Browsing by Author "Slachevsky, Andrea"
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Item Affective Style and Eating Disorders: a Field Study(2011) Silva, Jaime R.; Ortiz, Manuel; Quiñones, Álvaro; Vera-Villarroel, Pablo; Slachevsky, AndreaEating disorders (ED) are a heterogeneous group of problems related to restraint and/or overeating. It is proposed that individual differences in affective reactivity and moods (affective style) might be related to these behaviours. Variations in affective style are expressed by differing levels of sensitivity to the motivation systems of approach and avoidance. The present study tested whether a relation exists between ED and variations in the sensitivity of motivational systems as well as mood dispositions. A total of 2020 undergraduate students completed the Eating Disorder Diagnostic Scale (EDDS), the Behavioural Inhibition System and Behavioural Activation System Scales (BIS/BAS), and the Positive and Negative Affect Schedule (PANAS). The results showed a significant within-subject interaction of Alimentary group x Motivation (F=4.056; p<0.007). It was also observed that the Overeating group had lower levels of motivation asymmetry than the Normal (p<0.01) and Restrictive (p<0.005) groups and marginally lower levels than the Purgative group (p<0.07). The study results suggest mainly that the avoidance/inhibition motivational system is related to eating problems connected with overeating, including chronic alimentary restraint (chronic dieters). The theoretical and clinical implications of these findings are discussed. (Eating Weight Disord. 16: e73-e80, 2011). (C)2011, Editrice KurtisItem Aging and health policies in chile: New Agendas for research(2017) Thumala, Daniela; Kennedy, Brian K; Calvo, Esteban; Gonzalez-Billault, Chriastian; Zitko, Pedro; Lillo, Patricia; Villagra, Roque; Ibáñez, Agustín; Assar, Rodrigo; Andrade, Maricarmen; Slachevsky, AndreaPopulation aging is among the most important global transformations. Compared to European and North American countries, Chile is among the countries with the fastest growth of life expectancy at birth during recent decades. The aging of Chile's population is related to the improvement of living conditions, but also entails risks that tend to be associated with a rapid economic growth accompanied by large income inequalities and a chronic deficit of basic social benefits. The rapid demographic transition towards an aged population has unfolded in a context of poor development of public policies to tackle the opportunities and needs associated with an aging society. This article provides a brief overview of current Chilean public policy on aging, with a focus on healthy aging as defined by World Health Organization. The discussion addresses core challenges to successfully achieve healthy aging in Chile.Publication Apathy, Executive Function, and Emotion Recognition Are the Main Drivers of Functional Impairment in Behavioral Variant of Frontotemporal Dementia(2022) Musa, Gada; Lillo, Patricia; Van der Hiele, Karin; Méndez, Carolina; Ibáñez, Agustín; Slachevsky, AndreaBackground: The cognitive and neuropsychiatric deficits present in patients with behavioral variant frontotemporal dementia (bvFTD) are associated with loss of functionality in the activities of daily living (ADLs). The main purpose of this study was to examine and explore the association between the cognitive and neuropsychiatric features that might prompt functional impairment of basic, instrumental, and advanced ADL domains in patients with bvFTD. Methods: A retrospective cross-sectional study was conducted with 27 patients with bvFTD in its early stage (<2 years of evolution) and 32 healthy control subjects. A neuropsychological assessment was carried out wherein measures of cognitive function and neuropsychiatric symptoms were obtained. The informant-report Technology-Activities of Daily Living Questionnaire was used to assess the percentage of functional impairment in the different ADL domains. To identify the best determinants, three separate multiple regression analyses were performed, considering each functional impairment as the dependent variable and executive function, emotion recognition, disinhibition, and apathy as independent variables. Results: For the basic ADLs, a model that explains 28.2% of the variability was found, in which the presence of apathy (β = 0.33, p = 0.02) and disinhibition (β = 0.29, p = 0.04) were significant factors. Concerning instrumental ADLs, the model produced accounted for 63.7% of the functional variability, with the presence of apathy (β = 0.71, p < 0.001), deficits in