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Clinical and neuroimaging risk factors for cognitive decline in community‐dwelling older adults living in rural Ecuador. A population‐based prospective cohort study
Author(s) -
Del Brutto Oscar H.,
Mera Robertino M.,
Del Brutto Victor J.,
Zambrano Mauricio,
Wright Clinton B.,
Rundek Tatjana
Publication year - 2019
Publication title -
international journal of geriatric psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.28
H-Index - 129
eISSN - 1099-1166
pISSN - 0885-6230
DOI - 10.1002/gps.5037
Subject(s) - montreal cognitive assessment , cognitive decline , gerontology , cohort , hyperintensity , cohort study , longitudinal study , population , medicine , prospective cohort study , cognition , demography , psychology , dementia , cognitive impairment , psychiatry , disease , pathology , environmental health , magnetic resonance imaging , sociology , radiology
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.