Latin America is a vast heterogeneous territory where chronic diseases such as mild cognitive impairment or dementia are becoming higher. Frontotemporal dementia (FTD) prevalence in this region is estimated to be around 12–18 cases per thousand persons. However, this prevalence is underestimated given the lack of awareness of FTD even among healthcare professionals. Family members are responsible for the care of patients with FTD at home. These caregivers deliver care despite being ill-equipped and living in the context of austerity policies and social inequities. They often face unsurmountable financial and social burdens that are specific to the region. The most important step to support caregivers in Latin America is to increase awareness of the disease at all levels. Healthcare diplomacy is fundamental to create joint efforts that push policies forward to protect caregivers of FTD patients.

Background and objectivesThe homeless population in the US is aging. Cognitive impairment is prevalent in this population, yet little is known about the neurologic etiologies of such impairment. Addressing this gap in knowledge is important because homeless older adults with cognitive impairment due to neurodegenerative disease may need lifelong tailored support to obtain and maintain housing. In this study, we characterized the neurocognitive health of a sample of adults who experienced homelessness for the first time after age 50 using gold standard behavioral neurology examination practices.MethodsWe conducted a descriptive cross-sectional study of older adults who first experienced homelessness after age 50. We recruited our sample purposively from an ongoing longitudinal cohort study of adults who were aged 50 and over and homeless when they entered the cohort. For this sub study, we enrolled a convenience sample from those who reported their first episode of homelessness after age 50. We did not exclude individuals based on history of substance use. Neurologists conducted a structured neurocognitive history intake, neurological examination, neuropsychological evaluation, and functional assessment between November 2020 and February 2021. We screened all participants for neurocognitive disorders using gold standard clinical research diagnostic criteria.ResultsWe evaluated 25 participants, most were men (76%) and Black (84%), with a median age of 61 years. The most common neurocognitive complaints included deficits in recent episodic memory (n = 15, 60%), executive functions (n = 13, 52%), and behavior/mood, with apathy being the most common complaint (n = 20, 80%). Neuropsychological testing revealed a high prevalence of socioemotional deficits (n = 20, 80%). Common neurological examination deficits included difficulties with coordination, such as impaired Luria task (n = 16, 64%), signs of distal peripheral neuropathy (n = 8, 32%), anosmia/hyposmia (n = 4, 21%), and signs of mild Parkinsonism (n = 5, 20%). The most common diagnoses were MCI (n = 7, 28%), bvFTD (n = 4, 16%), AD (n = 4, 16%), and DLB (n = 2, 8%).DiscussionOur findings suggest that neurocognitive concerns and examination deficits are common among older homeless adults. Specific neurocognitive disorders may be overrepresented in this population, particularly frontotemporal disorders. Longitudinal studies involving brain biomarkers are needed to characterize the neurocognitive health of this vulnerable population more precisely.

Background There is a lack of instruments designed to capture exposures across various social and determinants of health throughout the lifespan in persons with late‐life neurodegenerative disorders. Responding to this need, we created and piloted the administration of the MAC‐RedLat Social Determinants of Health Questionnaire. Method The questionnaire was administered to 137 dyads of participants‐caregivers. An exploratory factor analysis was conducted using the software R. Results Participants had a mean age of 67 years (SD = 11.0). 47.7% had Alzheimer´s disease dementia and 12.4% had frontotemporal dementia, the rest were controls. Data were screened for multivariate assumptions (normality, linearity, homogeneity, and homoscedasticity). All assumptions were met with slight problems of heteroscedasticity. Bartlet’s test indicated correlation adequacy x2 = 2191.611, p<0.001, and the KMO test indicated borderline sampling adequacy, MSA = 0.75. A parallel analysis and Scree plot examination suggested 4 overall factors. Additionally, a 3‐factor model was run based on theory. Maximum likelihood examination was used with Oblimin rotation. After testing all the 37 questions, 19 items split among several factors using the criterion that loadings must be greater than .300. These items were eliminated from further analysis. The final 3‐factor model is presented in Table 1. This model achieved simple structure with each item loading on only one factor. This model had moderate fit: Tucker Lewis Index = 0.764, RMSEA = 0.062, 90%CI (0.054,0.071) and SRMR = 0.06. The CFI = 0.884 indicated room for improvement. Factor 1 included 9 items related to socioeconomic status, factor 2 included 5 items related to challenging life experiences, and factor 3 included 4 items related educational environment. The reliability of the 3 factors was 0.074, 0.071, and 0.069, for factors 1, 2, and 3 respectively. The mean scores for each factor were factor 1 M = 5.322(SD = 1.283), factor 2 M = 3.19(SD = 1.108), and factor 3 M = 1.809(SD = 0.444). Conclusion Our instrument is adequate to measure social determinants of health in persons with neurodegenerative dementia with the input of caregivers.