Clinical and neuroimaging risk factors for cognitive decline in community-dwelling older adults living in rural Ecuador. A population-based prospective cohort study

Oscar H. Del Brutto, Robertino M. Mera, Victor J. Del Brutto, Mauricio Zambrano, Clinton B. Wright, Tatjana Rundek

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Objective: There is limited information on factors influencing cognitive decline in rural settings from low- and middle-income countries. Using the Atahualpa Project cohort, we aimed to assess the burden of cognitive decline in older adults living in a rural Ecuadorian village. Methods: The study included Atahualpa residents aged greater than or equal to 60 years who had a follow-up Montreal Cognitive Assessment (MoCA) repeated at least 1 year after baseline. MoCA decline was assessed by multivariable longitudinal linear models, adjusted for demographics, days between MoCA tests, cardiovascular risk factors, and neuroimaging signatures of structural brain damage. Results: We included 252 individuals who contributed 923.7 person-years of follow-up (mean: 3.7 ± 0.7 years). The mean baseline MoCA was 19.5 ± 4.5 points, and the follow-up MoCA was 18.1 ± 4.9 points (P = 0.001). Overall, 154 individuals (61%) had lower MoCA scores at follow-up. The best fitted longitudinal linear model showed a decline of follow-up MoCA from baseline (β: 0.14; 95% CI, 0.0-0.21; P < 0.001). High glucose levels, global cortical atrophy, and white matter hyperintensities were independently and significantly associated with greater MoCA decline. Conclusion: This study provides evidence of cognitive decline in older adults living in a rural setting. Main targets for prevention should include glucose control and the control of factors that are deleterious for the development of cortical atrophy and white matter hyperintensities.

Original languageEnglish (US)
Pages (from-to)447-452
Number of pages6
JournalInternational Journal of Geriatric Psychiatry
Volume34
Issue number3
DOIs
StatePublished - Mar 2019

Keywords

  • Montreal Cognitive Assessment
  • cognitive decline
  • population-based cohort
  • rural settings

ASJC Scopus subject areas

  • Geriatrics and Gerontology
  • Psychiatry and Mental health

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