Parkinson's and Alzheimer's diseases in Costa Rica: a feasibility study toward a national screening program

• Type of Material: Article
• Authors: Catharina Wesseling, Universidad Nacional; Norbel Roman, Hospital San Juan de Dios; Indiana Quiros, Clínica de Santo Domingo de Heredia; Laura Paez, Clínica de Santo Domingo de Heredia; Vilma Garcia, Development of Health Services; Ana María Maria Mora, Universidad Nacional; Jorge Juncos, Emory University; Nelson Steenland, Emory University
• Language: English
• Date: 2013-01-01
• Publisher: Taylor & Francis Open: Creative Commons Attribution
• Publication Version: Final Published Version
• Copyright Statement: © 2013 Catharina Wesseling et al.
• License: Creative Commons Attribution-Noncommercial 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.3402/gha.v6i0.23061
• Title of Journal or Parent Work: Global Health Action
• ISSN: 1654-9716
• Volume: 6
• Start Page: 1
• End Page: 11
• Grant/Funding Information: The project was supported by Award Number P01ES016731 from the National Institute of Environmental Health Sciences.
• Keywords: PREVALENCE; ASSOCIATION WORKGROUPS; Alzheimer's; Costa Rica; Life Sciences & Biomedicine; HEALTH; DEMENTIA; public health system; RECOMMENDATIONS; INSTITUTE; SPIRAL ANALYSIS; screening; Public, Environmental & Occupational Health; aging; Science & Technology; Parkinson's; VALIDITY; DIAGNOSTIC GUIDELINES
• Research Categories: Health Sciences, Public Health

Abstract

The integration of mental and neurologic services in healthcare is a global priority. The universal Social Security of Costa Rica aspires to develop national screening of neurodegenerative disorders among the elderly, as part of the non-communicable disease agenda. This study assessed the feasibility of routine screening for Parkinson's disease (PD) and Alzheimer's disease (AD) within the public healthcare system of Costa Rica. The population (aged ≥65) in the catchment areas of two primary healthcare clinics was targeted for motor and cognitive screening during routine annual health check-ups. The screening followed a tiered three-step approach, with increasing specificity. Step 1 involved a two-symptom questionnaire (tremor-at-rest; balance) and a spiral drawing test for motor assessment, as well as a three-word recall and animal category fluency test for cognitive assessment. Step 2 (for those failing Step 1) was a 10-item version of the Unified Parkinson Disease Rating Scale and the Mini-Mental State Examination. Step 3 (for those failing Step 2) was a comprehensive neurologic exam with definitive diagnosis of PD, AD, mild cognitive impairment (MCI), other disorders, or subjects who were healthy. Screening parameters and disease prevalence were calculated. Of the 401 screened subjects (80% of target population), 370 (92%), 163 (45%), and 81 (56%) failed in Step 1, Step 2, and Step 3, respectively. Thirty-three, 20, and 35 patients were diagnosed with PD, AD, and MCI, respectively (7 were PD with MCI/AD); 90% were new cases. Step 1 sensitivities of motor and cognitive assessments regarding Step 2 were both 93%, and Step 2 sensitivities regarding definitive diagnosis 100 and 96%, respectively. Specificities for Step 1 motor and cognitive tests were low (23% and 29%, respectively) and for Step 2 tests acceptable (76%, 94%). Based on international data, PD prevalence was 3.7 times higher than expected; AD prevalence was as expected. Proposed protocol adjustments will increase test specificity and reduce administration time. A routine screening program is feasible within the public healthcare system of Costa Rica.