IPA Bulletin: VOLUME 35, NO. 2 • JUNE 2018
Mary Sano, IPA President
I have returned from a meeting in Buenos Aires, at which several IPA members spoke. I was so proud to hear the wisdom and knowledge of our colleagues shared with such an impressive audience. I was struck by the opening presentation given by the vice president of Argentina who drew our attention to a range of life-long health challenges that start in early life, can accumulate and can contribute to dementia. The keynote was given by Dr. Facundo Manes, whose talk on brain health further highlighted the fact that medical, biological, economic, environmental and social risks abound even for school aged children, and that a comprehensive plan for Alzheimer’s disease must begin by addressing the earliest brain risks. He explained why he focuses so much on programs to support youth to insure stimulating educational, social and physical activities at the earliest ages. These early efforts may change the trajectory of cognition as we age. Dr. Manes reminded us not to forget the importance of early life experiences that can shape our cognitive trajectories in aging.
I particularly want to highlight an insightful presentation by Dr. Daisy Acosta, one of our most active board members. She described the challenges of diagnosing dementia in low education individuals. It is estimated that more than half of those with dementia live in low and middle income countries, which have lower rates of literacy and of formal education. Additionally, living in a rural area may further isolate individuals, reducing the opportunity to learn to read. In fact, more than 700 million people worldwide are illiterate and yet most dementia screening instruments assume sufficient literacy to read, write or draw, activities which may be totally foreign to many elders. A review and meta analysis in our own journal by Dr. Stella Paddick highlights the limited availability of validated tools in non-literate and low literate populations (International Psychogeriatrics 2017). Criteria for dementia from the National Institute on Aging and Alzheimer's Association have expanded the cognitive category to include behavioral and psychiatric changes, and this area has barely been integrated into cross cultural studies. In fact, once trained to identify these symptoms, they may provide support for a dementia diagnosis when there is less confidence in cognitive measures. Beyond formal cognitive testing, the assessment of impairment in social and occupational functioning can also be challenged by cultural expectations. Observing impairment may be hindered by biases or social pressures, such as assumptions that changes are solely aging-related or an unwillingness to identify deficits in a respected elder. The historic work of the 10/66 Dementia Research Group has demonstrated that an assessment that integrates such local differences can indicate twice the dementia prevalence typically captured by DSM IV, and an even greater difference in both rural and urban samples in India.
Dr. Acosta proposed a call to action, specifically a working group or task force to focus on establishing valid test and diagnostic measures for use with non- and low literate cohorts in Latin America. Principles and practices established by such a task force could be shared globally and recapitulated in other regions and cultures. IPA stands ready to support such an effort; to provide a forum for this discussion and collaboration.
The meeting in Argentina brought together many friends of IPA and experts in geriatric psychiatry. This provided IPA -in collaboration with Universidad Favaloro- the opportunity to prepare its first online course in key themes of geriatric psychiatry, which will be released in June. The course will be available in Spanish and successful completion will be acknowledged with a certificate from IPA. We are proud to have had the opportunity to share this experience with our Latin American colleagues and look forward to other opportunities to provide high quality education and training services. The enthusiasm observed at the meeting has encouraged the Alzheimer’s Association to conduct other satellite meetings across the globe. The next endeavor will be in Bengaluru, India, in conjunction with the National Institute on Mental Health and Neurosciences and Center for Brain Research. We will look for opportunities to share our IPA expertise in this venue as well.
I urge members to join us at AAIC, where we will have a social to bring together friends and colleagues. We will update you on our activities and publication opportunities. Please come and share your ideas for new ways to serve all our members, grow our membership and to expand our reach to insure better mental health for older people.