Juan Jesús Llibre-Rodriguez

• MD, MS, PhD
• Head of Department at Universidad de Ciencias Médicas de la Habana

We aimed to estimate the prevalence, correlates and impact of dementia in Havana and Matanzas, Cuba. A 1-phase catchment area survey of all over 65-year-old residents of 7 catchment areas in Havana and 1 in Matanzas was conducted. Dementia diagnosis was established according to DSM-IV and our own, pre-validated 10/66 criteria. The impact of dementi...

The prevalence and incidence of dementia are low in Nigeria, but high among African-Americans. In these populations there is a high frequency of the risk-conferring APOE-e4 allele, but the risk ratio is less than in Europeans. In an admixed population of older Cubans we explored the effects of ethnic identity and genetic admixture on APOE genotype,...

Studies have suggested that the prevalence of dementia is lower in developing than in developed regions. We investigated the prevalence and severity of dementia in sites in low-income and middle-income countries according to two definitions of dementia diagnosis. We undertook one-phase cross-sectional surveys of all residents aged 65 years and olde...

Translated from the Spanish and reprinted with permission from the Revista Anales de la Academia de Ciencias de Cuba, [online] Vol. 2, No. 2, 2012. Original available at: http://www.revistaccuba.cu/index.php/acc/article/view/126 Dementia is a syndrome that has great repercussions for quality of life of patients and their families, as well as a high...

Background: There have been few cross-national studies of the prevalence of the frailty phenotype conducted among low or middle income countries. We aimed to study the variation in prevalence and correlates of frailty in rural and urban sites in Latin America, India, and China. Methods: Cross-sectional population-based catchment area surveys con...

Background Despite the high burden of Alzheimer’s disease and other dementias among the Hispanic population worldwide, little is known about how dementia affects healthcare utilizations among this population outside of the US, in particular among those in the Caribbean region. Objective This study examines healthcare utilization associated with Al...

Background While two‐thirds of the 57 million people with dementia worldwide live in low‐ and middle‐income countries, research to inform dementia‐related policy in these regions remains scarce. We aimed to increase early dementia diagnosis and the use of standardized cognitive assessment by PCP in primary care settings in Cuba Method We selected...

Background Cross‐national comparisons of dementia prevalence are essential for identifying unique determinants and cultural‐specific risk factors, but methodological differences in dementia ascertainment across countries hinder global comparisons. This study maps the 10/66 Dementia Research Group algorithm for dementia ascertainment, widely used an...

Background High‐income countries (HICs) are over‐represented in current global dementia incidence rates, skewing estimates. Variance in diagnostic methods between HICs and low‐ and middle‐income countries (LMICs) is speculated to contribute to the regional differences in rates. Cohort Studies of Memory in an International Consortium (COSMIC) offers...

Background Alzheimer’s disease and related dementias (ADRD) disproportionately affect Latinos compared to non‐Latino whites. Leveraging the non‐monolithic structure of Latin America, which represents a large variability in social determinants of health (SDoH) and high levels of genetic admixture, we aimed to determine contributors to ADRD dispariti...

Cross-national comparisons of dementia prevalence are essential for identifying unique determinants and cultural-specific risk factors, but methodological differences in dementia classification across countries hinder global comparisons. This study maps the 10/66 algorithm for dementia classification, widely used and validated in low- and middle-in...

Objectives: Population ageing will lead to a dramatic increase in dementia prevalence globally. Recent evidence suggests a decline in dementia incidence in HIC due to increasing education levels and improvements in cardiovascular health. Although, most of the increase will occur in low and middle-income countries (LMICs), there are no recent estima...

Objectives: Leveraging the non-monolithic structure of Latin America, which represents a large variability in social determinants of health (SDoH) and high levels of genetic admixture, we aim to evaluate the relative contributions of SDoH and genetic ancestry in predicting dementia risk in Latin American populations Methods: Community-dwelling part...

