Journal of Alzheimer’s Disease xx (20xx) x–xx 1

DOI 10.3233/JAD-190177
IOS Press

Review

Dementia Around the World

and the Latin America and Mexican
Scenarios

f
oo
Rafael Brito-Aguilar∗
Research Department, School of Health Sciences, Campus Victoria, Universidad del Valle de México,
Victoria, Tamaulipas, México

Accepted 24 June 2019

Pr
Abstract. Dementia has become a major public health concern around the world. Dementia risk factors are significantly
different among countries. The number of new cases of dementia anticipated each year worldwide is almost 7.7 million,
ed
one new case every four seconds. There are 3.6 million (46%) new cases per year in Asia, 2.3 million (31%) in Europe,
1.2 million (16%) in the Americas, and 0.5 million (7%) in Africa. Latin American and Caribbean low and middle-income
countries are at high risk. Air pollution is an important risk modifiable factor for dementia across the world, and the recent
report of the Alzheimer’s disease continuum in children and young adults residing in Metropolitan Mexico City along with
the presence of cognitive impairment in 55% of the young adult population residing in Mexican cities with fine particulate
ct

matter concentrations above the current USEPA annual standard of 12 ␮g/m3 makes this a severe public health problem in
progress. It is imperative to keep generating epidemiological data on dementia worldwide and their relationship with air
pollutants to improve the strategies to face all the challenges associated with dementia and Alzheimer’s disease in particular.
re

Alzheimer’s disease is a fatal disease, we have no cure, and we ought to invest in protecting our citizens by intervening in
modifiable environmental factors.

Keywords: Air pollution, Alzheimer’s disease, Alzheimer’s disease continuum, dementia, fine particulate matter, Latin
America, Mexico, nanoparticles, prevalence
or

INTRODUCTION vascular cerebral problems, Alzheimer’s disease

C

(AD), Parkinson’s disease, to normal pressure

Dementia is a syndrome characterized by a
progressive deterioration of higher mental functions,
leading to difficulties with language, memory,
thinking, attention, abstraction, perception and other
cognitive skills that affect the individual’s ability
to perform everyday activities [1]. Dementia could
be related to any number of diseases ranging from
∗ Correspondence to: Rafael Brito-Aguilar, MSc, Research
Department, School of Health Sciences, Universidad del Valle
de México, Juan B. Tijerina no. 306, Centro, Ciudad Victoria,
Tamaulipas, CP 87000, Victoria, Tamaulipas, Mexico. Tel.: +52
834 312 1392/Ext. 39050; E-mail: rafael.brito@uvmnet.edu.
hydrocephalus [2–4].
AD is the most common cause of dementia,
accounting for 60–80% of cases, followed by vascular
dementia, dementia with Lewy bodies, mixed demen-
tia, frontotemporal lobar dementia, and Parkinson’s
disease [5].
Dementia has become a major public health
concern, developing into a global epidemic and
increasing distribution around the world [6]. For the
year 2015, it was estimated that 47 million peo-
ple were living with dementia, and by 2030, this
number will likely increase to 75 million and trip-

