Browsing by Author "Gonzalez, Cecilia"
Now showing 1 - 7 of 7
Results Per Page
Sort Options
Publication Cost-effectiveness of strategies using preventive interventions to protect infants in Chile from respiratory syncytial virus(2025) Bolanos, Rafael; Araos Bralic, Rafael Ignacio; Gonzalez, Cecilia; Sepulveda, Dino; Falconi, Juan; Averin, Ahuva; Atwood, Mark; Quinn, Erin; Law, Amy; Mendes, DianaBackground: Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract illness (LRTI; RSV-LRTI) among infants in Chile; young infants and infants born prematurely are at greatest risk. Research design and methods: A cohort model was developed to evaluate cost-effectiveness of strategies preventing RSV-LRTI in infants. Using the model, we calculated the economically justifiable price (EJP) of maternal RSVpreF vaccination (MV) versus no intervention and then evaluated the cost-effectiveness of MV (cost/dose assumed at EJP) with complementary use of monoclonal antibody nirsevimab for unprotected infants (MV+N) versus nirsevimab alone (NA) to prevent RSV-LRTI. Nirsevimab published price was $260.00; costs/prices reported in 2023 US$. Results: NA yielded 20,247 cases (hospital: 3,773, emergency ward: 16,474) and $57.2 million (M) in total costs (medical: $6.3 M, intervention: $48.7 M, indirect: $2.2 M). MV+N yielded 23,906 cases (hospital: 3,137, emergency ward: 20,769) and $28.7 M in costs (medical: $4.8 M, intervention: $21.7 M [RSVpreF assumed $75.77/dose; nirsevimab procured $260.00/dose], indirect: $2.2 M). With costs lower by $28.4 M and increased quality-adjusted life-years, MV+N would be cost-saving versus NA. Conclusions: RSVpreF vaccination among pregnant women along with nirsevimab for unprotected infants in Chile would be the most efficient use of resources, yielding substantial cost savings compared to use of nirsevimab alone. Trial registration: ClinicalTrials.gov NCT04424316 NCT03979313.Publication Educational disparities in brain health and dementia across Latin America and the United States(2024) Gonzalez, Raul; Legaz, Agustina; Moguilner, Sebastián; Cruzat, Josephine; Hernández, Hernán; Baez, Sandra; Cocchi, Rafael; Coronel, Carlos; Medel,Vicente; Tagliazuchi, Enzo; Migeot, Joaquín; Ochoa, Carolina; Maito, Marcelo; Reyes, Pablo; Santamaria, Hernando; Godoy, Maria; Javande, Shireen; García, Adolfo; Matallana, Diana; Avila, José; Slachevsky Chonchol, Andrea; Behrens, María; Custodio, Nilton; Cardona, Juan; Brusco, Ignacio; Bruno, Martín; Sosa, Ana; Pina, Stefanie; Takada, Leonel; França, Elisa; Valcour, Victor; Possin, Katherine; De Oliveira, Maira; Lopera, Francisco; Lawlor, Brian; Hu, Kun; Miller, Bruce; Yokoyama, Jennifer; Gonzalez, Cecilia; Ibañez, AgustinBackground: Education influences brain health and dementia. However, its impact across regions, specifically Latin America (LA) and the United States (US), is unknown. Methods: A total of 1412 participants comprising controls, patients with Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD) from LA and the US were included. We studied the association of education with brain volume and functional connectivity while controlling for imaging quality and variability, age, sex, total intracranial volume (TIV), and recording type. Results: Education influenced brain measures, explaining 24%-98% of the geographical differences. The educational disparities between LA and the US were associated with gray matter volume and connectivity variations, especially in LA and AD patients. Education emerged as a critical factor in classifying aging and dementia across regions. Discussion: The results underscore the impact of education on brain structure and function in LA, highlighting the importance of incorporating educational factors into diagnosing, care, and prevention, and emphasizing the need for global diversity in research. Highlights: Lower education was linked to reduced brain volume and connectivity in healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). Latin American cohorts have lower educational levels compared to the those in the United States. Educational disparities majorly drive brain health differences between regions. Educational differences were significant in both conditions, but