Objectives: Because of the continued transition to older populations, various strategies have been developed to estimate the social impact and burden of health care. Regarding mental health, a strategy in the elderly is the measurement of neuropsychiatric symptoms (NPS), these include a wide range of behavioral and psychological manifestations. The...

Objectives: Dementia presents a growing public health challenge globally and its impact is significantly pronounced in low and middle-income countries (LMICs), including those in Latin America. This symposium aims to present recent findings on the prevalence, impact, and underlying factors of cognitive impairment and neuropsychiatric symptoms in ag...

Background Little is known about the relationship between parkinsonism or Parkinson's disease (PD) and frailty in Latin America. Objective The study aimed to determine the cross‐sectional and prospective associations between parkinsonism and PD with frailty in a large multi‐country cohort in Latin America. Frailty was assessed using three differen...

INTRODUCTION Leveraging the nonmonolithic structure of Latin America, which represents a large variability in social determinants of health (SDoH) and high levels of genetic admixture, we aim to evaluate the relative contributions of SDoH and genetic ancestry in predicting dementia prevalence in Latin American populations. METHODS Community‐dwelli...

Introduction: 56 million people are living with dementia worldwide. This number is estimated to increase to 82 million in 2030 and 152 million in 2050, representing one of the most serious challenges that public health will face in the coming years. Objective: To update on the most recent advances related to Alzheimer's disease, particularly the sc...

Background Previous studies in the Cuban population suggest that Alzheimer’s Disease and related dementias (ADRD) are under‐diagnosed at primary care relative to population estimates. Recent interventions aimed to introduce the use of technology based cognitive assessments have been validated for primary care (e.g., Brain Health Assessment).However...

Background Population ageing will lead to a dramatic increase in dementia prevalence globally. Recent evidence suggest a decline in dementia incidence in High Income Countries due to increasing education levels and improvements in cardiovascular health. Although, most of the increase will occur in low and middle‐income countries (LMICs), there are...

Background Dementia is a leading global cause of morbidity and mortality. There is evidence that population and community‐based interventions on early diagnosis of Dementia and Cognitive Impairment represent around US$10,000 of net savings per person with dementia across the disease course. They also avoid early or unnecessary admission to a care h...

Background Parkinson's disease (PD) is a rapidly growing neurodegenerative disorder, but up‐to‐date epidemiological data are lacking in Latin America. We sought to estimate the prevalence and incidence of PD and parkinsonism in Latin America. Methods We searched Medline, Embase, Scopus, Web of Science, Scientific Electronic Library Online, and Lit...

Background Little is known about the burden of parkinsonism and Parkinson’s disease (PD) in Latin America. Better understanding of health service use and clinical outcomes in PD is needed to improve its prognosis. Objective The aim of the study was to estimate the burden of parkinsonism and PD in six Latin American countries. Methods 12,865 parti...

Background intrinsic capacity (IC) is a construct encompassing people’s physical and mental abilities. There is an implicit link amongst IC domains: cognition, locomotion, nutrition, sensory and psychological. However, little is known about the integration of the domains. Objectives to investigate patterns in the presentation and evolution of IC d...

Background: Neuropsychiatric symptoms (NPSs) are common in neurodegenerative diseases; however, little is known about the prevalence of NPSs in Hispanic populations. Methods: Using data from community-dwelling participants age 65 years and older enrolled in the 10/66 study (N = 11,768), we aimed to estimate the prevalence of NPSs in Hispanic pop...

Latin America and the Caribbean (LAC) countries are experiencing unprecedentedly rapid demographic ageing. Growing evidence shows that cardiovascular health (CVH) is associated with brain health. Little is known about this topic among older adults in Latin America, where the number of people living with dementia is rising. The present study aimed t...

Introduction Evidence on the incidence and risk factors of frailty in low- and middle-income countries is very limited. We aimed to compare the incidence of frailty and explore its determinants in rural and urban areas in six Latin American countries and China. Methods The 10/66 is a multi-site cohort study in older adults. We conducted baseline a...

