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INTRODUCTION: Verbal fluency tasks are common in Alzheimer's disease (AD) assessments. Yet, standard valid response counts fail to reveal disease‐specific semantic memory patterns. Here, we leveraged automated word‐property analysis to capture neurocognitive markers of AD vis‐à‐vis behavioral variant frontotemporal dementia (bvFTD). METHODS: Patients and healthy controls completed two fluency tasks. We counted valid responses and computed each word's frequency, granularity, neighborhood, length, familiarity, and imageability. These features were used for group‐level discrimination, patient‐level identification, and correlations with executive and neural (magnetic resonanance imaging [MRI], functional MRI [fMRI], electroencephalography [EEG]) patterns. RESULTS: Valid responses revealed deficits in both disorders. Conversely, frequency, granularity, and neighborhood yielded robust group‐ and subject‐level discrimination only in AD, also predicting executive outcomes. Disease‐specific cortical thickness patterns were predicted by frequency in both disorders. Default‐mode and salience network hypoconnectivity, and EEG beta hypoconnectivity, were predicted by frequency and granularity only in AD. DISCUSSION: Word‐property analysis of fluency can boost AD characterization and diagnosis. Highlights: We report novel word‐property analyses of verbal fluency in AD and bvFTD.Standard valid response counts captured deficits and brain patterns in both groups.Specific word properties (e.g., frequency, granularity) were altered only in AD.Such properties predicted cognitive and neural (MRI, fMRI, EEG) patterns in AD.Word‐property analysis of fluency can boost AD characterization and diagnosis. [ABSTRACT FROM AUTHOR]

Background: Subjective cognitive complaints (SCCs), defined as cognitive concerns of people who may or may not have deficits in objective, is considered a predictor for cognitive and functional decline and incident to dementia risk of progression to dementia. SCC is a heterogeneous condition associated. Most of the studies have been carried out in populations other than those of Latin America. The objective of this study was to analyze the socio‐demographic and functional profile in SCC elderly with and without cognitive impairment. Method: The GERO cohort is a prospective cohort study of community‐dwelling elderly with SCC, without dementia, aged 70 or older living in Santiago, Chile. Participants were identified by a household census and information on demographics, biomedical, psychosocial, neuropsychological, neuropsychiatric, and motor function were collected by means of questionnaires and evaluations. Montreal Cognitive Assessment (MOCA) was used to compare individuals with and without cognitive impairment (MOCA score ≤ 21 and > 21 respectively). Functionality was measured with the Pfeffer Functional Activities Questionnaire (FAQ) and Technology Activities of Daily Living Questionnaire (T‐ADLQ) that yield a global score and score by domain of activities of daily living (ADL), i.e basic (BADL), instrumental (IADL), and advanced ADL (a‐ADL). Result: From May 2017 to December 2020, a total of 17,759 households were successfully approached, identifying 2,533 eligible subjects, of which 299 individuals were included. After evaluation, 7 individuals were excluded for different reasons and 291 individuals were analyzed, female 80% (n = 243). The age of the individuals was 76.8 ± 5 years old, 60% of the participants were older than 75 years old. Participants with cognitive impairment compared to those without it were older (p = 0.003), with lower education years (p = <0.001), lower income (p = 0.036), lower MMSE score (p = <0.001), decline in a‐ADL (p = 0.006) and with more hypertension prevalence (p = 0.009) Conclusion: Few other studies addressed cognitive complaint and functionality decline in recruited elderly at home. Older adults with cognitive impairments are characterized by less years of education, income, poor functionality and more comorbidities. Future multidimensional and prospective analysis of this cohort could bring more information about this association. [ABSTRACT FROM AUTHOR]

Background: Currently, dementia training is only offered in a few large medical centers in a handful of Latin America ́s biggest cities. Reduced access and the heterogeneous quality of dementia education for clinicians hinder the diagnosis and treatment of neurodegeneration in Latin America. Aim: This project aims to fill the education gaps and increase specialist´s diagnostic and therapeutic skills in neurodegenerative diseases through an interactive online Spanish‐language pilot program tailored for Latin America. Methods: We put together a 108 hour curriculum formed by four modules: basic aspects of behavioral neurology, neurobehavioral and neuropsychiatric syndromes,treatment, and other aspects of neurodegenerative diseases. It was delivered by 35 brain health experts and reviewers that coolaborate with the Global Brain Health Institute in at the University of California, San Francisco to a pilot group formed by 35 geriatricians, neurologists and psychiatrists from six Latin American Countries (Peru, Mexico, Chile, Colombia, Ecuador, and Venezuela). An initial and final evaluations were performed with the Spanish‐dementia knowledge assessment scale (Carnes et al, 2021), the Frontotemporal Dementia Knowledge Scale (Magrath et al 2021) and clinical cases. In addition, short evaluations submitted by professor were answered before and after each class. Separately, we requested feedback from the students about the course. Results: Comparing the overall scores between the initial and final evaluation, there was a 7% increase in the Geriatrician´s score, 4% in Neurologists´ score and 9% in the Psychiatrist's score. The greatest increase was in Frontotemporal Dementia Knowledge. (Figures 1 and 2). The topics with the worse baseline scores were clinical evaluation attention, executive functions, and atypical Alzheimer´s Disease. We observed an increase in knowledge after every class. Most of the feedback brought to light that there were many topics that specialists had not had the opportunity to learn before such as sleep in neurodegeneration, traumatic encephalopathy, and atypical dementia syndromes. Conclusion: It is imperative to find ways of bringing education to regions where dementia prevalence is increasing, and specialist do not have enough knowledge. Online programs are feasible and effective strategies to close educational gaps. [ABSTRACT FROM AUTHOR]