executive function (β = -0.36, p = 0.002), and lack of emotion recognition (β = 0.28, p = 0.017) as the main contributors. Finally, in terms of advanced ADLs, the model found explained 52.6% of the variance, wherein only the presence of apathy acted as a significant factor (β = 0.59, p < 0.001). Conclusions: The results of this study show the prominent and transverse effect of apathy in the loss of functionality throughout all the ADL domains. Apart from that, this is the first study that shows that the factors associated with loss of functionality differ according to the functional domain in patients with bvFTD in its early stage. Finally, no other study has analyzed the impact of the lack of emotion recognition in the functionality of ADLs. These results could guide the planning of tailored interventions that might enhance everyday activities and the improvement of quality of life.Publication Automated text-level semantic markers of Alzheimer’s disease(2022) Sanz, Camila; Carrillo, Facundo; Slachevsky, Andrea; Forno, Gonzalo; Gorno, Maria; Villagra, Roque; Ibáñez, Agustín; Tagliazucch, Enzo; García, AdolfoIntroduction Automated speech analysis has emerged as a scalable, cost‐effective tool to identify persons with Alzheimer's disease dementia (ADD). Yet, most research is undermined by low interpretability and specificity. Methods Combining statistical and machine learning analyses of natural speech data, we aimed to discriminate ADD patients from healthy controls (HCs) based on automated measures of domains typically affected in ADD: semantic granularity (coarseness of concepts) and ongoing semantic variability (conceptual closeness of successive words). To test for specificity, we replicated the analyses on Parkinson's disease (PD) patients. Results Relative to controls, ADD (but not PD) patients exhibited significant differences in both measures. Also, these features robustly discriminated between ADD patients and HC, while yielding near‐chance classification between PD patients and HCs. Discussion Automated discourse‐level semantic analyses can reveal objective, interpretable, and specific markers of ADD, bridging well‐established neuropsychological targets with digital assessment tools.Item Dementia in Latin America: Epidemiological Evidence and Implications for Public Policy(Frontiers Research Foundation, 2017) Custodio, Nilton; Wheelock, Ana; Thumala, Daniela; Slachevsky, AndreaPopulation aging is among the most important global transformations. Today, 12% of the world population is of age 60 and over and by the middle of this century this segment will represent 21.5%. The increase in population of those aged 80 and over, also referred to as the “oldest old” or the “very elderly”, will be even more pronounced, going from 1.7% of the population to 4.5% within the same period. Compared to European and North American countries, Latin America (LA) is experiencing this unprecedented demographic change at a significantly faster rate. Due to demographic and health transitions, the number of people with dementia will rise from 7.8 million in 2013 to over 27 million by 2050. Nowadays, the global prevalence of dementia in LA has reached 7.1%, with Alzheimer’s Disease (AD) being the most frequent type. This level is similar to those found in developed countries; however, the dementia rate is twice as high as that of the 65–69 years age group in developed countries. In addition, the prevalence and incidence of dementia is higher among illiterate people. Mortality rates due to dementia have risen considerably. The burden and costs of the disease are high and must be covered by patients’ families. The prevention of dementia and the development of longterm care policies and plans for people with dementia in LA, which take into account regional differences and similarities, should be urgent priorities.Item Evaluating the reliability of neurocognitive biomarkers of neurodegenerative diseases across countries: A machine learning approach(2020) Bachli, M. Belen; Sedeno, Lucas; Ochab, Jeremi K.; Piguet, Olivier; Kumfor, Fiona; Reyes, Pablo; Torralva, Teresa; Roca, María; Cardona, Juan Felipe; Gonzalez Campo, Cecilia; Herrera, Eduar; Slachevsky, Andrea; Matallana, Diana; Manes, Facundo; García, Adolfo M.; Ibanez, Agustín; Chialvo, Dante R.Accurate early diagnosis of neurodegenerative diseases represents a growing challenge for current clinical practice. Promisingly, current tools can be complemented by computational decision-support methods to objectively analyze multidimensional measures and increase diagnostic confidence. Yet, widespread application of these tools cannot be recommended