Introdução O envelhecimento populacional é uma realidade no Equador e este fato resulta em maior prevalência dos problemas mais frequentes em idosos, dentre eles, a deterioração das funções cognitivas. Objetivo Avaliar a função cognitiva, prevalência e fatores de risco associados ao declínio cognitivo e demência em pessoas com mais de 65 anos em Cumbayá-Quito, Equador. Métodos Este é um estudo de observação transversal que foi realizado em adultos com mais de 65 anos de idade. O Mini Exame do Estado Mental (MMSE), o Dementia Screening Interview (AD8) e a Mini Avaliação Nutricional (MNA) foram utilizados para avaliar o estado cognitivo e os hábitos nutricionais dessa população. Resultados Um total de 144 pacientes (idade média 75,3; 77,1% mulheres) fizeram parte deste estudo; 40% dos pacientes apresentaram testes positivos (AD8 e MMSE) consistentes com comprometimento cognitivo, possível demência. A idade (p<0,01), a escolaridade inferior (p <0,01), acidente vascular cerebral (p <0,01), hemorragia intracerebral (p<0,01), diabetes mellitus (p<0,01) e desnutrição (p<0,01) foram riscos significativos para o comprometimento cognitivo. O exercício (p <0,03) e o consumo de álcool (p=0,02) foram fatores de risco protetores para o declínio cognitivo nessa população. Gênero, etnia, localização, traumatismo craniano, doença de Parkinson, colesterol alto, diabetes, infarto do miocárdio, doença da tireóide, depressão, ansiedade, história familiar de demência não foram associados ao declínio cognitivo nessa população. Conclusões A prevalência de comprometimento cognitivo e possível demência aos 65 anos é de 18-21% e aos 85 anos é de 54-60% em Cumbayá, Quito, Equador. Os principais fatores de risco para deficiência cognitiva nesta população são idade, educação, desnutrição, acidente vascular cerebral e diabetes mellitus. Os fatores protetores para o declínio cognitivo foram o exercício e possivelmente o consumo moderado de álcool. / Introduction Population aging is a reality in Ecuador and this fact results in a higher prevalence of the most frequent problems in the elderly, among them, the deterioration of cognitive functions. Objective To assess the cognitive function, prevalence, and risk factors associated with cognitive decline and dementia in people over 65 years of age in Cumbayá-Quito, Ecuador. Methods This is a cross-sectional observational study that was carried out in adults over 65 years of age. The Mini Mental Scale Examination (MMSE), Dementia Screening Interview (AD8) and Mini Nutritional Assessment (MNA) were used to assess the cognition status and nutritional habits of this population. Results A total 144 patients (mean age 75.3; 77.1% females) were part of this study; 40% of patients had positive tests (AD8 & MMSE) consistent with cognitive impairment, possible dementia. The age (p<0.01), lower school education (p<0.01), stroke (p<0.01), intracerebral hemorrhage (p<0.01), diabetes (p<0.01) and malnutrition (p<0.01), were significant risk factors for cognitive impairment. Exercise (p<0.03) and consumption of alcohol were a protective risk factor for cognitive decline in this population. Gender, ethnicity, location, head trauma, Parkinson disease, high cholesterol, diabetes, myocardial infarction, thyroid disease, depression, anxiety, family history of dementia were not associated with cognitive decline in this population. Conclusions The prevalence of cognitive impairment and possible dementia at the age of 65 years is 18-21% and at age 85 years is 54-60% in Cumbayá, Quito, Ecuador. The main risk factors for cognitive impairment in this population were age, education, malnutrition, stroke, and diabetes. Protective factors for cognitive decline were exercise and possibly modest consumption of alcohol.