Background: Functional decline (FD) is defined as the deterioration of the ability to perform activities of daily living (ADLs). This FD is a critical dimension that allows determining the threshold between dementia disorders and previous stages of cognitive impairment. ADLs include activities that are divided into three main dimensions: basic (BADL), instrumental (IADL), and advanced (AADL). The Technology‐Activities of Daily Living Questionnaire (T‐ADLQ) (1) assesses these different ADL dimensions. To date, the dimensions of ADLs have not been assessed in the continuum ranging from healthy controls (HC), amnestic mild cognitive impairment (a‐MCI), to Alzheimer's disease dementia (ADD) in the illiterate population. The study aimed is to validate the T‐ADLQ and evaluate FD across the three dimensions of ADL in healthy and cognitively impaired illiterate adults >50 years. Method: A cross‐sectional study of illiterate subjects in Peru. Inclusion criteria: men and women over 50 years of age; with less than one whole year of formal education and unable to read and write and grouped into 1 of 3 cognitive categories: healthy controls (HC) (n = 64), a‐MCI (n = 60), and early ADD (n = 63). Neuropsychological measures included the RUDAS, MMSE, and IFS. FD was assessed with the FAQ and the T‐ADLQ. The latter questionnaire, assessed by informants, evaluated the different dimensions of ADLs. Result: The results on the global FD (T‐ADLQ total score) and the three ADL dimensions differed significantly among the three groups (Table 1). The T‐ADLQ total score correlated significantly with the FAQ (Table 2) and had high internal consistency (Cronbach's alpha = 0.966). In addition, the T‐ADLQ total correlated significantly with instruments of global cognition and executive functions (Table 2). Finally, receiver operating characteristic (ROC) analyses, through the calculation of the area under the curve (AUC), showed that the total T‐ADLQ and the different dimensions discriminated better between HC vs. ADD and HC vs. a‐MCI but not between a‐MCI and ADD (Table 3). Conclusion: The total T‐ADLQ scale and its three dimensions have good psychometric properties (validity and reliability) and excellent diagnostic utility. This result demonstrates that the T‐ADLQ is a good instrument to evaluate FD in illiterate populations. [ABSTRACT FROM AUTHOR]

Background: Social cognition dysfunction in neurodegenerative diseases such as the behavioral variant frontotemporal dementia (bvFTD) and Alzheimer's Disease (AD) is typically ascribed to the underlying pathophysiological processes spanning specific atrophy and connectivity alterations. However, social cognition performance might be modulated by a set of more heterogenous, non‐specific factors, including demographics (sex, age, education, socioeconomic status), general cognitive and executive abilities, and behavior inside the scanner (i.e., movements), but their relative contribution is poorly understood. Here, we develop a machine learning approach to characterize multimodal factors that explain the inter‐individual heterogeneity of social cognition in a diverse multicentric sample. Method: A total of 998 individuals > 50 years from international research networks in high‐ and middle‐income countries participated in this study: 102 with bvFTD, 339 with AD, 96 with mild cognitive impairment (MCI), and 461 with preserved cognition (with and without cognitive complaints). Social cognition was assessed with the Mini Social Cognition and Emotional Assessment (MiniSEA) battery, which includes tests of facial emotion recognition and theory of mind. After data harmonization, we implemented support vector regressions combined with bootstrapping to predict social cognition outcomes from multimodal features, including diagnosis, demographics, cognitive and executive functions, grey matter volume, fMRI resting‐state network connectivity, and movement artifacts, and assessed their relative contribution to performance (Figure 1). Models were assessed with the coefficient of determination R², Fisher's F test, Cohen's F², 95% confidence intervals, and p‐values. Result: General cognitive and executive functions and years of education consistently emerged among the top predictive features of social cognition performance and explained more variance than diagnosis. Other features making significant contributions were: sex, the gray matter volume of relevant regions, and in‐scanner movements. Age and resting‐state network connectivity did not make any significant contribution to performance heterogeneity (Figure 2). Conclusion: Social cognition performance was more strongly predicted by a set of heterogenous individual differences than by neurodegenerative diagnoses and associated brain signatures. Diagnoses might relate to complex profiles. Results highlight a critical modulator role of heterogeneity on social cognition, with implications for the neuropsychological assessment in brain health and disease across diverse, multi‐setting populations. [ABSTRACT FROM AUTHOR]

Limited knowledge on dementia biomarkers in Latin American and Caribbean (LAC) countries remains a serious barrier. Here, we reported a survey to explore the ongoing work, needs, interests, potential barriers, and opportunities for future studies related to biomarkers. The results show that neuroimaging is the most used biomarker (73%), followed by genetic studies (40%), peripheral fluids biomarkers (31%), and cerebrospinal fluid biomarkers (29%). Regarding barriers in LAC, lack of funding appears to undermine the implementation of biomarkers in clinical or research settings, followed by insufficient infrastructure and training. The survey revealed that despite the above barriers, the region holds a great potential to advance dementia biomarkers research. Considering the unique contributions that LAC could make to this growing field, we highlight the urgent need to expand biomarker research. These insights allowed us to propose an action plan that addresses the recommendations for a biomarker framework recently proposed by regional experts. [ABSTRACT FROM AUTHOR]

Background: Motricity has been proposed to shape our perception and the pre‐reflective knowledge of the other as embodied agents. Through our motor system, we have a meaningful pre‐reflective conception of the experience of the other (empathy). We compared the sensorimotor responses and emotional perception in persons with Alzheimer's disease (AD), Parkinson's disease (PD), and healthy older adults (HOA) while they watched videos of sportswomen/sportsmen suffering physical accidents and videos of a neutral condition. Method: 86 participants older than 60 years were recruited (AD = 28, PD = 25, HOA = 33). Subjects with AD were diagnosed following NINCDS‐ADRDA criteria and PD with the United Kingdom Parkinson's Disease Society Brain Bank. The assessment consisted of two parts. Firstly, a neuropsychological battery that included assessment in global cognition (ACE‐III), executive function (IFS, FAS), memory (FCRST), and social cognition (Minisea). Secondly, participants stood up without moving on a force platform while watching videos (60 seconds long and seven scenes each). One video showed sportswomen/sportsmen having physical accidents practicing extreme sports (pain condition), and the other was a neutral condition (home furnishings). At the end of each video, participants rated valence, intensity, and control (1‐9). Each scene was analyzed through six consecutive windows: three seconds before the fall and three after the fall. The six windows of the neutral condition were selected by taking the central temporal part of each scene. Subsequently, and in each window, the AnteroPosterior amplitude of the Center of Pressure (AP‐CoP) was calculated. Results: Participants with AD showed significant impairment in practically all cognitive domains, compared to PD and HOA. An Anova (group*condition*temporal windows) revealed a simple effect on group and condition in AP‐CoP displacement. AD and PD showed higher AP‐CoP in both pain and neutral condition than HOA. PD and HOA showed higher AP‐CoP in pain condition than neutral condition, but not AD. In the ANOVA (group*condition), AD rated (p <0.01) higher the emotional valence in the pain condition (5,93±2,72) than PD (3,52±2,2) and HOA (4,06±2,29). Conclusion: Sensorimotor responses in AD and PD showed enhanced AP‐CoP when compared to HOA. Moreover, AD patients showed a marked impairment in perceiving empathy towards the pain of others. [ABSTRACT FROM AUTHOR]