more in AD than FTLD. Education stands as a critical factor in classifying aging and dementia across regions.Publication Functional Capacity in Activities of Daily Living in the Alzheimer’s Disease Continuum(2024) Henriquez, Fernando; Domínguez, Carmen; Grandi, Fabrissio; Gonzalez, Cecilia; Riquelme, Patricio; Lillo, Patricia; Martínez, David; Thumala, Daniela; Henriquez, Rodrigo; Aboitiz, Francisco; Slachevsky Chonchol, AndreaBackground The most common and prevalent dementia worldwide is Alzheimer’s disease (AD). AD is a continuum composed of Subjective Cognitive Impairment (SCD), Mild Cognitive Impairment (MCI), and Alzheimer’s Disease dementia (ADD) stage. One of the main clinical variables in patients with dementia is performance in functional capacity since its alterations are associated with poor prognosis and disease progression. Functional capacity is measured through activities of daily living (ADL), which are divided into three domains: i) Basic (BADL), ii) Instrumental (IADL), and iii) Advanced (AADL). The study aimed to characterize the performance of the different stages of the AD continuum in the ADL domains and their association with cognitive abilities. Method A cross-sectional study of subjects at different stages of the AD continuum was conducted: Healthy Controls (CTR) (n = 17), SCD (n = 77), MCI (n = 30), and ADD (n = 23), who were matched for age, sex, and education. ADLs were estimated using The Technology-Activities of Daily Living Questionnaire (T-ADLQ), which assesses the three domains and a total score. T-ADLQ performance was compared across groups and correlated with cognitive ability instruments (ACE-III and IFS). Result The results showed that patients with ADD performed worse on the BADL, IADL, and total ADLs compared to the other three groups. There were no significant differences between the CTR, SCD, and MCI on the BADL, IADL, and total ADLs. However, the AADL, in addition to differentiating the ADD patients from the other three groups, also showed differences between CTR and MCI subjects and between SCD and MCI subjects (Table 1 and Figure 1). The correlation study showed that AADL correlated significantly with global cognitive and executive function assessment (Figure 2). Conclusion AADL shows progressive functional impairment at different stages of the AD continuum, which is further associated with global cognitive and executive function performances. As one progresses to a more advanced stage of the disease continuum, the performance of ADLs, especially AADLs, worsens, which could indicate a marker of disease progression, allowing for better patient follow-up.Publication Multi-feature computational framework for combined signatures of dementia in underrepresented settings(2022) Moguilner, Sebastián; Birba, Agustina; Fittipaldi, Sol; Gonzalez, Cecilia; Tagliazucchi, Enzo; Reyes, Pablo; Matallana, Diana; Parra, Mario; Slachevsky Chonchol, Andrea; Farías, Gonzalo; Cruzat, Josefina; García, Adolfo; Eyre, Harris; La Joie, Renaud; Rabinovici, Gil; Whelan, Robert; Ibáñez, AgustínObjective.The differential diagnosis of behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) remains challenging in underrepresented, underdiagnosed groups, including Latinos, as advanced biomarkers are rarely available. Recent guidelines for the study of dementia highlight the critical role of biomarkers. Thus, novel cost-effective complementary approaches are required in clinical settings.Approach. We developed a novel framework based on a gradient boosting machine learning classifier, tuned by Bayesian optimization, on a multi-feature multimodal approach (combining demographic, neuropsychological, magnetic resonance imaging (MRI), and electroencephalography/functional MRI connectivity data) to characterize neurodegeneration using site harmonization and sequential feature selection. We assessed 54 bvFTD and 76 AD patients and 152 healthy controls (HCs) from a Latin American consortium (ReDLat).Main results. The multimodal model yielded high area under the curve classification values (bvFTD patients vs HCs: 0.93 (±0.01); AD patients vs HCs: 0.95 (±0.01); bvFTD vs AD patients: 0.92 (±0.01)). The feature selection approach