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 cross-sectional survey, 2,944 older Cubans were recruited at a community-based level aimed to identify the effects of self-identified race and genetic admixture on cognitive performance. Dementia diagnosis was established using 10/66 Dementia and DSM-IV criteria. APOE-ε4 genotype was determined in 2,511 (85%) and genetic admixture was completed for all dementia cases and in a randomly selected sample of cognitive healthy participants (218 dementia cases and 367 participants without dementia). Results The overall prevalence of dementia was 8.7%, without large or statistically significant differences on dementia prevalence (p=0.12) by self-identified race. Mean cognitive scores were similar across racial groups (p=0.46). After controlling for age, sex and education, greater proportion of African ancestry was not associated with cognitive performance (p=0.17). Conclusions We found no evidence of an independent effect of self-identified race and/or population ancestry on dementia prevalence or cognitive performance. This suggests that observed differences in dementia prevalence among diverse populations may be driven primarily by social determinants of health.

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 Health Assessment (BHA) in detecting cognitive impairment in a Cuban population; 146 participants (cognitively healthy=53, MCI=46, dementia=47) were recruited at primary care and tertiary clinics. The main outcomes included: accuracy of the BHA in discriminating between controls and cognitively impaired groups (MCI and dementia) and correlations between the BHA subtests of memory, executive functions, and visuospatial skills and criterion‐standard paper‐and‐pencil tests in the same domains. Results The BHA had an AUC of .95 (95% CI: .91‐ .98) in discriminating between controls and cognitively impaired groups (MCI and dementia, combined) with .91 sensitivity at .85 specificity. In discriminating between control and MCI groups only, the BHA tests had an AUC of .94 (95% CI: .90‐ .99) with .71 sensitivity at .85 specificity. Performance was superior to the MoCA across all diagnostic groups. Concurrent and discriminant validity analyses showed moderate to strong correlations between the BHA tests and standard paper‐and‐pencil measures in the same domain and weak correlations with standard measures in unrelated domains. Conclusions The BHA has excellent performance characteristics in detecting cognitive impairment including dementia and MCI in a Hispanic population in Cuba and outperformed the MoCA. These results support potential application of digital cognitive assessment for older adults in LMIC.

Background: NeuroEPO, a nasal pharmaceutical solution of recombinant human erythropoietin with low sialic acid, was in clinical development for the treatment of mildmoderate Alzheimer's disease. Method:A double-blind, randomized, placebo-controlled, multicenter, prospective, with adaptive design, phase II/III clinical trial involving 174 patients with mild-tomoderate Alzheimer's, was conducted. NeuroEPO or placebo, with different doses, was administered by nasal route 3 times a weeks for 48 weeks. The primary outcome measure was score on the 11-item cognitive subscale of the Alzheimer's disease Assessment Scale (ADAS-cog11, with scores ranging from 0 to 70 and higher scores indicating greater impairment). Secondary outcome measures included Clinician's Interview-Based Impression of Change Plus Caregiver Input (CIBIC-plus), Global Dementia Scale (GDS), activities of daily living (ADL), hippocampal volume change over time (measured with MRI), neuropsychological scales, electroencephalography (EEG) and adverse events.Result: There were statistically significant differences between neuroEPO and placebo in median change from baseline in the primary outcome at week 48. The change in ADAS-cog11 scores final-initial (PP population) for patients in the neuroEPO 0.5 mg (n= 50, median change: -4.0), neuroEPO 1.0 mg (n=49, median change: -5.0) and placebo (n=49, median change: 4.0) groups. A difference of 8.0 points CI 95% (6.0; 10.0) neuroEPO 0.5 mg vs. placebo and 9.0 points CI 95% (6.8; 11.2) neuroEPO 1.0 mg vs. placebo at week 48, (p=0.000), was observed. Patients receiving both doses of neuroEPO also showed a significant difference in global improvement (CIBIC-Plus, p=0.000) and electroencephalography (EEG, p=0.003) compared with placebo group. About hippocampal volume change, 105 patients were analyzed. From them, 58% remained stable and 42% decline hippocampus volume. No serious adverse events related with neuroEPO were reported. Conclusion:NeuroEPO improved clinical outcomes in patients with Alzheimer's disease with good security profile. Therefore, it could be useful in the treatment of these kind of patients.

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