Prevalence, incidence and demographics of dementia in Ecuador

Prevalence, incidence and demographics of dementia in Ecuador | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence, incidence and demographics of dementia in Ecuador José Alejandro Valdevila Figueira, Xavier Rodrigo Yambay-Bautista, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5521995/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : This study examines the prevalence and incidence of dementia in Ecuador, with a focus on understanding demographic and social factors associated with increased risk. Data were obtained from the Institute of Neurosciences of Guayaquil, covering patient records from 2010 to 2022. The purpose was to identify prevalence trends and key risk factors to inform targeted prevention and early intervention efforts in high-risk groups. Methods: This observational, correlational study analysed patient data to estimate dementia prevalence and incidence. Statistical analyses included descriptive statistics to calculate overall and age-specific prevalence rates, while incidence was calculated per 1,000 person-years. Correlations and chi-square analyses were used to evaluate associations between dementia and potential risk factors, including age, gender, education level, and marital status. Results: The overall prevalence of dementia was 3.1%, with higher rates among women (1.8%) compared to men (1.3%). Dementia incidence was calculated at 2.4 per 1,000 person-years. Prevalence increased significantly with age, from 1.2% in individuals aged 65–69 to 54.8% in those aged 95 and older. Advanced age, female gender, lower education levels, and lack of a marital partner were associated with higher dementia prevalence. Conclusions: These findings highlight a rising dementia prevalence in Ecuador, particularly among women and older individuals, with social and educational factors contributing to increased risk. The results underscore the need for tailored dementia prevention and early intervention strategies, especially as prevalence rates continue to rise across Latin America. dementia Alzheimer's disease vascular dementia incidence prevalence comorbidity Figures Figure 1 Figure 2 Background Dementia is a chronic and progressive syndrome that affects various higher cognitive functions, such as memory, thinking, orientation, comprehension, calculation, learning, language, and judgement. These impairments may be accompanied or preceded by issues in emotional control, social behaviour, or motivation, worsening the prognosis due to the increased level of disability. [ 1 ] Dementias present diverse manifestations but share an aetiology rooted in brain disease that leads to dysfunction. This can be primary, as in diseases, injuries, and trauma that directly affect the brain, or secondary, as in systemic disorders impacting multiple organs, including the brain. [ 1 ] Over the past decade, significant advancements have been made in understanding the clinicopathological correlation and in the development of new biomarkers. [ 2 ] Dementia is very common in the elderly population. The disease prevalence doubles every five years among individuals over 65 years of age. [ 3 ] Numerous epidemiological studies have demonstrated the variability in dementia prevalence rates. [ 4 , 5 , 6 ] This variability may be related to age differences, the instruments used for cognitive and functional assessments, the diagnostic criteria applied, rural or urban residency, and the representativeness of the studied samples. [ 7 ] People with mild cognitive impairment have a 10 to 15% chance of developing dementia compared to healthy individuals, in whom the annual likelihood is 1 to 2%. [ 8 ] Compared to women, men have a higher incidence of dementia diagnosis before the age of 70 but a lower incidence after 70. [ 9 ] It is estimated that more than 55 million people worldwide live with dementia, the most common type being Alzheimer's disease, accounting for approximately 60–70% of cases. The remaining percentage includes other types, such as vascular dementia, dementia with Lewy bodies, and frontotemporal dementia, though dementia can also result from stroke, HIV infection, harmful alcohol consumption, repeated brain injuries, or nutritional deficiencies. [ 10 , 11 , 12 ] Population ageing, initially occurring in high-income countries, is now happening in low- and middle-income countries. By 2050, two-thirds of the world’s population over 60 years will live in these countries. [ 13 ] The World Health Organisation estimates that between 2015 and 2050, the percentage of people aged 60 or older will nearly double, from 12–22%, and the number of people aged 80 or older will triple, reaching 426 million. By 2050, 80% of older adults will live in low- and middle-income countries, which will place a heavy burden on healthcare systems due to the rise in chronic diseases. [ 14 ] The latest descriptive epidemiological research on dementia allows for the investigation of changes in prevalence and incidence over time. A review of 14 studies examining trends in dementia prevalence and incidence in Sweden, Spain, the United Kingdom, the Netherlands, France, the United States, Japan, and Nigeria indicates stable or declining dementia rates, with some studies providing evidence of sex-specific changes with a multifactorial aetiology, considering significant social changes and improvements in living conditions, education, and healthcare. [ 15 ] The 2017 Lancet Commission identified nine modifiable risk factors for dementia: lower educational attainment, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact. [ 16 ] Each year, demographic indicators in Latin American and developing countries converge, and the expected prevalence of dementia in the former now surpasses that in the latter. [ 17 ] Dementia has been declared a global challenge; however, regions worldwide show differences in both the nature and magnitude of this challenge. [ 18 ] The strategies, procedures, and tools to address ageing in general, and dementia in particular, have fallen short of the international call to tackle this medical-social issue. [ 19 ] Much remains to be done to achieve the goal of "living well with dementia" set out in the World Alzheimer Report 2016 [ 20 ] because, as in many countries, Ecuador faces pronounced fragmentation in long-term healthcare, along with inadequate and poor quality of care, as well as limited coverage of basic support for individuals with dementia and their caregivers. Relatively little attention is given to systems and services that provide healthcare to people with dementia, with coverage not exceeding 10–15% of the total population. [ 21 ] Globally, diagnostic coverage is low. Only between 40% and 50% of people living with dementia have received a diagnosis. [ 22 ] In low- and middle-income countries, there are few available estimates, but current data suggest a diagnostic coverage of between 5% and 10% [ 23 ], limiting strategies for healthcare and social planning throughout the course of the disease. Studies conducted with samples from large cities reveal significant diversity among subjects, including individuals from rural areas with different cultural backgrounds, educational systems, and professional activities with varying levels of demand. [ 24 ] The assessment of subjects with similar backgrounds and socioeconomic, cultural, and environmental factors enables the observation of cognitive impairment prevalence and the effect of schooling, although such studies are rarely conducted. [ 25 ] The demographic structure of Latin America presents multiple unique challenges as its indicators are rapidly approaching those of developing countries; furthermore, fertility rates and their relative decline have been uneven in Latin America and the Caribbean. [ 26 ] However, the understanding of relevant factors for dementia is currently limited. [ 27 ] A high proportion of people with dementia in the region lack basic support. [ 28 ] In 2010, 10.6% of the Ecuadorian population consisted of children under five years of age, marking a 2.4% decrease in this age group compared to the previous decade. By this time, the population structure exhibited a broad-based pyramid characteristic of developing countries, with approximately 1.2 million people over the age of 60 and about 160,000 individuals aged 80 or older. Life expectancy at birth was 77.9 years for women and 72.3 years for men, with an average of 75 years. [ 10 ] Currently, Ecuador has slightly over 16 million inhabitants, and by 2050, it is expected that only 5.8% of the population will be under five years old, while 30% will be over 60 years of age. [ 29 ] The purpose of this study was to determine the epidemiological and demographic factors associated with dementia in the Ecuadorian population. Addressing this issue is essential, as understanding the epidemiology, risk factors, and socioeconomic impact will enable the design of interventions that improve the quality of life of those affected and alleviate the burden on their families and the healthcare system. Methods Population, Sample, and Type of Study This was an observational, correlational study with a quantitative approach. Anonymised data were obtained from the registry of outpatient care at the Institute of Neurosciences of Guayaquil (INSG) between January 1, 2010, and December 31, 2022. A total of 125,458 outpatients across various medical specialties and conditions were analysed. The study variables included sociodemographic factors (age, gender, region of residence, level of education, and marital status) and epidemiological factors (distribution, prevalence, incidence, burden of disease, and comorbidities). Inclusion and Exclusion Criteria Patients with a diagnosis established by the International Classification of Diseases (ICD-10) of some type of dementia during their