successfully filtered non-informative multimodal markers (from thousands to dozens).Results. Proved robust against multimodal heterogeneity, sociodemographic variability, and missing data.Significance. The model accurately identified dementia subtypes using measures readily available in underrepresented settings, with a similar performance than advanced biomarkers. This approach, if confirmed and replicated, may potentially complement clinical assessments in developing countriesPublication Multivariate word properties in fluency tasks reveal markers of Alzheimer's dementia(2024) Ferrante, Franco J.; Migeot, Joaquín; Birba, Agustina; Amoruso, Lucía; Pérez, Gonzalo; Hesse, Eugenia; Tagliazucchi, Enzo; Estienne, Claudio; Serrano, Cecilia; Slachevsky, Andrea; Matallana, Diana; Reyes, Pablo; Ibáñez, Agustín; Fittipaldi, Sol; Gonzalez, Cecilia; García, Adolfo M.Introduction: Verbal fluency tasks are common in Alzheimer's disease (AD) assessments. Yet, standard valid response counts fail to reveal disease-specific semantic memory patterns. Here, we leveraged automated word-property analysis to capture neurocognitive markers of AD vis-à-vis behavioral variant frontotemporal dementia (bvFTD). Methods: Patients and healthy controls completed two fluency tasks. We counted valid responses and computed each word's frequency, granularity, neighborhood, length, familiarity, and imageability. These features were used for group-level discrimination, patient-level identification, and correlations with executive and neural (magnetic resonanance imaging [MRI], functional MRI [fMRI], electroencephalography [EEG]) patterns. Results: Valid responses revealed deficits in both disorders. Conversely, frequency, granularity, and neighborhood yielded robust group- and subject-level discrimination only in AD, also predicting executive outcomes. Disease-specific cortical thickness patterns were predicted by frequency in both disorders. Default-mode and salience network hypoconnectivity, and EEG beta hypoconnectivity, were predicted by frequency and granularity only in AD. Discussion: Word-property analysis of fluency can boost AD characterization and diagnosis. Highlights: We report novel word-property analyses of verbal fluency in AD and bvFTD. Standard valid response counts captured deficits and brain patterns in both groups. Specific word properties (e.g., frequency, granularity) were altered only in AD. Such properties predicted cognitive and neural (MRI, fMRI, EEG) patterns in AD. Word-property analysis of fluency can boost AD characterization and diagnosis.Publication Qualitative and quantitative educational disparities and brain signatures in healthy aging and dementia across global settings(2025) Gonzalez, Raul; Cruzat, Josephine; Hernández, Hernán; Migeot, Joaquín; Legaz, Agustina; Santamaria, Hernando; Fittipaldi, Sol; Maito, Marcelo; Medel, Vicente; Tagliazucchi, Enzo; Barttfeld, Pablo; Franco-O'Byrne, Daniel; Castro, Ana; Borquez, Patricio; Avila, José; Behrens, Maria Isabel; Custodio, Nilton; Farombi, Temitope; García, Adolfo; Garcia, Indira; Godoy, Maria; Gonzalez, Cecilia; Hu, Kun; Lawlor, Brian; Matallana, Diana; Miller, Bruce; Okada, Maira; Pina, Stefanie; França, Elisa de Paula; Reyes, Pablo; Slachevsky Chonchol, Andrea; Takada, Leonel; Yener, Görsev; Coronel, Carlos; Ibañez, AgustinBackground: While education is crucial for brain health, evidence mainly relies on individual measures of years of education (YoE), neglecting education quality (EQ). The effect of YoE and EQ on aging and dementia has not been compared. Methods: We conducted a cross-sectional assessment of the effect of EQ and YoE on brain health in 7533 subjects from 20 countries, including healthy controls (HCs), Alzheimer's disease (AD), and frontotemporal lobar degeneration (FTLD). EQ was based on country-level quality indicators provided by the programme for international student assessment (PISA). After applying neuroimage harmonization, we examined its effect, along with YoE, on gray matter volume and functional connectivity. Regression models were adjusted for age, sex, and cognition, controlling for multiple comparisons. The influence of image quality was assessed through sensitivity