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 The impacts of social determinants of health and cardiometabolic factors on cognitive and functional aging in Colombian underserved populations(2023) Santamaria, Hernando; Moguilner, Sebastian; Rodriguez, Odir; Botero, Felipe; Pina, Stefanie; O’Donovan, Gary; Albala, Cecilia; Matallana, Diana; Schulte, Michael; Slachevsky Chonchol, Andrea; Yokoyama, Jennifer; Possin, Katherine; Ndhlovu, Lishomwa; Al‑Rousan, Tala; Corley, Michael; Kosik, Kenneth; Muniz, Graciela; Miranda, J. Jaime; Ibanez, AgustinGlobal initiatives call for further understanding of the impact of inequity on aging across underserved populations. Previous research in low- and middle-income countries (LMICs) presents limitations in assessing combined sources of inequity and outcomes (i.e., cognition and functionality). In this study, we assessed how social determinants of health (SDH), cardiometabolic factors (CMFs), and other medical/social factors predict cognition and functionality in an aging Colombian population. We ran a cross-sectional study that combined theory- (structural equation models) and data-driven (machine learning) approaches in a population-based study (N = 23,694; M = 69.8 years) to assess the best predictors of cognition and functionality. We found that a combination of SDH and CMF accurately predicted cognition and functionality, although SDH was the stronger predictor. Cognition was predicted with the highest accuracy by SDH, followed by demographics, CMF, and other factors. A combination of SDH, age, CMF, and additional physical/psychological factors were the best predictors of functional status. Results highlight the role of inequity in predicting brain health and advancing solutions to reduce the cognitive and functional decline in LMICs.Publication Cardiovascular risk factors and the allostatic interoceptive network in dementia(2025) Hazelton, Jessica; Migeot, Joaquín; Gonzalez, Raul; Altschuler, Florencia; Duran, Claudia; Wen, Olivia; Galván, Dante; Barttfeld, Pablo; Medel , Vicente; González, Cecilia; Castro, Ana; Hernández, Hernán; Gonzalez, Carolina; Castaner, Olga; Hu, Kun; Li, Peng; Maria Isabel Behrens; Behrens, Maria Isabel; Bruno, Martin; Cardona, Juan; Custodio, Nilton; Santamaria, Hernando; Garcia, Adolfo; Godoy, Maria; Avila, José; Maito, Marce; Matallana, Diana; Miller, Bruce; Lopera, Francisco; Okada , Maira; Pina, Stefanie; Possin, Katherine; France, Elisa de Paula; Reyes, Pablo; Slachevsky Chonchol, Andrea; Sosa, Ana; Takada, Leonel; Yokoyama, Jennifer; Ibanez, AgustinAims: Cardiovascular risk factors, such diabetes, hypertension, blood pressure, obesity, and smoking, are linked with allostatic-interoception-the continuous monitoring of internal bodily states in anticipation of environmental demands. These risk factors are associated with dementia risk. How these factors affect brain networks vulnerable to neurodegeneration and involved in allostatic-interoception, such as the Allostatic-Interoceptive Network (AIN), is unknown. We investigated the relationship between cardiovascular risk and AIN structure and function in frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD). Methods and results: We recruited 1501 participants (304 with FTLD, 512 with AD, and 685 healthy controls) from the Multi-Partner Consortium to Expand Dementia Research in Latin America (ReDLat). A cardiovascular risk score was calculated based on: age, sex, diabetes, hypertension, systolic blood pressure, body mass index, and smoking status. Cardiovascular risk was associated with grey matter integrity and functional connectivity in age- and sex-matched patient-control groups focusing on predefined regions of interest within the AIN. Higher cardiovascular risk was associated with reduced structural integrity and functional connectivity within the AIN in both FTLD and AD. FTLD patients showed more extensive structural and functional connectivity disruptions throughout the AIN. In AD patients, structural reductions in the AIN were prominent, with functional connectivity restricted to the hippocampus, parahippocampal gyrus, and orbitofrontal regions. Conclusion: Cardiovascular risk factors appear to adversely impact the AIN structure and function, with disease-specific patterns of vulnerability. Results underscore the importance of integrating cardiovascular health into models of