Background: The worldwide COVID‐19 pandemic has been a major challenge for the health system in the past years. From March 2020 until 2022 there were extensive lockdowns in Latin America to ensure physical distance and reduce virus transmission. Previous studies reported the negative impact of social isolation on people living with dementia, however, the impact on caregivers has been little studied so far. This study analyses the mental impact of the pandemic time on caregivers of people with dementia. Method: In order to evaluate clinical and behavioral changes from the prior assessment conducted in 2020 with people with dementia and their family caregivers, a 1‐year follow‐up phone study was conducted with the same sample from the previous research. Participants from Chile were assessed by two semi‐structured questionnaires. Results: 106 caregivers of patients with dementia were interviewed during the year 2020 (age: 73.3 ± 9.5 years; female: 57%). After one year of follow‐up, 61 caregivers were contacted. Compared to baseline, after one year of follow‐up, 75% % of the caregivers reported worse physical and mental health (p:0.028), 56% more sadness associated with patient care (p:0.001); 93% reduced sleeping time (p:0.07) and 51% received more help to care the patient with dementia (p:0.036). Results are reported in table 1. Conclusion: Although the caregiver had more daily assistance in 2021 compared with 2020, the pandemic time had a negative impact on their physical and psychological health. Even if these results might be explained by the normal evolution of dementia, the follow‐up results did not show a significant behavioral change in the person with dementia, and so the changes in the caregiver might be more a consequence of the pandemic rather than exclusively the disease. [ABSTRACT FROM AUTHOR]

Background: COVID‐19‐related restrictions led to an increase in loneliness and social isolation Historically, dementia care partners present worse mental health and higher burden than non‐dementia care partners. We aimed to analyse the during‐COVID‐19 loneliness levels of Latin American care partners and explore differences between care partners of people with dementia compared to those of people with other enduring health conditions. Method: This was a sub‐study of the 'Coping with Loneliness and Isolation during COVID‐19' (CLIC) Study, an international self‐report survey of 5236 care partners during the COVID‐19 pandemic. People living at home in one of three Latin American countries: Mexico, Chile, Brazil and others. We analysed data from 241 care partners living in Latin American countries who responded to the CLIC Study survey. We used linear regression models to identify factors associated with loneliness and compared care partners of people living with dementia with care partners with other chronic deseases. Result: Compared to pre‐pandemic, there was a significant increase in the prevalence of self‐reported total loneliness reported by the care partners. The levels of social and emotional loneliness between care partners of people with dementia vs other conditions did not differ. Low education and low perception of mental health was associated with emotional and social loneliness during the COVID‐19 pandemic. Conclusion: loneliness during the pandemic was similar across care partners. Some groups are at special risk for higher levels of loneliness and should be considered when planning public health interventions for major societal disruptions, such as a pandemic, in the future. [ABSTRACT FROM AUTHOR]

Background: Subjective cognitive complaint (SCC) is a risk factor of functional impairment in activities of daily living (ADL). ADL are divided from basic (BADL), instrumental (IADL), and advanced activities of daily living (a‐ADL), according to their cognitive complexity. These three dimensions of ADL have been scarcely explored in SCC The objective of this study was to analyze these three dimensions of ADL and their association with global cognition and sociodemographic factors in SCC. Method: 291 participants from the GERO prospective cohort study of community‐dwelling elderly with SCC, aged 70 or older, living in Santiago ‐ Chile were analyzed. ADL were evaluated with the Technology Activities of Daily Living Questionnaire (T‐ADLQ), an informant‐rated questionnaire measuring BADL, IADL and aADL (T‐ADLQ total score and dimension score range 0‐100, higher values meaning worse performance), global cognition with the Mini‐mental state (MMSE) and sociodemographic factors measured with age, gender, marital status, education, household‐income, working status. A multivariate logistic regression model was performed considering MMSE and sociodemographic factors as explanatory variables and the different dimensions of ADL as dependent variables. Results were evaluated with coefficient of regression and 95% confidence intervals. Result: Performances in T‐ADLQ total score ranged from 0 to 56; in BADL from 0 to 40; in IADL from 0 to 67 and a‐ADL from 0 to 100. T‐ADLQ total score was independently associated with MMSE (Coef: ‐0.24), age (Coef: 0.40) and marital status (Coef: 3.44), BADL with age (Coef: 0.14), IADL with age (Coef: 0.45) and marital status (Coef: 3.59), a‐ADL with marital status (Coef: 7.25). Results are presented in Table 1. Conclusion: Impairment in ADL and their associated factors in SCC differ according to their complexity, being the aADL the most affected. Studying dimensions of ADL could contribute to better understanding functionality in SCC. Slachevsky, A., ..., Thumala, D. (2020). GERO Cohort Protocol, Chile, 2017‐2022: Community‐based Cohort of Functional Decline in Subjective Cognitive Complaint elderly. BMC geriatrics, 20(1), 505. Slachevsky, A., ... Hornberger, M. (2019). Mapping the neuroanatomy of functional decline in Alzheimer's disease from basic to advanced activities of daily living. Journal of neurology, 266(6), 1310‐1322 Funding: ANID/FONDAP/15150012; ANID /FONDECYT/ 1231839 and ANID/PIA/ANILLOS ACT210096. [ABSTRACT FROM AUTHOR]

