Background
Methods
Design
Measurements
10/66 dementia
Socio-demographical variables and general health indicators
NEUROEX assessment
Statistical analyses
Exploratory and confirmatory factor analysis
Factor scores
Regression analyses
Results
Absolute values (%) | Across sites | Cuba | Dominican Republic | Peru | Venezuela | Mexico |
---|---|---|---|---|---|---|
Number of subjects | 10,856 (100.0) | 2941 (27.1) | 2000 (18.5) | 1931 (17.8) | 1534 (18.1) | 2002 (27.1) |
Age | ||||||
65–69 | 3230 (29.8) | 760 (25.9) | 533 (26.4) | 554 (28.6) | 839 (41.8) | 544 (27.1) |
70–74 | 2852 (26.3) | 789 (26.9) | 520 (25.9) | 493 (25.5) | 469 (23.6) | 581 (29.0) |
75–79 | 2206 (20.3) | 639 (21.7) | 397 (19.7) | 399 (207) | 345 (18.4) | 426 (21.3) |
> 79 | 2555 (23. 6) | 749 (25.5) | 561 (27.9) | 486 (25.2) | 308 (16.3) | 451 (22.5) |
Female | 6941 (62.9) | 1913 (65.0) | 1325 (65.9) | 1183 (61.2) | 1252 (64.6) | 1268 (63.3) |
Educational level | ||||||
None | 1298 (12.0) | 75 (2.5) | 392 (19.7) | 121 (6.3) | 156 (8.1) | 554 (27.7) |
Some, did not complete primary | 3217 (29.9) | 655 (22.3) | 1022 (51.3) | 231 (12.0) | 445 (23.1) | 864 (43.2) |
Completed primary | 3392 (31.5) | 979 (33.3) | 370 (18.6) | 727 (37.9) | 965 (50.1) | 351 (17.5) |
Completed secondary | 1770 (16.4) | 728 (24.8) | 135 (6.8) | 517 (27.0) | 266 (13.8) | 124 (6.2) |
Tertiary | 1094 (10.2) | 499 (17.0) | 73 (3.7) | 321 (16.7) | 93 (4.8) | 108 (5.4) |
Number of assets | ||||||
0–3 assets | 1673 (15.4) | 451 (15.4) | 643 (32.0) | 155 (8.0) | 48 (2.4) | 376 (18.8) |
4–5 assets | 4596 (42.4) | 876 (29.8) | 444 (22.1) | 1134 (58.7) | 0 (0.0) | 844 (42.1) |
6 assets | 2152 (19.8) | 1073 (36.5) | 733 (36.5) | 181 (9.4) | 1298 (66.1) | 165 (8.2) |
More than 6 assets | 2422 (22.3) | 536 (18.3) | 186 (9.3) | 463 (23.9) | 619 (31.5) | 618 (30.8) |
Food insecurity | 752 (7.0) | 140 (4.8) | 240 (12.1) | 137 (7.2) | 111 (6.0) | 124 (6.2) |
Income insecurity | 4433 (40.8) | 527 (17.9) | 1400 (69.6) | 668 (34.6) | 818 (41.6) | 1020 (50.9) |
Prevalence and distribution of neurological symptoms
NEUROEX Absolute numbers (%) | Across sites | Cuba | Dominican Republic | Peru | Venezuela | Mexico |
---|---|---|---|---|---|---|
Glabellar reflex more than 4 taps | 3011 (29.0) | 1095 (37.3) | 367 (18.4) | 252 (13.1) | 536 (35.2) | 761 (38.3) |
