news in aging and dementia at the 13th pan american congress of neurology

3
10.1586/ERN.12.57 777 ISSN 1473-7175 © 2012 Expert Reviews Ltd www.expert-reviews.com Meeting Report Pan American Congresses are the regional meetings of the World Federation of Neurology that are held every 4 years. The first Pan American Congress took place in Lima, Peru, in 1963, and was run by J Oscar Trelles, the famed Latin American neuroscientist and Prime Minister of Peru [1] . The objective of Pan American Congresses is to highlight neurology and its recent advances in the host country. In March 2012, the 13th Pan American Congress of Neurology was organized in La Paz, Bolivia, by Juan Carlos Durand Quiroz and his colleagues from the Bolivian Society of Neurology on behalf of the World Federation of Neurology – an umbrella organization rep- resenting national and regional societies of neurology. The official congress language was Spanish. The congress attracted more than 500 delegates from approximately 20 countries of America. The congress offered a program developed by an international panel of experts, with the assistance of a brilliant scientific committee. It therefore provided an excellent opportunity for continued education in all fields of neurol- ogy. The scientific program included ‘state-of- the-art’ lectures in parallel sessions, together with volunteer oral communications and sev- eral hundred posters. Abstracts were reviewed and assigned to appropriate sessions. Accepted abstracts will be available on a CD-ROM to be distributed at the congress. A limited number of abstracts were scheduled for oral presentation. The program had parallel sessions focusing on epilepsy, cerebrovascular disease, epidemiology, movement disorders, and headache, as well as aging and dementia. The aging and dementia track was organized by Raul Arizaga and his colleagues from the Research Group on Dementia from the World Federation of Neurology in two sessions and consisted of eight lectures and several sessions of oral communications and posters. Epidemiology of dementia in Latin America A review of epidemiology of dementia in Latin America (LA) was presented by Ricardo Nitrini (University of Sao Paulo, Brazil). Dementia has become a major public health problem in the region. Eight epidemiological studies have been carried out in different countries of LA (Cerro, Uruguay; Concepcion, Chile; Catanduva and Sao Paulo, Brazil; Maracaibo, Venezuela; La Ricardo F Allegri* and María Julieta Russo Department of Cognitive Neurology, Instituto de Investigaciones Neurológicas (FLENI), Buenos Aires, Argentina *Author for correspondence: Tel.: +54 9 114 470 4855 Fax: +54 114 433 3443 rallegri@fleni.org.ar 13th Pan American Congress of Neurology La Paz, Bolivia, 4–8 March 2012 The Pan American Congress of Neurology was organized by the Bolivian Society of Neurology on behalf of the World Federation of Neurology in La Paz, Bolivia. Aging and dementia was one of the main congress tracks that has been highlighted in recent Latin American research in the field, focusing specifically on epidemiological studies, the economic cost of dementia and new Alzheimer’s disease (AD) biomarkers. A 4-year follow-up study of AD biomarkers was discussed and a survey was conducted in Argentina on the opinion of the general population in relation to the clinical use of these biomarkers, and early diagnosis criteria of AD were presented. In parallel, a newly developed Neurology International Conference for Primary Care was run that was designed for the education of more than 350 general practitioners from all the regions of Bolivia. News in aging and dementia at the 13th Pan American Congress of Neurology Expert Rev. Neurother. 12(7), 777–779 (2012) KEYWORDS: aging • congress • dementia • neurology • Pan American For reprint orders, please contact [email protected] Expert Review of Neurotherapeutics Downloaded from informahealthcare.com by Case Western Reserve University on 11/02/14 For personal use only.

Upload: maria-julieta

Post on 09-Mar-2017

216 views

Category:

Documents


1 download

TRANSCRIPT

Page 1: News in aging and dementia at the 13th Pan American Congress of Neurology

10.1586/ERN.12.57 777ISSN 1473-7175© 2012 Expert Reviews Ltdwww.expert-reviews.com

Meeting Report

Pan American Congresses are the regional meetings of the World Federation of Neurology that are held every 4 years. The first Pan American Congress took place in Lima, Peru, in 1963, and was run by J Oscar Trelles, the famed Latin American neuroscientist and Prime Minister of Peru [1]. The objective of Pan American Congresses is to highlight neurology and its recent advances in the host country.

In March 2012, the 13th Pan American Congress of Neurology was organized in La Paz, Bolivia, by Juan Carlos Durand Quiroz and his colleagues from the Bolivian Society of Neurology on behalf of the World Federation of Neurology – an umbrella organization rep-resenting national and regional societies of neurology. The official congress language was Spanish. The congress attracted more than 500 delegates from approximately 20 countries of America.

The congress offered a program developed by an international panel of experts, with the assistance of a brilliant scientific committee. It therefore provided an excellent opportunity for continued education in all fields of neurol-ogy. The scientific program included ‘state-of-the-art’ lectures in parallel sessions, together

with volunteer oral communications and sev-eral hundred posters. Abstracts were reviewed and assigned to appropriate sessions. Accepted abstracts will be available on a CD-ROM to be distributed at the congress. A limited number of abstracts were scheduled for oral presentation. The program had parallel sessions focusing on epilepsy, cerebrovascular disease, epidemiology, movement disorders, and headache, as well as aging and dementia.

The aging and dementia track was organized by Raul Arizaga and his colleagues from the Research Group on Dementia from the World Federation of Neurology in two sessions and consisted of eight lectures and several sessions of oral communications and posters.

Epidemiology of dementia in Latin AmericaA review of epidemiology of dementia in Latin America (LA) was presented by Ricardo Nitrini (University of Sao Paulo, Brazil). Dementia has become a major public health problem in the region. Eight epidemiological studies have been carried out in different countries of LA (Cerro, Uruguay; Concepcion, Chile; Catanduva and Sao Paulo, Brazil; Maracaibo, Venezuela; La

Ricardo F Allegri* and María Julieta RussoDepartment of Cognitive Neurology, Instituto de Investigaciones Neurológicas (FLENI), Buenos Aires, Argentina*Author for correspondence: Tel.: +54 9 114 470 4855 Fax: +54 114 433 3443 [email protected]

13th Pan American Congress of NeurologyLa Paz, Bolivia, 4–8 March 2012

The Pan American Congress of Neurology was organized by the Bolivian Society of Neurology on behalf of the World Federation of Neurology in La Paz, Bolivia. Aging and dementia was one of the main congress tracks that has been highlighted in recent Latin American research in the field, focusing specifically on epidemiological studies, the economic cost of dementia and new Alzheimer’s disease (AD) biomarkers. A 4-year follow-up study of AD biomarkers was discussed and a survey was conducted in Argentina on the opinion of the general population in relation to the clinical use of these biomarkers, and early diagnosis criteria of AD were presented. In parallel, a newly developed Neurology International Conference for Primary Care was run that was designed for the education of more than 350 general practitioners from all the regions of Bolivia.

News in aging and dementia at the 13th Pan American Congress of NeurologyExpert Rev. Neurother. 12(7), 777–779 (2012)

Keywords: aging • congress • dementia • neurology • Pan American

Expert Review of Neurotherapeutics

2012

12

7

777

779

© 2012 Expert Reviews Ltd

10.1586/ERN.12.57

1473-7175

1744-8360

News in aging & dementia at the 13th Pan American Congress of Neurology

Allegri & Russo

Expert Rev. Neurother.

Meeting Report

For reprint orders, please contact [email protected]

Exp

ert R

evie

w o

f N

euro

ther

apeu

tics

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Cas

e W

este

rn R

eser

ve U

nive

rsity

on

11/0

2/14

For

pers

onal

use

onl

y.

Page 2: News in aging and dementia at the 13th Pan American Congress of Neurology

Expert Rev. Neurother. 12(7), (2012)778

Meeting Report

Habana, Cuba; Piraju, Brazil; and Lima, Peru), but these were relatively unknown to the neurological international community because they were published in local or regional journals. Nitrini’s lecture showed that the global prevalence of dementia in the elderly (≥65 years of age) in LA was 7.1% (95% CI: 6.8–7.4), mirroring the rates found in developed countries. However, the prevalence in relatively young subjects (65–69 years) was higher in the LA studies. The rate of illiteracy among the elderly was 9.3%, and the prevalence of dementia in illiterates was two-times higher than in the literates. Alzheimer’s disease (AD) was the most common cause of dementia. The higher prevalence of dementia in relatively young subjects may be related to the association between low education level and lower cognitive reserve, causing earlier emergence of clinical signs of dementia in the LA elderly population [2].