first medical care (n = 4,485) were included. Cases with incomplete or inconsistent data (n = 619) were excluded, leaving a final sample consisting of 3,866 records. Procedure This study was based on the analysis of an anonymised outpatient database from the INSG. Patients in the database were initially classified according to their primary clinical diagnosis, specifically targeting dementia, to ensure accurate categorisation. Following this, subjects’ eligibility was verified against the study's predefined selection criteria. Data curation involved the removal of missing, duplicate or inconsistent entries. Statistical Analysis To determine the prevalence of dementias, the following formula was used: (Number of cases of the disease / Total number of cases) x 100. The incidence rate (IR) was calculated based on the number of new cases from 2010–2022 (n = 3,866), divided by the time in years (13 years), multiplied by the population at risk (125,458 patients), with this result further multiplied by an adjustment factor (1,000). The estimation of disease burden for patients with dementia was conducted using Disability-Adjusted Life Years (DALY), a measure that combines both Years of Life Lost (YLL) due to premature death and Years Lived with Disability (YLD). The YLL metric was calculated as the number of deaths (D) multiplied by life expectancy at the age of death (L), where YLL = D × L. The YLD metric was calculated as the product of the number of new cases (I), age of onset (A), duration of the condition (T), and disability weight (DW), where YLD = I × A × T × DW. The extracted information was exported to SPSS® v.26, Jamovi® v.2.3.28, and Epidat® v3.1 statistical packages for analysis. The results are presented in tables and figures showing absolute frequency, relative frequency, and epidemiological measures. Non-parametric tests (Chi-square and Cramer’s V) were used to examine the relationship between dementia, demographic variables and comorbidities. Setting The INSG, Ecuador, provided the data analysed in this study. The database included outpatient records collected as part of routine care at the institution. The INSG is the largest of the three specialised psychiatric hospitals in Ecuador, with 121 hospital beds for managing mental health crises. Its outpatient clinic offers an average of 6,000 visits monthly across various specialities (psychiatry, psychology, neurocognitive rehabilitation, and neurology). During the study period, 400 new cases were diagnosed annually in the coastal region, each receiving an average of 8 annual visits. Due to issues of distance and transportation costs, the Sierra and Amazonia regions use our services less, with 9 new cases annually in the former, receiving more than 90 visits per year, and 6 new cases per year in the latter, receiving psychiatric care once annually on average. The INSG uses a systematic, multidisciplinary approach to diagnosing mental illness and dementia. However, in many cases, diagnoses are based on symptom profiles and family reports due to limited service access, which restricts specific diagnostic accuracy in cases with dementia and explains why most treated patients with this pathology are classified as non-specific. Results A total of 3,866 records of new cases of dementia treated in the outpatient clinic of the INSG during the period 2010–2022 were included. The median age was 79 years, with an interquartile range of 13, and participants’ ages ranged from 45 to 104 years. A higher number of dementia cases were found in women (n = 2,285), representing 59.1% of the analysed records (Fig. 1 ). Most cases attended were from the Coastal region (n = 3,734; 96.5%), primarily from the province of Guayas (n = 3,005; 77.7%). The educational level distribution showed a majority with primary schooling (n = 789; 46.3%), followed by secondary education (n = 714; 18.5%), with a significant percentage of illiterate individuals (n = 554; 14.3%). Marital status indicated 39.9% single (n = 1,544) and 32.6% married (n = 1,261). Table 1 presents the complete results of the demographic variables analysed. Table 1 Characteristics of the population with dementia treated in the INSG. 2010–2022 Demographic variables f (% ) Region Coast 3734 (96.6) Mountain Region 125 (3.2) Eastern Region (tropical forest) 7 (0.2) Educational level None 554 (14.3) Elementary school 1789 (46.3) High School 714 (18.5) University 190 (4.9) Does not refer, does not know 619 (16) Marital status Single 1544 (39.9) Cohabiting 260 (6.7) Married 1261 (32.6) Separated/Divorced 119 (3.1) Widow 682 (17.7) Total 3866 (100%) Note : f = frequency. % = percentage A predominance of unspecified dementias (62.6%) was observed, followed by Alzheimer’s disease dementia (20.8%), vascular dementia (13.4%), and dementia linked to other diseases (3.2%). The prevalence of dementia among patients treated at INSG was 3.1% (1.3% in men, 1.8% in women), with an IR of 2.4 per 1,000 person-years, varying notably over the study period. In 2014, dementia cases increased by 77.34% from 2010, coinciding with the introduction of government health policies and agreements with external providers. Higher incidences of unspecified dementia cases in 2021 and 2022 likely reflected the post-COVID-19 period, where cognitive assessment was handled online with limited access to appropriate assessment tools. Figure 2 presents the number of cases by year for each type of dementia. The burden of disease, representing the loss of healthy life years due to death, illness, or injury, indicated that DALYs reached 242,184 years, with a greater burden on women (DALYs = 141,969 years). Table 2 presents the main indicators of the dementia burden in 2021. Table 2 Annual Burden of Dementia in the INSG, 2021 Indicator Gender Man Women Total Death due to dementia 54 87 141 Life expectancy 70.26 77.46 73.67 Age of death 89 89 89 AVP 675 480 1155 Number of new cases (year 2021) 140 199 339 Age of onset 79 79 79 Duration of dementia 10 10 10 Disability weight 0.9 0.9 0.9 AVD 99 540 141 489 241 029 AVISA 100 215 141 969 242 184 Note : YLL = Years of Life Lost due to Premature Death. YLD = Years Lived with Disability. DALY = Disability-Adjusted Life Years. It is important to note that 6.4% of patients with dementia have one or more comorbidities. Among the main comorbidities, mental and behavioural disorders are the most frequent (54.5%), followed by hypertension (14.5%) and nervous system diseases (14.5%). Table 3 lists the top 10 comorbidities of patients with dementia seen in the INSG's outpatient clinic. Table 3 Comorbidities of dementias 2010–2022. INSG Comorbidity f (%) Mental and Behavioural Disorders 135 (54.5) Hypertension 36 (14.5) Nervous System Diseases 36 (14.5) Cerebrovascular Diseases 11 (4.5) Endocrine, Nutritional, and Metabolic Diseases 10 (4.0) Tumours 2 (0.8) Respiratory System Diseases 2 (0.8) Digestive System Diseases 2 (0.8) Genitourinary System Diseases 2 (0.8) Other Conditions 12 (4.8) Total 248 (100) Note : f = frequency. % = percentage. The results of the bivariate analysis showed statistically significant associations between dementia and age, gender, level of education, and marital status. Additionally, a significant association was observed between dementia and some comorbidities (behavioural disorders, nervous system diseases, and hypertension). These results can be found in Table 4 . Table 4 Results from the Chi-square analyses Variables χ2 p V Age 349.51 < 0,001* 0.174 Gender 66.7 < 0,001* 0.130 Region (Coast, Mountain Region, Eastern Region) 5.04 0.538 - Educational level 41.4 < 0,001* 0.059 Marital status 21.9 0.039* 0.043 Mental and Behavioural Disorders (F00-F99) 10.2 0,017* 0.051 Hypertension (I10-I15) 36.8 < 0,001* 0.097 Nervous System Diseases (G00-G99) 12,8 0,005* 0.057 Cerebrovascular Diseases (I60-I69) 2.67 0.446 - Endocrine, Nutritional, and Metabolic Diseases (E00-E90) 2.96 0.398 - Note : χ2 = Chi-square. p = asymptotic significance. V = Cramer's V. *= Significant association. Discussion Dementia represents a significant challenge for both public health and society, affecting millions of people worldwide [ 30 ] and imposing an economic, emotional, and physical burden on healthcare systems and caregivers. Due to population ageing, the number of dementia cases is rapidly increasing globally, particularly in low- and middle-income regions, where approximately 60% of cases are concentrated [ 31 ]. This phenomenon is driven mainly by rising life expectancy and an ageing population, factors that increase the incidence of dementia, especially Alzheimer's disease, which accounts for 60–70% of dementia cases [ 32 , 33 , 34 ]. The situation in Latin America and the Caribbean is alarming, as these regions experience a faster growth in dementia prevalence compared to others [ 31 ]. In this study, based on 3,866 cases seen at the INSG, most diagnosed patients had a median age of 79 years, aligning with similar population studies that indicate an increased dementia risk with advancing age [ 35 ]. Statistics reported by Custodio et al. [ 36 ] in Latin America show higher incidence rates than those found in this study, which could be related to sociodemographic factors specific to Ecuador as well as to limitations in diagnostic access in certain parts of the country. Research on dementia across different contexts has revealed significant variations in the incidence and prevalence of the disease based on gender, educational level, and healthcare access. Findings in European and Asian populations, for example, show a generally higher prevalence among women than men, a trend also observed in this study in Ecuador, where a higher prevalence in women is recorded [ 37 ]. These differences may be explained by women’s greater longevity and by sociocultural factors that influence the risk of developing dementia [ 38 ]. Data from this study also emphasise