unless they are proven to perform consistently and reproducibly across samples from different countries. We implemented machine-learning algorithms to evaluate the prediction power of neurocognitive biomarkers (behavioral and imaging measures) for classifying two neurodegenerative conditions –Alzheimer Disease (AD) and behavioral variant frontotemporal dementia (bvFTD)– across three different countries (>200 participants). We use machine-learning tools integrating multimodal measures such as cognitive scores (executive functions and cognitive screening) and brain atrophy volume (voxel based morphometry from fronto-temporo-insular regions in bvFTD, and temporo-parietal regions in AD) to identify the most relevant features in predicting the incidence of the diseases. In the Country-1 cohort, predictions of AD and bvFTD became maximally improved upon inclusion of cognitive screenings outcomes combined with atrophy levels. Multimodal training data from this cohort allowed predicting both AD and bvFTD in the other two novel datasets from other countries with high accuracy (>90%), demonstrating the robustness of the approach as well as the differential specificity and reliability of behavioral and neural markers for each condition. In sum, this is the first study, across centers and countries, to validate the predictive power of cognitive signatures combined with atrophy levels for contrastive neurodegenerative conditions, validating a benchmark for future assessments of reliability and reproducibilityItem From Snapshots to Movies: The Association Between Retirement Sequences and Aging Trajectories in Limitations to Perform Activities of Daily Living(2019) Azar, Ariel; Standinger, Ursula; Slachevsky, Andrea; Madero-Cabib, Ignacio; Calvo, EstebanObjective: This study analyzes the dynamic association between retirement sequences and activities of daily living (ADLs) trajectories between ages 60 and 70. Method: Retirement sequences previously established for 7,880 older Americans from the Health and Retirement Study were used in hierarchical linear and propensity score full matching models, analyzing their association with ADL trajectories. Results: Sequences of partial retirement from full- or part-time jobs showed higher baseline and slower decline in ADL than sequences characterized by early labor force disengagement. Discussion: The conventional model in which people completely retire from a full-time job at normative ages and the widely promoted new conventional model of late retirement are both associated with better functioning than early labor force disengagement. But unconventional models, where older adults keep partially engaged with the labor force are also significantly associated with better functioning. These findings call attention to more research on potential avenues to simultaneously promote productive engagement and health later in life.Item Fronto-Subcortical Circuits for Cognition and Motivation: Dissociated Recovery in a Case of Loss of Psychic Self-Activation(Frontiers Ed., 2019-01) Riveros, Rodrigo; Bakchine, Serge; Pillon, Bernard; Poupon, Fabrice; Miranda, Marcelo; Slachevsky, AndreaIn humans and non-humans primates, extensive evidence supports the existence of subcortico-cortical circuits for cognition and behavior. Lesions studies are critical to understand the clinical significance of these functionally segregated circuits. Mapping these circuits from lesion studies is difficult given the heterogeneous etiology of the lesions, the lack of long-term and systematic testing of cognitive and behavioral disturbances, as well as the scarcity of neuroimaging data for identifying the precise location and extent of subcortical lesions. Here, we report the long-term follow-up study of a patient who developed a loss of psychic self-activation associated to a dysexecutive syndrome following resuscitation from cardiac arrest. Neuroimaging revealed extensive bilateral lesions in the putamen, with a relative spare of the caudate, and exhibiting a dorsoventral gradient that was predominantly rostrally to the anterior commissure and spared most of the ventral striatum. In comprehensive neuropsychological and neuropsychiatric assessments, we observed dissociation between the improvement of the self-activation deficits and the stability of the dysexecutive syndrome. The pattern of recovery after this lesion lends support to current models proposing the existence of two main subcortico-cortical circuits: a dorsal circuit, mostly mediating cognitive processes, and a ventral circuit, implicated in motivation.Item GERO Cohort Protocol, Chile, 2017-2022: Community-based Cohort