neurodegenerative disease and managing cardiovascular health to support brain integrity in dementia.Publication Social exposome and brain health outcomes of dementia across Latin America(2025) Migeot, Joaquin; Pina, Stefanie; Hernandez, Hernan; Gonzalez, Raul; Legaz, Agustina; Fittipaldi, Sol; Resende, Elisa de Paula França; Duran, Claudia; Avila, Jose; Behrens, Maria Isabel; Bruno, Martin; Cardona, Juan; Custodio, Nilton; García, Adolfo; Godoy, Maria; Hu, Kun; Lanata, Serggio; Lawlor, Brian; Lopera, Francisco; Maito, Marcelo; Matallana, Diana; Miller, Bruce; Miranda, J Jaime; Okada, Maira; Reyes, Pablo; Santamaria, Hernando; Slachevsky Chonchol, Andrea; Sosa, Ana; Takada, Leonel; Torres, Jacqueline; Vanneste, Sven; Valcour, Victor; Wen, Olivia; Yokoyama, Jennifer; Possin, Katherine; Ibañez, AgustinA multidimensional social exposome (MSE)-the combined lifespan measures of education, food insecurity, financial status, access to healthcare, childhood experiences, and more-may shape dementia risk and brain health over the lifespan, particularly in underserved regions like Latin America. However, the MSE effects on brain health and dementia are unknown. We evaluated 2211 individuals (controls, Alzheimer's disease, and frontotemporal lobar degeneration) from a non-representative sample across six Latin American countries. Adverse exposomes associate with poorer cognition in healthy aging. In dementia, more complex exposomes correlate with lower cognitive and functional performance, higher neuropsychiatric symptoms, and brain structural and connectivity alterations in frontal-temporal-limbic and cerebellar regions. Food insecurity, financial resources, subjective socioeconomic status, and access to healthcare emerge as critical predictors. Cumulative exposome measures surpass isolated factors in predicting clinical-cognitive profiles. Multiple sensitivity analyses confirm our results. Findings highlight the need for personalized approaches integrating MSE across the lifespan, emphasizing prevention and interventions targeting social disparities.Publication Critical Review of the Methodological Shortcoming of Ambulatory Blood Pressure Monitoring and Cognitive Function Studies(2025) Haghayegh, Shahab; Hermida, Ramon; Smolensky, Michael; Jimenez, Mili; Duran, Claudia; Slachevsky Chonchol, Andrea; Behrens, Maria Isabel; Aguillon, David; Santamaria, Hernando; García, Adolfo; Matallana, Diana; Ibáñez, Agustín; Hu, KunGrowing evidence suggests that abnormal diurnal blood pressure rhythms may be associated with many adverse health outcomes, including increased risk of cognitive impairment and dementia. This study evaluates methodological aspects of research on bidirectional associations between ambulatory blood pressure monitoring (ABPM) patterns and cognitive function. By examining the 28 recent studies included in a recent systematic review on the association between ABPM patterns with cognitive function and risk of dementia, our review revealed several significant limitations in study design, sample characteristics, ABPM protocol, cognitive assessment, and data analysis. The major concerns include a lack of diversity in study populations with underrepresentation of Blacks and Latinos, a predominant focus on Alzheimer's disease or all-cause dementia without distinguishing other dementia subtypes, different and not standardized measures of cognition or dementia, prevalent use of 24 h monitoring without considering the adaption effect, inconsistent definitions of dipping status, and ignorance of individual differences in timings of daily activities such as bed and awakening times. In addition, confounding variables such as class, dose, and timing of antihypertensive medication are inadequately controlled or considered. Further, longitudinal studies were scarce examining the bidirectional relationship between ABPM patterns and cognitive decline over time. Collectively, these deficiencies undermine the reliability and generalizability of current findings. Addressing these methodological challenges is crucial for a more comprehensive understanding of diurnal blood pressure rhythms in diverse populations and for developing an evidence-based guideline for ambulatory monitoring and control of blood pressure across the sleep-wake cycle to prevent cognitive decline and dementia.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.