the importance of educational level as a relevant risk factor for dementia incidence. Research indicates that individuals with lower educational levels exhibit a higher dementia prevalence compared to those with higher education [ 45 ]. This may be linked to the concept of cognitive reserve, which suggests that greater cognitive stimulation throughout life can protect against cognitive decline in old age [ 46 ]. According to Parra et al. [ 44 ], Latin American countries face specific challenges due to limitations in health infrastructure and policies, which affect effective prevention and management of dementia in the region. The geographic distribution of dementia cases in Ecuador also reveals interesting patterns. The high concentration of cases in the Coastal region, particularly in the province of Guayas, suggests both greater access to healthcare services and potential regional differences in risk factors. In contrast, other studies in nearby countries, such as Colombia, show a higher prevalence of dementia in rural areas and among people with lower educational levels [ 8 ]. These findings underscore the need to consider demographic and geographic characteristics in the design of public health interventions to address dementia. Marital status and social support also emerge as factors that influence the prevalence and progression of dementia. Studies in various populations have indicated that single, divorced, or widowed individuals have a higher risk of developing dementia compared to those who are married [ 47 ]. This social vulnerability, combined with a lack of family support, can impact the quality of life of individuals with dementia and their disease management. In Ecuador, a high percentage of the cases analysed involved individuals without a partner, which could indicate a greater risk and a reduced capacity to face the challenges of the disease. An important aspect identified in this research is the impact of comorbidities on dementia patients [ 49 ]. The presence of mental disorders, hypertension, and nervous system diseases is associated with faster functional decline and reduced quality of life in individuals with dementia [ 3 ]. Multimorbidity complicates clinical management and increases associated costs, which has significant implications for the Ecuadorian health system and underscores the need for a comprehensive approach to the care of these patients. Globally, evidence suggests that a significant portion of the Alzheimer’s disease burden could be prevented by modifying risk factors such as hypertension, obesity, physical inactivity, and low educational attainment [ 48 ]. In the Ecuadorian context, these interventions could have a notable impact on reducing the burden of dementia, especially if preventive strategies address both biological and social factors. The study by Lanctôt et al. [ 12 ], which identified a high prevalence of unspecified dementias, highlights the need to improve diagnostic precision in primary care to provide more effective and targeted care tailored to patients' individual needs. This analysis highlights the importance of addressing dementia from a multidimensional perspective that considers both early diagnosis and clinical management, as well as public education and awareness about modifiable risk factors. In Ecuador, the prevalence of dementia at the INSG stands at 3.1%, notably lower than in countries such as Cuba, where prevalence among individuals over 65 ranges from 10.8–26%, and in Peru, with a prevalence of 6.85% [ 37 , 39 , 40 , 41 ]. The variability in prevalence rates across Latin America is also observed in countries like Mexico, where rates as high as 10.88% have been reported in the metropolitan area of Monterrey for those over 65 [ 42 ]. The incidence in Ecuador, at 2.4 per 1,000 person-years, is also low compared to regional studies in Latin America, which report rates up to 18.4 per 1,000 person-years [ 36 ]. These differences may be explained by demographic factors and disparities in healthcare access. Globally, low- and middle-income countries, where 58% of people with dementia reside, face a disproportionate burden from this condition, a situation expected to worsen in the coming decades [ 43 ]. In this context, it is essential for Ecuador to consider these disparities when implementing public health strategies. Although this study does not closely analyse dementia-predisposing factors in the Ecuadorian population, the demographic and pathological description of the studied population allows us to outline a profile for this type of patient in Ecuador. Unfortunately, our data is limited to a specific region of the country, and thus, studies involving a more demographically diverse population are needed to adequately represent the situation across Ecuador’s various regions, particularly given the country’s rich cultural diversity and significant regional variations. Similarly, the disproportionately high number of unspecified dementia diagnoses greatly limits the identification of causes and the development of a more specific dementia profile for Ecuador. This latter situation also reveals an even more concerning aspect of the mental health system: the limited access to advanced diagnostic methods, which, in turn, impacts the ability to provide targeted treatment for this condition. Conclusions This study highlights the growing prevalence and incidence of dementia in Ecuador, emphasising the need for targeted prevention and intervention strategies, particularly in high-risk groups such as older adults, women, and individuals with lower education levels or limited social support. The observed association between dementia and factors such as age, education, marital status, and comorbidities underscores the complexity of dementia as a public health issue and the necessity of a multidimensional approach in managing it. The study’s findings are particularly relevant for Ecuador and similar low- and middle-income countries, where access to healthcare and diagnostic precision can be limited. By identifying demographic and social risk factors unique to the Ecuadorian population, this study provides valuable insights for policymakers and health professionals, paving the way for more effective, context-sensitive dementia diagnosis, prevention and care strategies. Given the anticipated rise in dementia cases across Latin America, addressing modifiable risk factors through public health initiatives and improving diagnostic capabilities are crucial steps towards mitigating the burden of dementia and enhancing quality of life for affected individuals and their families. Abbreviations DALY Disability-Adjusted Life Years DW Disability weight ICD-10 International Classification of Diseases, 10th edition INSG Institute of Neurosciences of Guayaquil IR Incidence rate YLD Years Lived with Disability YLL Years of Life Lost Declarations Ethics approval and consent to participate The study complied with the ethical principles of the International Ethical Guidelines for Health-Related Research with Human Subjects and was approved by the Human Research Ethics Committee of the Catholic University of Cuenca (CEISH-UCACUE), with code CEISH-UCACUE 2024-011. Consent to participate was waived for this retrospective study as it involved the use of anonymised data obtained from existing records, in accordance with ethical guidelines and institutional regulations. Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding Funding for the publication of this article was provided by the Intitute of Neurosciences of Guayaquil. Authors' contributions Conceptualization of the study: JAVF, IDCP; methodology and analyses: AARC, LFAC, MJPC; original draft: JAVF , XDY , IDCP , RVS, AARC, LFAC, MJPC, JAR; final version of the article: JAR, JAVF, IDCP. Acknowledgements Not applicable Conflicts of interest The authors declare that they have no conflict of interest. Financial Information The authors did not receive funding for this work. Contributions from authors Conceptualization: JAVF, XRY, IDCP; Data curation: JAVF, XRY; Formal Analysis: JAVF, XRY, IDCP; Investigation: JAVF, XRY, IDCP; Methodology: JAVF, XRY; Project Management: JAVF; Writing - Preparation of the original draft: JAVF, XRY, IDCP, AARC, LFAC, MJPC and Writing - Proofreading and editing: JAVF, JAR, XRY, IDCP, AARC, LFAC, MJPC. Data availability Supplementary file: Research database. Excel 2024. References World Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision. Geneva: World Health Organization. 2019 [cited 2024 Jan 10]. https://icd.who.int/browse10/2019/en#/F00-F09 Instituto Nacional de Estadística y Censos. INEC estima que, según proyecciones en el mediano plazo, Ecuador tendrá más adultos mayores, menos niños y adolescentes en 2050. 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Prevalence of major psychiatric disorders in a cohort of oldest old in Brazil: The Pieta study. Alzheimers Dement. 2009;5:392. https://doi.org/10.1016/j.jalz.2009.04.1039 Nitrini R, Bottino CM, Albala C, Custodio NS, Ketzoian C, Llibre JJ et al. Prevalence of dementia in Latin America: A collaborative study of population-based cohorts. Int Psychogeriatr. 2009;21:622–630. 10.1017/S1041610209009430 Ladecola C. Hypertension and dementia. Hypertension. 2014;64:3–5. https://doi.org/10.1161/HYPERTENSIONAHA.114.0304 Manes F. La enorme carga de la demencia en América Latina. Lancet Neurol. 2016;15:29. 10.1016/S1474-4422(15)00360-9 Dubois B, Hampel H, Feldman HH et al. Enfermedad de Alzheimer preclínica: definición, historia natural y criterios diagnósticos. Alzheimer Dement. 2016;12:292–323. 10.1016/j.jalz.2016.02.002 Sperling RA, Karlawish J, Johnson KA. Enfermedad de Alzheimer preclínica: los retos que tenemos por delante. Nat Rev Neurol. 2013;9:54–58. 