ISSN 1387-2877/19/$35.00 © 2019 – IOS Press and the authors. All rights reserved
2 R. Brito-Aguilar / Dementia Around the World and the Latin America and Mexican Scenarios
licate to 135 million by 2050 [7]. The projected
increases are driven by population aging which is
occurring at a very rapidly rate in low- and middle-
income countries. The number of new cases of
dementia anticipated each year worldwide is almost
7.7 million—one new case every four seconds [6].
Unfolding this by region, it means that there are 3.6
million (46%) new cases per year in Asia, 2.3 million
(31%) in Europe, 1.2 million (16%) in the Americas,
and 0.5 million (7%) in Africa [6].
Prevalence of dementia has been studied by epi-
demiologists all over the world and the projected
estimates come from several sources such as epi-
demiologic surveys, hospital records, and electronic
medical history databases. A meta-analysis involv-
ing 157 epidemiologic studies conducted between
1980–2009 worldwide, reported a prevalence of
dementia between 5–8% in those aged ≥60 years,
Pr
showing an exponential growth with age, two-fold
increases every five years [8]. Similar results were
reported in a different worldwide meta-analysis
study, with a prevalence of 4.8% and a period preva-
lence of 6.9% in a population ≥60 years [9].
ed
Dementia prevalence studies from Sweden,
France, Spain, United States of America, United
Kingdom, and Japan have shown a constant or
slightly decreased prevalence through time [10–17].
The Stockholm Study showed a prevalence of 17.5%
ct
and 17.9% for the years 1987 and 2001, respectively
[10]. Population studies from Spain showed a preva-
lence ranging from 9.4% [11] and 8.5% [12] on adults
re
≥70 years, and between 5.5% [13] and 5.8% [14] on
adults ≥65 years. Data from the Cognitive Function
and Ageing Study in UK between 1994 and 2008
showed a prevalence ranging from 6.3% to 8.3% [15].
or
Data from the United States from the Health and
Retirement Study from the years 2000 and 2012,
showed a 25% decrease on dementia prevalence from
11.6% to 8.8% on adults ≥65 years [16]. Interest-
C
ingly, years of education was associated with a lower
risk for dementia, and in the USA between 2000 and
2012 the average years of education increased sig-
nificantly from 11.8 years to 12.7 years. It is clear
that educational attainment is associated with some
of the decline in dementia prevalence; however, the
role of economic, environmental, social, behavioral,
and medical factors contributing to the decline is still
uncertain [16].
In contrast, in Japan, studies from 1985 and 2012
showed an increment of prevalence on adults ≥64
years from 6.8% to 11.3% [17]. Lack of methodolog-
ical uniformity among dementia prevalence studies
and differences in diagnostic criteria could likely
account for some of the differences in the litera-
ture; however, it is also becoming clear there are
striking risk factors applicable to low and middle
income countries and ethnic and age differences
in populations diagnosed with dementia [18, 19].
The issue of income is critical for one powerful
reason: potentially modifiable dementia risk factors
for lower income countries like India, China, Cuba,
Dominican Republic, Mexico, Peru, Puerto Rico, and
Venezuela include variables where interventions can
occur, like childhood education, midlife hearing loss,
f
hypertension, obesity, smoking, depression, physical
oo
inactivity, social isolation, and diabetes [18].
THE LATIN AMERICA AND MEXICAN
SCENARIOS
Latin American and Caribbean low and middle-
income countries face a grim scenario in terms of
dementia. The situation in Mexico is particularly
difficult because there are 53.4 million people in
poverty. Additionally, there is a progressive change
