Journal Article Annotations
2024, 4th Quarter

Hispanoamerican Psychiatry

Annotations by Felipe León, MD
January, 2025

Population attributable fractions for risk factors for dementia in seven Latin American countries: an analysis using cross-sectional survey data.

PUBLICATION #1 — Hispanoamerican Psychiatry

Population attributable fractions for risk factors for dementia in seven Latin American countries: an analysis using cross-sectional survey data.

Regina Silva Paradela, Ismael Calandri, Natalia Pozo Castro, Emanuel Garat, Carolina Delgado, Lucia Crivelli, Kristine Yaffe, Cleusa P Ferri, Naaheed Mukadam, Gill Livingston, Claudia Kimie Suemoto.

Abstract Lancet Glob Health. 2024 Oct;12(10):e1600-e1610. doi: 10.1016/S2214-109X(24)00275-4.

Background:
Approximately 40% of dementia cases worldwide are attributable to 12 potentially modifiable risk factors. However, the proportion attributable to these risks in Latin America remains unknown. We aimed to determine the population attributable fraction (PAF) of 12 modifiable risk factors for dementia in seven countries in Latin America.

Methods:
We used data from seven cross-sectional, nationally representative surveys with measurements of 12 modifiable risk factors for dementia (less education, hearing loss, hypertension, obesity, smoking, depression, social isolation, physical inactivity, diabetes, excessive alcohol intake, air pollution, and traumatic brain injury) done in Argentina, Brazil, Bolivia, Chile, Honduras, Mexico, and Peru. Data were collected between 2015 and 2021. Sample sizes ranged from 5995 to 107 907 participants (aged ≥18 years). We calculated risk factor prevalence and communalities in each country and used relative risks from previous meta-analyses to derive weighted PAFs. Pooled PAFs for Latin America were obtained using random effect meta-analyses.

Findings:
The overall proportion of dementia cases attributed to 12 modifiable risk factors varied across Latin American countries: weighted PAF 61·8% (95% CI 37·9-79·5) in Chile, 59·6% (35·8-77·3) in Argentina, 55·8% (35·7-71·5) in Mexico, 55·5% (35·9-70·4) in Bolivia, 53·6% (33·0-69·3) in Honduras, 48·2% (28·1-63·9) in Brazil, and 44·9% (25·8-61·2) in Peru. The overall PAF for dementia was 54·0% (48·8-59·6) for Latin America. The highest weighted PAFs in Latin American countries overall were for obesity (7%), physical inactivity (6%), and depression (5%).

Interpretation:
The estimated PAFs for Latin American countries were higher than previous global estimates. Obesity, physical inactivity, and depression were the main risk factors for dementia across seven Latin American countries. These findings have implications for public health and individually targeted dementia prevention strategies in Latin America. Although these results provide new information about Latin American countries, demographics and representativeness variations across surveys should be considered when interpreting these findings.

Funding:
None.

Annotation

The finding:
In the Latin American countries evaluated, obesity, sedentary lifestyle and depression were the three most important factors for dementia. The population attributable fractions (PAF) calculated by the random-effects meta-analysis were higher than the worldwide estimations. These findings are relevant for the development of public policies for dementia prevention oriented to these modifiable risk factors in Latin American countries.

Strength and weaknesses:
The present study calculated the population attributable to each of the 12 risk factors for dementia in Latin America. With this, they also calculated the expected decrease in dementia cases through a 15% reduction in each risk factor. As a weakness, this study did not evaluate other risk factors, such as non-modifiable risk factors. Furthermore, it was carried out in some countries of the continent, which could not necessarily be extrapolated to other countries that were not evaluated.

Relevance:
In this work, we observe the relevance of prevention in modifiable risk factors for dementia, in which C-L psychiatrists play an active role, by providing guidance and support to patients with medical illnesses, in terms of promoting the improvement of their lifestyles and treating mental symptoms.