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Dementia screening protocol for primary care in South America: a Delphi consensus study
(Frontiers Media SA, 2026-04-08)
Belen Custodio
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Rosa Montesinos
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Paulo Caramelli
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Ismael Calandri
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Sonia Maria Dozzi Brucki
<jats:sec> <jats:title>Introduction</jats:title> <jats:p>Rapid population aging in South America (SA) highlights the need for effective dementia detection strategies. Primary care is essential for early identification, yet no shared, regionally contextualized approach exists. This study aimed to develop expert-based recommendations for dementia screening in SA primary care.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>A two-round modified Delphi process involved 20 SA experts from different specialties. Round 1 explored open-ended and ranking questions on cognitive and functional screening tools, cut-offs, referral criteria, administration time, and professional roles. Round 2 sought consensus (≥75%) on items informed by Round 1.</jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>Consensus was reached on using an initial screening question to identify potential cognitive decline, the duration of a brief screening battery, and the primary care team’s roles. Experts emphasized the need for educational, cultural, and sensory adaptations and proposed strategies for patients without reliable informants. An agreement on functional assessment tools and some cut-off points was not achieved.</jats:p> </jats:sec> <jats:sec> <jats:title>Discussion</jats:title> <jats:p>These recommendations provide a structured, flexible, and culturally sensitive framework for primary care dementia screening, supporting timely detection, timely referral and integration into person-centered approaches to healthy aging, while highlighting areas requiring further research and standardization.</jats:p> </jats:sec>
Scopus© Citations 1 2
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The landscape of dementia research, diagnosis, treatment, and care in Latin America
(Wiley, 2026-03)
Claudia K. Suemoto
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Nilton Custodio
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Diego Aguilar
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José A. Avila‐Funes
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Sandra Baez
<jats:title>Abstract</jats:title> <jats:sec> <jats:label/> <jats:p>Latin America is undergoing rapid population aging alongside a rising burden of dementia. While the region holds substantial potential for dementia risk reduction, challenges remain, such as delayed diagnoses, limited access to specialized care and biomarker testing, persistent stigma, and deep‐rooted structural inequities. To address these gaps and foster regionally informed solutions, the Alzheimer's Association convened the 2025 Alzheimer's Association International Conference (AAIC) Satellite Symposium in Lima, Peru, on May 14–15, in collaboration with the Global Brain Health Institute (GBHI) and the Atlantic Fellows for Equity in Brain Health. The meeting aimed to bring core elements of the global AAIC meeting to regional Latin American settings, recognizing that national and cultural contexts demand tailored approaches to dementia prevention, risk reduction, treatment and care all aimed at promoting brain health in the region. This manuscript synthesizes the symposium's key discussions, scientific advances, and opportunities for collaboration across the region.</jats:p> </jats:sec>
1Scopus© Citations 1
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Brief Cognitive Screening Tools for Dementia in Low-Educated Population from South America: A Systematic Review
(S. Karger AG, 2025-09-29)
Diego Chambergo-Michilot
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Nilton Custodio
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Rosa Montesinos
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Belen Custodio
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Nelson Luis Cahuapaza-Gutierrez
<jats:p>Introduction: Despite less education being common in Latin America, there is no systematic review on the use of brief cognitive screening (BCS) tools in illiterate and low-educated adults in the region. We systematically reviewed brief cognitive tests used to identify dementia in illiterate or low-educated adults from South America (SA). Methods: A systematic review was conducted according to the PRISMA and Cochrane guidelines. We searched four major databases: PubMed, Scopus, Web of Science, and Embase, for studies up to September 2023, and included observational studies that reported at least sensitivity, specificity, area under the receiver operating characteristic (ROC) curve, positive predictive value, or negative predictive value of dementia screening tools in illiterate or low-educated (less than 6 years of education) adults from SA. Results: Most studies in samples with illiteracy or low education across SA used BCS tools adapted to the local population’s language. Seventeen tests were identified; among them, the Mini-Mental State Examination (MMSE) and Rowland Universal Dementia Assessment Scale (RUDAS) were the more common tools with good diagnostic accuracy in people with dementia. The sensitivity and specificity of reported BCS tools were at least 90%, and the area under the ROC curve was higher than 0.95. Conclusions: The cutoff points for detecting dementia in illiterates and the low-educated adult population of SA should be adjusted for most brief cognitive tests. Developing specific and sensitive cognitive batteries for our region for cognitive evaluation in low-educated/illiterate participants is mandatory, including specific functionality evaluation.</jats:p>
Scopus© Citations 3 1
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Alzheimer Disease as a Clinical-Biological Construct—An International Working Group Recommendation
(2024)
Bruno Dubois
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Nicolas Villain
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Lon Schneider
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Nick Fox
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Noll Campbell
<jats:sec id="ab-nsc240001-1"><jats:title>Importance</jats:title><jats:p>Since 2018, a movement has emerged to define Alzheimer disease (AD) as a purely biological entity based on biomarker findings. The recent revision of the Alzheimer’s Association (AA) criteria for AD furthers this direction. However, concerns about a purely biological definition of AD being applied clinically, the understanding of AD by society at large, and the translation of blood-based biomarkers into clinical practice prompt these International Working Group (IWG) updated recommendations.</jats:p></jats:sec><jats:sec id="ab-nsc240001-2"><jats:title>Objective</jats:title><jats:p>To consider the revised AA criteria and to offer an alternative definitional view of AD as a clinical-biological construct for clinical use. The recommendations of the 2021 IWG diagnostic criteria are updated for further elaborating at-risk and presymptomatic states.</jats:p></jats:sec><jats:sec id="ab-nsc240001-3"><jats:title>Evidence Review</jats:title><jats:p>PubMed was searched for articles published between July 1, 2020, and March 1, 2024, using the terms “biomarker” OR “amyloid” OR “tau” OR “neurodegeneration” OR “preclinical” OR “CSF” OR “PET” OR “plasma” AND “Alzheimer’s disease.” The references of relevant articles were also searched.</jats:p></jats:sec><jats:sec id="ab-nsc240001-4"><jats:title>Findings</jats:title><jats:p>In the new AA diagnostic criteria, AD can be defined clinically as encompassing cognitively normal people having a core 1 AD biomarker. However, recent literature shows that the majority of biomarker-positive cognitively normal individuals will not become symptomatic along a proximate timeline. In the clinical setting, disclosing a diagnosis of AD to cognitively normal people with only core 1 AD biomarkers represents the most problematic implication of a purely biological definition of the disease.</jats:p></jats:sec><jats:sec id="ab-nsc240001-5"><jats:title>Conclusions and Relevance</jats:title><jats:p>The ultimate aim of the field was to foster effective AD treatments, including preventing symptoms and dementia. The approach of diagnosing AD without a clinical and biological construct would be unwarranted and potentially concerning without a clear knowledge of when or whether symptoms will ever develop. It is recommended that those who are amyloid-positive only and, more generally, most biomarker-positive cognitively normal individuals, should not be labeled as having AD. Rather, they should be considered as being at risk for AD. The expansion of presymptomatic AD is viewed as a better diagnostic construct for those with a specific pattern of biomarkers, indicating that they are proximate to the expression of symptoms in the near future.</jats:p></jats:sec>
Scopus© Citations 73 2
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Gaps in biomedical research in frontotemporal dementia: A call for diversity and disparities focused research
(2024)
Karen Nuytemans
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Sanne Franzen
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Iris J. Broce
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Paulo Caramelli
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Ratnavalli Ellajosyula
<jats:title>Abstract</jats:title><jats:p>Frontotemporal dementia (FTD) is one of the leading causes of young‐onset dementia before age 65, typically manifesting as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). Although FTD affects all populations across the globe, knowledge regarding the pathophysiology and genetics derives primarily from studies conducted in North America and Western Europe. Globally, biomedical research for FTD is hindered by variable access to diagnosis, discussed in this group's earlier article, and by reduced access to expertise, funding, and infrastructure. This perspective paper was produced by two professional interest areas of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) and discusses the field's current status on the cross‐cultural aspects of basic and translational research in FTD (including that focused on epidemiology, genetics, biomarkers, and treatment). It subsequently provides a summary of gaps and needs to address the disparities and advance global FTD biomedical research.</jats:p>
Scopus© Citations 4
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Impact of the Pandemic Time on the Mental Health of People with Dementia and Their Family Caregivers in Brazil and Chile: One-Year Follow-Up
(2024)
Loreto Olavarría
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Paulo Caramelli
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José Lema
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Caíssa Bezerra de Andrade
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Alejandra Pinto
<jats:p>Background: Previous studies reported the negative impact of social isolation on mental health in people with dementia (PwD) and their caregivers, butlongitudinal studies seem scarcer. Objective: To describe a one-year follow-up impact of the COVID-19 pandemic on PwD and their caregivers in both Brazil and Chile. Methods: This study analyzed the impact of the pandemic on the psychological and physical health of PwD and their family caregivers after one year of follow-up in three outpatient clinics in Brazil (n = 68) and Chile (n = 61). Results: In both countries, PwD reduced their functional capacity after one year of follow-up (p = 0.017 and p = 0.009; respectively) and caregivers reported worse physical and mental health (p = 0.028 and p = 0.039). Only in Chile, caregivers reported more sadness associated with care (p = 0.001), and reduced time sleeping (p = 0.07). Conclusions: In conclusion, the COVID-19 pandemic appears to have had a long-lasting impact on PwD and their caregivers. However, it is essential to acknowledge that the inherent progression of dementia itself may also influence changes observed over a year.</jats:p>