in the pyramid population distribution, with elderly
populations >65 years increasing, and the Mexican
economic, health system, and social problems pose
difficulties in taking care of this growing population,
expected to triple to 20% by 2050 [20]. The demo-
graphic structure of Latin American and Caribbean
countries (LACC) is changing rapidly compared to
North American and European countries, and it is
expected that the number of people with dementia in
LACC will increase from 7.8 million in 2013 to over
27 million by 2050. Studies from Brazil, Cuba, Chile,
Peru, and Venezuela showed a global prevalence of
AD at 7.1% [21]. These analyses also revealed that
prevalence of dementia doubles every 5 years from
65 years of age onwards, ranging from 2.40% in the
60–64 years of age group to 33.07% in the 90–94
years of age group [21].
Although LACC can be considered a uniform
region, the rate of development in each country is
different, so risk factors and social impact of demen-
tia varies between countries. It is also important to
note that reliable epidemiological data is scarce and
there no clear strategies to urge the governments to
establish specific dementia health policies.
Mexico is facing significant health problems,
including maternal mortality (34.6 deaths per
100,000 live births), mortality in children ≤1 year
and of ≤5 years of age (12.5 deaths and 15.1 per
 R. Brito-Aguilar / Dementia Around the World and the Latin America and Mexican Scenarios
1,000 live births, respectively), and lack of health
care and impoverishing effects of health care costs
in a country where 46% of the population is poor
[22–25]. The elderly population in Mexico and across
Latin America will be seriously affected in the next 30
years as the population grows without health care, in
poverty, with gender inequality, and without support
[20, 26–30].
In the last 15 years, several population-based
studies have been conducted to estimate dementia
prevalence in Mexico. The Health, Wellness and
Aging Study (SABE) was one of the first multina-
tional surveys in the late 1990 s to evaluate the general
health of elderly adults in Mexico [26]. The National
Study on Health and Aging in Mexico (ENSAEM)
was created by the Health National Institute and
the US National Institute on Aging, and its main
objectives were to evaluate the impact of illnesses
Pr
and mortality on adults 50 years and over in rural
and urban areas from Mexico, showing a preva-
lence of 6.1% on dementia cases for the year 2003
[31]. Important contributions have been made by the
10/66 Dementia Research Group, which includes 30
ed
research groups in 20 countries in Latin America, the
Caribbean, India, Russia, China, and south east Asia.
For Mexico, the 10/66 Dementia Research Group
reports a prevalence of 8.6% in urban areas and 8.5%
in rural areas, adjusted for sex, age, and academic
ct
level [32].
In 1986, the Mexican government implemented
the National System of Health Surveys with the
re
purpose of having a better understanding of the Mex-
ican health situation. Unfortunately, in the beginning,
elderly adults were not considered in the surveys. It
was only in 2012 when the latest version of the sur-
or
vey, known as National Health and Nutrition Survey
(ENSANUT), included elderly adults. Eight thou-
sand eight hundred seventy-four adults aged 60 and
C
over were interviewed to learn their main health con-
cerns, including dementia [33].
The Mexican Health and Aging Study (MHAS), a
sample of 13 million Mexicans ≥50 years, was used
to estimate the prevalence and incidence of dementia
and cognitive impairment without dementia (CIND)
in a sample of 7,166 subjects older than 60 years [31].
Results showed a prevalence of 6.1% for dementia
and 28.7% for CIND; interestingly higher educa-
