Professional Documents
Culture Documents
DOI 10.3233/JAD-190177
IOS Press
Review
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Rafael Brito-Aguilar∗
Research Department, School of Health Sciences, Campus Victoria, Universidad del Valle de México,
Victoria, Tamaulipas, México
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Abstract. Dementia has become a major public health concern around the world. Dementia risk factors are significantly
different among countries. The number of new cases of dementia anticipated each year worldwide is almost 7.7 million,
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one new case every four seconds. There are 3.6 million (46%) new cases per year in Asia, 2.3 million (31%) in Europe,
1.2 million (16%) in the Americas, and 0.5 million (7%) in Africa. Latin American and Caribbean low and middle-income
countries are at high risk. Air pollution is an important risk modifiable factor for dementia across the world, and the recent
report of the Alzheimer’s disease continuum in children and young adults residing in Metropolitan Mexico City along with
the presence of cognitive impairment in 55% of the young adult population residing in Mexican cities with fine particulate
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matter concentrations above the current USEPA annual standard of 12 g/m3 makes this a severe public health problem in
progress. It is imperative to keep generating epidemiological data on dementia worldwide and their relationship with air
pollutants to improve the strategies to face all the challenges associated with dementia and Alzheimer’s disease in particular.
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Alzheimer’s disease is a fatal disease, we have no cure, and we ought to invest in protecting our citizens by intervening in
modifiable environmental factors.
Keywords: Air pollution, Alzheimer’s disease, Alzheimer’s disease continuum, dementia, fine particulate matter, Latin
America, Mexico, nanoparticles, prevalence
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ISSN 1387-2877/19/$35.00 © 2019 – IOS Press and the authors. All rights reserved
2 R. Brito-Aguilar / Dementia Around the World and the Latin America and Mexican Scenarios
licate to 135 million by 2050 [7]. The projected and differences in diagnostic criteria could likely
increases are driven by population aging which is account for some of the differences in the litera-
occurring at a very rapidly rate in low- and middle- ture; however, it is also becoming clear there are
income countries. The number of new cases of striking risk factors applicable to low and middle
dementia anticipated each year worldwide is almost income countries and ethnic and age differences
7.7 million—one new case every four seconds [6]. in populations diagnosed with dementia [18, 19].
Unfolding this by region, it means that there are 3.6 The issue of income is critical for one powerful
million (46%) new cases per year in Asia, 2.3 million reason: potentially modifiable dementia risk factors
(31%) in Europe, 1.2 million (16%) in the Americas, for lower income countries like India, China, Cuba,
and 0.5 million (7%) in Africa [6]. Dominican Republic, Mexico, Peru, Puerto Rico, and
Prevalence of dementia has been studied by epi- Venezuela include variables where interventions can
demiologists all over the world and the projected occur, like childhood education, midlife hearing loss,
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estimates come from several sources such as epi- hypertension, obesity, smoking, depression, physical
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demiologic surveys, hospital records, and electronic inactivity, social isolation, and diabetes [18].
medical history databases. A meta-analysis involv-
ing 157 epidemiologic studies conducted between
1980–2009 worldwide, reported a prevalence of THE LATIN AMERICA AND MEXICAN
dementia between 5–8% in those aged ≥60 years, SCENARIOS
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showing an exponential growth with age, two-fold
increases every five years [8]. Similar results were Latin American and Caribbean low and middle-
reported in a different worldwide meta-analysis income countries face a grim scenario in terms of
study, with a prevalence of 4.8% and a period preva- dementia. The situation in Mexico is particularly
lence of 6.9% in a population ≥60 years [9]. difficult because there are 53.4 million people in
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Dementia prevalence studies from Sweden, poverty. Additionally, there is a progressive change
France, Spain, United States of America, United in the pyramid population distribution, with elderly
Kingdom, and Japan have shown a constant or populations >65 years increasing, and the Mexican
slightly decreased prevalence through time [10–17]. economic, health system, and social problems pose
The Stockholm Study showed a prevalence of 17.5% difficulties in taking care of this growing population,
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and 17.9% for the years 1987 and 2001, respectively expected to triple to 20% by 2050 [20]. The demo-
[10]. Population studies from Spain showed a preva- graphic structure of Latin American and Caribbean
lence ranging from 9.4% [11] and 8.5% [12] on adults countries (LACC) is changing rapidly compared to
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≥70 years, and between 5.5% [13] and 5.8% [14] on North American and European countries, and it is
adults ≥65 years. Data from the Cognitive Function expected that the number of people with dementia in
and Ageing Study in UK between 1994 and 2008 LACC will increase from 7.8 million in 2013 to over
showed a prevalence ranging from 6.3% to 8.3% [15]. 27 million by 2050. Studies from Brazil, Cuba, Chile,
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Data from the United States from the Health and Peru, and Venezuela showed a global prevalence of
Retirement Study from the years 2000 and 2012, AD at 7.1% [21]. These analyses also revealed that
showed a 25% decrease on dementia prevalence from prevalence of dementia doubles every 5 years from
11.6% to 8.8% on adults ≥65 years [16]. Interest-
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1,000 live births, respectively), and lack of health morbidity with two major health problems: diabetes
care and impoverishing effects of health care costs and hypertension.
in a country where 46% of the population is poor One major problem in Mexico is the underre-
[22–25]. The elderly population in Mexico and across porting of dementia cases, partially due to lack of
Latin America will be seriously affected in the next 30 knowledge reported by 59% of physicians [34] that
years as the population grows without health care, in likely reflects the reporting of 150 cases of new AD
poverty, with gender inequality, and without support in 2015 and 227 in 2017 in Mexico City, a megacity
[20, 26–30]. with ∼9 million people [35]. A review of death cer-
In the last 15 years, several population-based tificates in Mexico from 1980 to 2014 shows a trend
studies have been conducted to estimate dementia to writing the diagnosis in the certificates in the last
prevalence in Mexico. The Health, Wellness and two decades [36].