Economic costs of dementia in LANew data about the economic costs of dementia in Argentina were presented by Ricardo F Allegri (University of Buenos Aires, Argentina). There was limited information about the economic costs of dementia in South America.

Allegri showed that the annual direct costs of patients with AD in Argentina increased with cognitive deterioration from US$3420.4 in mild AD to US$9657.6 in severe AD, and with institutionalization (US$3189.2 for outpatients vs US$14, 447.68 for those institutionalized) [3]. In LA, most direct costs were paid for by the family because social security was limited in this region. Another study comparing the differential costs of various subtypes of dementia [4] showed that the annual direct costs were US$4625 for dementia of Alzheimer’s type (DAT), US$4924 for frontotemporal dementia (FTD) and US$5112 for vascular dementia (VaD; p > 0.05 between groups). In the post-hoc analysis, VaD showed higher hospitalization costs than DAT (p < 0.001). VaD exhibited lower medication costs than FTD (p < 0.001). DAT exhibited higher antidementia drug costs, and FTD had higher psychotropic costs. In the multivariate anal-ysis, depression, activities of daily living and caregiver burden were correlated with direct costs (r2 = 0.76). With an increasing aging population in our region, analyses of health resource distri-bution in dementia patients and the resultant healthcare policies have become indispensable.

AD biomarkers in South AmericaA promising advancement in making early diagnosis of AD pos-sible has been the development of biomarkers. Recently, in 2011, after gathering evidence from multiple trials and publications on biomarkers, the National Institute on Aging has issued new diagnostic recommendations for dementia and for mild cogni-tive impairment (MCI) due to AD [5,6]. Levels of Aβ42, total tau (tau-t) and tau phosphorylated at position 181 (tau-p) in the cerebrospinal fluid (CSF) are one of the widely recognized bio-markers for AD. The decrease in CSF Aβ42 pathologically cor-relates with the accumulation of β-amyloid, whereas the increased tau-t and tau-p indicate deposition of neurofibrillary tangles and neuronal degeneration. The first report of a long follow-up with

AD biomarkers in LA was presented by Jorge Campos (FLENI, Buenos Aires, Argentina). He described a 4-year follow-up of 20 patients (ten MCI, seven AD and three FTD) studied with CSF biomarkers (Aβ42, total-tau and phospho-tau 181). Longitudinal analysis confirmed that MCI patients with positive risk for AD (n = 5) showed an outright decline in their scores of Mini Mental State Exam and worsening in their Clinical Dementia Rating status (p < 0.05). Four of these patients had clinically probable AD. The remaining MCI patients with negative or intermediate risk for AD (n = 5) had no significant changes in their scores. Only one patient progressed to probable dementia. The final analysis at the end of the study showed that patients with higher clinical progression (worsening of Mini Mental State Exam and Clinical Dementia Rating scores) in the MCI group and AD had the lowest values of Aβ42, Aβ42/tau-p and profile for AD in CSF and higher val-ues in tau-t and tau-p compared with the group of patients with MCI who did not progress to AD and FTD. In this context, CSF biomarker analysis allows an approach to the physiopathological process underlining AD, possibly leading to a more accurate diag-nosis. In addition, the presence of CSF biomarkers in preclinical and prodromic phases can improve the estimation of conversion to AD and would permit an earlier diagnosis of the disease.

Survey about early diagnosis of ADThe results of a survey applied to 360 normal subjects from the general population in Buenos Aires were presented by Pablo Bagnati (University of Buenos Aires, Argentina) [7]. The results of the survey indicated that AD was the third biggest health fear after cancer and stroke. A total of 85% of the participants identified the common symptoms (forgetfulness), and approximately 40% considered it to be fatal disease. More than 90% of the people said that they would want to know the true diagnosis if they had the disease and 80% of the participants agreed to make an ancil-lary study to confirm the diagnosis at the preclinical state of AD. Only 50% in this situation said that they would accept a lumbar puncture for early diagnosis. Bagnati discussed how the public opinion survey shows the level of fear and concern in relation to the disease, but it was interesting to see that most of the people prefer to know the diagnosis. This demonstrated a big change in the attitude of Latin American people, because a few years ago, doctors usually assumed that patients did not want to know their AD or dementia diagnosis. The other surprise was that most of the people would like to know about the disease even in its preclinical state because they wish to be in control of what happens in the future. This survey provided a very important ethical context to the development of new biomarkers and the possibility of very early diagnosis; the opinion of patients in relation to the clinical use of these biomarkers should be considered.

