{
  "abstract": "Introduction Dementia is a chronic and progressive neurological condition characterised by cognitive and functional impairment. It is often associated with multimorbidity and imposes a significant economic burden on healthcare systems and families, especially in low-income and middle-income countries. In Peru, where dementia cases are increasing rapidly, timely detection and referral for diagnosis is crucial. This protocol is part of the IMPACT Salud project in Peru. Here, we focus on a specific component aimed at validating an mHealth tool for the detection of cognitive and functional impairment and assessing its cost-effectiveness. We will also assess changes in cognitive and functional impairment as well as health economic outcomes over 1 year.Methods and analysis This observational study will be conducted in four geographically diverse regions of Peru. Community health workers are expected to contact approximately 32 000 participants (≥60 years) to apply an mHealth-enabled tool that includes cognitive and functional instruments: Ascertain Dementia 8, Peruvian version of Rowland Universal Dementia Assessment Scale and Pfeffer Functional Activities Questionnaire. From this large sample, we aim to find 3600 participants and their study partners to enrol and interview at baseline regarding sociodemographic characteristics, lifestyles, comorbidities and health economic data including resource use, costs and health-related quality of life (HR-QoL). Psychologists, blind to previous results, will assess dementia stage of the participants using an abbreviated Clinical Dementia Rating (CDR) scale. At 6-month follow-up, participants will complete a brief health economics questionnaire on resource use, costs and HR-QoL. To validate the accuracy of the detection tool, a subsample of 600 participants who completed the baseline will undergo a gold-standard clinical neuropsychological assessment. This subsample will participate in a 12-month follow-up, including health economics, cognitive and functional impairment tests and the CDR scale. Results will be analysed and presented by cognitive status, site, sex and multimorbidity profile. Finally, data from all stages and external sources will inform a decision model to implement a cost-effectiveness analysis of the detection tool at the national level.Ethics and dissemination The study received ethics approval in Peru (Universidad Peruana Cayetano Heredia: CONSTANCIA-CIEI-378-33-23) and in the UK (Imperial College London: ICREC/SETREC reference number 6647445). Informed consent will be obtained from participants and their study partners, considering the participant’s capacity to consent. For illiterate participants, consent will be obtained through a witnessed procedure involving study partners, with a fingerprint obtained instead of a signature. The results will be disseminated through conferences, published articles, public presentations (particularly to those involved in dementia care) and presentations or meetings with local health authorities.",
  "authors": [
    {
      "affiliations": [
        "Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK",
        "CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru"
      ],
      "name": "Maria Kathia Cardenas"
    },
    {
      "affiliations": [
        "CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru",
        "Department of Brain Sciences, Imperial College London, London, UK"
      ],
      "name": "Cecilia Anza-Ramirez"
    },
    {
      "affiliations": [
        "CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru"
      ],
      "name": "Antonio Bernabe-Ortiz"
    },
    {
      "affiliations": [
        "Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru",
        "Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru"
      ],
      "name": "Nilton Custodio"
    },
    {
      "affiliations": [
        "Unidad de Diagnóstico de Deterioro Cognitivo y Prevención de Demencia, Instituto Peruano de Neurociencias, Lima, Peru",
        "Unidad de Investigación, Instituto Peruano de Neurociencias, Lima, Peru"
      ],
      "name": "Rosa Montesinos"
    },
    {
      "affiliations": [
        "CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru",
        "Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia"
      ],
      "name": "Juan Jaime Miranda"
    },
    {
      "affiliations": [
        "Dyson School of Design Engineering, Imperial College London, London, UK"
      ],
      "name": "Marco Da Re"
    },
    {
      "affiliations": [
        "CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru"
      ],
      "name": "Maria Veronica Belon-Hercilla"
    },
    {
      "affiliations": [
        "CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru"
      ],
      "name": "Maria Lazo-Porras"
    },
    {
      "affiliations": [
        "School of Social Sciences, Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK"
      ],
      "name": "Jemma Hawkins"
    },
    {
      "affiliations": [
        "CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru"
      ],
      "name": "Francisco Diez-Canseco"
    },
    {
      "affiliations": [
        "School of Social Sciences, Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK"
      ],
      "name": "Graham Moore"
    },
    {
      "affiliations": [
        "Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK"
      ],
      "name": "William Whiteley"
    },
    {
      "affiliations": [
        "Dyson School of Design Engineering, Imperial College London, London, UK"
      ],
      "name": "Rafael A Calvo"
    },
    {
      "affiliations": [
        "Center for Research in Primary Health Care, Universidad Peruana Cayetano Heredia, Lima, Peru"
      ],
      "name": "Maria Sofia Cuba-Fuentes"
    },
    {
      "affiliations": [
        "Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK"
      ],
      "name": "Filipa Landeiro"
    },
    {
      "affiliations": [
        "Department of Brain Sciences, Imperial College London, London, UK",
        "The George Institute for Global Health, School of Public Health, Imperial College London, London, UK"
      ],
      "name": "Christopher R Butler"
    },
    {
      "affiliations": [],
      "name": "On behalf of the IMPACT Salud Study Group"
    }
  ],
  "title": "Validation and cost-effectiveness of an mHealth tool for cognitive impairment detection in Peru: protocol for the IMPACT Salud observational study",
  "uid": "03943616-52a5-5852-b96b-7b3a1e111426"
}