Pout reflex present | 1575 (15.2) | 244 (8.0) | 382 (19.2) | 95 (4.9) | 181 (11.9) | 673 (33.6) |
FPS sequencing unsuccessful after 5 demonstration | 3513 (34.4) | 750 (26.0) | 823 (42.0) | 277 (14.5) | 431 (28.7) | 1232 (62.8) |
Reciprocal sequencing unsuccessful after 5 tries | 2911 (28.2) | 796 (27.2) | 385 (19.6) | 229 (11.9) | 442 (29.6) | 1059 (52.9) |
Tremor at least one limb | 1348 (13.0) | 222 (7.8) | 224 (11.2) | 213 (11.0) | 264 (17.4) | 425 (21.2) |
Cogwheeling at least one limb | 832 (9.9) | 183 (6.2) | 96 (4.8) | 221 (11.5) | 106 (7.2) | 226 (11.3) |
Rigidity at least one limb | 1549 (15.0) | 374 (12.7) | 272 (13.7) | 278 (14.5) | 291 (19.6) | 334 (16.7) |
Fine finger movement | 1214 (11.7) | 207 (7.1) | 236 (12.0) | 184 (9.6) | 221 (14.8) | 336 (18.3) |
Dysdiadochokinesia Speed | 970 (9.3) | 242 (8.2) | 160 (8.1) | 231 (12.0) | 99 (6.6) | 238 (12.0) |
Dysdiadochokinesia coordination | 910 (8.7) | 187 (6.4) | 143 (7.3) | 168 (8.7) | 90 (6.0) | 322 (16.1) |
Armswing | 2160 (21.2) | 432 (14.8) | 702 (36.8) | 276 (14.3) | 215 (15.3) | 535 (26.7) |
Ataxia | 1413 (13.9) | 234 (8.0) | 428 (22.4) | 266 (13.8) | 125 (8.8) | 360 (18.0) |
Bradykinesia | 1949 (19.1) | 382 (13.0) | 637 (33.4) | 328 (17.0) | 178 (12.6) | 424 (21.2) |
Gait steps Q2 (Q1-Q3) in steps | 18 (14–22) | 20 (17–24) | 20 (18–24) | 18 (15–20) | 17 (11–20) | 12 (10–15) |
Gait time Q2 (Q1-Q3) in seconds | 14 (10–18) | 15 (12–20) | 17 (15–23) | 14 (10–18) | 12 (9–15) | 8 (7–11) |
Exploratory and confirmatory factor analysis
NEUROEX items factor loadings | Cuba | Dominican Republic | Peru | Venezuela | Mexico | Across sites | |
Frontal signs | Pout reflex | 0.3 | 0.5 | 0.3 | 0.3 | 0.5 | 0.4 |
Glabellar reflex | 0.3 | 0.3 | 0.3 | 0.3 | 0.5 | 0.4 | |
FPS sequencing | 0.6 | 0.5 | 0.4 | 0.5 | 0.3 | 0.5 | |
Reciprocal sequencing | 0.5 | 0.3 | 0.4 | 0.4 | 0.4 | 0.5 | |
Extrapyramidal signs | Tremor | 0.4 | 0.4 | 0.5 | 0.5 | 0.4 | 0.5 |
Cogwheeling | 0.5 | 0.3 | 0.6 | 0.4 | 0.4 | 0.5 | |
Rigidity | 0.8 | 0.4 | 0.6 | 0.3 | 0.3 | 0.5 | |
Cerebellar signs | Fine finger movement | 0.7 | 0.6 | 0.7 | 0.6 | 0.5 | 0.6 |
Dysdiadochokinesia speed | 0.8 | 0.9 | 0.7 | 0.7 | 0.6 | 0.7 | |
Dysdiadochokinesia coordination | 0.7 | 0.8 | 0.8 | 0.5 | 0.7 | 0.7 | |
Gait disturbance signs | Armswing | 0.4 | 0.6 | 0.7 | 0.6 | 0.6 | 0.6 |