tional level was protective for dementia, and diabetes,
hypertension, and depression were seen at baseline in
incident dementia cases. Mejia-Arango and Gutier-
rez [31] suggested cognition in Mexican elders likely
reflects educational level, economic status, and co-
3
morbidity with two major health problems: diabetes
and hypertension.
One major problem in Mexico is the underre-
porting of dementia cases, partially due to lack of
knowledge reported by 59% of physicians [34] that
likely reflects the reporting of 150 cases of new AD
in 2015 and 227 in 2017 in Mexico City, a megacity
with ∼9 million people [35]. A review of death cer-
tificates in Mexico from 1980 to 2014 shows a trend
to writing the diagnosis in the certificates in the last
two decades [36].
It is certainly of great concern the relationship
f
between the risk of dementia, including AD and
oo
air pollution [37–42] and the presence of iron-rich
magnetic nanoparticles in the brains of Mexico City
residents [40].
The recent reports of the evolving AD continuum
in Mexico City residents starting in childhood [41]
and the significant cognitive deficits in young adults
[42] raises serious concerns about the early onset
and rapid progression of AD, as described by the
2018 NIA-AA research framework [43], in the Mex-
ican residents exposed to concentrations above the
USEPA standard for both fine particulate matter and
ozone. The question posed by Richly et al. [34] will
most certainly apply for the millions of Mexican peo-
ple with high air pollution exposures sharing other
factors such as low socioeconomic status, low educa-
tion, and co-morbidities: Are medical doctors prepare
to deal with the dementia epidemic?; and we should
add: are authorities prepare to deal with health, social,
economic, education, judicial, etc., consequences?
The 2018 Latino population in the US reaches
almost 59 million [44], 18.1% of the nation’s total
population. Arizona, California, Colorado, Florida,
Georgia, Illinois, New Jersey, New Mexico, New
York, and Texas are the states with more Latinos,
and Mexicans are the largest foreign-born group in
the country: 25% of the 44.5 million immigrants as
of 2017. Mexicans on average are more likely to be
Limited English Proficient, have lower levels of edu-
cation, experience poverty, and lack health insurance
[45].
It is clear that aging is the greatest risk factor for
AD, but other demographic factors also contribute
to the increment on AD cases. One of these is the
rapidly growing Latino population in the US, and
Latinos are more prone to develop AD than White
Non-Hispanics. Furthermore, within the Latino pop-
ulation there are differences on the prevalence of AD
cases, and despite this, the differences are still poorly
understood and controversial. The variances might be
4 R. Brito-Aguilar / Dementia Around the World and the Latin America and Mexican Scenarios
based on nationality origin such as Mexicans, South
and Central America, and the Caribbean Hispan-
ics. The AD prevalence in the Latino population has
reach epidemic proportions and has become a social
and economic issue. Latino community idiosyncrasy
influences the decision of seeking appropriate health-
care, leading to an increase risk for development of
chronic diseases that place Latinos at a higher risk of
AD [46].
It is imperative to keep generating epidemiological
data on dementia worldwide to improve the strategies
to face all the challenges associated with dementia
and AD in particular.
Air pollution control ought to be a health issue
across the world and of particular importance for
Latin America. Identifying key environmental factors
impacting neural risk trajectories in the developing
brain and monitoring cognitive performance would
Pr
facilitate multidisciplinary early diagnosis and pre-
vention of dementias in high risk young populations.
DISCLOSURE STATEMENT
ed
The author’s disclosure is available online (https://
www.j-alz.com/manuscript-disclosures/19-0177r2).
REFERENCES
ct
[1] Alzheimer’s Association (2018) Alzheimer’s disease facts
and figures. Alzheimers Dement 14, 367-429.
[2] O’Brien JT, Thomas A (2015) Vascular dementia. Lancet
re
386, 1698-1706.
[3] James BD, Bennett DA (2019) Causes and patterns of
dementia: An update in the era of redefining Alzheimer’s
disease. Annu Rev Public Health 40, 65-84.
[4] Bräutigam K, Vakis A, Tsitsipanis C (2019) Pathogenesis
or
of idiopathic normal pressure hydrocephalus: A review of
knowledge. J Clin Neurosci 61, 10-13.
[5] Garcı́a-Pedroza F, Rodrı́guez Leyva I, Peñalosa Y (2003)
La epidemiologı́a de las demencias. Rev Mex Neurosci 4,
C
259-268.
[6] World Health Organization (2019) Towards a dementia
plan: A WHO guide [Internet]. World Health Organization,
Geneva, Switzerland. Available from: https://www.who.int/
mental health/neurology/dementia/en/
[7] World Health Organization (2015) Dementia: A public
health priority.
[8] Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri
CP (2013) The global prevalence of dementia: A systematic
review and meta-analysis. Alzheimers Dement 9, 63-75.e2.
[9] Fiest KM, Jetté N, Roberts JI, Maxwell CJ, Smith EE, Black
SE, Blaikie L, Cohen A, Day L, Holroyd-Leduc J, Kirk
A, Pearson D, Pringsheim T, Venegas-Torres A, Hogan DB
(2016) The prevalence and incidence of dementia: A system-
atic review and meta-analysis. Can J Neurol Sci 43(Suppl
1), S3-S50.
[10] Wu YT, Beiser AS, Breteler MMB, Fratiglioni L, Helmer
C, Hendrie HC, Honda H, Ikram MA, Langa KM, Lobo A,
Matthews FE, Ohara T, Pérès K, Qiu C, Sjölund BM, Skoog
I, Brayne C (2017) The changing prevalence and incidence
of dementia over time –current evidence. Nat Rev Neurol
13, 327-339.
[11] Gascón-Bayarri J, Reñé R, Del Barrio JL, De Pedro-
Cuesta J, Ramón JM, Manubens JM, Sánchez C, Hernández
M, Estela J, Juncadella M, Rubio FR (2007) Prevalence
of dementia subtypes in El Prat de Llobregat, Catalo-
nia, Spain: The PRATICON Study. Neuroepidemiology 28,
224-234.
[12] Tola-Arribas MA, Yugueros MI, Garea MJ, Ortea-
Valı́n F, Cerón-Fernández A, Fernández-Malvido B, San
José-Gallegos A, González-Touya M, Botrán-Velicia A,
f
Iglesias-Rodrı́guez V, Dı́az-Gómez B (2013) Prevalence of
oo
dementia and subtypes in Valladolid, Northwestern Spain:
The DEMINVALL Study. PLoS One 8, e77688.
[13] Gavrila D, Antúnez C, Tormo MJ, Carles R, Garcı́a Santos
JM, Parrilla G, Fortuna L, Jiménez J, Salmerón D, Navarro C
(2009) Prevalence of dementia and cognitive impairment in
Southeastern Spain: The Ariadna study. Acta Neurol Scand
120, 300-307.
[14] de Pedro-Cuesta J, Virués-Ortega J, Vega S, Seijo-Martı́nez
M, Saz P, Rodrı́guez F, Rodrı́guez-Laso A, Reñe R, de las
Heras SP, Mateos R, Martı́nez-Martı́n P, Manubens JM,
Mahilo-Fernandez I, López-Pousa S, Lobo A, Reglá JL,
Gascón FJ, Fernández Martı́nez M, Boix R, Bermejo-Pareja
F, Bergareche A, Benito-León J, de Arce A, del Barrio JL
(2009) Prevalence of dementia and major dementia subtypes
in Spanish populations: A reanalysis of dementia prevalence
surveys, 1990-2008. BMC Neurol 9, 55.
[15] Garre-Olmo J (2018) Epidemiologı́a de la enfermedad de
Alzheimer y otras demencias. Rev Neurol 66, 377-386.
[16] Langa KM, Larson EB, Crimmins EM, Faul JD, Levine
DA, Kabeto MU, Weir DR (2017) A comparison of the
prevalence of dementia in the United States in 2000 and
2012. JAMA Intern Med 177, 51-58.
[17] Ohara T, Hata J, Yoshida D, Mukai N, Nagata M, Iwaki
T, Kitazono T, Kanba S, Kiyohara Y, Ninomiya T (2017)
Trends in dementia prevalence, incidence, and survival rate
in a Japanese community. Neurology 88, 1925-1932.