Background: Timely diagnosis of Alzheimer's disease (AD) is a critical first step in clinical care treatment. However, the availability of diagnostic tools for these conditions is either unavailable or unaffordable, especially in Latin American and the Caribbean (LAC) countries. In this scenario, microRNAs (miRNA) have recently emerged as promising cost‐effective and noninvasive biomarkers since they can be readily detected in different biofluids such as plasma bound to protein or inside exosomes. Our aim is to identify new blood biomarkers to calculate the risk to develop AD in the early stages using machine learning based on exosomal miRNAs detection and different cognitive domains. Method: miRNAs were extracted from plasma circulating exosomes samples of Subjective Cognitive Complaint subjects belonging to the GERO cohort in two different times (T1 = baseline and T2 = 18 months, n = 50). miRNAs were sequencing to identify the expression levels. Dysregulated miRNAs were analyzed and correlated with neuropsychological evaluations to create machine learning algorithms. miRNAs obtained from algorithms were validated in a new population of subjects at both stages (T1 and T2, n = 50), using qRT‐PCR and correlation analysis with neuropsychological tests. Result: For algorithm development, we classified subjects into stationary and progressive impairment. Algorithms were trained using the sequenced miRNAs, neuropsychological tests and neuroimaging. As possible predictors of progression of cognitive impairment, the best performing algorithm was Random forest using only miRNAs data. In a new group of subjects, three miRNAs selected by the algorithm and four miRNAs obtained from the literature were validated and the ROC curves were constructed. The combination of these miRNAs (algorithm and literature miRNAs), were the best predictor of the progression of cognitive impairment. Conclusion: This study could be used in the initial phases of the diagnostic process of AD because it is minimally invasive, low cost and accessible to a large number of patients in Latin American and the Caribbean (LAC) countries. [ABSTRACT FROM AUTHOR]

Latin American and Caribbean countries face complex challenges to improve brain health and reduce the impact of dementia. Regional hubs devoted to research, capacity building, implementation science, and education are critically needed. The Latin American Brain Health Institute represent an important step to address many of these needs. [ABSTRACT FROM AUTHOR]

Apathy is a common neuropsychiatric syndrome observed across many neurocognitive and psychiatric disorders. Although there are currently no definitive standard therapies for the treatment of apathy, nonpharmacological treatment (NPT) is often considered to be at the forefront of clinical management. However, guidelines on how to select, prescribe, and administer NPT in clinical practice are lacking. Furthermore, although new Information and Communication Technologies (ICT) are beginning to be employed in NPT, their role is still unclear. The objective of the present work is to provide recommendations for the use of NPT for apathy, and to discuss the role of ICT in this domain, based on opinions gathered from experts in the field. The expert panel included 20 researchers and healthcare professionals working on brain disorders and apathy. Following a standard Delphi methodology, experts answered questions via several rounds of web-surveys, and then discussed the results in a plenary meeting. The experts suggested that NPT are useful to consider as therapy for people presenting with different neurocognitive and psychiatric diseases at all stages, with evidence of apathy across domains. The presence of a therapist and/or a caregiver is important in delivering NPT effectively, but parts of the treatment may be performed by the patient alone. NPT can be delivered both in clinical settings and at home. However, while remote treatment delivery may be cost and time-effective, it should be considered with caution, and tailored based on the patient's cognitive and physical profile and living conditions. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of dementia in Chile is 1.06%, and it is expected to triple in the next 30 years. The current regulations establish that over 80% of the people living with dementia and their care partners should receive care in primary care with only the hard or atypical cases. However, the knowledge and confidence of primary care teams are low, and there is no current training scheme for them. Objectives: To identify the training needs of primary care teams, people living with dementia and their care partners, gathering information to create a course on dementia for primary care teams. Methodology: Qualitative research methods were used, including focus group interviews for health professionals and individual interviews for people living with dementia and their care partners. A complete analysis of the recorded interviews was performed. Results: Disregarding their previous training or background, all primary care professionals recognise the importance of continuous instruction. There is also a lack of preparation for interpersonal skills, like providing bad news and empathy. Caregivers and people living with dementia highlight a lack of continuity in their care team, being unaware of their diagnosis and low support. Conclusions: Our study supports the need for training for primary care on dementia. Even more, it finds some areas, like interpersonal skills, that are usually not covered in dementia education. Adding the patient's and care partners' voices will allow our course to be adapted to their reality and expectations. [ABSTRACT FROM AUTHOR]

Background: The COVID‐19 pandemic has impacted the wellbeing of older adults. Pandemic‐related stress has implications on cognitive status, including decline due to Alzheimer's disease and related dementias. Yet, evidence suggests that COVID‐19 has impacted culturally and linguistically diverse communities differently. We sought to examine the role of COVID‐19 on coping and wellbeing in an international, multi‐ethnic sample of older adults. Method: Data from 955 older adults (age = 66.7±7.9 years; education = 15.2±5.9 years; 71% female; 41% Hispanic/Latino) were pulled from a larger, international sample examining the response of older adults to COVID‐19. All participants completed demographic questionnaires, measures of psychological distress, the Brief‐COPE – a 28‐item self‐report questionnaire used to measure respondent's efforts to minimize distress from a stressful life event – and the Epidemic‐Pandemic Impacts Inventory (EPII) – a 92‐item inventory of pandemic related experiences across several life domains. Using linear regression, we examined relationships between Brief‐COPE scores, ethnicity, and select EPII items controlling for several covariates (age, sex, education, marital status, number of children, employment status, household income, and history of COVID‐19 symptoms) in all analyses. Result: Hispanic/Latino (H/L) ethnicity was associated with slightly higher scores on the approach‐focused coping subscale compared to the non‐Hispanic White (NHW) group (Approach: 27.3±6.6 vs 26.1±6.1; B = 1.205, p = 0.015, CI: 0.238, 2.172). There was no effect of ethnicity on Brief‐COPE Total or Avoidance subscale scores (both ps>0.050). Notably, review of covariates suggested increased age was associated with lower scores on Approach (B = ‐0.065, p = 0.041, CI: ‐0.128, ‐0.003), Avoidance (B = ‐0.054, p = 0.034, CI: ‐0.104, ‐0.004), and Total scores (B = ‐0.136, p = 0.028, CI: ‐0.257, ‐0.015). Higher Approach scores were associated with greater endorsement of Positive Life Changes in both ethnic groups (NHW: partial r = 0.298, p<0.001; H/L: partial r = 0.249, p<0.036), but with endorsement of Mental Health Problems in NHWs only (NHW: partial r = 0.144; p = 0.001; H/L: partial r = ‐0.019, p>0.050). Conclusion: Findings suggest cross‐cultural differences in the stress coping response of older adults during the pandemic, even after controlling for symptomatic history and other relevant covariates. Moreover, coping may be differentially related to positive and negative outcomes across cultural groups. These results support the need to consider cultural background when considering coping and wellbeing in older adults. [ABSTRACT FROM AUTHOR]