of Functional Decline in Subjective Cognitive Complaint elderly(2020) Slachevsky, Andrea; Zitko, Pedro; Martínez-Pernía, David; Forno, Gonzalo; Court, Felipe A; Lillo, Patricia; Villagra, Roque; Duran-Aniotz, Claudia; Parrao, Teresa; Assar, Rodrigo; Orellana, Paulina; Toledo, Carolina; Rivera, Rodrigo; Ibañez, Agustín; Parra, Mario A; Christian González-Billault, Christian; Amieva, Helena; Thumala, DanielaBackground: With the global population aging and life expectancy increasing, dementia has turned a priority in the health care system. In Chile, dementia is one of the most important causes of disability in the elderly and the most rapidly growing cause of death in the last 20 years. Cognitive complaint is considered a predictor for cognitive and functional decline, incident mild cognitive impairment, and incident dementia. The GERO cohort is the Chilean core clinical project of the Geroscience Center for Brain Health and Metabolism (GERO). The objective of the GERO cohort is to analyze the rate of functional decline and progression to clinical dementia and their associated risk factors in a community-dwelling elderly with subjective cognitive complaint, through a population-based study. We also aim to undertake clinical research on brain ageing and dementia disorders, to create data and biobanks with the appropriate infrastructure to conduct other studies and facilitate to the national and international scientific community access to the data and samples for research. Methods: The GERO cohort aims the recruitment of 300 elderly subjects (> 70 years) from Santiago (Chile), following them up for at least 3 years. Eligible people are adults not diagnosed with dementia with subjective cognitive complaint, which are reported either by the participant, a proxy or both. Participants are identified through a household census. The protocol for evaluation is based on a multidimensional approach including socio-demographic, biomedical, psychosocial, neuropsychological, neuropsychiatric and motor assessments. Neuroimaging, blood and stool samples are also obtained. This multidimensional evaluation is carried out in a baseline and 2 follow-ups assessments, at 18 and 36 months. In addition, in months 6, 12, 24, and 30, a telephone interview is performed in order to keep contact with the participants and to assess general well-being. Discussion: Our work will allow us to determine multidimensional risks factors associated with functional decline and conversion to dementia in elderly with subjective cognitive complain. The aim of our GERO group is to establish the capacity to foster cutting edge and multidisciplinary research on aging in Chile including basic and clinical research.Item Health conditions and unmet needs for assistance to perform activities of daily living among older adults with dementia in Chile(2018) Zhou, Yi; Slachevsky, Andrea; Calvo, EstebanObjective:This study aims to address gaps in health conditions and unmet needs in dailyactivities between people with dementia (PWD) and without dementia in a developing countryand to identify the variables associated with unmet needs among PWD to guide practitionersand policymakers in dealing with an increased burden of dementia.Methods:Nationally representative data on 4655 Chileans age 60 and over were used tocompare health conditions and unmet needs in daily life activities between individuals with(N = 455, 9.6%) and without dementia. Regression analysis was conducted to identify the vari-ables associated with unmet needs among PWD.Results:Overall, PWD had worse health and needed greater assistance in performing dailyactivities than people without dementia. Among PWD, being male was associated with moreunmet needs, in both activities of daily living (ADL) and instrumental ADL. Lower educationallevel and fewer caregivers were associated with more unmet needs for ADL, while inferior func-tional ability was associated with more unmet needs for instrumental ADL.Conclusions:The results from this study call for action by practitioners and policymakers tofoster caregiver training, increase supportive services, and advance care planning for PWDItem Mapping the neuroanatomy of functional decline in Alzheimer's disease from basic to advanced activities of daily living(Springer Nature, 2019-06) Slachevsky, Andrea; Forno, Gonzalo; Barraza, Paulo; Mioshi, Eneida; Delgado, Carolina; Lillo, Patricia; Henríquez, Fernando; Bravo, Eduardo; Farias, Mauricio; Muñoz-Neira, Carlos; Ibáñez, Agustín; Parra, Mario; Hornberger, MichaelBackground: Impairments in activities of daily living (ADL) are a criterion for Alzheimer's disease (AD) dementia. However, ADL