Dementia is a major cause of dependency and disability among older persons, and imposes huge economic burdens. Only a few cost-of-illness studies for dementia have been carried out in middle and low-income countries.ObjectiveThe aim of this study was to analyze costs of dementia in demented patients of a private clinic in Lima, Peru.Methods.We performed a retrospective, cohort, 3-month study by extracting information from medical records of demented patients to assess the use of both healthcare and non-healthcare resources. The total costs of the disease were broken down into direct (medical and social care costs) and indirect costs (informal care costs).Results.In 136 outpatients, we observed that while half of non-demented patients had total care costs of less than US$ 23 over three months, demented patients had costs of US$ 1500 or over (and more than US$ 1860 for frontotemporal dementia). In our study, the monthly cost of a demented patient (US$ 570) was 2.5 times higher than the minimum wage (legal minimum monthly wage in Peru for 2011: US$ 222.22).Conclusion.Dementia constitutes a socioeconomic problem even in developing countries, since patients involve high healthcare and non-healthcare costs, with the costs being especially high for the patient's family.

Despite the limitations of this study, the collected information supports the existence of differences in the clinical and radiological traits of SC patients between Asian and Latin-American hospitals. The possible biological factors that may underlie these differences are discussed.

Background and purpose Stroke is the leading cause of neurological impairment in the South American Andean region. However, the epidemiology of stroke in the region has been poorly characterized. Methods We conducted a staged three-phase population-based study applying a validated eight-question neurological survey in 80 rural villages in Tumbes, northern Peru, then confirmed presence or absence of stroke through a neurologist’s examination to estimate the prevalence of stroke. Results Our survey covered 90% of the population (22,278/24,854 individuals, mean age 30±21.28, 48.45% females), and prevalence of stroke was 7.05/1,000 inhabitants. After direct standardization to WHO’s world standard population, adjusted prevalence of stroke was 6.94/1,000 inhabitants. Participants aged ≥85 years had higher stroke prevalence (>50/1000 inhabitants) compared to other stratified ages, and some unusual cases of stroke were found among individuals aged 25–34 years. The lowest age reported for a first stroke event was 16.8 years. High blood pressure (aPR 4.2 [2.7–6.4], p>0.001), and sedentary lifestyle (aPR 1.6 [1.0–2.6], p = 0.045) were more prevalent in people with stroke. Conclusions The age-standardized prevalence of stroke in this rural coastal Peruvian population was slightly higher than previously reported in studies from surrounding rural South American settings, but lower than in rural African and Asian regions. The death rate from stroke was much higher than in industrialized and middle-income countries.

ObjectiveThe aim of this study was to evaluate caregiver burden based on Zarit Burden Interview (ZBI) and depression in caregivers on the Beck Depression Inventory-II (BDI-II).MethodsLiterate individuals, 18 years or older, who spoke Spanish as their native language were included. Demographic characteristics: Age, sex, education, relationship to person with dementia, length of time caregiving, other sources of help for caring, impact on the household economy, family support, and perception of impaired health; and Clinical data on care-recipients: type of dementia, time since diagnosis, treatment, and Global Deterioration Scale (GDS); the ZBI and BDI-II. Descriptive and analytical statistics were employed to assess caregiver burden and predictors of higher burden in caregivers.ResultsA total of 92 informal caregivers were evaluated. Regarding care-recipients, 75% were 69 years old or over, 75% had at least one year since diagnosis, 73.9% had Alzheimer's disease, 84.8% received treatment, 75% scored 5 or over on the GDS. For caregivers, 75% were 55.5 years old or over, predominantly female (81.5%), married (83.7%), the spouse of care-recipients (60.87%), had at least 10 years of education (75.0%) and one year of caregiving (75%), reduced entertainment time (90.2%) and self-perception of impaired health (83.7%). Median score on the ZBI was 37.5 (minimum value = 3; and maximum value = 74). The coefficient of BDI was 1.38 (p-value <0.001).ConclusionThis sample of Peruvian informal caregivers showed elevated ZBI values. Self-perception of worsened health, repercussion on the family economy and time caregiving were the main determinants of ZBI, although only BDI was a consistent predictor of ZBI.

Resumen El trastorno neurocognitivo asociado a VIH (TNAV) es una complicación poco conocida pero de elevada prevalencia e impacto en los pacientes con VIH. El término TNAV agrupa un espectro de complicaciones progresivas del sistema nervioso central (SNC), desde un compromiso neurocognitivo asintomático y un trastorno neurocognitivo leve hasta una demencia asociada a VIH (DAV). Mientras que la incidencia de DAV ha disminuido significativamente con el tratamiento antirretroviral de gran actividad (TARGA), las formas más leves de TNAV se han incrementado. En esta revisión, describimos la nomenclatura actualizada y definiciones de caso para orientar el diagnóstico del TNAV. También, resumimos las manifestaciones clínicas, diagnóstico y recomendaciones para el tratamiento. Finalmente, mientras que el deterioro cognitivo es típicamente diagnosticado con una evaluación neuropsicológica completa, la interpretación de los resultados se basa en la comparación entre el rendimiento del paciente con valores normalizados en poblaciones ajustados culturalmente y según edad; así, los resultados de estas pruebas son válidos solo si existen datos representativos normalizados adecuadamente para un paciente. Por lo tanto, proponemos un grupo de pruebas neuropsicológicas breves validadas en nuestra población peruana, que pueden ser utilizadas para la detección temprana del TNAV no solo por los neurólogos sino también por el médico tratante del paciente con VIH o en centros de escasos recursos.