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“ The 10/66 Dementia Research Group Studies” .

“ The 10/66 Dementia Research Group Studies” . Incidence phase. Juan J. Llibre Rodriguez. For and on behalf of 10/66. 26 th International Conference of Alzheimer’s Disease International. INCIDENCE RATES Burden of a disease. Risk of disease

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“ The 10/66 Dementia Research Group Studies” .

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  1. “ The 10/66 Dementia Research Group Studies”. Incidence phase. Juan J. Llibre Rodriguez. For and on behalf of 10/66 26th International Conference of Alzheimer’s Disease International.

  2. INCIDENCE RATES • Burden of a disease. • Risk of disease • I x duration = Prevalence • I x case fatality = Burden of mortality • Predict future cases • Planning health services • Evaluate the impact of prevention • Study risk factors.

  3. Incidence phase (n=13,000) • Sites • Cuba, DR, Venezuela, Mexico, Peru, China • Outcomes • Dementia, Stroke, Dependence, Mortality • Aetiology • Cardiovascular risk (BP/ smoking/ fasting glucose/ cholesterol) • Diet (anaemia, B12, folate, subclinical hypothyrodism, albumin, anthropometry) • Developmental factors • APOE and other genetic factors

  4. Incidence wave, by country

  5. Mortality in dementia

  6. Mortality among people with dementia, by site

  7. Factors tested as possible predictors of mortality, among people with dementia

  8. Predictors of mortality (stepwise regression), among people with dementia

  9. Carer strain

  10. Changes in carer strain since baseline

  11. Factors tested as possible predictors of carer strain at follow-up

  12. Predictors of carer strain (stepwise regression), among people with dementia

  13. Incidence of dementia by sex and age, Cuba Cohort 65 years and over N=2728 * Incidence rate/ 1000 pyr

  14. Risk factors for incident dementia

  15. Population 11,6 millons • Life expectancy • Men 79 years • Women 80 years • Dementia´s prevalence • 6.4-10.2 % (130 000 cases ) • Incidence rate 21.7 per • 1000/year (28 760 new • cases/year) • Mortality rate in dementia • people 195.5 per 1000/year

  16. Does African ancestry protect against dementia? A population-based case-control study in an admixed Cuban population? Admixtures mapping provides information about the contribution of genetic and non genetic factors. In Cuba, there is sufficient variation of admixture between individuals to detect relationships of disease risk to proportionate admixture.

  17. 10/66 admixture studies Design Populations of mixed African and Caucasian ancestry Genotype to measure ancestry directly in individuals Hypothesis Higher levels of African ancestry associated with lower risk of dementia

  18. Main source of admixture Migration , 1400–1800,

  19. Cuba – association of APOE genotype with dementia * Adjusted age, sex and education

  20. APOE allele frequency by ethno-racial identity

  21. Mean admixture proportion by APOE allele status (case control subsample) *

  22. Incidence of dementia according age group and APOE 4 genotype (HR). Cuba 10/66 incidence phase. *p<0.006

  23. Conclusions • The world is facing a new epidemic of unprecedented proportions • Its effects will be felt particularly in low and middle income countries - currently least prepared to meet the challenge • Societal costs will rise inexorably, driven by the increasing need for long term care • Time for action • Clinical care • Social policy • Prevention

  24. Care/ Impact Intervention! Incidence phase I (2006-2010) II (2010 -2014) Aetiology Cardiovascular risk (BP/ smoking/ fasting glucose/ cholesterol) Diet (anaemia, B12, folate, subclinical hypothyrodism, albumin, anthropometry) Developmental factors APOE effect modification African ancestry Chronic non communicabke diseases The next steps

  25. 10/66 Dementia Research Group www.alz.co.uk/1066

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