10.1038/nrneurol.2012.241 Instituto Nacional de Estadística y Censos. Base de Datos-Censo de Población y Vivienda 2010. Ecuador: Instituto Nacional de Estadística y Censos; 2010 [cited 2024 Jan 10]. https://www.ecuadorencifras.gob.ec/base-de-datos-censo-de-poblacion-y-vivienda-2010-a-nivel-de-manzana/ Organización Panamericana de la Salud. Demencia. 2023. https://www.paho.org/es/temas/demencia Organización Mundial de la Salud. Demencia. 15 de marzo de 2023. https://www.who.int/es/news-room/fact-sheets/detail/dementia Oe N, et al. Diferencias en la soledad y el aislamiento social entre los adultos mayores que viven en la comunidad según el tipo de hogar: una encuesta nacional en Japón. Cuidado de la Salud; 2023. Troy AS et al. Resiliencia psicológica: un marco de regulación de los afectos. Annual Review of Psychology. 2023;74:123–148. https://doi.org/10.1146/annurev-psych-020122-041854 Dai H, Qin J, Huang R, Sun D, Zhang Q. The serial mediating effects of social isolation and resilience on the relationship between fear of dementia and insomnia in community-dwelling older adults. J Adv Nurs. 2023;79(5):1994–2003. doi: 10.1111/jan.15567. Epub 2023 Jan 24. PMID: 36694435. https://pubmed.ncbi.nlm.nih.gov/36694435/ Manly JJ, Jones RN, Langa KM, Ryan LH, Levine DA, McCammon R et al. Estimating the prevalence of dementia and mild cognitive impairment in the US: The 2016 Health and Retirement Study Harmonized Cognitive Assessment Protocol Project. JAMA Neurol. 2022; 79(12):1242–1249. https://jamanetwork.com/journals/jamaneurology/fullarticle/2797274 Custodio N, Wheelock A, Thumala D, Slachevsky A. Dementia in Latin America: Epidemiological evidence and implications for public policy. Front Aging Neurosci. 2017; 9:221. https://doi.org/10.3389/fnagi.2017.00221 Corrada MM, Brookmeyer R, Paganini-Hill A, Berlau D, Kawas CH. Dementia incidence continues to increase with age in the oldest old: The 90 + study. Ann Neurol. 2010;67:114–121. https://doi.org/10.1002/ana.21915 Cao Q, Tan CC, Xu W, Hu H, Cao XP, Dong Q et al. The prevalence of dementia: A systematic review and meta-analysis. J Alzheimers Dis. 2020; 73(3):1157–1166. https://pubmed.ncbi.nlm.nih.gov/31884487/ Llibre JJ, Fernández Y, Marcheco B, Contreras N, Lopez A, Otero M et al. Prevalence of dementia and Alzheimer's disease in a Havana Municipality: A community-based study among elderly residents. MEDICC Rev. 2009;11:29–35. 10.37757/MR2009V11.N2.8 Sotolongo O, Rodríguez L. Prevalencia del síndrome demencial y la enfermedad de Alzheimer en pacientes del policlínico Pedro Fonseca. Rev cubana Med Gen Integr. 2012;28:694–702. http://scielo.sld.cu/scielo.php?pid=S0864-21252012000400012&script=sci_abstract Custodio N, García A, Montesinos R, Escobar J, Bendezú L. Prevalencia de demencia en una población urbana de Lima-Perú: estudio puerta a puerta. An Fac Med. 2008;69:233–238. https://dialnet.unirioja.es/servlet/articulo?codigo=8415333 De la Cruz M. Deterioro cognitivo en la población mayor de 65 años que reside en el área metropolitana de Monterrey, México. Med Univer. 2008;10:154–158. https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=29169 Prince M, Bryce R, Albanese E et al. La prevalencia mundial de la demencia: una revisión sistemática y metaanálisis. Alzheimer Dement. 2013;9:63–75. https://doi.org/10.1016/j.jalz.2012.11.007 Parra MA, Baez S, Allegri R, Nitrini R, Lopera F, Slachevsky A et al. Dementia in Latin America. Neurology. 2018; 90(5):222–231. https://doi.org/10.1212/WNL.0000000000004897 Ribeiro F, Teixeira-Santos AC, Caramelli P, Leist AK. Prevalence of dementia in Latin America and Caribbean countries: systematic review and meta-analyses exploring age, sex, rurality, and education as possible determinants. Ageing Res Rev. 2022; 81:101703. https://doi.org/10.1016/j.arr.2022.101703 Seyedsalehi A, Warrier V, Bethlehem RAI, Perry BI, Burgess S, Murray GK. Educational attainment, structural brain reserve and Alzheimer’s disease: a Mendelian randomization analysis. Brain. 2023; 146(5):2059–2074. https://doi.org/10.1093/brain/awac392 Najar J, Aakre JA, Vassilaki M, Wetterberg H, Rydén L, Zettergren A et al. Sex difference in the relation between marital status and dementia risk in two population-based cohorts. J Alzheimers Dis. 2021; 83(3):1269–1279. https://doi.org/10.3233/JAD-210246 Norton S, Matthews FE, Barnes DE et al. Potencial para la prevención primaria de la enfermedad de Alzheimer: un análisis de datos poblacionales. Lancet Neurol. 2014;13:788–794. 10.1016/S1474-4422(14)70136-X Valdevila Figueira JA, Valdevila Santiesteban R, Carvajal I, Benenaula Vargas LP, Ramirez Coronel A, Leon-Rojas JE, et al. Multimorbidity patterns in dementia and mild cognitive impairment. Front Psychiatry. 2024;15:1432848. 10.3389/fpsyt.2024.1432848 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5521995","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":410924671,"identity":"2a430d83-7c04-47a8-bd77-c2a530e32384","order_by":0,"name":"José Alejandro Valdevila Figueira","email":"data:image/png;base64,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","orcid":"","institution":"Ecotec University","correspondingAuthor":true,"prefix":"","firstName":"José","middleName":"Alejandro Valdevila","lastName":"Figueira","suffix":""},{"id":410924672,"identity":"b06b528e-a5cd-4da8-8df6-725366d07797","order_by":1,"name":"Xavier Rodrigo Yambay-Bautista","email":"","orcid":"","institution":"Catholic University of Cuenca","correspondingAuthor":false,"prefix":"","firstName":"Xavier","middleName":"Rodrigo","lastName":"Yambay-Bautista","suffix":""},{"id":410924673,"identity":"8c7c18d1-98e9-47b9-a9eb-f608fe47ccde","order_by":2,"name":"Indira Dayana Carvajal Parra","email":"","orcid":"","institution":"Institute of Neurosciences of Guayaquil","correspondingAuthor":false,"prefix":"","firstName":"Indira","middleName":"Dayana Carvajal","lastName":"Parra","suffix":""},{"id":410924674,"identity":"61c7db69-882f-468e-b766-d87bdcc9d4e2","order_by":3,"name":"Rocio Valdevila Santiestevan","email":"","orcid":"","institution":"Research network in psychology and psychiatry","correspondingAuthor":false,"prefix":"","firstName":"Rocio","middleName":"Valdevila","lastName":"Santiestevan","suffix":""},{"id":410924675,"identity":"37636ce0-296b-4293-852f-8cdc82c3e575","order_by":4,"name":"Andrés Alexis Ramírez Coronel","email":"","orcid":"","institution":"Catholic University of Cuenca","correspondingAuthor":false,"prefix":"","firstName":"Andrés","middleName":"Alexis Ramírez","lastName":"Coronel","suffix":""},{"id":410924676,"identity":"4f9a7cc9-fe90-42ca-bcfc-91b4aee4ab31","order_by":5,"name":"Luis Francisco Altamirano Cárdenas","email":"","orcid":"","institution":"Catholic University of Cuenca","correspondingAuthor":false,"prefix":"","firstName":"Luis","middleName":"Francisco Altamirano","lastName":"Cárdenas","suffix":""},{"id":410924677,"identity":"aa90a1dc-200d-4d40-8220-878962093f13","order_by":6,"name":"María José Pico Cucalón","email":"","orcid":"","institution":"Research network in psychology and psychiatry","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"José Pico","lastName":"Cucalón","suffix":""},{"id":410924678,"identity":"a042efb7-32cb-430a-818c-312ee794fe54","order_by":7,"name":"Jose A Rodas","email":"","orcid":"","institution":"Universidad Espíritu Santo","correspondingAuthor":false,"prefix":"","firstName":"Jose","middleName":"A","lastName":"Rodas","suffix":""}],"badges":[],"createdAt":"2024-11-25 16:38:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5521995/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5521995/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75502937,"identity":"6cd7584b-8514-4f94-937f-8084cd90db5c","added_by":"auto","created_at":"2025-02-05 09:19:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":141429,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eDistribution of dementias treated at the INSG by age and sex, 2010-2022\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote: n men = 1,581; Median = 79 years. n women = 2,285; Median = 79 years\u003c/em\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5521995/v1/c30ce9f46a01e970e501f620.png"},{"id":75502632,"identity":"952fbb65-85f0-47d8-9de6-5611a9cb63a5","added_by":"auto","created_at":"2025-02-05 09:11:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":170177,"visible":true,"origin":"","legend":"\u003cp\u003eIncidence of Dementia 2010-2022, According to ICD-10 Classification\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote: The number of new cases for each type of dementia from 2010-2022\u003c/em\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5521995/v1/d8ba3dddaaafa08eef1675ff.png"},{"id":75504600,"identity":"bcadd053-3dbb-4290-b440-e710898939d3","added_by":"auto","created_at":"2025-02-05 09:27:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1210322,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5521995/v1/296c80f4-4cae-4e2e-9f27-a836d303f8d4.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence, incidence and demographics of dementia in Ecuador","fulltext":[{"header":"Background","content":"\u003cp\u003eDementia is a chronic and progressive syndrome that affects various higher cognitive functions, such as memory, thinking, orientation, comprehension, calculation, learning, language, and judgement. These impairments may be accompanied or preceded by issues in emotional control, social behaviour, or motivation, worsening the prognosis due to the increased level of disability. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDementias present diverse manifestations but share an aetiology rooted in brain disease that leads to dysfunction. This can be primary, as in diseases, injuries, and trauma that directly affect the brain, or secondary, as in systemic disorders impacting multiple organs, including the brain. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] Over the past decade, significant advancements have been made in understanding the clinicopathological correlation and in the development of new biomarkers. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDementia is very common in the elderly population. The disease prevalence doubles every five years among individuals over 65 years of age. [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Numerous epidemiological studies have demonstrated the variability in dementia prevalence rates. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThis variability may be related to age differences, the instruments used for cognitive and functional assessments, the diagnostic criteria applied, rural or urban residency, and the representativeness of the studied samples. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] People with mild cognitive impairment have a 10 to 15% chance of developing dementia compared to healthy individuals, in whom the annual likelihood is 1 to 2%. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Compared to women, men have a higher incidence of dementia diagnosis before the age of 70 but a lower incidence after 70. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIt is estimated that more than 55\u0026nbsp;million people worldwide live with dementia, the most common type being Alzheimer's disease, accounting for approximately 60\u0026ndash;70% of cases. The remaining percentage includes other types, such as vascular dementia, dementia with Lewy bodies, and frontotemporal dementia, though dementia can also result from stroke, HIV infection, harmful alcohol consumption, repeated brain injuries, or nutritional deficiencies. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ePopulation ageing, initially occurring in high-income countries, is now happening in low- and middle-income countries. By 2050, two-thirds of the world\u0026rsquo;s population over 60 years will live in these countries. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] The World Health Organisation estimates that between 2015 and 2050, the percentage of people aged 60 or older will nearly double, from 12\u0026ndash;22%, and the number of people aged 80 or older will triple, reaching 426\u0026nbsp;million. By 2050, 80% of older adults will live in low- and middle-income countries, which will place a heavy burden on healthcare systems due to the rise in chronic diseases. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe latest descriptive epidemiological research on dementia allows for the investigation of changes in prevalence and incidence over time. A review of 14 studies examining trends in dementia prevalence and incidence in Sweden, Spain, the United Kingdom, the Netherlands, France, the United States, Japan, and Nigeria indicates stable or declining dementia rates, with some studies providing evidence of sex-specific changes with a multifactorial aetiology, considering significant social changes and improvements in living conditions, education, and healthcare. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe 2017 Lancet Commission identified nine modifiable risk factors for dementia: lower educational attainment, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eEach year, demographic indicators in Latin American and developing countries converge, and the expected prevalence of dementia in the former now surpasses that in the latter. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Dementia has been declared a global challenge; however, regions worldwide show differences in both the nature and magnitude of this challenge. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] The strategies, procedures, and tools to address ageing in general, and dementia in particular, have fallen short of the international call to tackle this medical-social issue. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMuch remains to be done to achieve the goal of \"living well with dementia\" set out in the World Alzheimer Report 2016\u003c/span\u003e [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ebecause, as in many countries, Ecuador faces pronounced fragmentation in long-term healthcare, along with inadequate and poor quality of care, as well as limited coverage of basic support for individuals with dementia and their caregivers. Relatively little attention is given to systems and services that provide healthcare to people with dementia, with coverage not exceeding 10\u0026ndash;15% of the total population.\u003c/span\u003e [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eGlobally, diagnostic coverage is low. Only between 40% and 50% of people living with dementia have received a diagnosis.\u003c/span\u003e [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIn low- and middle-income countries, there are few available estimates, but current data suggest a diagnostic coverage of between 5% and 10%\u003c/span\u003e [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003elimiting strategies for healthcare and social planning throughout the course of the disease.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStudies conducted with samples from large cities reveal significant diversity among subjects, including individuals from rural areas with different cultural backgrounds, educational systems, and professional activities with varying levels of demand.\u003c/span\u003e [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe assessment of subjects with similar backgrounds and socioeconomic, cultural, and environmental factors enables the observation of cognitive impairment prevalence and the effect of schooling, although such studies are rarely conducted.\u003c/span\u003e [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe demographic structure of Latin America presents multiple unique challenges as its indicators are rapidly approaching those of developing countries; furthermore, fertility rates and their relative decline have been uneven in Latin America and the Caribbean.\u003c/span\u003e [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eHowever, the understanding of relevant factors for dementia is currently limited.\u003c/span\u003e [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eA high proportion of people with dementia in the region lack basic support.\u003c/span\u003e [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIn 2010, 10.6% of the Ecuadorian population consisted of children under five years of age, marking a 2.4% decrease in this age group compared to the previous decade. By this time, the population structure exhibited a broad-based pyramid characteristic of developing countries, with approximately 1.2\u0026nbsp;million people over the age of 60 and about 160,000 individuals aged 80 or older. Life expectancy at birth was 77.9 years for women and 72.3 years for men, with an average of 75 years.\u003c/span\u003e [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eCurrently, Ecuador has slightly over 16\u0026nbsp;million inhabitants, and by 2050, it is expected that only 5.8% of the population will be under five years old, while 30% will be over 60 years of age.\u003c/span\u003e [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe purpose of this study was to determine the epidemiological and demographic factors associated with dementia in the Ecuadorian population. Addressing this issue is essential, as understanding the epidemiology, risk factors, and socioeconomic impact will enable the design of interventions that improve the quality of life of those affected and alleviate the burden on their families and the healthcare system.\u003c/span\u003e \u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePopulation, Sample, and Type of Study\u003c/h2\u003e \u003cp\u003eThis was an observational, correlational study with a quantitative approach. Anonymised data were obtained from the registry of outpatient care at the Institute of Neurosciences of Guayaquil (INSG) between January 1, 2010, and December 31, 2022. A total of 125,458 outpatients across various medical specialties and conditions were analysed.\u003c/p\u003e \u003cp\u003eThe study variables included sociodemographic factors (age, gender, region of residence, level of education, and marital status) and epidemiological factors (distribution, prevalence, incidence, burden of disease, and comorbidities).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003ePatients with a diagnosis established by the International Classification of Diseases (ICD-10) of some type of dementia during their first medical care (n\u0026thinsp;=\u0026thinsp;4,485) were included. Cases with incomplete or inconsistent data (n\u0026thinsp;=\u0026thinsp;619) were excluded, leaving a final sample consisting of 3,866 records.\u003c/p\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eThis study was based on the analysis of an anonymised outpatient database from the INSG. Patients in the database were initially classified according to their primary clinical diagnosis, specifically targeting dementia, to ensure accurate categorisation. Following this, subjects\u0026rsquo; eligibility was verified against the study's predefined selection criteria. Data curation involved the removal of missing, duplicate or inconsistent entries.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eTo determine the prevalence of dementias, the following formula was used: (Number of cases of the disease / Total number of cases) x 100. The incidence rate (IR) was calculated based on the number of new cases from 2010\u0026ndash;2022 (n\u0026thinsp;=\u0026thinsp;3,866), divided by the time in years (13 years), multiplied by the population at risk (125,458 patients), with this result further multiplied by an adjustment factor (1,000).