Neurology International Conference in primary careOne of the most exciting events of the meeting was a neurological conference in primary care organized in parallel with the main congress by Silvia Kochen (University of Buenos Aires, Argentina) and Maria Cusicanqui (Society of Neurology, La Paz, Bolivia) on behalf of the World Federation of Neurology, the Pan American

Allegri & Russo

Exp

ert R

evie

w o

f N

euro

ther

apeu

tics

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Cas

e W

este

rn R

eser

ve U

nive

rsity

on

11/0

2/14

For

pers

onal

use

onl

y.

Page 3: News in aging and dementia at the 13th Pan American Congress of Neurology

779www.expert-reviews.com

Meeting Report

Society of Neuro-epidemiology and in agreement with the health authorities of Bolivia.

The conference was organized as a 5-day course (covering stroke, epilepsy, dementia, headache and CNS infections) with 20 days of teaching, divided into 4 h per day. Each session was presented by a leading neurology specialist from different parts of the world. There were 350 participants enrolled in total (most of them general practitioners [GPs]), but admission was reduced to approximately 100 attedees due to a lack of space in the event venue. This course was very important because it was organized specifically for GPs and was presented in simple language with practical diagnostic and treatment protocols. Each participant received a CD with all the materials presented in each class. It was the first time that an extension of an international neuro-logical congress was used for teaching local GPs, and Kochen proposed that this should be replicated at the next Pan American Congresses of the region.

ConclusionThe lectures in aging and dementia at the 13th Pan American Congress brought together an extraordinary spectrum of under-standing and expertise in the field of cognitive impairment and dementia in the underdeveloped countries, which may impact powerfully on the health system. They also provide useful data as models for planning and defining aging health policies in at the region.

Financial & competing interests disclosureThe authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

References1 Allegri RF. History of clinical neurology in

Central and South America. In: Handbook of Neurology (Volume 95) – History of Clinical Neurology. Finger S, Boller F, Tyler KL (Eds). Elsevier, Amsterdam, The Netherlands, 801–814 (2009).

2 Nitrini R, Bottino CM, Albala C et al. Prevalence of dementia in Latin America: a collaborative study of population-based cohorts. Int. Psychogeriatr. 21(4), 622–630 (2009).

3 Allegri RF, Butman J, Arizaga RL et al. Economic impact of dementia in developing countries: an evaluation of costs

of Alzheimer-type dementia in Argentina. Int. Psychogeriatr. 19(4), 705–718 (2007).

4 Rojas G, Bartoloni L, Dillon C, Serrano CM, Iturry M, Allegri RF. Clinical and economic characteristics associated with direct costs of Alzheimer’s, frontotemporal and vascular dementia in Argentina. Int. Psychogeriatr. 23(4), 554–561 (2011).

5 McKhann GM, Knopman DS, Chertkow H et al. The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 7(3), 263–269 (2011).

6 Albert MS, DeKosky ST, Dickson D et al. The diagnosis of mild cognitive impairment due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement. 7(3), 270–279 (2011).

7 Bagnati P, Russo MJ, Bartoloni L, Iturri M, Allegri RF. Visión poblacional sobre la Enfermedad de Alzheimer y sus nuevos paradigmas diagnósticos y terapéuticos. Presented at: 13th Pan American Congress of Neurology. La Paz, Bolivia, 4–8 March 2012.

News in aging & dementia at the 13th Pan American Congress of Neurology

Exp

ert R

evie

w o

f N

euro

ther

apeu

tics

Dow

nloa

ded

from

info

rmah

ealth

care

.com

by

Cas

e W

este

rn R

eser

ve U

nive

rsity

on

11/0

2/14

For

pers

onal

use

onl

y.