Introduction: Apolipoprotein E (APOE) is considered the major susceptibility gene for developing Alzheimer's disease. However, the strength of this risk factor is not well established across diverse Hispanic populations. Methods: We investigated the associations among APOE genotype, dementia prevalence, and memory performance (immediate and dela...

Introducción: En el mundo, 55 millones de personas viven con demencia. Se estima que este número se incrementará a 82 millones en 2030 y 152 millones en 2050, a menos que se implementen intervenciones que permitan su prevención, retardar su comienzo, enlentecer o detener su progresión. Objetivo: Actualizar sobre los cambios recientes en la epidemi...

Background: Age and gender specific prevalence rates for parkinsonism and Parkinson's disease (PD) are important to guide research, clinical practice, and public health planning; however, prevalence estimates in Latin America (LatAm) are limited. We aimed to estimate the prevalence of parkinsonism and PD and examine related risk factors in a cohor...

Background Rapid technological advances offer a possibility to develop cost‐effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and Middle‐Income Countries (LMIC). Methods In this cross‐sectional study, we examined the accuracy and validity of the Brian He...

Background Previous research showed that up to 56% of all dementia cases in Latin America could potentially be prevented if all modifiable risk factors were eliminated. Trends of studies in Latin America show, however, that lifestyles are declining. In absence of a cure, prevention is crucial. The aim was to develop a tool that can be used in prima...

Background: Latinos represent the fastest growing proportion of dementia cases among different ethnic groups. Most of the studies in Alzheimer's Disease (AD) include Latino populations within the same group, failing to sufficiently account for the real richness of linguistic, ethnic, ancestry, cultural, and socioeconomic diversity represented acro...

Background: APOE-ε4 allele is the most significant genetic risk factor for late-onset Alzheimer disease (AD). The magnitude of the association between the APOE-ε4 allele, AD, and cognitive decline has been shown to be stronger in populations of European descent relative to populations of African descent. However, these associations have been under...

Introducción: La COVID-19 ha incrementado el distanciamiento social y el confinamiento de las personas mayores, lo cual tiene efectos adversos para su salud física y mental. Objetivo: estudiar la influencia sobre la salud mental (depresión, ansiedad y trastornos del sueño) de los sentimientos de soledad durante la actual pandemia por la COVID-19 en...

Objective Teleneuropsychology (teleNP) could potentially expand access to services for patients who are confined, have limited personal access to healthcare, or live in remote areas. The emergence of the COVID-19 pandemic has significantly increased the use of teleNP for cognitive assessments. The main objective of these recommendations is to ident...

Alzheimer’s disease (AD) and dementia has emerged as a significant societal issue and a global priority. The prevalence of dementia is rising more rapidly in low and middle income countries (LMIC) than in high income countries. A growing body of evidence shows that prevention through risk factor management is the key to reducing the burden of demen...

Background The World Health Organization (WHO) has reframed health and healthcare for older people around achieving the goal of healthy ageing. The recent WHO Integrated Care for Older People (ICOPE) guidelines focus on maintaining intrinsic capacity, i.e., addressing declines in neuromusculoskeletal, vitality, sensory, cognitive, psychological, an...

Introduction: Despite high dementia prevalence in Hispanic populations globally, especially Caribbean Hispanics, no study has comparatively examined the association between education and dementia among Hispanics living in the Caribbean Islands and older adults in the United States. Methods: We used data on 6107 respondents aged 65 and older in t...

Introducción: La demencia es el padecimiento que más contribuye a la discapacidad, dependencia y mortalidad en las personas mayores.⁽¹⁾ Sin embargo, se desconoce la frecuencia y naturaleza del problema en la población más envejecida de la provincia La Habana, Cuba. Objetivos: Determinar la prevalencia y factores de riesgo de demencia en personas d...

Introducción: En Cuba se han realizado estudios de base poblacional que resaltan las elevadas cifras de enfermedades demenciales (entre el 6,4 % y el 10,8 %) que afectan cada vez más la vida cotidiana de muchas personas y sus familias. Objetivo: Estimar la prevalencia y los factores de riesgo del síndrome demencial en personas mayores. Métodos: E...