\u003c/p\u003e \u003cp\u003eThe estimation of disease burden for patients with dementia was conducted using Disability-Adjusted Life Years (DALY), a measure that combines both Years of Life Lost (YLL) due to premature death and Years Lived with Disability (YLD). The YLL metric was calculated as the number of deaths (D) multiplied by life expectancy at the age of death (L), where YLL\u0026thinsp;=\u0026thinsp;D \u0026times; L. The YLD metric was calculated as the product of the number of new cases (I), age of onset (A), duration of the condition (T), and disability weight (DW), where YLD\u0026thinsp;=\u0026thinsp;I \u0026times; A \u0026times; T \u0026times; DW.\u003c/p\u003e \u003cp\u003eThe extracted information was exported to SPSS\u0026reg; v.26, Jamovi\u0026reg; v.2.3.28, and Epidat\u0026reg; v3.1 statistical packages for analysis. The results are presented in tables and figures showing absolute frequency, relative frequency, and epidemiological measures. Non-parametric tests (Chi-square and Cramer\u0026rsquo;s V) were used to examine the relationship between dementia, demographic variables and comorbidities.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSetting\u003c/h3\u003e\n\u003cp\u003eThe INSG, Ecuador, provided the data analysed in this study. The database included outpatient records collected as part of routine care at the institution. The INSG is the largest of the three specialised psychiatric hospitals in Ecuador, with 121 hospital beds for managing mental health crises. Its outpatient clinic offers an average of 6,000 visits monthly across various specialities (psychiatry, psychology, neurocognitive rehabilitation, and neurology). During the study period, 400 new cases were diagnosed annually in the coastal region, each receiving an average of 8 annual visits. Due to issues of distance and transportation costs, the Sierra and Amazonia regions use our services less, with 9 new cases annually in the former, receiving more than 90 visits per year, and 6 new cases per year in the latter, receiving psychiatric care once annually on average. The INSG uses a systematic, multidisciplinary approach to diagnosing mental illness and dementia. However, in many cases, diagnoses are based on symptom profiles and family reports due to limited service access, which restricts specific diagnostic accuracy in cases with dementia and explains why most treated patients with this pathology are classified as non-specific.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 3,866 records of new cases of dementia treated in the outpatient clinic of the INSG during the period 2010\u0026ndash;2022 were included. The median age was 79 years, with an interquartile range of 13, and participants\u0026rsquo; ages ranged from 45 to 104 years. A higher number of dementia cases were found in women (n\u0026thinsp;=\u0026thinsp;2,285), representing 59.1% of the analysed records (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eMost cases attended were from the Coastal region (n\u0026thinsp;=\u0026thinsp;3,734; 96.5%), primarily from the province of Guayas (n\u0026thinsp;=\u0026thinsp;3,005; 77.7%). The educational level distribution showed a majority with primary schooling (n\u0026thinsp;=\u0026thinsp;789; 46.3%), followed by secondary education (n\u0026thinsp;=\u0026thinsp;714; 18.5%), with a significant percentage of illiterate individuals (n\u0026thinsp;=\u0026thinsp;554; 14.3%). Marital status indicated 39.9% single (n\u0026thinsp;=\u0026thinsp;1,544) and 32.6% married (n\u0026thinsp;=\u0026thinsp;1,261). Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e presents the complete results of the demographic variables analysed.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eCharacteristics of the population with dementia treated in the INSG. 2010\u0026ndash;2022\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eDemographic variables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ef\u003c/em\u003e (%\u003cem\u003e)\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eRegion\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCoast\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3734 (96.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMountain Region\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e125 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEastern Region (tropical forest)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (0.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e554 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eElementary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1789 (46.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHigh School\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e714 (18.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUniversity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e190 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDoes not refer, does not know\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e619 (16)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1544 (39.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCohabiting\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e260 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1261 (32.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSeparated/Divorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e682 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e3866 (100%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\u003cstrong\u003eNote\u003c/strong\u003e: \u003cem\u003ef\u0026thinsp;=\u0026thinsp;frequency. % = percentage\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eA predominance of unspecified dementias (62.6%) was observed, followed by Alzheimer\u0026rsquo;s disease dementia (20.8%), vascular dementia (13.4%), and dementia linked to other diseases (3.2%). The prevalence of dementia among patients treated at INSG was 3.1% (1.3% in men, 1.8% in women), with an IR of 2.4 per 1,000 person-years, varying notably over the study period. In 2014, dementia cases increased by 77.34% from 2010, coinciding with the introduction of government health policies and agreements with external providers. Higher incidences of unspecified dementia cases in 2021 and 2022 likely reflected the post-COVID-19 period, where cognitive assessment was handled online with limited access to appropriate assessment tools. Figure \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the number of cases by year for each type of dementia.\u003c/p\u003e\n\u003cp\u003eThe burden of disease, representing the loss of healthy life years due to death, illness, or injury, indicated that DALYs reached 242,184 years, with a greater burden on women (DALYs\u0026thinsp;=\u0026thinsp;141,969 years). Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e presents the main indicators of the dementia burden in 2021.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eAnnual Burden of Dementia in the INSG, 2021\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eIndicator\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMan\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDeath due to dementia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLife expectancy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73.67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of death\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAVP\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e480\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1155\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of new cases (year 2021)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e140\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e339\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of onset\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of dementia\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisability weight\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAVD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e99 540\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e141 489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e241 029\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAVISA\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e100 215\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e141 969\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e242 184\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cstrong\u003eNote\u003c/strong\u003e: YLL\u0026thinsp;=\u0026thinsp;Years of Life Lost due to Premature Death. YLD\u0026thinsp;=\u0026thinsp;Years Lived with Disability. DALY\u0026thinsp;=\u0026thinsp;Disability-Adjusted Life Years.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eIt is important to note that 6.4% of patients with dementia have one or more comorbidities. Among the main comorbidities, mental and behavioural disorders are the most frequent (54.5%), followed by hypertension (14.5%) and nervous system diseases (14.5%). Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e lists the top 10 comorbidities of patients with dementia seen in the INSG\u0026apos;s outpatient clinic.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComorbidities of dementias 2010\u0026ndash;2022. INSG\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"2\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eComorbidity\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ef\u003c/em\u003e (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental and Behavioural Disorders\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135 (54.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eHypertension\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNervous System Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36 (14.