Person: Slachevsky Chonchol, Andrea
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Slachevsky Chonchol
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Andrea
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Andrea María Slachevsky Conchol
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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 A Multidimensional, Person-Centered Framework for Functional Assessment in Dementia: Insights from the 'What', 'How', 'To Whom', and 'How Much' Questions(2024) Slachevsky Chonchol, Andrea; Grandi, Fabrissio; Thumala, Daniela; Baez, Sandra; Santamaria, Hernando; Schmitter, Maureen; Parra, MarioDementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.Publication Dementia prevention requires moving beyond individual choice: the costs of effort and time intersect with social determinants of health(2025) Migeot, Joaquín; Araya, Daniel; Montecinos, Matias; Baez, Sandra; Behrens, Maria Isabel; Castaner, Olga; Cruzat, Josephine; Delgado, Carolina; De Jong- Bambagioni, David; Duran, Claudia; Durón, Dafne; Evans, Tavia; Gonzalez, Raul; Gutiérrez, Myriam; Hayden, Katheen; Hernandez, Hernan; Ibañez, Agustin; Legaz, Agustina; Miller, Johnny; Ma iulskyt, Sonata; Putthinun, Pongpat; Santamaría, Hernando; Slachevsky Chonchol, Andrea; Trépel, DominicSocial determinants of health strongly influence modifiable risk factors for dementia, yet prevention frameworks list only individual-level behaviours and conditions, overlooking the impact of social and environmental factors on the risk of dementia. In this perspective, we introduce the concept of non-monetary costs as a central mechanism through which social determinants shape modifiable risk factors by influencing individuals' ability to adopt healthy behaviours. Drawing from economic theory, we define non-monetary costs as the time and metabolic cost, perceived by individuals as physical and cognitive effort, required to engage in healthy behaviours. Under adverse social determinants of health, individuals effectively lack choice, as the non-monetary costs required to engage in healthy behaviours become prohibitively high. We propose a framework that links social determinants of health adversity to increased dementia risk through non-monetary costs. We apply this framework to each of the fourteen modifiable risk factors for dementia identified by the Lancet Commission, demonstrating how these costs systematically elevate risk in populations facing social adversity. Finally, we explore the implications of incorporating non-monetary cost assessments across research, interventions, clinical care, and public policy. We propose that quantifying and addressing these costs is essential for designing equitable, scalable, and contextually grounded strategies for dementia prevention across socially diverse populations.