Introdução O envelhecimento populacional é uma realidade no Equador e este fato resulta em maior prevalência dos problemas mais frequentes em idosos, dentre eles, a deterioração das funções cognitivas. Objetivo Avaliar a função cognitiva, prevalência e fatores de risco associados ao declínio cognitivo e demência em pessoas com mais de 65 anos em Cumbayá-Quito, Equador. Métodos Este é um estudo de observação transversal que foi realizado em adultos com mais de 65 anos de idade. O Mini Exame do Estado Mental (MMSE), o Dementia Screening Interview (AD8) e a Mini Avaliação Nutricional (MNA) foram utilizados para avaliar o estado cognitivo e os hábitos nutricionais dessa população. Resultados Um total de 144 pacientes (idade média 75,3; 77,1% mulheres) fizeram parte deste estudo; 40% dos pacientes apresentaram testes positivos (AD8 e MMSE) consistentes com comprometimento cognitivo, possível demência. A idade (p<0,01), a escolaridade inferior (p <0,01), acidente vascular cerebral (p <0,01), hemorragia intracerebral (p<0,01), diabetes mellitus (p<0,01) e desnutrição (p<0,01) foram riscos significativos para o comprometimento cognitivo. O exercício (p <0,03) e o consumo de álcool (p=0,02) foram fatores de risco protetores para o declínio cognitivo nessa população. Gênero, etnia, localização, traumatismo craniano, doença de Parkinson, colesterol alto, diabetes, infarto do miocárdio, doença da tireóide, depressão, ansiedade, história familiar de demência não foram associados ao declínio cognitivo nessa população. Conclusões A prevalência de comprometimento cognitivo e possível demência aos 65 anos é de 18-21% e aos 85 anos é de 54-60% em Cumbayá, Quito, Equador. Os principais fatores de risco para deficiência cognitiva nesta população são idade, educação, desnutrição, acidente vascular cerebral e diabetes mellitus. Os fatores protetores para o declínio cognitivo foram o exercício e possivelmente o consumo moderado de álcool. / Introduction Population aging is a reality in Ecuador and this fact results in a higher prevalence of the most frequent problems in the elderly, among them, the deterioration of cognitive functions. Objective To assess the cognitive function, prevalence, and risk factors associated with cognitive decline and dementia in people over 65 years of age in Cumbayá-Quito, Ecuador. Methods This is a cross-sectional observational study that was carried out in adults over 65 years of age. The Mini Mental Scale Examination (MMSE), Dementia Screening Interview (AD8) and Mini Nutritional Assessment (MNA) were used to assess the cognition status and nutritional habits of this population. Results A total 144 patients (mean age 75.3; 77.1% females) were part of this study; 40% of patients had positive tests (AD8 & MMSE) consistent with cognitive impairment, possible dementia. The age (p<0.01), lower school education (p<0.01), stroke (p<0.01), intracerebral hemorrhage (p<0.01), diabetes (p<0.01) and malnutrition (p<0.01), were significant risk factors for cognitive impairment. Exercise (p<0.03) and consumption of alcohol were a protective risk factor for cognitive decline in this population. Gender, ethnicity, location, head trauma, Parkinson disease, high cholesterol, diabetes, myocardial infarction, thyroid disease, depression, anxiety, family history of dementia were not associated with cognitive decline in this population. Conclusions The prevalence of cognitive impairment and possible dementia at the age of 65 years is 18-21% and at age 85 years is 54-60% in Cumbayá, Quito, Ecuador. The main risk factors for cognitive impairment in this population were age, education, malnutrition, stroke, and diabetes. Protective factors for cognitive decline were exercise and possibly modest consumption of alcohol.

This dissertation addresses critical gaps in dementia research in Native Hawaiian and Pacific Islander (NHPI) communities. Focusing on Samoan and Tongan communities, the study successfully adapted and validated the AD8 informant interview and the Clinical Dementia Rating (CDR) scale in native languages, establishing these instruments as reliable tools for detecting cognitive impairment in these populations. The research process prioritized meaningful community engagement and forged partnerships with indigenous professionals, ensuring alignment with and responsiveness to the specific needs of the community. These invaluable connections were the foundation of making this difficult work possible. Subjects assessed with these adapted instruments were enrolled in the largest NHPI dementia study to date. Evaluation of this cohort led to new Insights into dementia prevalence and potential risk factors among NHPIs including assessment of APOE isoform frequencies and other genetic data. The ɛ4 allele was found to be much more frequent in NHPIs than in other ethnic groups, and does not appear to show association with dementia risk. NHPI Early-onset Alzheimer's disease families were also studied using whole genome sequence data, setting a foundation for future genetic studies. Future efforts should focus on disseminating these adapted tools, expanding genetic studies across diverse NHPI sub-populations, and conducting longitudinal studies to track cognitive changes. Collaborations between clinical, scientific, and cultural experts are encouraged for comprehensive, culturally-sensitive research strategies. In summary, this dissertation serves as a bridge between current Alzheimer's research and a promising future for new efforts in NHPI populations. It also creates a roadmap for adapting other clinical and research instruments into new languages and cultures. Through linguistic adaptations, genetic insights, and epidemiological investigations, it demonstrates a more precise, culturally relevant approach to Alzheimer's research that can significantly impact healthcare practices and the overall well-being of NHPI communities.