Aging Study (SABE) was one of the first multina- It is certainly of great concern the relationship
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tional surveys in the late 1990 s to evaluate the general between the risk of dementia, including AD and
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health of elderly adults in Mexico [26]. The National air pollution [37–42] and the presence of iron-rich
Study on Health and Aging in Mexico (ENSAEM) magnetic nanoparticles in the brains of Mexico City
was created by the Health National Institute and residents [40].
the US National Institute on Aging, and its main The recent reports of the evolving AD continuum
objectives were to evaluate the impact of illnesses in Mexico City residents starting in childhood [41]
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and mortality on adults 50 years and over in rural and the significant cognitive deficits in young adults
and urban areas from Mexico, showing a preva- [42] raises serious concerns about the early onset
lence of 6.1% on dementia cases for the year 2003 and rapid progression of AD, as described by the
[31]. Important contributions have been made by the 2018 NIA-AA research framework [43], in the Mex-
10/66 Dementia Research Group, which includes 30 ican residents exposed to concentrations above the
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research groups in 20 countries in Latin America, the USEPA standard for both fine particulate matter and
Caribbean, India, Russia, China, and south east Asia. ozone. The question posed by Richly et al. [34] will
For Mexico, the 10/66 Dementia Research Group most certainly apply for the millions of Mexican peo-
reports a prevalence of 8.6% in urban areas and 8.5% ple with high air pollution exposures sharing other
in rural areas, adjusted for sex, age, and academic factors such as low socioeconomic status, low educa-
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purpose of having a better understanding of the Mex- economic, education, judicial, etc., consequences?
ican health situation. Unfortunately, in the beginning, The 2018 Latino population in the US reaches
elderly adults were not considered in the surveys. It almost 59 million [44], 18.1% of the nation’s total
was only in 2012 when the latest version of the sur- population. Arizona, California, Colorado, Florida,
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vey, known as National Health and Nutrition Survey Georgia, Illinois, New Jersey, New Mexico, New
(ENSANUT), included elderly adults. Eight thou- York, and Texas are the states with more Latinos,
sand eight hundred seventy-four adults aged 60 and and Mexicans are the largest foreign-born group in
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over were interviewed to learn their main health con- the country: 25% of the 44.5 million immigrants as
cerns, including dementia [33]. of 2017. Mexicans on average are more likely to be
The Mexican Health and Aging Study (MHAS), a Limited English Proficient, have lower levels of edu-
sample of 13 million Mexicans ≥50 years, was used cation, experience poverty, and lack health insurance
to estimate the prevalence and incidence of dementia [45].
and cognitive impairment without dementia (CIND) It is clear that aging is the greatest risk factor for
in a sample of 7,166 subjects older than 60 years [31]. AD, but other demographic factors also contribute
Results showed a prevalence of 6.1% for dementia to the increment on AD cases. One of these is the
and 28.7% for CIND; interestingly higher educa- rapidly growing Latino population in the US, and
tional level was protective for dementia, and diabetes, Latinos are more prone to develop AD than White
hypertension, and depression were seen at baseline in Non-Hispanics. Furthermore, within the Latino pop-
incident dementia cases. Mejia-Arango and Gutier- ulation there are differences on the prevalence of AD
rez [31] suggested cognition in Mexican elders likely cases, and despite this, the differences are still poorly
reflects educational level, economic status, and co- understood and controversial. The variances might be
4 R. Brito-Aguilar / Dementia Around the World and the Latin America and Mexican Scenarios
based on nationality origin such as Mexicans, South [10] Wu YT, Beiser AS, Breteler MMB, Fratiglioni L, Helmer
and Central America, and the Caribbean Hispan- C, Hendrie HC, Honda H, Ikram MA, Langa KM, Lobo A,
Matthews FE, Ohara T, Pérès K, Qiu C, Sjölund BM, Skoog
ics. The AD prevalence in the Latino population has I, Brayne C (2017) The changing prevalence and incidence
reach epidemic proportions and has become a social of dementia over time –current evidence. Nat Rev Neurol
and economic issue. Latino community idiosyncrasy 13, 327-339.
influences the decision of seeking appropriate health- [11] Gascón-Bayarri J, Reñé R, Del Barrio JL, De Pedro-
Cuesta J, Ramón JM, Manubens JM, Sánchez C, Hernández
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It is imperative to keep generating epidemiological 224-234.
[12] Tola-Arribas MA, Yugueros MI, Garea MJ, Ortea-
data on dementia worldwide to improve the strategies Valı́n F, Cerón-Fernández A, Fernández-Malvido B, San
to face all the challenges associated with dementia José-Gallegos A, González-Touya M, Botrán-Velicia A,
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and AD in particular. Iglesias-Rodrı́guez V, Dı́az-Gómez B (2013) Prevalence of
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dementia and subtypes in Valladolid, Northwestern Spain:
Air pollution control ought to be a health issue
The DEMINVALL Study. PLoS One 8, e77688.
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F, Bergareche A, Benito-León J, de Arce A, del Barrio JL
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The author’s disclosure is available online (https:// (2009) Prevalence of dementia and major dementia subtypes
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