2Scopus© Citations 2
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Rehabilitation Services for Young-Onset Dementia: Examples from High- and Low–Middle-Income Countries
(2024)
Aida Suárez-González
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Sharon A Savage
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Suvarna Alladi
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Viviane Amaral-Carvalho
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Faheem Arshad
<jats:p>The WHO Dementia Global Action Plan states that rehabilitation services for dementia are required to promote health, reduce disability, and maintain quality of life for those living with dementia. Current services, however, are scarce, particularly for people with young-onset dementia (YOD). This article, written by an international group of multidisciplinary dementia specialists, offers a three-part overview to promote the development of rehabilitation services for YOD. Firstly, we provide a synthesis of knowledge on current evidence-based rehabilitative therapies for early-onset Alzheimer’s disease (EOAD), behavioural variant frontotemporal dementia (bvFTD), primary progressive aphasia (PPA), and posterior cortical atrophy (PCA). Secondly, we discuss the characteristics of rehabilitation services for YOD, providing examples across three continents for how these services can be embedded in existing settings and the different roles of the rehabilitation multidisciplinary team. Lastly, we conclude by highlighting the potential of telehealth in making rehabilitation services more accessible for people with YOD. Overall, with this paper, we aim to encourage clinical leads to begin introducing at least some rehabilitation into their services, leveraging existing resources and finding support in the collective expertise of the broader multidisciplinary dementia professional community.</jats:p>
12Scopus© Citations 2
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Gaps in clinical research in frontotemporal dementia: A call for diversity and disparities–focused research
(2023)
Sanne Franzen
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Karen Nuytemans
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Renelle Bourdage
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Paulo Caramelli
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Ratnavalli Ellajosyula
<jats:title>Abstract</jats:title><jats:p>Frontotemporal dementia (FTD) is one of the leading causes of dementia before age 65 and often manifests as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). FTD's exact clinical presentation varies by culture, language, education, social norms, and other socioeconomic factors; current research and clinical practice, however, is mainly based on studies conducted in North America and Western Europe. Changes in diagnostic criteria and procedures as well as new or adapted cognitive tests are likely needed to take into consideration global diversity. This perspective paper by two professional interest areas of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment examines how increasing global diversity impacts the clinical presentation, screening, assessment, and diagnosis of FTD and its treatment and care. It subsequently provides recommendations to address immediate needs to advance global FTD research and clinical practice.</jats:p>
27Scopus© Citations 12
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Biomarkers for dementia in Latin American countries: Gaps and opportunities
(2022)
Mario A. Parra
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ORELLANA VILLENA, VIVIANA PAULINA
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Tomas Leon
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Cabello G. Victoria
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Rodrigo Gomez
1Scopus© Citations 32 2
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Impact of Social Isolation on People with Dementia and Their Family Caregivers
(2021)
Lílian Viana dos Santos Azevedo
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Ismael Luis Calandri
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SLACHEVSKY CHONCHOL, ANDREA MARÍA
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Héctor Gastón Graviotto
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Maria Carolina Santos Vieira
<jats:p>Background: People with dementia and their family caregivers may face a great burden through social isolation due to the COVID-19 pandemic, which can be manifested as various behavioral and clinical symptoms. Objective: To investigate the impacts of social isolation due to the COVID-19 pandemic on individuals with dementia and their family caregivers. Methods: Two semi-structured questionnaires were applied via telephone to family caregivers of people diagnosed with dementia in three cities in Argentina, Brazil, and Chile, in order to assess clinical and behavioral changes in people with dementia and in their caregivers. Results: In general, 321 interviews were conducted. A significant decline in memory function has been reported among 53.0%of people with dementia. In addition, 31.2%of individuals with dementia felt sadder and 37.4%had increased anxiety symptoms. These symptoms of anxiety were greater in individuals with mild to moderate dementia, while symptoms of agitation were greater in individuals with severe dementia. Moreover, compulsive-obsessive behavior, hallucinations, increased forgetfulness, altered appetite, and increased difficulty in activities of daily living were reported more frequently among individuals with moderate to severe dementia. Caregivers reported feeling more tired and overwhelmed during this period and these symptoms were also influenced by the severity of dementia. Conclusion: Social isolation during the COVID-19 pandemic triggered a series of negative behavioral repercussions, both for people with dementia and for their family caregivers in these three South American countries.</jats:p>
Scopus© Citations 56 10

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