Gait –steps | 0.5 | 0.6 | 0.3 | 0.4 | 0.4 | 0.3 | |
Gait –time | 0.3 | 0.5 | 0.3 | 0.4 | 0.4 | 0.4 | |
Ataxia | 0.7 | 0.5 | 0.9 | 0.7 | 0.8 | 0.7 | |
Bradykinesia | 0.9 | 0.8 | 0.9 | 0.9 | 0.9 | 0.9 | |
Goodness of fit | |||||||
χ2 (81) | 531.0 | 480.5 | 418.0 | 323.6 | 291.0 | 1072.0 | |
TLI | 0.91 | 0.90 | 0.95 | 0.95 | 0.93 | 0.94 | |
RMSEA | 0.05 | 0.06 | 0.05 | 0.05 | 0.05 | 0.04 | |
AIC | 58,147.3 | 40,061.3 | 51,287.9 | 35,137.0 | 41,058.3 | 216,584.0 | |
Measurement invariance model | Without constraints | With constraints | Difference | ||||
χ2 | 1942.7 | 3342.3 | χ2 change | 1399.7 | |||
Df | 405 | 449 | df change | 44 | |||
TLI | 0.92 | 0.89 | p-value | p < 0.0001 | |||
RMSEA | 0.05 | 0.07 | |||||
AIC | 200,452.1 | 289,429.0 |
Poisson regression analyses
Prevalence ratios (PR) with 95% CI | |||
---|---|---|---|
Unadjusted model | Adjusted model 1 | Adjusted model 2 | |
PR | PR | PR | |
Frontal signs | |||
Mildly-impaired | 4.7 (3.8–5.8) | 3.9 (3.1–4.9) | 3.8 (2.9–4.9) |
Heavily-impaired | 15.0 (12.1–18.6) | 9.5 (7.4–12.1) | 6.7 (5.0–8.9) |
Extrapyramidal signs | |||
Mildly-impaired | 4.2 (3.4–5.0) | 2.9 (2.4–3.6) | 2.5 (2.0–3.1) |
Heavily-impaired | 10.0 (8.1–12.3) | 5.4 (4.3–6.9) | 3.3 (2.5–4.3) |
Cerebellar signs | |||
Mildly-impaired | 4.2 (3.6–5.0) | 2.8 (2.4–3.4) | 2.4 (2.0–3.0) |
Heavily-impaired | 8.9 (7.2–10.7) | 4.8 (3.9–6.0) | 2.9 (2.2–3.7) |
Gait disturbance signs | |||
Mildly-impaired | 3.5 (2.3–5.1) | 2.5 (1.7–3.7) | 2.1 (1.3–3.3) |
Heavily-impaired | 3.9 (3.3–4.5) | 2.3 (1.9–2.7) | 2.0 (1.7–2.4) |
Cox proportional hazard regression analyses
Hazard ratios (HR) with 95% CI | |||
---|---|---|---|
Unadjusted model | Adjusted model 1 | Adjusted model 2 | |
HR | HR | HR | |
Frontal signs | |||
Mildly-impaired | 1.2 (1.1–1.2) | 1.1 (1.1–1.2) | 1.1 (1.1–1.2) |
Heavily-impaired | 2.1 (2.0–2.3) | 1.9 (1.7–2.1) | 1.6 (1.4–1.8) |
Extrapyramidal signs | |||
Mildly-impaired | 1.3 (1.2–1.3) | 1.2 (1.1–1.2) | 1.1 (1.1–1.2) |
Heavily-impaired | 1.9 (1.7–2.1) | 1.7 (1.5–1.9) | 1.4 (1.3–1.6) |
Cerebellar signs | |||
Mildly-impaired | 1.5 (1.4–1.6) | 1.4 (1.3–1.5) | 1.3 (1.2–1.4) |
Heavily-impaired | 1.7 (1.5–1.9) | 1.6 (1.4–1.7) | 1.3 (1.1–1.5) |
Gait disturbance signs | |||
Mildly-impaired | 1.1 (1.0–1.3) | 1.0 (0.9–1.2) | 1.0 (0.8–1.1) |
Heavily-impaired | 1.1 (1.0–1.2) | 1.1 (1.0–1.1) | 1.0 (0.9–1.0) |