El síndrome de fragilidad se caracteriza por una mayor vulnerabilidad y riesgo de deterioro funcional y cognitivo ante un estrés mínimo, siendo la demencia una de las principales causas de discapacidad y dependencia entre los adultos mayores a nivel global, con impacto físico, psicológico y social. y económico no solo en las personas que lo padecen...

Introducción: En Cuba, la prevalencia de las enfermedades demenciales (10,2 %) constituye una realidad a la que se enfrenta hoy día el Sistema Nacional de Salud. La demencia repercute no solo en la persona que la padece, sino en su familia y sobre todo en la salud del cuidador, quien es sometido a cambios físicos y emocionales que comprometen su ca...

Background: Rapid technological advances offer a possibility to develop cost-effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in Spanish-speaking populations living in the United States and in Low and Middle-Income Countries (LMIC). The Brain Health Assessment (BHA) is a tablet...

In Cuba, 10 % of people aged 65 years and over are living with dementia, mainly Alzheimer's disease. The aim of this review is to provide information about the impact of COVID 19 on one of the most vulnerable groups in the population, people with dementia, and to provide useful recommendations to healthcare professionals, families and caregivers. T...

Background Cuba’s life expectancy at 79 is third highest in Latin America. Many attribute this to social investments in health and education, but comparative research is sparse, thus we compare Cuba with neighboring Dominican Republic, Costa Rica due to its strong social protections, and the U.S. Given high cardiovascular mortality, we focus on car...

Objectives: This study was designed to explore prevalence and correlates of self-reported loneliness and to investigate whether loneliness predicts mortality among older adults (aged 65 or above) in Latin America, China and India. Methods: The study investigated population-based cross-sectional (2003–2007) and longitudinal surveys (follow-up 2007–2...

Background: Population aging will lead to a dramatic increase in dementia prevalence, which will disproportionally affect racial minorities. The presence of racial differences in dementia prevalence has been widely reported in United States, but there are no relevant studies on this topic in low-middle income countries (LMIC). Methods: In a cros...

Across Latin American and Caribbean countries (LACs), the fight against dementia faces pressing challenges, such as heterogeneity, diversity, political instability, and socioeconomic disparities. These can be addressed more effectively in a collaborative setting that fosters open exchange of knowledge. In this work, the Latin American and Caribbean...

During the last decade, the Caribbean Hispanic islands experienced accelerated demographic aging, representing the fastest aging region within Latin America. Age-related non-communicable diseases, including dementia, are now reported at high prevalence. The Caribbean islands share similar genetic ancestry, culture, migration patterns, and risk prof...

Background More than 300 pathogenic variants in APP , PSEN1 and PSEN2 genes have been reported causing Dominant Inhered Alzheimer Disease (DIAD); most of these reports come from Northern hemisphere countries. In recent years, a growing number of familial AD cases have become known in Central and South American countries; however, little is known ab...

Background Hispanics populations in the U.S. are more likely to develop dementia than non‐Hispanic White populations; among Hispanics, those with Caribbean origin seem to carry the higher risk for developing dementia. However, little is known about how various social risk factors for dementia differentially affect non‐Hispanic Whites and Hispanics...

Background Little is known about risk factors of dementia in Latin American countries. Findings from western countries cannot be readily translated to Latin American countries. To inform risk stratification and targeted preventive strategies, we aimed to identify risk factors of incident dementia in Cuban older adults and explores how these change...

Background Most people with dementia live in Low and Middle Income Countries (LMICs), where little research on dementia risk prediction modelling has occurred. This study aimed to develop new models to simply predict all‐cause dementia, suitable for use in LMICs. Country‐specific models were expected, due to different risk profiles. Method Data wa...

