Objective The purposes of this study were three‐fold: (i) to describe handgrip strength in older individuals aged ≥60 years in Colombia; (ii) to identify sex‐specific and age‐specific muscle weakness cut‐off points in older adults; and (iii) to determine the odds of adverse events for each of the intrinsic capacity domains for individuals with handgrip strength greater than the muscle weakness cut‐off points, as compared with their weaker counterparts. Methods A cross‐sectional study was conducted in Colombia, among 5237 older adults aged ≥60 years old (58.5% women, 70.5 ± 7.8 years), according to ‘SABE Survey 2015’. Handgrip strength data were obtained with a Takei dynamometer. Sociodemographic variables, five domains of intrinsic capacity (i.e. locomotion, vitality, cognition, psychological, and sensory), and medical conditions were assessed and analyzed. Adjustments variables were age, ethnicity, socio‐economic status, urbanicity, body mass index, smoking status, alcohol intake, drug use, physical activity, and co‐morbid chronic diseases. Sex‐stratified analyses were conducted with logistic regression models. Results Handgrip strength was greater among men than among women (26.7 ± 8.5 vs. 16.7 ± 5.7 kg, respectively, P < 0.001) at all ages. Weak handgrip strength cut‐off points ranged from 17.4 to 8.6 and from 10.1 to 4.9 in men and women, respectively. Overall, participants with optimal handgrip strength had better intrinsic capacity [in men, odds ratio (OR) = 0.62, 95% confidence interval (CI) 0.53 to 0.71; P < 0.001; and in women, OR = 0.79, 95% CI 0.68 to 0.92; P = 0.002] than their weaker counterparts. Also, men with optimal handgrip strength had a lower risk of hospitalization (OR = 0.47, 95% CI 0.29 to 0.78; P = 0.004) than their weaker counterparts. Conclusions This study is the first to describe handgrip strength values and cut‐off points for muscle weakness among a nationally representative sample of Colombian older adults by age and sex. After categorizing older adults as weak or not weak based on the handgrip cut‐off points, non‐weakness was associated with a decreased odds of intrinsic capacity impairments. These cut‐off points may be good candidates for clinical assessment of risks to physical and mental health in older Colombian adults.

To study the effect of education on the performance in the Mini-Mental State Examination (MMSE) domains, we included 2,861 Mexican Americans aged 65 and older from the Hispanic Established Populations for Epidemiologic Studies of the Elderly (EPESE) followed from 1993-1994 until 2004-2005. The MMSE was examined as total score (0-30) or divided in two global domains: 1) no-memory (score 0-24): Orientation, attention, and language; and 2) memory (score 0-6): working and delayed memory. Mean age and total MMSE were 72.7 and 24.6 at wave 1, and 81.7 and 20.5 at wave 5. Spanish speaking subjects had lower years of education (4.1 vs. 7.4, p<. 0001), they had significantly higher adjusted (by age, education, and gender) mean scores for memory, no-memory and the total MMSE compared with English speaking subjects across the five waves of follow-up. In multivariate longitudinal analyses over 11 years of follow-up, subjects with more years of education performed better than those less educated, especially in no-memory and the total MMSE. Spanish speaking subjects with 4-6 years of education had higher memory scores than those speaking English (estimate 0.40, standard error [SE] = 0.14, p<.001), [7][8][9][10][11] SE= 0.13, p<.01) or 12+ (estimate 0.44, SE= 0.13, p<.001). This suggests that cultural factors and factors related to preferred language use may determine variations in MMSE performance. Since the memory domain of the MMSE is less affected by education, it may be used along with other cognitive tests in older populations with low education.

Objective Examine the association between frailty and cognitive impairment as predictors of mortality over a 10-year period in a selected sample of older Mexican Americans. Design Longitudinal analyses using data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (1995–96/2004–05). Setting Five southwestern states: Texas, New Mexico, Colorado, Arizona, and California. Participants Mexican Americans aged 67 and older with complete information on the frailty index and the Mini Mental State Examination (MMSE) (n=1,815). Measurements Cognitive impairment determined by a score in the MMSE < 21. Frailty defined as three or more of the following components: 1) weight-loss, 2) weakness, 3) self-reported exhaustion, 4) slow walking speed, and 5) low physical activity level. Sociodemographic characteristics and chronic medical conditions were used as covariates. Mortality was determined using the National Death Index or by proxy. Results As MMSE score declined over time, the percent of frail individuals increased in a linear fashion. Frailty and cognitive impairment are independent risk factors for mortality after controlling for all covariates (HR 2.03 95% CI 1.57–2.62; HR 1.26 95% CI 1.05–1.52, respectively). When both cognitive impairment and frailty were added to the model, HR for individuals with cognitive impairment was no longer statistically significant. Conclusion The relation between frailty and cognitive impairment needs careful analysis in this population to establish pathways increasing mortality and decreasing quality of life. Our results suggest frailty is a stronger predictor of mortality for older Mexican Americans than cognitive impairment.

Frailty, sarcopenia and multimorbidity are overlapping, yet distinct conditions in this sample. There are potentially reversible factors that are associated with frailty and sarcopenia in this sample. Future studies need to analyze the best way to prevent these conditions, and examine individuals that have frailty, sarcopenia and comorbidities to design interventions to improve their quality of life.

