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PONE-D-20-39225

Prevalence and incidence of possible vascular dementia among older Mexican adults: analysis of the Mexican Health and Aging Study

PLOS ONE

Dear Dr. Aguilar-Navarro,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Apr 17 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Claudia K. Suemoto

Academic Editor

PLOS ONE

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Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This manuscript subject stands out a great health concern since dementia population will increase in the next years in Latin America. The topic is interesting and here I present some suggestions for the authors to make the manuscript more suitable and complete for publication:

1. Introduction

Cardiovascular diseases, including stroke, are the leading cause of death globally. Its consequences bring a significant burden to its carriers and we can identify post-stroke cognitive impairment as being one of the greatest onuses, as it affects labor independence and quality of life. As dementia is the 5th cause of mortality in the world, the authors should bring information about dementia and vascular dementia mortality rates and burden to the health system (costs, for example). This might increase the relevance of recognizing the prevalence and incidence of vascular cognitive impairment, so interventions are targeted to potentially modifiable risk factors associated with VCI.

Still in the introduction, pg 11, line 81, I would quote that “a meta-analysis reported rates of post-stroke dementia that ranged from 7.4% […] to 41.3% […]”.

2. Methods

The methods and study design are appropriate for the questions and claims of this study. When reading the section “Cognitive assessment”, I suggest the authors to cite the reference for the criterion of overall dementia for self-respondents (pg 7, line 134).

Regarding IADLs impairment, some cultural influences may affect the interpretation of this matter. One to consider is the effect of gender on IADLs for the Latin population (some men do not usually prepare a meal and some women may not manage money) – was that considered? Still in IADLs impairment, it can happen due to stroke complications (focal symptoms), as difficult to move arms/legs (so the patient will have difficult in cooking, for example). Was it possible to separate IADL disability due to cognitive impairment and not due to stroke complications? If these two points could not be considered, the authors should cite them as limitations.

Still in the method section, as this study involved human participants, it is important to include ethical approval, as the name of the institutional review board or ethics committee that approved the research. The MHAS protocols and instruments were approved by the Institutional Review Board of the University of Texas Medical Branch, the National Institute of Statistics and Geography (INEGI for its acronym in Spanish) and the National Institute of Public Health (INSP) in Mexico (In pg 5, line 101) – is this the ethical approval? This information needs to be more specific.

3. Figures, tables and results

The figures and tables are clearly presented and correctly labeled. I suggest that, throughout the text, the results can be cited with only one decimal place, as an example on pg 22 line 294: “At age 75 years and older individuals had 3.6 greater odds of incident PVD…” and line 295: “Being in the lowest quartile of the education distribution increased in 2.8 the odds of incident PVD”.

4. Conclusions

The overall rate of PVD incidence found was lower of that reported in other studies and authors pointed out that methodological differences between studies could account for variability in results. The authors should mention which differences there are that could explain this variability, with references (e.g. use of different PVD criteria and cognition scales?).

In the limitation section of the discussion, the fact two thirds of the PVD population were diagnosed by proxy respondents may have made the criterion for detecting PVD less sensitive, so the authors should mention that. Second, the exclusion of new cases of dementia without history of stroke is also a limitation and must be explained through the manuscript, such as patients with cerebral small vessel disease without typical stroke history and evolving with dementia.

I suggest the authors make a careful analysis of grammatical and spelling errors, as: Pg 17, line 316 – “found an increasing pattern”, Pg 18, line 332: “hypothesis where pre-existing mechanisms” and Pg 18, line 340: methodological.

Reviewer #2: The study by Yeverino-Castro et al. reported the prevalence and incidence of vascular dementia in the MHAS.

The manuscript is well-written and the findings are consistent with other studies performed previously.

I have only 2 major comments:

1. was the weights of MHAS that are needed to have prevalence and incidence rates representative of the Mexican population used?

2. In the Discussion, the authors need to discuss how using a criteria attached to the presence of stroke influence the prevalence and incidence of vascular dementia. They need to make clearer that the findings probably understimante the rates of VaD in this study.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-20-39225R1

Prevalence and incidence of possible vascular dementia among Mexican older adults: analysis of the Mexican Health and Aging Study

PLOS ONE

Dear Dr. Aguilar-Navarro,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jul 22 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Claudia K. Suemoto

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: No

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: In my previous review, I have requested information on the use of sampling weigths.

However, the authors did not answer this comment.

They provided information about the sample procedure.

In epidemioloic sutdies, we cannot evaluate the whole population, so we sample some individuals.

To make the sample representative of the population, we can weight the analyses by the sampling weigths.

This is a common procedure in studies that aim to measure prevalence and incidence rates.

Please, provide information if you used the weights.

If you have not used them, recalculate your analyses.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: Yes: Claudia Kimie Suemoto

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Prevalence and incidence of possible vascular dementia among Mexican older adults: analysis of the Mexican Health and Aging Study

PONE-D-20-39225R2

Dear Dr. Aguilar-Navarro,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Claudia K. Suemoto

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: