Objective: To determine the prevalence of dementia and dementia types in Jamaica. Methods: An embedded case-control design was used to investigate dementia within the ageing population. Cases (Mini-Mental State Examination [MMSE] scores of ≤ 20) and controls (MMSE scores of > 20) were evaluated using DSM-IV protocol and magnetic resonance imaging. Prevalences (crude and age-adjusted) were calculated and distribution of dementia by type described. Results: Dementia prevalence was 5.9%. Alzheimer's pattern dementia accounted for 61.8% and vascular dementia 32.4%. However, vascular disease was prominent in 45.5% of the Alzheimer's cases. Female gender and increasing age were associated with higher rates of dementia. Dementia was 38 times more likely in participants with MMSE scores below 20. Conclusion: This first nationally representative study indicated that dementia rates in Jamaica were comparable with regional and global estimates. Regardless of the dementia type, vascular change was pervasive and suggested that synergistic efforts should be made to address underlying contributory factors. Cardiovascular and cerebrovascular risk reduction should be deliberately pursued as integral adjuncts to dementia risk reduction.

The prevalence of delirium in acute medical inpatients is high, with estimates ranging from 10% to 31%. [1] Short-and long-term complications of delirium include increased mortality and length of hospitalisation, post-discharge institutionalisation, and long-term functional and cognitive decline. [2] This is a considerable healthcare burden: in developed countries the cost of delirium is equal to that of falls and diabetes mellitus. [3] A number of risk factors for delirium have been identified, including predisposing factors such as dementia and advancing age and acute precipitating factors such as drugs, infections and metabolic abnormalities. [2] Protective factors include a higher level of education, a marker of cognitive reserve. [4] Unfortunately, the data on delirium outcomes and risk factors in general medical inpatients are derived almost exclusively from geriatric populations in developed countries, a very different population to acute medical admissions in developing country settings with a high HIV/tuberculosis (TB) burden. [5] Furthermore, the few studies from developing country settings such as sub-Saharan Africa (SSA) have either been conducted in medical patients aged >60 years or in specialised populations, such as psychiatric and intensive care settings. [6][7][8] In developed countries such as the USA, studies were done among HIV-infected populations before universal access to combination antiretroviral therapy (ART). [9][10][11][12][13][14] HIV targets the central nervous system (CNS) with resultant neurocognitive impairment (NCI), a well-described predisposing risk factor for delirium. Acute and opportunistic infections (OIs), also known risk factors for delirium, occur more commonly with advancing immunosuppression. It is therefore unsurprising that studies have shown high prevalence rates of delirium (3.7 -57%) in HIV-infected populations. [6,[11][12][13] Delirium in HIV is often concomitant with NCI, in 8 -22% of cases. [15] Combination ART both prevents and improves NCI and decreases the incidences of acute and OIs. Widespread access to ART may therefore mitigate delirium risk. It is unclear whether HIV infection remains an independent risk factor for delirium in acute medical admissions in endemic HIV settings with universal ART programmes. [9] Furthermore, in developing country settings such as South Africa (SA), with high This open-access article is distributed under Creative Commons licence CC-BY-NC 4.0.

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Background: The Cambridge Cognitive Examination-Revised (CAMCOG-R) is a sensitive screening tool for the early diagnosis of dementia in older adults. Overall performance on the CAMCOG-R is influenced by educational attainment. Few studies have, however, examined the association between educational attainment and performance on the individual CAMCOG subscales. We aimed to address this question in a sample from a low-and middle-income country (LAMIC), where resource constraints may have compromised access to, and quality of, education for many older adults. Methods: Participants, all over 60 years of age, were 51 cognitively healthy community-dwelling volunteers and 47 individuals diagnosed with mild-moderate stage Alzheimer's disease (AD). Most participants had some high school education. They were administered the CAMCOG-R under standardized conditions. Results: Within both the control and AD patient groups, there were significant associations between years of completed education and CAMCOG-R total score, MMSE score, and CAMCOG-R Language subscale score. In both groups, level of education was not associated with scores on these subscales: in controls, recent memory, R 2 = .21, p = .055, learning memory, R 2 = .16, p = .398, attention/calculation, R 2 = .19, p = .467, and perception, R 2 = .18, p = .984; in AD patients, recent memory, R 2 = .14, p = .340, learning memory, R 2 = .03, p = .680, perception, R 2 = .09, p = .723, and attention/calculation, R 2 = .19, p = .097. Conclusions: Some CAMCOG-R subscale scores were more strongly associated with educational attainment than others. Importantly, however, performance on the recent memory and learning memory subscales was not affected by education. These subscales are sensitive indicators of amnestic mild cognitive impairment (MCI) and early AD. These subscales may therefore remain valid for use as an AD screening tool in resource-poor healthcare settings.

Stress is viewed as a state of real or perceived threat to homeostasis, the management of which involves the endocrine, nervous, and immune systems. These systems work independently and interactively as part of the stress response. The scientific stress literature, which spans both animal and human studies, contains heterogeneous findings about the effects of stress on the brain and the body. This review seeks to summarise and integrate literature on the relationships between these systems, examining particularly the roles of physiological and psychosocial stress, the stress hormone cortisol, as controlled by the hypothalamic-pituitary-adrenal (HPA) axis, and the effects of stress on cognitive functioning. Health conditions related to impaired HPA axis functioning and their associated neuropsychiatric symptoms will also be considered. Lastly, this review will provide suggestions of clinical applicability for endocrinologists who are uniquely placed to measure outcomes related to endocrine, nervous and immune system functioning and identify areas of intervention.

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