Parkinson's and Alzheimer's diseases in Costa Rica: a feasibility study toward a national screening program
Open accessAbstract
BACKGROUND: 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. OBJECTIVE: 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. DESIGN: 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. RESULTS: 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. CONCLUSION: 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.
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Further studies in India and Costa Rica also supported improved case detection rates of comorbid conditions.
“while further studies in India and Costa Rica also supported improved case detection rates of comorbid conditions 57,64 .”
From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [64]
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- Authors
- Wesseling, C., Román, N., Quirós, I., Páez, L., García, V., María Mora, A., Juncos, J. L., & Steenland, K. N.
- Affiliations
- Universidad Nacional (CR)
- Costa Rican Department of Social Security (CR)
- Central American Institute for Studies on Toxic Substances (IRET), Universidad Nacional, Heredia, Costa Rica
- Emory University (US)
- Corresponding author
- Wesseling, Catharina
- Venue
- Global Health Action
- Publisher
- Informa UK Limited
- Published
- 2013-12
- Volume
- 6
- Issue
- 1
- Pages
- 23061
- ISSN
- 1654-9716 (ISSN-L)
- 1654-9880
- PMC
- PMC3875350
- OpenAlex
- W2116386118
- Cited by
- 9
- References
- 21
- Citations by year
- 2025: 1 · 2023: 1 · 2021: 1 · 2019: 2 · 2018: 1 · 2016: 2 · 2014: 1
- FWCI
- 0.71
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Global Health Action (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- National Institutes of Health
- National Institute of Environmental Health Sciences (P01ES016731)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Keywords
- Parkinson's disease, Alzheimer's disease, neurodegenerative disease screening, screening feasibility, older adults, mild cognitive impairment, Unified Parkinson's Disease Rating Scale, Mini-Mental State Examination, cognitive assessment, disease prevalence, public health system, Costa Rica
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Costa Rica, Feasibility Studies, Female, Humans, Male, Mass Screening, Middle Aged, Parkinson Disease, Public Health, Surveys and Questionnaires, Delivery of Health Care, Integrated
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