gradually decline in AD, impacting on advanced (a-ADL, complex interpersonal or social functioning), instrumental (IADL, maintaining life in community), and finally basic functions (BADL, activities related to physiological and self-maintenance needs). Information and communication technologies (ICT) have become an increasingly important aspect of daily functioning. Yet, the links of ADL, ICT, and neuropathology of AD dementia are poorly understood. Such knowledge is critical as it can provide biomarker evidence of functional decline in AD. Methods: ADL were evaluated with the Technology-Activities of Daily Living Questionnaire (T-ADLQ) in 33 patients with AD and 30 controls. ADL were divided in BADL, IADL, and a-ADL. The three domain subscores were covaried against gray matter atrophy via voxel-based morphometry. Results: Our results showed that three domain subscores of ADL correlate with several brain structures, with a varying degree of overlap between them. BADL score correlated mostly with frontal atrophy, IADL with more widespread frontal, temporal and occipital atrophy and a-ADL with occipital and temporal atrophy. Finally, ICT subscale was associated with atrophy in the precuneus. Conclusions: The association between ADL domains and neurodegeneration in AD follows a traceable neuropathological pathway which involves different neural networks. This the first evidence of ADL phenotypes in AD characterised by specific patterns of functional decline and well-defined neuropathological changes. The identification of such phenotypes can yield functional biomarkers for dementias such as AD.Publication Multidimensional Clinical Assessment in Frontotemporal Dementia and Its Spectrum in Latin America and the Caribbean: A Narrative Review and a Glance at Future Challenges(2022) Henríquez, Fernando; Cabello, Victoria; Baez, Sandra; Cruz de Souza, Leonardo; Lillo, Patricia; Martínez, David; Olavarría, Loreto; Torralva, Teresa; Slachevsky, AndreaFrontotemporal dementia (FTD) is the third most common form of dementia across all age groups and is a leading cause of early-onset dementia. The Frontotemporal dementia (FTD) includes a spectrum of diseases that are classified according to their clinical presentation and patterns of neurodegeneration. There are two main types of FTD: behavioral FTD variant (bvFTD), characterized by a deterioration in social function, behavior, and personality; and primary progressive aphasias (PPA), characterized by a deficit in language skills. There are other types of FTD-related disorders that present motor impairment and/or parkinsonism, including FTD with motor neuron disease (FTD-MND), progressive supranuclear palsy (PSP), and corticobasal syndrome (CBS). The FTD and its associated disorders present great clinical heterogeneity. The diagnosis of FTD is based on the identification through clinical assessments of a specific clinical phenotype of impairments in different domains, complemented by an evaluation through instruments, i.e., tests and questionnaires, validated for the population under study, thus, achieving timely detection and treatment. While the prevalence of dementia in Latin America and the Caribbean (LAC) is increasing rapidly, there is still a lack of standardized instruments and consensus for FTD diagnosis. In this context, it is important to review the published tests and questionnaires adapted and/or validated in LAC for the assessment of cognition, behavior, functionality, and gait in FTD and its spectrum. Therefore, our paper has three main goals. First, to present a narrative review of the main tests and questionnaires published in LAC for the assessment of FTD and its spectrum in six dimensions: (i) Cognitive screening; (ii) Neuropsychological assessment divided by cognitive domain; (iii) Gait assessment; (iv) Behavioral and neuropsychiatric symptoms; (v) Functional assessment; and (vi) Global Rating Scale. Second, to propose a multidimensional clinical assessment of FTD in LAC identifying the main gaps. Lastly, it is proposed to create a LAC consortium that will discuss strategies to address the current challenges in the field.Item Neuroanatomical Comparison of the "Word" and "Picture" Versions of the Free and Cued Selective Reminding Test in Alzheimer's Disease(2018) Slachevsky, Andrea; Barraza, Paulo; Hornberger, Michael; Muñoz, Carlos; Flanagan, Emma; Henríquez, Fernando; Bravo, Eduardo; Farías, Mauricio; Delgado, CarolinaEpisodic memory tests with cued recall, such as the Free and Cued Selective Reminding Test (FCSRT), allow for the delineation of hippocampal and prefrontal atrophy contributions to memory performance in Alzheimer’s disease (AD). Both Word and Picture versions of the test exist but show different profiles, with the Picture version usually scoring higher across different cohorts. One possible explanation for this divergent performance between the different modality versions of the test might be that they rely on different sets of neural correlates. The current study explores this by contrasting the neural correlates of the Word and Picture versions of the FCSRT with voxel-based morphometry (VBM) in AD and healthy subjects. We predicted that the Picture version would be associated with different cortical regions than the Word version, which might be more hippocampal-centric. When comparing 35 AD patients and 34 controls, AD patients exhibited impairments on both versions of the FCSRT and both groups performed higher in the Picture version. A region of interest analysis based on prior work revealed significant correlations between free recall of either version with atrophy of the temporal pole and hippocampal regions. Thus, contrary to expectations, performance on both the Word and the Picture version of the FCSRT is associated with largely overlapping networks. Free recall is associated with hippocampal volume and might be properly considered as an indicator of hippocampal structural integrity.Publication Population attributable fraction of modifiable risk factors for dementia in Chile(2022) Vergara, Rodrigo; Zitko, Pedro; Slachevsky, Andrea; San Martin, Consuelo; Delgado, CarolinaIntroduction: Projected dementia incidence in Latin America and the Caribbean for the next decades is overwhelming. Access to local data, stratified by sex, is imperative for planning precise dementia-prevention strategies. Methods: We analyzed the individual and overall weighted population attributable fraction (PAF) of nine modifiable risk factors for dementia, in dementia-free subjects ≥45-years-old, using the 2016-2017 Chilean National Health Survey. Results: The overall weighted PAF for modifiable risk factors was 45.8% (42.2% to 49.3%). Variables with the highest PAF were lower education, high blood pressure, hearing loss, and obesity. Women showed a greater overall weighted PAF: 50.7% (45.3% to -56.1%), compared to men: 40.2% (35.4% to 45.0%), driven by a higher PAF for physical inactivity and depression in women. Discussion: The PAF for modifiable risk factors for dementia in Chile is higher than in previous world reports, due to a greater prevalence of cardiovascular risk factors. Women have a higher potential for dementia prevention. Highlights: The proportion of dementia associated to modifiable risk factors in Chile is 45.8%.The main modifiable risk factors are high blood pressure, obesity, and hearing loss.Women had a greater prevalence of physical inactivity and depression than men.Chile had a greater prevalence of metabolic risk factors than other world regions.Item Predictors of unmet needs in Chilean older people with dementia: a cross-sectional study(BioMed Central Ltd, 2019-04) Tapia-Muñoz, Thamara; Slachevsky, Andrea; León-Campos, María; Madrid, Michel; Caqueo-Urizar, Alejandra; Rohde, Gustav; Miranda-Castillo, ClaudiaBackground The needs of people with dementia (PWD) have not been assessed in any Latin American country. Several European countries have already related unmet needs with quality of life, caregiver’s age, burden, stress, anxiety and depression. The aim of this study was to identify met and unmet needs in Chilean older adults with dementia and to determine if those needs were associated with PWD’s, their informal caregivers’ and social factors. Method This was a cross-sectional study. One-hundred and sixty-six informal caregivers and their care recipients were interviewed. PWD was assessed about cognitive function and their caregivers answered instruments about PWD’s needs, functional status and behavioral and psychological symptoms. Caregiver’s burden, depression, anxiety and social support were also evaluated. A stepwise multiple linear regression analysis was performed to determine predictors of unmet needs in Chilean PWD. Results The most frequent met needs were “Looking after home” (81.3%%), “Food” (78.9%) and “Selfcare” (75.3%). Most common unmet needs were “Daily living activities” (39.2%), “Company” (36.1%), and “Memory” (34.9%). Caregivers’ lower age was correlated to a higher number of PWD’s unmet needs (rs = −.216; p < 0.005). Higher PWD’s dependence was associated with higher number of unmet needs (rs = .177; p < 0.05). The best predictors of unmet needs were caregivers’ low level of social support, high burden, young age and high level of anxiety. Conclusion It is necessary to address psychological and social needs of PWD. The fact that PWD’s unmet needs were associated mostly with caregivers’ factors, highlights the importance of considering both, the PWD and their informal caregivers as targets of institutional support. It is expected that recently launched national public policies decrease PWD’s unmet needs by the provision of new services for them and their informal caregivers.Item Relationship between Social Cognition and traditional cognitive impairment in Progressive Multiple Sclerosis and possible implicated neuroanatomical regions(2018) Ciampi, E.; Uribe-San-Martin, R.; Vásquez, M.; Ruiz-Tagle, A.; Labbe, T.; Cruz, J.P.; Lillo, P.; Slachevsky, Andrea; Reyes, D.; Reyes, A.; Cárcamo-Rodríguez, C.Background Cognitive impairment is a relevant contributor of the medical and social burden in Progressive MS. Social Cognition, the neurocognitive processes underlying social interaction, has been explored mainly in European and North American cohorts, influencing social aspects of quality of life (QOL) of early MS patients and families. Few studies have studied Social Cognition in Progressive MS and the literature on its neuroanatomical bases or brain atrophy measurements is still scarce. Objectives To explore the relationship between Social Cognition performance and its correlations with traditional cognitive domains, brain atrophy and QOL in primary and secondary Progressive MS patients. Methods Cross-sectional analysis including: mini-Social-Cognition-and-Emotional-Assessment (mini-SEA), neuropsychological battery, disability, depression, fatigue, QOL, and brain volume. Results Forty-three MS patients, 23 primary and 20 secondary Progressive, 65% women, mean age and disease duration of 57.2 and 15.7 years, respectively, with high levels of disability (median EDSS 6.0) and a widespread impairment in traditional domains (mostly episodic verbal/visual and working memories) were assessed. The Mini-SEA score was correlated with executive functions (cognitive shifts Rho:0.55; p = 0.001) analyzing the whole group, and with visual episodic memory (Rho:0.58, p = 0.009) in the primary Progressive MS group. Mini-SEA score was also correlated with total normalized grey matter volume (Rho:0.48; p = 0.004). Particularly, atrophy within bilateral cortical regions of orbitofrontal, insula and cerebellum, and right regions of fusiform gyrus and precuneus were significantly associated with higher Social Cognition impairment. In this cohort, QOL was not correlated with Social Cognition, but with EDSS, fatigue and depression. Conclusions In Progressive MS, Social Cognition is directly correlated with traditional cognitive domains such as executive function and episodic memory. It is also associated with global grey matter atrophy and regional atrophy within associative visual and executive cortical areas, but no correlations with QOL were found in this cohort. These findings may contribute to the understanding of the pathological bases behind Social Cognition in Progressive MS.Item ¿Sé y puedo? Toma de decisión y consentimiento informado en los trastornos demenciantes: dilemas diagnósticos y jurídicos en Chile(2017) Arenas Massa, Angela; Slachevsky, AndreaIn Chile, more than 180 thousand people (1% of the population) have some form of dementia. The figure should increase to approximately 600,000 (3% of Chileans) by 2050. This disease poses major challenges to the society. One of them is the effective recognition of the autonomy and responsibility of the person living with this condition. This article aims to review the clinical assessment of competence, its agreement with the Chilean legal system and the challenges that the assessment of competence poses in clinical decision-making and the capacity of an individual make decisions, according to the new international obligations subscribed by Chile. It is concluded that inclusion is a pending challenge, reflected among other things, by the non-compliance with binding rules such as Article 12 of the Convention on the Rights of Persons with Disabilities, which affirms that persons with disabilities have the right to be recognized as a person everywhere, before the law.Item Systematic Review of the Diagnostic Validity of Brief Cognitive Screenings for Early Dementia Detection in Spanish-Speaking Adults in Latin America(2020) Custodio, Nilton; Duque, Lissette; Montesinos, Rosa; Alva-Díaz, Carlos; Mellado, Martin; Slachevsky, AndreaObjectives: The aim of this study was to evaluate the validity of brief cognitive screening (BCS) tools designed to diagnose mild cognitive impairment (MCI) or