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCerebrovascular Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndocrine, Nutritional, and Metabolic Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTumours\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRespiratory System Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDigestive System Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGenitourinary System Diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther Conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e248 (100)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"2\"\u003e\u003cstrong\u003eNote\u003c/strong\u003e: \u003cem\u003ef\u0026thinsp;=\u0026thinsp;frequency. % = percentage.\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eThe results of the bivariate analysis showed statistically significant associations between dementia and age, gender, level of education, and marital status. Additionally, a significant association was observed between dementia and some comorbidities (behavioural disorders, nervous system diseases, and hypertension). These results can be found in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eResults from the Chi-square analyses\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026chi;2\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eV\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e349.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0,001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0,001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRegion (Coast, Mountain Region, Eastern Region)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.04\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducational level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0,001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.059\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.039*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMental and Behavioural Disorders (F00-F99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,017*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eHypertension\u003c/span\u003e (I10-I15)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;\u0026thinsp;0,001*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.097\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNervous System Diseases (G00-G99)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e0,005*\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.057\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCerebrovascular Diseases (I60-I69)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.446\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eEndocrine, Nutritional, and Metabolic Diseases\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003e(E00-E90)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.398\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003e\u003cstrong\u003eNote\u003c/strong\u003e: \u003cem\u003e\u0026chi;2\u0026thinsp;=\u0026thinsp;Chi-square. p\u0026thinsp;=\u0026thinsp;asymptotic significance. V\u0026thinsp;=\u0026thinsp;Cramer\u0026apos;s V. *= Significant association.\u003c/em\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eDementia represents a significant challenge for both public health and society, affecting millions of people worldwide\u003c/span\u003e [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eand imposing an economic, emotional, and physical burden on healthcare systems and caregivers. Due to population ageing, the number of dementia cases is rapidly increasing globally, particularly in low- and middle-income regions, where approximately 60% of cases are concentrated\u003c/span\u003e [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis phenomenon is driven mainly by rising life expectancy and an ageing population, factors that increase the incidence of dementia, especially Alzheimer's disease, which accounts for 60\u0026ndash;70% of dementia cases\u003c/span\u003e [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe situation in Latin America and the Caribbean is alarming, as these regions experience a faster growth in dementia prevalence compared to others\u003c/span\u003e [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIn this study, based on 3,866 cases seen at the INSG, most diagnosed patients had a median age of 79 years, aligning with similar population studies that indicate an increased dementia risk with advancing age\u003c/span\u003e [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eStatistics reported by Custodio et al.\u003c/span\u003e [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ein Latin America show higher incidence rates than those found in this study, which could be related to sociodemographic factors specific to Ecuador as well as to limitations in diagnostic access in certain parts of the country.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eResearch on dementia across different contexts has revealed significant variations in the incidence and prevalence of the disease based on gender, educational level, and healthcare access. Findings in European and Asian populations, for example, show a generally higher prevalence among women than men, a trend also observed in this study in Ecuador, where a higher prevalence in women is recorded\u003c/span\u003e [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThese differences may be explained by women\u0026rsquo;s greater longevity and by sociocultural factors that influence the risk of developing dementia\u003c/span\u003e [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eData from this study also emphasise the importance of educational level as a relevant risk factor for dementia incidence. Research indicates that individuals with lower educational levels exhibit a higher dementia prevalence compared to those with higher education\u003c/span\u003e [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis may be linked to the concept of cognitive reserve, which suggests that greater cognitive stimulation throughout life can protect against cognitive decline in old age\u003c/span\u003e [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAccording to Parra et al.\u003c/span\u003e [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e], \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eLatin American countries face specific challenges due to limitations in health infrastructure and policies, which affect effective prevention and management of dementia in the region.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe geographic distribution of dementia cases in Ecuador also reveals interesting patterns. The high concentration of cases in the Coastal region, particularly in the province of Guayas, suggests both greater access to healthcare services and potential regional differences in risk factors. In contrast, other studies in nearby countries, such as Colombia, show a higher prevalence of dementia in rural areas and among people with lower educational levels\u003c/span\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThese findings underscore the need to consider demographic and geographic characteristics in the design of public health interventions to address dementia.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMarital status and social support also emerge as factors that influence the prevalence and progression of dementia. Studies in various populations have indicated that single, divorced, or widowed individuals have a higher risk of developing dementia compared to those who are married\u003c/span\u003e [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis social vulnerability, combined with a lack of family support, can impact the quality of life of individuals with dementia and their disease management. In Ecuador, a high percentage of the cases analysed involved individuals without a partner, which could indicate a greater risk and a reduced capacity to face the challenges of the disease.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAn important aspect identified in this research is the impact of comorbidities on dementia patients\u003c/span\u003e [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe presence of mental disorders, hypertension, and nervous system diseases is associated with faster functional decline and reduced quality of life in individuals with dementia\u003c/span\u003e [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eMultimorbidity complicates clinical management and increases associated costs, which has significant implications for the Ecuadorian health system and underscores the need for a comprehensive approach to the care of these patients.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eGlobally, evidence suggests that a significant portion of the Alzheimer\u0026rsquo;s disease burden could be prevented by modifying risk factors such as hypertension, obesity, physical inactivity, and low educational attainment\u003c/span\u003e [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIn the Ecuadorian context, these interventions could have a notable impact on reducing the burden of dementia, especially if preventive strategies address both biological and social factors. The study by Lanct\u0026ocirc;t et al.\u003c/span\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003ewhich identified a high prevalence of unspecified dementias, highlights the need to improve diagnostic precision in primary care to provide more effective and targeted care tailored to patients' individual needs.