From the School of Life Sciences (M.A.P.), Psychology, University Heriot-Watt; Human Cognitive Neuroscience (M.A.P.), Psychology, Edinburgh University; Alzheimer's Scotland Dementia Research Centre and Scottish Dementia Clinical Research Network (M.A.P.), Edinburgh; Centre for Cognitive Ageing and Cognitive Epidemiology (M.A.P., T.B.) and Department of Psychology, School of Philosophy, Psychology and Language Sciences (P.C., T.B.), University of Edinburgh, UK; Universidad Autónoma del Caribe (M.A.P., A.I.), Barranquilla, Colombia; Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) (S.B., F.M., A.I.); Institute of Translational and Cognitive Neuroscience (INCYT) (S.B., F.M., A.I.), INECO Foundation, Favaloro University, Buenos Aires, Argentina; Departamento de Psicología (S.B.) Universidad de los Andes, Bogotá, Colombia; Department of Cognitive Neurology and Neuropsychology (R.A.), Instituto de Investigaciones Neurológicas "Raúl Carrea" (FLENI) (R.A.), Buenos Aires, Argentina; Universidad de la Costa (CUC) (R.A.), Barranquilla, Colombia; Department of Neurology (R.N.), University of São Paulo Medical School, Brazil; Group of Neuroscience (F.L.), University of Antioquia, Medellín, Colombia; Geroscience Center for Brain Health and Metabolism (A.S.); Physiopathology Department, ICBM, and East Neuroscience Department, Faculty of Medicine (A.S.), and Center for Advanced Research in Education (CIAE) (A.S.), University of Chile; Cognitive Neurology and Dementia, Neurology Department (A.S.), Hospital del Salvador; Neurology Department, Clínica Alemana (A.S.), Santiago, Chile; Research Unit, Peruvian Institute of Neurosciences (N.C., D.L.) and Unit Cognitive Impairment and Dementia Prevention (N.C., D.L.), Lima, Peru; Brain and Mind Centre & School of Psychology (O.P., F.K.), Faculty of Science, University of Sydney; ARC Centre of Excellence in Cognition and its Disorders (O.P., F.K., F.M., A.I.), Sydney, Australia; Fraunhofer Chile (O.P., P.C.), Santiago; and Center for Social and Cognitive Neuroscience (CSCN), School of Psychology (D.H., A.I.), Universidad Adolfo Ibáñez, Santiago, Chile.
Neurology. 2018 Jan 30;90(5):222-231. doi: 10.1212/WNL.0000000000004897. Epub 2018 Jan 5.
The demographic structure of Latin American countries (LAC) is fast approaching that of developing countries, and the predicted prevalence of dementia in the former already exceeds the latter. Dementia has been declared a global challenge, yet regions around the world show differences in both the nature and magnitude of such a challenge. This article provides evidence and insights on barriers which, if overcome, would enable the harmonization of strategies to tackle the dementia challenge in LAC. First, we analyze the lack of available epidemiologic data, the need for standardizing clinical practice and improving physician training, and the existing barriers regarding resources, culture, and stigmas. We discuss how these are preventing timely care and research. Regarding specific health actions, most LAC have minimal mental health facilities and do not have specific mental health policies or budgets specific to dementia. In addition, local regulations may need to consider the regional context when developing treatment and prevention strategies. The support needed nationally and internationally to enable a smooth and timely transition of LAC to a position that integrates global strategies is highlighted. We focus on shared issues of poverty, cultural barriers, and socioeconomic vulnerability. We identify avenues for collaboration aimed to study unique populations, improve valid assessment methods, and generate opportunities for translational research, thus establishing a regional network. The issues identified here point to future specific actions aimed at tackling the dementia challenge in LAC.
拉美国家(LAC)的人口结构正迅速接近发展中国家,预计前者的痴呆症患病率已经超过后者。痴呆症已被宣布为全球性挑战,但世界各地在这一挑战的性质和规模上存在差异。本文提供了有关障碍的证据和见解,如果克服这些障碍,将能够协调策略,以应对 LAC 的痴呆症挑战。首先,我们分析了缺乏可用的流行病学数据、需要标准化临床实践和改善医生培训,以及资源、文化和污名方面存在的障碍。我们讨论了这些障碍如何阻碍了及时的护理和研究。关于具体的卫生行动,大多数 LAC 只有很少的心理健康设施,并且没有针对痴呆症的特定心理健康政策或预算。此外,在制定治疗和预防策略时,地方法规可能需要考虑到区域背景。本文强调了为使 LAC 顺利及时地过渡到整合全球战略的地位而在国家和国际层面提供支持的必要性。我们关注贫困、文化障碍和社会经济脆弱性等共同问题。我们确定了合作的途径,旨在研究独特的人群、改进有效的评估方法,并为转化研究创造机会,从而建立区域网络。这里确定的问题指出了未来针对 LAC 痴呆症挑战的具体行动。