[18] Mukadam N, Sommerlad A, Huntley J, Livingston G (2019)
Population attributable fractions for risk factors for demen-
tia in low-income and middle-income countries: An analysis
using cross-sectional survey data. Lancet Glob Health 7,
e596-e603.
[19] Mukadam N, Lewis G, Mueller C, Werbeloff N, Stewart R,
Livingston G (2019) Ethnic differences in cognition and age
in people diagnosed with dementia: A study of electronic
health records in two large mental healthcare providers. Int
J Geriatr Psychiatry 34, 504-510.
[20] Angel JL, Vega W, López-Ortega M (2017) Aging in Mex-
ico: Population trends and emerging issues. Gerontologist
57, 153–162.
[21] Nitrini R, Bottino CM, Albala C, Custodio Capuñay NS,
Ketzoain C, Libre Rodriguez JJ, Maestre GE, Ramos-
Cerqueira AT, Carmelli P (2009) Prevalence of dementia in
Latin America: A collaborative study of population-based
cohorts. Int Psychogeriatry 21, 622-630.
[22] Pan American Health Organization. Health in the Amer-
icas [Internet]. World Health Organization, Washington,
DC. Available from: https://www.paho.org/salud-en-las-
americas-2017/?page id=137, Accessed June 8, 2019,
 R. Brito-Aguilar / Dementia Around the World and the Latin America and Mexican Scenarios
[23] Organization for Economic Co-operation and Develop-
ment. Health at a glance [Internet]. Paris, France; 2017.
Available from: https://www.oecd.org/mexico/Health-at-
a-Glance-2017-Key-Findings-MEXICO-in-English.pdf,
Accessed June 8, 2019.
[24] Consejo Nacional de Evaluación de la Polı́tica de Desarrollo
Social (CONEVAL). Multidimensional measurement of
poverty in Mexico [Internet]. Mexico City: 2019. Available
from: https://www.coneval.org.mx/informesPublicaciones/
FolletosInstitucionales/Documents/Multidimensional-Mea
surement-of-poverty-in-Mexico.pdf, Accessed June 8,
2019.
[25] Geldsetzer P, Haakenstad A, James EK, Atun R (2018)
Non-technical health care quality and health system respon-
siveness in middle-income countries: A cross-sectional
study in China, Ghana, India, Mexico, Russia, and South
Africa. J Glob Health 8, 020417.
[26] Albala C, Lebrão ML, León Dı́az EM, Ham-Chande R,
Hennis AJ, Palloni A, Peláez M, Pratts O (2005) Encuesta
Salud, Bienestar y Envejecimiento (SABE): Metodologı́a de
la encuesta y perfil de la población estudiada. Rev Panam
Salud Publica 17, 307-322.
[27] Hojman DA, Duarte F, Ruiz-Tagle J, Budnich M, Delgado
C, Slachevsky A (2017) The cost of dementia in an unequal
country: The case of Chile. PLoS One 12, e0172204.
[28] Tapia Muñoz T, Slachevsky A, León-Campos MO, Madrid
M, Caqueo-Urı́zar A, Rohde GC, Miranda-Castillo C (2019)
Predictors of unmet needs in Chilean older people with
dementia: A cross-sectional study. BMC Geriatr 19, 106.
ed
[29] Maestre GE, Mena LJ, Melgarejo JD, Aguirre-Acevedo
DC, Pino-Ramı́rez G, Urribarrı́ M, Chacon IJ, Chávez
CA, Falque-Madrid L, Gaona CA, Terwilliger JD, Lee
JH, Scarmeas N (2018) Incidence of dementia in elderly
Latin Americans: Results of the Maracaibo Aging Study.
Alzheimers Dement 14, 140-147.
ct
[30] Johansson L, Guerra M, Prince M, Hörder H, Falk H,
Stubbs B, Prina AM (2019) Associations between depres-
sion, depressive symptoms, and incidence of dementia in
Latin America: A 10/66 Dementia Research Group Study.
re
J Alzheimers Dis 69, 433-441.
[31] Mejia-Arango S, Gutierrez LM (2011) Prevalence and
incidence rates of dementia and cognitive impairment no
dementia in the Mexican population: Data from the Mexican
Health and Aging Study. J Aging Health 23, 1050-1074.
or
[32] Prina AM, Acosta D, Acosta I, Guerra M, Huang Y,
Jotheeswaran AT, Jimenez-Velazquez IZ, Liu Z, Llibre
Rodriguez JJ, Salas A, Sosa AL, Williams JD, Prince M
(2017) Cohort profile: The 10/66 study. Int J Epidemiol 46,
C
406-406i.
