Background: There is a high frequency of the risk-conferring APOE e4 allele in African populations, but in some studies, the risk of dementia is less than in Caucasians in Europe and North America. In an admixed population of older Cubans I estimate the prevalence, incidence, correlates and impact of dementia among older Cubans; I assess the effects of reported ethnicity, admixture and apolipoprotein E genotype on dementia prevalence and estimate the association between cardiovascular risk factors and dementia incidence. -- Methods: I undertook a one phase survey (baseline) of all over 65 year old residents of seven catchment areas in Cuba (n=2944) during 2003 to 2007. Dementia diagnosis was established according to DSM-IV and 10/66 criteria. APOE genotype was determined in 2520 participants, and genetic admixture in 235 dementia cases and 349 controls. Baseline data was used to estimate prevalence, impact, and the effect of ethinicity, and apolipoprotein E genotype on dementia prevalence. The case control study was used to test the hypothesis that the effect of APOE genotype on dementia is modified by ethnic group. An incidence wave was conducted 4.5 years after cohort inception in order to estimate incidence and cardiovascular risk factors associations -- Results: The prevalence of DSM-IV dementia was 6.4% and 10.8% according to the 10/66. Both dementia outcomes were associated with older age, less education, a family history of dementia, shorter leg length and smaller skull circumference. Dementia, rather than physical health problems or depression, was the main contributor to needs for care and caregiver cutting back on work. The incidence rate of 10/66 dementia was 20.5 per 1000/pyear (95% Cl, 17.6-23.5). African admixture was linearly related to number of APOE e4 alleles, but was not associated with the prevalence of dementia.
|Date of Award||May 2012|
|Supervisor||Cleusa Ferri (Supervisor) & Martin Prince (Supervisor)|