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThis analysis highlights the importance of addressing dementia from a multidimensional perspective that considers both early diagnosis and clinical management, as well as public education and awareness about modifiable risk factors. In Ecuador, the prevalence of dementia at the INSG stands at 3.1%, notably lower than in countries such as Cuba, where prevalence among individuals over 65 ranges from 10.8\u0026ndash;26%, and in Peru, with a prevalence of 6.85%\u003c/span\u003e [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe variability in prevalence rates across Latin America is also observed in countries like Mexico, where rates as high as 10.88% have been reported in the metropolitan area of Monterrey for those over 65\u003c/span\u003e [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThe incidence in Ecuador, at 2.4 per 1,000 person-years, is also low compared to regional studies in Latin America, which report rates up to 18.4 per 1,000 person-years\u003c/span\u003e [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eThese differences may be explained by demographic factors and disparities in healthcare access. Globally, low- and middle-income countries, where 58% of people with dementia reside, face a disproportionate burden from this condition, a situation expected to worsen in the coming decades\u003c/span\u003e [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eIn this context, it is essential for Ecuador to consider these disparities when implementing public health strategies.\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cspan type=\"SmallCaps\" class=\"SmallCaps\" name=\"Emphasis\"\u003eAlthough this study does not closely analyse dementia-predisposing factors in the Ecuadorian population, the demographic and pathological description of the studied population allows us to outline a profile for this type of patient in Ecuador. Unfortunately, our data is limited to a specific region of the country, and thus, studies involving a more demographically diverse population are needed to adequately represent the situation across Ecuador\u0026rsquo;s various regions, particularly given the country\u0026rsquo;s rich cultural diversity and significant regional variations. Similarly, the disproportionately high number of unspecified dementia diagnoses greatly limits the identification of causes and the development of a more specific dementia profile for Ecuador. This latter situation also reveals an even more concerning aspect of the mental health system: the limited access to advanced diagnostic methods, which, in turn, impacts the ability to provide targeted treatment for this condition.\u003c/span\u003e \u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study highlights the growing prevalence and incidence of dementia in Ecuador, emphasising the need for targeted prevention and intervention strategies, particularly in high-risk groups such as older adults, women, and individuals with lower education levels or limited social support. The observed association between dementia and factors such as age, education, marital status, and comorbidities underscores the complexity of dementia as a public health issue and the necessity of a multidimensional approach in managing it. The study\u0026rsquo;s findings are particularly relevant for Ecuador and similar low- and middle-income countries, where access to healthcare and diagnostic precision can be limited. By identifying demographic and social risk factors unique to the Ecuadorian population, this study provides valuable insights for policymakers and health professionals, paving the way for more effective, context-sensitive dementia diagnosis, prevention and care strategies. Given the anticipated rise in dementia cases across Latin America, addressing modifiable risk factors through public health initiatives and improving diagnostic capabilities are crucial steps towards mitigating the burden of dementia and enhancing quality of life for affected individuals and their families.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDALY\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDisability-Adjusted Life Years\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDisability weight\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eICD-10\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInternational Classification of Diseases, 10th edition\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eINSG\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eInstitute of Neurosciences of Guayaquil\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eIR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eIncidence rate\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eYLD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eYears Lived with Disability\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eYLL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eYears of Life Lost\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study complied with the ethical principles of the International Ethical Guidelines for Health-Related Research with Human Subjects and was approved by the Human Research Ethics Committee of the Catholic University of Cuenca (CEISH-UCACUE), with code CEISH-UCACUE 2024-011.\u003c/p\u003e\n\u003cp\u003eConsent to participate was waived for this retrospective study as it involved the use of anonymised data obtained from existing records, in accordance with ethical guidelines and institutional regulations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFunding for the publication of this article was provided by the Intitute of Neurosciences of Guayaquil.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors' contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization of the study: JAVF, IDCP; methodology and analyses: AARC, LFAC, MJPC; original draft: JAVF , XDY , IDCP , RVS, AARC, LFAC, MJPC, JAR; final version of the article: JAR, JAVF, IDCP.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgements\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cbr\u003e \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFinancial Information\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors did not receive funding for this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eContributions from authors\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eConceptualization: JAVF, XRY, IDCP; Data curation: JAVF, XRY; Formal Analysis: JAVF, XRY, IDCP; Investigation: JAVF, XRY, IDCP; Methodology: JAVF, XRY; Project Management: JAVF; Writing - Preparation of the original draft: JAVF, XRY, IDCP, AARC, LFAC, MJPC and Writing - Proofreading and editing: JAVF, JAR, XRY, IDCP, AARC, LFAC, MJPC.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupplementary file: Research database. Excel 2024.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization. International Statistical Classification of Diseases and Related Health Problems 10th Revision. Geneva: World Health Organization. 2019 [cited 2024 Jan 10]. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://icd.who.int/browse10/2019/en#/F00-F09\u003c/span\u003e\u003cspan address=\"https://icd.who.int/browse10/2019/en#/F00-F09\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eInstituto Nacional de Estad\u0026iacute;stica y Censos. INEC estima que, seg\u0026uacute;n proyecciones en el mediano plazo, Ecuador tendr\u0026aacute; m\u0026aacute;s adultos mayores, menos ni\u0026ntilde;os y adolescentes en 2050. 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Front Psychiatry. 2024;15:1432848. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3389/fpsyt.2024.1432848\u003c/span\u003e\u003cspan address=\"10.3389/fpsyt.2024.1432848\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"dementia, Alzheimer's disease, vascular dementia, incidence, prevalence, comorbidity","lastPublishedDoi":"10.21203/rs.3.rs-5521995/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5521995/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: This study examines the prevalence and incidence of dementia in Ecuador, with a focus on understanding demographic and social factors associated with increased risk. Data were obtained from the Institute of Neurosciences of Guayaquil, covering patient records from 2010 to 2022. The purpose was to identify prevalence trends and key risk factors to inform targeted prevention and early intervention efforts in high-risk groups.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThis observational, correlational study analysed patient data to estimate dementia prevalence and incidence. Statistical analyses included descriptive statistics to calculate overall and age-specific prevalence rates, while incidence was calculated per 1,000 person-years. Correlations and chi-square analyses were used to evaluate associations between dementia and potential risk factors, including age, gender, education level, and marital status.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eThe overall prevalence of dementia was 3.1%, with higher rates among women (1.8%) compared to men (1.3%). Dementia incidence was calculated at 2.4 per 1,000 person-years. Prevalence increased significantly with age, from 1.2% in individuals aged 65–69 to 54.8% in those aged 95 and older. Advanced age, female gender, lower education levels, and lack of a marital partner were associated with higher dementia prevalence.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions: \u003c/strong\u003eThese findings highlight a rising dementia prevalence in Ecuador, particularly among women and older individuals, with social and educational factors contributing to increased risk. The results underscore the need for tailored dementia prevention and early intervention strategies, especially as prevalence rates continue to rise across Latin America.\u003c/p\u003e","manuscriptTitle":"Prevalence, incidence and demographics of dementia in Ecuador","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-05 09:11:36","doi":"10.21203/rs.3.rs-5521995/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1f31988f-be57-4c67-911d-d81ed47c7f20","owner":[],"postedDate":"February 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-05T09:11:36+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-05 09:11:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5521995","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5521995","identity":"rs-5521995","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}