chronic stress, systemic inflammation, and lifestyle factors disrupt IGF-I pathways, accelerating cognitive and social impairments. Special attention is given to high-level cognitive processes, including executive functions and social cognition, which are particularly vulnerable to these disruptions. Highlighting the interplay between IGF-I, neuroinflammation, and stress, this work underscores the need for affordable and accessible diagnostic tools and therapeutic strategies. This review contributes to a deeper understanding of IGF-I’s multifaceted role in AD, offering new insights for addressing the growing global burden of dementia.

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.