Introduction: A growing number of dominantly inherited Alzheimer's disease (DIAD) cases have become known in Latin American (LatAm) in recent years. However, questions regarding mutation distribution and frequency by country remain open. Methods: A literature review was completed aimed to provide estimates for DIAD pathogenic variants in the Lat...

The SARS-CoV-2 global pandemic will disproportionately impact countries with weak economies and vulnerable populations including people with dementia. Latin American and Caribbean countries (LACs) are burdened with unstable economic development, fragile health systems, massive economic disparities, and a high prevalence of dementia. Here, we unders...

Background Rapid technological advances offer a possibility to develop cost-effective digital cognitive assessment tools. However, it is unclear whether these measures are suitable for application in populations from Low and middle-income countries (LMIC). Objective To examine the accuracy and validity of the Brain Health Assessment (BHA) in detec...

INTRODUCTION Age-related cognitive disorders, including Alzheimer disease, are among the main causes of disability and dependence in older adults worldwide. High blood homocysteine levels (hyperhomocysteinemia) are a risk factor for diseases whose metabolism involves different B vitamins. Antioxidant vitamins provide a protective effect by mitigati...

Alzheimer’s disease (AD) and dementia has emerged as a significant societal issue and a global priority. The prevalence of dementia is rising more rapidly in low and middle income countries (LMIC) than in high income countries. Yet, knowledge of dementia risk factors is dominated by research from high income countries (HIC), which cannot be readily...

Introduction: Little is known about risk factors of dementia in Latin American countries. We aimed to identify socio–demographic, health and lifestyle risk factors of incident dementia in Cuban older adults. Methods: Data were from 1,846 participants in the Cuban cohort of the 10/66 Dementia Research Group. Participants completed questionnaires, he...

Background: Dementia shows sex difference in its epidemiology. Childbirth, a distinctive experience of women, is associated with the risk for various diseases. However, its association with the risk of dementia in women has rarely been studied. Methods: We harmonized and pooled baseline data from 11 population-based cohorts from 11 countries ove...

Background We examined how the relationship between education and latelife cognitive impairment (defined as a Mini Mental State Examination score below 24) is influenced by age, sex, ethnicity, and Apolipoprotein E epsilon 4 (APOE*4). Methods Participants were 30,785 dementia-free individuals aged 55-103 years, from 18 longitudinal cohort studies,...

Objective: The objective of this study was to estimate healthy life expectancies in eight low- and middle-income countries (LMICs), using two indicators: disability-free life expectancy (DFLE) and dependence-free life expectancy (DepFLE). Method: Using the Sullivan method, healthy life expectancy was calculated based on the prevalence of dependence...

The impact of COVID–19 on Mental Health in the Hispanic Caribbean Region - Jorge J Llibre-Guerra, Ivonne Z. Jiménez-Velázquez, Juan J Llibre-Rodriguez, Daisy Acosta

Background To date, dementia prediction models have been exclusively developed and tested in high-income countries (HICs). However, most people with dementia live in low-income and middle-income countries (LMICs), where dementia risk prediction research is almost non-existent and the ability of current models to predict dementia is unknown. This st...

Background Research carried out in high income countries suggests that loneliness may be a common experience among older adults living in these settings. Loneliness is correlated with poor socioeconomic status, living alone, being widowed and is associated with adverse health outcomes, including mortality. There is still a lack of evidence about th...

Cuba, the Dominican Republic, and Puerto Rico, otherwise known as the Spanish Insular Caribbean, comprise a subgroup of insular territories that have similar cultural, historical, and colonial backgrounds. The Spanish Insular Caribbean population faces a particularly high risk for dementia, and only steadily emerging, albeit unique behavioral and p...

Objectives: Depression and anxiety are common mental disorders in later life. Few population-based studies have investigated their potential impacts on mortality in low- and middle-income countries (LMICs). The aim of this study is to examine the associations between depression, anxiety, their comorbidity and mortality in later life using a popula...

