Alzheimer s & Dementia, Год журнала: 2024, Номер 20(11), С. 8206 - 8208
Опубликована: Окт. 6, 2024
The demographic transition to an increase in life expectancy is occurring faster Latin America and Caribbean (LAC) countries than high-income (HIC), leading a higher prevalence of chronic neurodegenerative disorders, such as dementia. Indeed, recent systematic review meta-analyses reported that the all-cause dementia LAC 9% among individuals aged 65+ years, with women, lower-educated individuals, rural areas.1 are diverse terms culture, socioeconomic status, education, ethnicity. Socioeconomic educational disparities explain inequalities on minorities,2 mainly due lack awareness, stigma associated aging dementia, insufficient training health professionals, limited availability assessment tools, especially for primary care, besides fact most do not have national plan.3 Recently, Alzheimer's Association (AA) updated criteria diagnosis staging disease (AD).4 These fundamentally based biological aspects can be detected by specific biomarkers measured positron emission tomography (PET), cerebrospinal fluid (CSF), or blood. We foresee main problems adapting revised lie (1) categorization imaging biomarkers, we shall able consider core 1 (Aβ proteinopathy) 2 (AD Tau criteria, (2) criterion treatment because few research centers will complete absence PET. Nowadays, use PET currently recommended various international AD guidelines,5 its application remains restricted Argentina, Brazil, Colombia,6 Uruguay. Magnetic resonance (MRI) essential tool allows structural analysis brain regions, which assists diagnostic workup follow-up constitutes biomarker neurodegeneration vascular copathology.4 In this sense, LatAm-FINGERS study uses complex harmonization procedure ensure external other neuroimaging cohorts (e.g., ADNI), internal enable data sharing across databases while considering regional feasibility.7 Similarly, Multi partner Consortium explore (ReDLat) applying different postrecording has been utilized understanding development multimodal markers Chile, Colombia, Mexico, Peru.8 Only Colombia conducted studies using CSF samples, principally carriers PSEN1 mutation noncarriers6 isolated reports combining MRI blood sample,9 but information best candidates, local normative values, cutoff points, time-of-day conditions they should collected. Some plasma p-tau assays demonstrated very good clinical performance trials observational standalone biomarker,4 although scarce evidence community-based studies. first largest ever carried out South American population (Peru Bolivia) investigating p-tau217 found AUC 68%–82% depending adjusted models, validating biomarker's modest performances non-White population.10 However, values lower concerning populations,4 so it necessary larger number samples populations LAC. While true, AA Workgroup emphasizes these research, trials, debatable practice. past 3 United States Food Drug Administration (FDA) approved anti-amyloid agents, demonstrating reduction amyloid rates cognitive functional decline after 18 months treatment. For future adequate agents practice LAC, specialists need harmonize new biomarkers. So, researchers clinicians specialized management investigate how apply context. anticipate increasing make more widely deployable within region where PET- CSF-based may readily available. needs investigated. order reduce gap between HIC, develop working group recommendations knowledge resources, collaborative networks, transfer exchange protocols procedures. New take into consideration barriers proposals implement (Table 1). Available ADRD. Lack cost-effective care. efficiency indigenous Absence guidelines suggest administration screening tools select better candidates Stimulate formation basic advanced ADRD process blood-based epidemiological care centers. Investigate potential value improve selection Myths about procedure. Processing transport laboratories USA. validation reference values. evaluation probable confounding factors correct interpretation results. Increase lumbar puncture. processing Control processed samples. only two (Argentina Uruguay). cyclotrons. 3. commercial markers. Coordinate governments implementation Improve processes radioactive materials produced Encourage High costs families (out-pockets expensive from USD 650 1000). transporting countries. 4. 2. Centralize provider consensus then 350 800) long time receive results (> 60 days). supplier 1660 2800). establish diagnosis. possible Negotiate suppliers affordable prices. extend our gratitude Dr. David Aguillon supporting letter. Dr Custodio, Allegri, Lopera, Caramelli had supported (ALZ Strategic Initiatives SG-21- 715176-LATAM FINGERS). authors declare no conflicts interest. Author disclosures available Supporting Information. Please note: publisher responsible content functionality any supplied authors. Any queries (other missing content) directed corresponding author article.
Язык: Английский