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Abstract. The effects of bromocriptine discontinuation after a 2 year course of therapy on prolactin (Prl) serum levels and the radiological size of the sella turcica were investigated in 16 women with amenorrhoea-galactorrhoea due to prolactinoma. During therapy, all but 2 patients had normalized serum Prl levels, and 4 women with macroprolactinomas exhibited a reduction in the size of the tumour as documented by CT-scanning and tomography of the sellae. After bromocriptine withdrawal and follow-up during 2 additional years, Prl levels remained normal in 6 patients, 2 of them with microprolactinomas and 4 with macroprolactinoma. The remaining 10 women developed hyperprolactinaemia associated with amenorrhoea and galactorrhoea within 3 months after discontinuation of therapy. No tumour expansion was observed in any case during the 4 year observation period. In the present study bromocriptine treatment seemed to result in permanent cure in 6 out of 16 cases of prolactinomas; nevertheless it is difficult to justify an indefinite medical treatment since the natural history of prolactinoma remains unknown. We presently feel that bromocriptine is more appropriate than neurosurgical transsphenoidal exploration for the primary treatment of prolactinomas. Further investigation is needed before a more definitive conclusion regarding the management of prolactinomas can be reached.

Nearly all mutations in the presenilin 1 (PSEN1), presenilin 2 (PSEN2), and amyloid b precursor protein (APP) genes lead to early-onset Alzheimer disease (EOAD, onset age at or before 65 years). In order to assess the genetic contribution of these genes in a series of Colombian AD cases, we performed a systematic mutation analysis in 11 autosomal dominant, 23 familial, and 42 sporadic AD patients (34% with age of onset 65 years). No APP missense mutations were identi®ed. In three autosomal dominant cases (27.2%), two different PSEN1 missense mutations were identi®ed. Both PSEN1 mutations are missense mutations that occurred in early-onset autosomal AD cases: an I143T mutation in one case (onset age 30 years) and an E280A mutation in two other cases (onset ages 35 and 42 years). In addition, a novel PSEN1 V94M mutation was present in one early-onset AD case without known family history (onset age 53 years) and absent in 53 controls. The E318G polymorphism was present in ®ve AD cases and absent in controls. In PSEN2, two different silent mutations were detected, including one not reported elsewhere (P129). The majority of the Colombian AD cases, predominantly late-onset, were negative for PSEN and APP mutations.

-Objective: As the strength of the association between the APOE ε4 allele and Alzheimers disease (AD) varies across ethnic groups, we studied if there was such an association in Colombian patients. Method: We performed apolipoprotein E (APOE) genotyping in a clinical sample of 83 unrelated AD patients, predominantly late-onset (>65 yrs) including familial ( n =30) and sporadic AD cases (n= 53) diagnosed according to NINCDS-ADRDA criteria and assessed by a multi-disciplinary team. Control subjects (n = 44) had no significant cognitive impairment by medical interview and neuro-psychological testing. Results: We found a high association (OR= 5.1 95%CI 1.9 -13.6) between APOE ε4 and AD, in this series with predominantly late-onset cases with familial aggregation in 24 cases (28.9%). A significant negative association was found between ε2 and AD (OR= 0.2 95% CI 0.05-0.75). Conclusion: Further population-based surveys in Colombia are warranted to precise a possible dose effect of APOE ε4.KEY WORDS: Alzheimers disease, APOE, dementia, risk factors, ethnic groups, Colombia.Asociación positiva entre apoe ε ε ε ε ε4 y demencia de Alzheimer en una serie clinica en Bogotá (Colombia) y revision de los estudios latinoamericanos RESUMEN -Objetivo: Como la fortaleza de la asociación entre el alelo ε4 del gen APOE y la enfermedad de Alzheimer (EA) difiere entre grupos étnicos, quisimos evaluar si esta asociación existe en pacientes colombianos. Métodos: Realizamos una genotipificación para el gen de la apolipoproteina E (APOE) en una muestra clínica de 83 pacientes con EA no relacionados, de inicio predominantemente tardío (> 65 años), incluyendo casos familiares (n=30) y esporádicos (n=53) diagnosticados según los criterios del NINCDS-ADRDA y evaluados por un equipo multi-disciplinario. Los sujetos control (n= 44) no presentaban deterioro cognoscitivo de acuerdo con la entrevista médica y la evaluación neuropsicológica. Resultados: Hallamos una alta asociación (OR= 5.1; IC95% 1.9-13.6) entre APOE ε4 y EA en la serie de casos de inicio tardío y con agregación familiar en 24 sujetos (28.9%). Una asociación negativa, estadísticamente significativa, fue encontrada entre ε2 y EA (OR= 0.2; IC95% 0.05-0.75). Conclusión: En Colombia son necesarios futuros estudios con base poblacional para poder precisar la existencia o no de un efecto de dosis de APOE ε4.PALABRAS-CLAVES: enfermedad de Alzheimer, APOE, demencia, factores de riesgo, grupos étnicos, Colombia.