Background: Dementia worldwide is one of the most important causes of disability in the elderly and the most rapidly growing cause of death in the last 20 years in Chile. Cognitive complaint is considered a predictor for cognitive and functional decline (FD), incident mild cognitive impairment, and incident dementia. The GERO cohort aims to determine multidimensional risks factors associated with the prognosis of elderly with cognitive complaint on DF. Method: The GERO cohort is a prospective cohort study of community‐dwelling elderly with cognitive complaint, without dementia, aged 70 or older living in 4 municipalities in Santiago, Chile. Participants were identified by a household census and information on demographics, biomedical, psychosocial, neuropsychological, neuropsychiatric, and motor function were collected by means of questionnaires and evaluations. Neuroimaging, blood, and stool samples were also obtained. FD was measured by the Pfeffer (score range 0‐33), Technology Activities of Daily Living Questionnaire (T‐ADLQ, score range 0‐100), and Everyday Cognition (ECOG, score range 0‐36) questionnaires. Result: A total of 17,759 households were successfully approached, identifying 2,533 eligible subjects, accepting to participate 299 (59 men; 240 women). The mean age was 76.8±5.1, 25% older than 79. The average years of schooling was 8.9± 4.8. None of participants showed underweight. The average score for the Mini‐mental State Exam (MMSE) was 27.1± 2.4, with 5.3% of the sample scoring less than 23. The mean values for Pfeffer, T‐ADLQ, and ECOG were 0.8±1.3, were 11.9± 10.3, and 0.4±0.4 respectively. In the multivariate analysis MMSE was inversely correlated with the ECOG score (regression coefficient: ‐0.03 [95%CI ‐0.07; ‐0.002]. Pfeffer also was associated, but its statistical significance was lost after the multivariate adjustment. Conclusion: Few other studies addressed cognitive complaint and functionality in elderly recruited at home. Elderly in the GERO‐cohort with cognitive complaint, without dementia, show a good level of functioning at the first assessment. Cognitive function measured by the MMSE seems to be associated to a subtle decline in general functioning as everyday cognition. Future multidimensional and prospective analysis of this cohort could bring more information about this association. [ABSTRACT FROM AUTHOR]

Background: During the COVID‐19 pandemic, loneliness has increased in the general population due to government measures to contain the spread of the disease. In Latin America (LA), caregiving is most often delivered informally by family members Family caregivers often face mental health challenges linked to their caregiving role and their social context. Pandemic‐related social restrictions have been especially detrimental for older people with dementia or other brain health challenges, as well as their family caregivers. We aimed to investigate the associations of loneliness, social isolation and care burden in these family caregivers. Method: We undertook a cross‐sectional survey of over 300 informal caregivers of people with dementia or enduring mental health problems living in 4 Latin American countries, Mexico, Brazil, Chile, and Peru. We categorized loneliness into 3 groups 'low', 'moderate' and 'severe loneliness'. Here, we analyzed factors related to changes in the prevalence of moderate and severe loneliness before and during the pandemic using a longitudinal multinomial logistic regression model. Result: During the pandemic, there was a significant increase in loneliness prevalence (p<.001) among caregivers in Latin America, with more people having moderate (6.25% pre‐pandemic; 17.67% mid‐pandemic) and severe loneliness (2.78% pre‐pandemic; 15.19% mid‐pandemic). Gender differences in the prevalence of loneliness or higher levels of loneliness among dementia caregivers compared to caregivers of other conditions were not seen. The regression model revealed that the increment in risk for moderate loneliness during the pandemic was related to caregivers' age, level of education, and social contact/isolation. Increased risk for severe loneliness was related to caregivers' social contact during the pandemic and perceived mental health. Conclusion: Public health interventions regarding COVID‐19 pandemic should consider increased loneliness in Latin‐American caregivers. This population will need both, short and long‐term mental health and practical support. Next steps include gathering more evidence on specific risk factors for loneliness and its impact on caregivers' physical and mental health. [ABSTRACT FROM AUTHOR]

The assessment of functional status is a critical component of clinical neuropsychological evaluations used for both diagnostic and therapeutic purposes in patients with cognitive brain disorders. There are, however, no widely adopted neuropsychological tests that are both ecologically valid and easily administered in daily clinical practice. This discrepancy is a roadblock to the widespread adoption of functional assessments. In this paper, we propose a novel approach using a serious game authoring platform (eAdventure) for creating screen-based simulated functional assessments. We created a naturalistic functional task that consisted of preparing a cup of tea (SBS-COT) and applied the assessment in a convenience sample of eight dyads of therapists/patients with mild executive dysfunction after traumatic brain injury. We had three main aims. First, we performed a comprehensive review of executive function assessment in activities of daily living. Second, we were interested in measuring the feasibility of this technology with respect to staffing, economic and technical requirements. Third, a serious game was administered to patients to study the feasibility of this technology in the clinical context (pre-screening test). In addition, quantitative (Technology Acceptance Model (TAM) questionnaires) and qualitative (semistructured interviews) evaluations were applied to obtain user input. Our results suggest that the staffing, economic and technical requirements of the SBS-COT are feasible. The outcomes of the pre-screening test provide evidence that this technology is useful in the functional assessment of patients with executive dysfunction. In relation to subjective data, the TAM questionnaire showed good user acceptability from a professional perspective. Interview analyses with professionals and patients showed positive experiences related to the use of the SBS-COT. Our work indicates that the use of these types of authoring platforms could have positive long-term implications for neuropsychological research, opening the door to more reproducible, cooperative and efficient research by allowing the facilitated production, reuse and sharing of neuropsychological assessment tools. [ABSTRACT FROM AUTHOR]