[33] Romero-Martı́nez M, Shamah-Levy T, Franco-Núñez A,
Villalpando S, Cuevas-Nasu L, Gutiérrez JP, Rivera-
Dommarco JÁ (2013) Encuesta Nacional de Salud y
Nutrición 2012: Diseño y cobertura. Salud Pública Méx
55(Suppl 2), S332-S340.
[34] Richly P, Lopez P, Prats M, Mastadueno R, Bustin J,
Gonzalez M, Flichtentrei D, Manes F, Oneill S (2018)
Are medical doctors in Latin America prepared to deal
with the dementia epidemic? Int Psychogeriatr. doi:
10.1017/S1041610218001825
[35] Dirección General de Epidemiologı́a (2017) Anuario de
Morbilidad 1984-2017, Sistema Único de Información y
Vigilancia Epidemiológica (SUIVE), Secretarı́a de Salud.
http://www.epidemiologia.salud.gob.mx/anuario/html/anua
rios.html
5
[36] Celis-De la Rosa AJ, Cabrera-Pivaral CE, Báez-Báez MGL,
Celis-Orozco A, Gabriel Ortiz G, Zavala-González MA
(2018) Mortalidad por enfermedad de Alzheimer en México
de 1980 a 2014. Gac Med Mex 154, 550-554.
[37] Jung CR, Lin YT, Hwang B (2015) Ozone, particu-
late matter, and newly diagnosed Alzheimer’s disease: A
population-based cohort study in Taiwan. J Alzheimers Dis
44, 573-584.
[38] Chen H, Kwong JC, Copes R, Tu K, Villeneuve PJ, van
Donkelaar A, Hystad P, Martin RV, Murray BJ, Jessiman B,
Wilton AS, Kopp A, Burnett RT (2017) Living near major
roads and the incidence of dementia, Parkinson’s disease,
and multiple sclerosis: A population-based cohort study.
Lancet 389, 718-726.
[39] Oudin A, Forsberg B, Adolfsson AN, Lind N, Modig L,
f
Nordin M, Nordin S, Adolfsson R, Nilsson LG (2015)
oo
Traffic-related air pollution and dementia incidence in
Northern sweden: A longitudinal study. Environ Health Per-
spect 124, 306-312.
[40] Maher B, Ahmed IAM, Karloukovski V, MacLaren
DA, Foulds PG, Allsop D, Mann DMA, Torres-Jardón
R, Calderón-Garcidueñas L (2016) Magnetite pollution
Pr
nanoparticles in the human brain. Proc Natl Acad Sci U
S A 113, 10797-10801.
[41] Calderón-Garcidueñas L, Gónzalez-Maciel A, Reynoso-
Robles R, Delgado-Chávez R, Mukherjee PS, Kulesza RJ,
Torres-Jardón R, Ávila-Ramı́rez J, Villarreal-Rı́os R (2018)
Hallmarks of Alzheimer disease are evolving relentlessly
in Metropolitan Mexico City infants, children and young
adults. APOE4 carriers have higher suicide risk and higher
odds of reaching NFT stage V at ≤40 years of age. Environ
Res 164, 475-487.
[42] Calderón-Garcidueñas L, Mukherjee PS, Kulesza RJ,
Torres-Jardón R, Hernández-Luna J, Ávila-Cervantes R,
Macı́as-Escobedo E, González-González O, González-
Maciel A, Garcı́a-Hernández K, Hernández-Castillo A,
Villarreal-Rı́os R; Research Universidad del Valle de
México UVM Group (2019) Mild cognitive impairment and
dementia involving multiple cognitive domains in Mexican
urbanites. J Alzheimers Dis 68, 1113-1123.
[43] Jack CR Jr, Bennett DA, Blennow K, Carrillo MC, Dunn
B, Haeberlein SB, Holtzman DM, Jagust W, Jessen F,
Karlawish J, Liu E, Molinuevo JL, Montine T, Phelps C,
Rankin KP, Rowe CC, Scheltens P, Siemers E, Snyder HM,
Sperling R; Contributors (2018) 2018 NIA-AA research
framework: Toward a biological definition of Alzheimer’s
disease. Alzheimers Dement 14, 535-562.
[44] United States Census Bureau. Facts for Features: His-
panic Heritage Month 2018 [Internet]. United States
Census Bureau; 2018 [updated 2018 October 4].
Available from: https://www.census.gov/newsroom/facts-
for-features/2018/hispanic-heritage-month.html.
[45] Zong J, Batalova J. Mexican Immigrants in the United
States [Internet]. Migration Policy Institute, Washington,
DC; 2019. Available from: https://www.migrationpolicy.
org/article/mexican-immigrants-united-states
[46] Vega IE, Cabrera LY, Wygant CM, Velez-Ortiz D, Counts
SE (2017) Alzheimer’s disease in the Latino community:
Intersection of genetics and social determinants of health. J
Alzheimers Dis 58, 979-992.