dementia in Spanish-speaking individuals over the age of 50 years from Latin America (LA). Methods: A systematic search of titles and abstracts in Medline, Biomed Central, Embase, Scopus, Scirus, PsycINFO, LILACS, and SciELO was conducted. Inclusion criteria were papers written in English or Spanish involving samples from Spanish-speaking Latin American individuals published until 2018. Standard procedures were applied for reviewing the literature. The data related to the study sample, methodology, and procedures applied, as well as the performance obtained with the corresponding BCS, were collected and systematized. Results: Thirteen of 211 articles met the inclusion criteria. The studies primarily involved memory clinic-based samples, with the exception of two studies from an adult day-care center, one from a primary care clinic, and one from a community-based sample. All the studies originated from five of the 20 countries of LA and all used standardized diagnostic criteria for the diagnosis of dementia and MCI; however, the diagnostic protocols applied differed. Most studies reported samples with an average of 10 years of education and only one reported a sample with an average of <5 years of education. No publication to date has included an illiterate population. Although the Montreal cognitive assessment (MoCA) is the most widely-used BCS tool in LA, it is significantly influenced by education level. Conclusions: Although evidence is still limited, the findings from studies on LA populations suggest that MoCA requires cultural adaptations and different cutoff points according to education level. Moreover, the diagnostic validity of the INECO frontal screening (IFS) test should be evaluated in populations with a low level of education. Given the heterogeneity that exists in the levels of education in LA, more studies involving illiterate and indigenous populations are required.Item The cost of dementia in an unequal country: The case of Chile(PLoS, 2017) Hojman, Daniel; Duarte, Fabian; Ruiz-Tagle, Jaime; Budnich, Marilu; Delgado, Carolina; Slachevsky, AndreaWe study the economic cost of dementia in Chile, and its variation according to socioeconomic status (SES). We use primary data from a survey of 330 informal primary caregivers who completed both a RUD-Lite and a socio-demographic questionnaire to evaluate the severity of dementia and caregiver’s burden. The costs of dementia are broken into three components: direct medical costs (medical care, drugs, tests); direct social costs (social service, daycare); and indirect costs (mostly associated to informal care). The average monthly cost per patient is estimated at US$ 1,463. Direct medical costs account for 20 per cent, direct social costs for 5 per cent and indirect costs for 75 per cent of the total cost. The mean monthly cost is found to be inversely related to SES, a pattern largely driven by indirect costs. The monthly cost for high SES is US$ 1,083 and US$ 1,588 for low SES. A multivariate regression analysis suggests that severity of dementia and caregiver’s burden account for between 49 and 70 per cent of the difference in the indirect cost across SES. However, between one-third and one-half of the variation across SES is not due to gradient in severity of dementia. Direct medical costs increase in higher SES, reflecting differences in purchasing power, while indirect costs are inversely related to SES and more than compensate differences in medical costs. Moreover, in lower SES groups, female caregivers, typically family members who are inactive in the labor market, mostly provide informal care. The average annual cost of dementia in Chile (US$ 17,559) is lower in comparison to high-income countries (US$ 39,595) and the proportion of cost related to informal cost is higher (74 per cent compared to 40 per cent). SES is a key determinant in the cost of dementia. In the absence of universal access to treatment, part of the social cost of dementia potentially preserves or increases income and gender inequality.Publication The Latin American Brain Health Institute, a regional initiative to reduce the scale and impact of dementia(2022) Duran, Claudia; Sanhueza, Jorge; Grinberg, Lea; Slachevsky, Andrea; Valcour, Víctor; Robertson, Ian; Lawlor, Brian; Miller, Bruce; Ibáñez, AgustínLatin American and Caribbean countries face complex challenges to improve brain health and reduce the impact of dementia. Regional hubs devoted to research, capacity building, implementation science, and education are critically needed. The Latin American Brain Health Institute represent an important step to address many of these needs.