Background: The Multi‐Partner Consortium to Expand Dementia Research in Latin America (RedLat) study is a niche for the implementation of clinical trials on Frontotemporal Dementia in Latin America. We identified that one of the main limitations of recruitment was a lack of clinicians with comprehensive knowledge on Frontotemporal Dementia in the region. We aimed to fill these gaps by creating an online training for physicians. Method: A group of American and Latin American brain health experts trained at the Global Brain Health Institute at the University of San Francisco California is delivering an abridged online behavioral neurology training project to a pilot group of 30 neurologists, geriatricians, and psychiatrists from Latin America. The training highlights important aspects such as culturally appropriate neuropsychological assessment and functional assessment to adequately classify participants under the frontotemporal dementia umbrella. A component about the importance of research including clinical trials is also being delivered. Baseline evaluations about the quality of their medical training regarding dementia and a dementia knowledge evaluation were conducted and we are expecting to conduct an evaluation in the third and sixth months. Result: On the baseline evaluation, 80% classified the information they received as "poor", 12% classified the information as "sufficient" and 8% classified it as "good". Regarding baseline dementia knowledge, the mean score was 5.2 (SD ± 2.5) out of a maximum score of 10 points. We expect an increase in these numbers during the upcoming evaluations. As a side outcome, participants from this project are building pipelines to increase recruitment in RedLat. Conclusion: Overcoming existing educational barriers of diagnosis of Frontotemporal Dementia as well as generating awareness of the importance of clinical trials in Latin America will hopefully be a key tool to increase the representation of persons with Frontotemporal Dementia. We will discuss the importance of adequate diagnosis and classification of frontotemporal dementia by the professionals who serve these underrepresented populations and the importance that this first step has to adequate recruitment into clinical trials. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease dementia (ADD) and Parkinson's disease (PD) have a significant impairment in social emotion recognition. Most of these studies assess emotional perception as the ability to identify others' facial emotions (Ekman faces). Nevertheless, emotional recognition with information that integrates whole‐body and postural control responses has not been investigated in ADD or PD. Method: 66 participants were recruited (ADD, PD, healthy controls (HC)). Subjects were diagnosed following NINCDS‐ADRDA criteria for ADD, and the United Kingdom Parkinson's Disease Society Brain Bank criteria for PD. Inclusion criteria considered older than 60 years and non‐other neuropsychiatric comorbidity. All participants were assessed in global cognition (ACE‐III), executive function (IFS, FAS), memory (FCRST), and social cognition (Minisea (Faux Pas (FP), Ekman faces (EF)). Three videos were elaborated with persons practicing risk sports (neutral, pleasant, unpleasant); and another unpleasant condition that did not show a human body (car accidents). Videos were previously validated by their emotional properties (120 subjects) following the Self‐assessment Manikin. Participants stood up at a force platform while videos (60 seconds) were presented at a TV screen (40 inches) at face height and 1 meter to the front. Postural control data to compute center of pressure (COP) were collected at a sample rate of 125Hz. At the end of each video, participants had to rate (1‐9) valence, intensity, and control. COP parameters included velocity, area, and frequency decomposition. Statistical analysis was performed on the first principal component (PC1) on those parameters. Emotional recognition was analyzed by ANOVA (3*3) (group*self‐perception), and postural data by Repeated‐Measures ANOVA (3*4) (group*emotional condition). Result: Participants with ADD(n=25) show significant impairment in all cognitive domains assessed even when FP was adjusted for control questions, compared to PD(n=14) and HC(n=27). ADD showed significant differences in the recognition of whole‐body negative emotions (6,04+2,752), compared to PD (3,71+2,585) and HC (4,19+2,286). When postural control responses were analyzed, the pleasant condition showed significantly bigger displacements (PC1) than the other emotional conditions. Conclusion: ADD participants have problems recognizing negative social emotions that involve whole‐body. Emotional stimuli produce changes similar in postural control among groups, which depend on emotional conditions. These results suggest studying the emotion beyond facial emotion. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease dementia (ADD) and Parkinson's disease (PD) have a significant impairment in social emotion recognition. Most of these studies assess emotional perception as the ability to identify others' facial emotions (Ekman faces). Nevertheless, emotional recognition with information that integrates whole‐body and postural control responses has not been investigated in ADD or PD. Method: 66 participants were recruited (ADD, PD, healthy controls (HC)). Subjects were diagnosed following NINCDS‐ADRDA criteria for ADD, and the United Kingdom Parkinson's Disease Society Brain Bank criteria for PD. Inclusion criteria considered older than 60 years and non‐other neuropsychiatric comorbidity. All participants were assessed in global cognition (ACE‐III), executive function (IFS, FAS), memory (FCRST), and social cognition (Minisea (Faux Pas (FP), Ekman faces (EF)). Three videos were elaborated with persons practicing risk sports (neutral, pleasant, unpleasant); and another unpleasant condition that did not show a human body (car accidents). Videos were previously validated by their emotional properties (120 subjects) following the Self‐assessment Manikin. Participants stood up at a force platform while videos (60 seconds) were presented at a TV screen (40 inches) at face height and 1 meter to the front. Postural control data to compute center of pressure (COP) were collected at a sample rate of 125Hz. At the end of each video, participants had to rate (1‐9) valence, intensity, and control. COP parameters included velocity, area, and frequency decomposition. Statistical analysis was performed on the first principal component (PC1) on those parameters. Emotional recognition was analyzed by ANOVA (3*3) (group*self‐perception), and postural data by Repeated‐Measures ANOVA (3*4) (group*emotional condition). Result: Participants with ADD(n=25) show significant impairment in all cognitive domains assessed even when FP was adjusted for control questions, compared to PD(n=14) and HC(n=27). ADD showed significant differences in the recognition of whole‐body negative emotions (6,04+2,752), compared to PD (3,71+2,585) and HC (4,19+2,286). When postural control responses were analyzed, the pleasant condition showed significantly bigger displacements (PC1) than the other emotional conditions. Conclusion: ADD participants have problems recognizing negative social emotions that involve whole‐body. Emotional stimuli produce changes similar in postural control among groups, which depend on emotional conditions. These results suggest studying the emotion beyond facial emotion. [ABSTRACT FROM AUTHOR]