Background The World Health Organization has reframed health and healthcare for older people around achieving the goal of healthy ageing. Recent evidence-based guidelines on Integrated Care for Older People focus on maintaining intrinsic capacity, addressing declines in mobility, nutrition, vision and hearing, cognition, mood and continence aiming...

Background With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups. Methods and findings We harmoniz...

With no effective treatments for cognitive decline or dementia, improving the evidence base for modifiable risk factors is a research priority. This study investigated associations between risk factors and late-life cognitive decline on a global scale, including comparisons between ethno-regional groups.

Introduction: The World Health Organization (WHO) approved the Plan of Action to tackle dementia in its 70th World Meeting held on May 29th, 2017 in Geneva, Switzerland. Dementia affects 50 million people in the world, and if there is not an effective intervention, this figure will nearly triple by the year 2050. This disease can become the most ex...

Objective: Frailty and depression are highly comorbid conditions, but the casual direction is unclear and has not been explored in low- and middle-income countries. The aim of this study was to investigate the potential impact of depression on incident frailty in older people living in Latin America. Methods: This study was based on a population...

Objectives: Growing evidence shows that cardiovascular health (CVH) is associated with brain health. Little is known about this topic among older adults in Latin America, where the number of people living with dementia is rising. This study aimed to assess the longitudinal association between cardiovascular health and dementia in six Latin America...

Introducción: Las demencias son consideradas la primera causa de discapacidad en los adultos mayores. A la vez, los ancianos, por lo general, suelen necesitar progresivas atenciones y, por lo tanto, se vuelven en cierta medida dependientes, contribuyendo así a la carga económica y al estrés psicológico de sus familiares, cuidadores, enfermeros y de...

Background Adult leg length is influenced by nutrition in the first few years of life. Adult head circumference is an indicator of brain growth. Cross-sectional studies indicate inverse associations with dementia risk, but there have been few prospective studies. Methods Population-based cohort studies in urban sites in Cuba, Dominican Republic Pu...

Background Exposure to endogenous estrogen may protect against dementia, but evidence remains equivocal. Such effects may be assessed more precisely in settings where exogenous estrogen administration is rare. We aimed to determine whether reproductive period (menarche to menopause), and other indicators of endogenous estrogen exposure are inversel...

Background Diabetes prevalence is already high in middle income countries, particularly among older people. Current evidence on diabetes as a risk factor for dementia is limited to cohort studies in high income countries. Few studies carried out fasting glucose assessments to identify undiagnosed cases, and assess diabetes control. We aimed to dete...

Background Adult leg length is influenced by nutrition in the first few years of life. Adult head circumference is an indicator of brain growth. Cross-sectional studies indicate inverse associations with dementia risk, but there have been few prospective studies. Methods Population-based cohort studies in urban sites in Cuba, Dominican Republic Pu...

Background Exposure to endogenous estrogen may protect against dementia, but evidence remains equivocal. Such effects may be assessed more precisely in settings where exogenous estrogen administration is rare. We aimed to determine whether reproductive period (menarche to menopause), and other indicators of endogenous estrogen exposure are inversel...

Aging and Alzheimer is a prospective, longitudinal cohort study involving 2944 adults aged ≥65 years from selected areas in Cuba’s Havana and Matanzas Provinces. This door-to-door study, which began in 2003, includes periodic assessments of the cohort based on an interview; physical exam; anthropometric measurements; and diagnosis of dementia and i...

Resumen Introducción: La Asociación Mundial de Alzheimer en 2012 llevó a cabo una campaña para superar el estigma hacia la demencia. El estigma constituye el mayor obstáculo para identificar los problemas de salud, encontrar sus soluciones y explotar de forma más eficiente los servicios de salud. Objetivo: Exponer la repercusión del estigma hacia...

Introduction: Worldwide Alzheimer Disease Organization in the year 2012 carried out a campaign to overcome the stigma to dementia. The stigma constitutes the biggest obstacle to identify health's problems of, to find its solutions and to use in a more efficient way the health's services. Objective: To show it repercussion of the stigma to the patie...