analysis. Data collection was conducted between June 1 and October 30, 2024. Findings: Less EQ and YoE were associated with brain alterations across groups. However, EQ had a stronger influence, mainly targeting the critical areas of each condition. At the whole-brain level, EQ influenced volume (HCs: Δmean = 2·0 [1·9-2·0] × 10-2, p < 10-5; AD: Δmean = 0·1 [-0·0 to 0·3] × 10-2, p = 0·18; FTLD: Δmean = 3·5 [3·0-4·0] × 10-2, p < 10-5; all with 95% confidence intervals) and networks (HCs: Δmean = 13·5 [13·2-13·7] × 10-2, p < 10-5; AD: Δmean = 5·9 [5·2-6·7] × 10-2, p < 10-5; FTLD: Δmean = 13·2 [11·2-13·7] × 10-2, p < 10-5) 1·3 to 7·0 times more than YoE. These effects remain robust despite variations in income and socioeconomic factors at country and individual levels. Interpretation: The results support the need to incorporate education quality into studying and improving brain health, underscoring the importance of country-level measures. Funding: Multi-partner consortium to expand dementia research in Latin America (ReDLat).Publication White matter hyperintensities and their impact in brain structure and function in alzheimer's disease and behavioral variant frontotemporal dementia across Latin America and the United States: a cross-sectional study(2025) Altschuler, Florencia; Canziani, Verónica; Fraile, Matías; Gonzalez, Raul; Hernández, Hernán; Baez, Sandra; Migeot, Joaquín; Fittipaldi, Sol; Maito, Marcelo; Legaz, Agustina; Godoy, Maria; Moguilner, Sebastián; Cruzat, Josephine; Coronel, Carlos; Tagliazucchi, Enzo; Santamaria, Hernando; Reyes, Pablo; Matallana, Diana; Avila, José; Slachevsky Chonchol, Andrea; Behrens, María; Custodio, Nilton; Cardona, Juan; Brusco, Luis; Bruno, Martin; Sosa, Ana; Pina, Stefanie; Takada, Leonel; Franca, Elisa de Paula; Possin, Katherine; De Oliveira, Maira; Hu, Kun; Lawlor, Brian; Yokoyama, Jennifer; Miller, Bruce; Lopera, Francisco; Martin, Adolfo; Medel, Vicente; Ibañez, Agustin; Gonzalez, CeciliaBackground: White matter hyperintensities (WMHs) are a core manifestation of normal and pathological aging and are potentially linked to geographical differences in social and physical exposomes. Previous studies have not examined the impact of WMHs burden on neurodegeneration and cognition in healthy controls (HCs) and patients with Alzheimer's disease (AD) and behavioral variant frontotemporal dementia (bvFTD) across geographic regions. This study addressed this gap by assessing the impact of WMHs burden on participants with and without dementia from Latin America (LA) and the United States (US). Methods: The study comprised 994 participants, including HCs (n = 402), AD (n = 359), and bvFTD subjects (n = 233) from LA and the US. WMHs and their association with grey matter (GM) atrophy, assessed through GM volume and cortical thickness, were evaluated and compared among groups (HCs, AD, and bvFTD) in LA and the US using a voxel-wise brain imaging approach (p < 0.05 family-wise error-corrected for multiple comparisons, minimum cluster size = 50 voxels). Multiple regressions analysis were employed to examine geographic differences in WMHs burden, WMHs-GM associations, and the effect of WMHs on cognitive performance, as assessed by the Mini-Mental State examination. Results: In the LA cohort only, higher WMHs load was associated with greater GM atrophy across all groups (HCs, AD, bvFTD), with a specific neurodegenerative pattern involving orbitofrontal, cingulate, and temporal areas. HCs from LA showed a greater WMHs load than their US counterparts, and this effect was dependent on GM atrophy. Finally, WMHs burden negatively impacted cognitive performance in dementia subjects, with a greater effect observed in bvFTD subjects from the US. Conclusion: WMHs have a more pronounced impact on neurodegeneration across the LA cohort, with a worse impact on HCs, which also show higher WMHs burden than their US counterparts. This could increase the risk of developing dementia. Moreover, WMHs burden differentially impacts cognition, with a greater negative effect observed in bvFTD subjects from the US. These findings highlight geographic variations in WMHs-related conditions, offering valuable insights for tailored future research.