Background: Dementia is one of the mean causes of disability in elderly. Peripheral inflammatory biomarkers and ApoE‐ε4 allele have been described as important biological risk factors of dementia in Caucasian population. Currently, there is scarce information about the specific age‐related and predisposition factors to develop dementia in Latino populations. The aim of this study is to investigate these biological risks factors in Chilean elderly with healthy and pathological brain ageing. Method: We evaluated and quantified plasma samples obtained from the GERO cohort (114 elderly subjects, >70 years, classified in 51 subjects with subjective cognitive complaint (SCC) and 63 with mild cognitive impairment (MCI)), in addition to 36 healthy brain controls (HBC) and 31 subjects with Alzheimer's disease dementia (ADD). Genotyping of ApoE gene was analyzed by qPCR. We analyzed inflammatory biomarkers using Luminex technique including IL‐2, IL‐6, IL‐10, TNF‐α, CRP and SAP proteins. All subjects receive a clinical and neuropsychological assessment. Result: CRP protein was found significant decrease expression in SCC and ADD groups compared to MCI and HBC (p=0.048). In SAP protein was found a significant decrease in expression in the SSC (p=0.04) and MCI (p=0.0178) groups compared to HBC. It was observed a positive correlation in the SCC, MCI and ADD groups with the IL‐6 and TNFα, and, SAP and CRP. A negative correlation between IL‐2, IL‐6 and IL‐10 cytokines was found with Direct Span Digit test, which assess attentional capacity. Also was identified a negative correlation between SAP protein and the Free and Cued Selective Reminding Test (FCSRT), which assess verbal episodic memory, and IL‐10 cytokine and Montreal Cognitive Assessment (MoCA), which assess global cognition. Finally, a positive correlation was found in CRP protein with Pfeffer Functional Activity Questionnaire. Frequency of the ApoE‐ε4 allele, was significantly higher in ADD (52%) and SCC (27%) patients than controls and MCI (p=1x10‐4). Conclusion: The results shown correlations between the different inflammatory proteins and performance in neuropsychological test suggesting that inflammatory biomarkers are associated with pathological brain ageing. The correlations in SCC and MCI are not being reported previously. Additionally, the frequency of ApoE‐ε4 allele in ADD group is higher than worldwide populations. [ABSTRACT FROM AUTHOR]

Background: New procedures based on attributional methods have not been used to estimate the burden of Dementia in term of loss of Health‐State Utilities (HSU) or Quality‐Adjusted Life Years (QALY) at the populational level. Chile, in recent decades, has presented an accelerated aging process and has few studies on dementia. Method: We analysed data from the Chilean National Health Survey carried out between 2016‐2017 (n=5,004). Participants older than 59 years were screened for dementia, defined by a score higher than 5 in the Pfeffer and lower than 13/19 points in a modified MMSE‐version, previously validated in Chile. HSU were measured using the health‐related quality of life instrument EQ5D plus national values for utilities for each health state. The number and fraction of total HSU lost due to dementia were calculated using attributable fraction methods. We repeated the procedure on each one of five domains of EQ5D. Factors associated with dementia were explored using a logistic regression model. Other comorbidities (depression, chronic musculoskeletal pain, hypertension, diabetes) were included in the models. Result: We estimated a prevalence of 4.4% [2.9‐5.9] for dementia in people older than 59 years. Dementia, compared with other comorbidities, showed the highest loss of HSU, accounting 38.3 [26.0‐50.6] additional points of loss of HSU over the score from those without dementia (where 0 means healthy, and 100 is equivalent to death). Prevalent cases of dementia were associated with a loss of 41,046 QALYs [29,727 – 52,158], which was equivalent to a 5.0% [3.0‐7.6] of total burden among elderlies, and 1.5% [0.9‐2.4] in the population older than 14 years. 'Self‐care' was the domain were dementia accounted higher burden followed by 'usual activities' (see figure). Age was associated with dementia, while male sex, lower education, widower compared with married, and some comorbidities showed high OR but without reaching statistical significance. Conclusion: Dementia at the population level showed a high impact in terms of QALY lost, as well as at the individual level in terms of loss of HUS, overpassing to other diseases. Key domains of quality of life affected higher for Dementia were self‐care and usual activities. FONDAP Program Grant 15150012. [ABSTRACT FROM AUTHOR]

Background: Cognitive assessments able to detect impairments as early as neuropathological changes that occur in neurodegenerative diseases initiate are urgently needed. The Visual Short‐Term Memory Binding Test (VSTMBT) and the Free and Cued Selective Reminding Test (FCRST) have been recently recommended by the Neurodegenerative Diseases Working Group (Costa et al., 2017) as promising preclinical markers of AD. They have never been used before to assess elderlies with cognitive complain recruited from the community. Method: A total of 271 subjects (37 healthy controls (HC), 112 subjective cognitive complain (SCC), 96 mild cognitive impairment (MCI) and 26 Alzheimer's disease dementia (ADD)), recruited from Geroscience Center for Brain Health and Metabolism (GERO) Cohort and the Memory and Neuropsychiatric Clinic (CMYN), underwent assessment with the VSTMBT and the Visual Version of the FCRST (FCRST‐Visual). Two memory loads were used for the VSTMBT (low and high). The ability of these tests to discriminate between groups. Result: Significant differences were found between HC, MCI and ADD using the VSTMBT and the FCRST‐Visual version. Notably, the STMB was the only test that "marginally" differentiated between HC from SCC (p = 0.055). Moreover, whereas the FCRST‐Visual showed a gradient (HC = SCC) > MCI > AD, the VSTMBT's gradient was HC > (SCC = MCI = ADD) suggesting that the function assessed by the latter test may be sensitive to the very early stages of the disease dropping to levels that cannot decline further. Conclusion: Our results suggest that the VSTMBT and FCSRT are sensitive to the early stages of dementia. Whereas the former detects changes in the early subjective stages, the latter is more sensitive to later objective stages of cognitive decline. The latter but not the former could help monitor disease progression. These results raise important questions about the usefulness of cognitive screening tools to detect and monitor disease progression and to separate normal and abnormal ageing trajectories. We propose the need of cognitive assessments that detect subtle differences as early as neuropathological changes occur in the brain, which will lead to the development of new "cognitive biomarkers" for dementia. [ABSTRACT FROM AUTHOR]

Background: Availability of culture‐free cognitive tests with marker properties for AD has proved a barrier to global harmonization strategies. The European Neurodegenerative Diseases Working Group suggested that the Short‐Term Memory Binding Test (STMBT) and the Free and Cued Selective Reminding Test (FCSRT) are useful tests for the early detection of AD (Costa et al., 2017). Yassuda et al. (2019) showed that STMB is insensitive to age and education among healthy Brazilian adults. Parra et al. (2019) suggested that these tests should enter global strategies to aid the early detection of AD. Evidence is still needed to ascertain that such a validity translates to the assessment of affected individuals from underrepresented populations. The current study aimed to shed new light on such an outstanding question. Methods: We recruited 64 healthy controls (HC), 60 patients with Mild Cognitive Impairment (MCI), and 63 patients with mild AD from Lima, regional area health clinics (DIRESA) between 06/2018‐05/2019. They were all illiterate. We considered Illiterate individuals who (1) attended no school or were enrolled for less than one year and (2) could not read or write (a booklet was given which showed a simple sentence). We assessed them with the STMBT, the visual FCSRT, and a brief clinical‐neuropsychological protocol. Results: The assessment confirmed the healthy (CDR=0.0, pFAQ=2.2, BDI=5.9), MCI (CDR=0.5, pFAQ=3.7, BDI=6.2), and dementia (CDR=1.3, pFAQ=16.5, BDI=7.2) status of our groups. Significant between‐group differences were found with both the STMBT (F(2,184)=590.1, p<0.001) and Free Recall during the visual FCSRT (F(2,184)=3936.2, p<0.001), with HC>>>MCI>>>AD. ROC analysis with STMB revealed AUC=0.98 for HC vs. MCI, AUC=1.00 for HC vs. AD, and AUC=0.97 for MCI vs. AD. For the visual FCSRT, an AUC=1.00 was found for HC vs (MCI & AD), and AUC=0.99 for MCI vs AD. Conclusion: The two cognitive markers recently recommended for harmonisation of neuropsychological assessment in neurodegenerative dementias in Europe seem suitable to support such practices in illiterate populations. Parra et al. (2019) recently suggested that only global strategies will help meet global challenges. Here we provide evidence of cognitive markers for AD that can reliably enter such strategies. [ABSTRACT FROM AUTHOR]

Background: Availability of culture‐free cognitive tests with marker properties for AD has proved a barrier to global harmonization strategies. The European Neurodegenerative Diseases Working Group suggested that the Short‐Term Memory Binding Test (STMBT) and the Free and Cued Selective Reminding Test (FCSRT) are useful tests for the early detection of AD (Costa et al., 2017). Yassuda et al. (2019) showed that STMB is insensitive to age and education among healthy Brazilian adults. Parra et al. (2019) suggested that these tests should enter global strategies to aid the early detection of AD. Evidence is still needed to ascertain that such a validity translates to the assessment of affected individuals from underrepresented populations. The current study aimed to shed new light on such an outstanding question. Methods: We recruited 64 healthy controls (HC), 60 patients with Mild Cognitive Impairment (MCI), and 63 patients with mild AD from Lima, regional area health clinics (DIRESA) between 06/2018‐05/2019. They were all illiterate. We considered Illiterate individuals who (1) attended no school or were enrolled for less than one year and (2) could not read or write (a booklet was given which showed a simple sentence). We assessed them with the STMBT, the visual FCSRT, and a brief clinical‐neuropsychological protocol. Results: The assessment confirmed the healthy (CDR=0.0, pFAQ=2.2, BDI=5.9), MCI (CDR=0.5, pFAQ=3.7, BDI=6.2), and dementia (CDR=1.3, pFAQ=16.5, BDI=7.2) status of our groups. Significant between‐group differences were found with both the STMBT (F(2,184)=590.1, p<0.001) and Free Recall during the visual FCSRT (F(2,184)=3936.2, p<0.001), with HC>>>MCI>>>AD. ROC analysis with STMB revealed AUC=0.98 for HC vs. MCI, AUC=1.00 for HC vs. AD, and AUC=0.97 for MCI vs. AD. For the visual FCSRT, an AUC=1.00 was found for HC vs (MCI & AD), and AUC=0.99 for MCI vs AD. Conclusion: The two cognitive markers recently recommended for harmonisation of neuropsychological assessment in neurodegenerative dementias in Europe seem suitable to support such practices in illiterate populations. Parra et al. (2019) recently suggested that only global strategies will help meet global challenges. Here we provide evidence of cognitive markers for AD that can reliably enter such strategies. [ABSTRACT FROM AUTHOR]

Background: The prevalence of dementia in Chile is 1.06%, meaning that over 200,000 people are affected. In 2017, the Ministry of Health launched the National Plan of Dementia in Chile which proposed establishing a range of health‐care services from primary care to Memory Units (MU). MUs have emerged as a new health care service composed of multidisciplinary teams with the goal of improving diagnosis and/or management of dementia patients. The creation and implementation of an MU should take into consideration policies and the organization of a particular healthcare system. In this context, the evaluation of a Chilean MU might provide information for the standardization and replication of such a health service nationwide. The objective of this paper was to evaluate the implementation processes of an MU using the RE‐AIM model, a multi‐component model aimed to assist the evaluation of the implementation of ongoing programs. Method: We analyze the interventions made during the MU lifespan using the RE‐AIM model, a multi‐component model useful in evaluating the implementation of ongoing programs Result: From March 2018 up to June 2019, a total of 510 patients were referred and assessed at the Hospital del Salvador, Santiago, Chile. Most patients came from primary care (51.9%) and from outpatient services at the Hospital (39.2%), particularly from the Neurology (63.3%) and Psychiatry (16.0%) departments. We estimated that MU assessed 5.39% of dementia patients in the referring area. Of all the patients evaluated by the MU, 11.11% were discharged. Of these, 66.1% were referred to primary health care, 16.94% to other outpatient services, 10.16% to a specialized mental health care centre, and 6.77% % to a daycare centre. Conclusion: This was the first evaluation of the implementation of an MU as part of the Plan. It showed that it is possible to implement an MU in a low‐middle income country and improve access to dementia diagnosis, management, and treatment. Ongoing challenges include continuing to collect clinical data, creating research projects as part of the MU, and developing an MU protocol that can be adopted elsewhere in Chile. [ABSTRACT FROM AUTHOR]

A 62 year-old patient is presented, without family antecedents of dementia who begins with 45 years of age with sudden crisis of dyspnea, blurred vision, fall to the floor and repetitive jerks of arms. Tried by epilepsy with phenytoin and valproate repeats similar crisis sporadically. Four years ago their relatives began to notice changes of personality, irritability and obsessive behaviors. Later on, are added episodes of disorientation of days of duration, some with auditory hallucinations and also convulsive manifestations. Finally appear polymorphic crisis, some with continue alteration of consciousness, catatonic states and sphincteric incontinence. Physical and neurological examination without abnormalities. Neuropsychological evaluation evidenced consistent defects in frontal functions. EEG showed widespread slowness and sporadic irritative activity in frontotemporal regions. Anterior cortical atrophy in CTscan and bilateral frontotemporal hypoperfusion in SPECT. Labs exams and CSF were normal. CONCLUSION: The association of FTD and epilepsy, in non-family form, suggests a different neurodegenerative cortical syndrome. [ABSTRACT FROM AUTHOR]