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Atim LM, Kaggwa MM, Mamun MA, Ashaba S, Maling S. Prevalence of Severe Neurocognitive Impairment and Its Association with Socio-Demographics and Functionality Among Ugandan Older Persons: A Hospital-Based Study. Clin Interv Aging 2021; 16:1415-1425. [PMID: 34326633 PMCID: PMC8314681 DOI: 10.2147/cia.s319891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/30/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The prevalence of neurocognitive disorders, especially dementia, is rising due to an increase in longevity. Early detection and diagnosis of neurocognitive impairments are important for early interventions and appropriate management of reversible causes, especially by the primary health workers. However, this study aimed to determine the prevalence and associated factors of severe neurocognitive impairment among elderly persons attending a tertiary hospital in Uganda. METHODS This cross-sectional survey was conducted in a Ugandan hospital setting, where older adults go for treatment for their chronic health problems. Following the inclusion criteria, interviews were conducted, where information about socio-demographics was collected, whereas neurocognitive impairment and functionality were assessed by Mini-Mental State Examination and Barthel Index, respectively. Chi-square test, Pearson correlation test, and logistic regression were performed to determine the factors associated with severe neurocognitive impairment. RESULTS A total of 507 elderly persons aged 60 years and above were enrolled in this study (mean age 68.62 ±7.95 years), and the prevalence of severe neurocognitive impairment was 28.01%. Advanced age, female gender, lower education level, and functional dependency were significantly associated with severe neurocognitive impairment. CONCLUSION Severe neurocognitive impairment is prevalent among Ugandan hospital attending elderlies with functional dependency. This suggests a need to routinely screen cognitive disorders among older persons who visit the healthcare facilities with other physical complaints to enable early detection and treatment of reversible causes of neurocognitive impairment, such as depression and delirium to enable better functionality.
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Affiliation(s)
- Letizia Maria Atim
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Mark Mohan Kaggwa
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- African Centre for Suicide Prevention and Research, Mbarara, Uganda
| | - Mohammed A Mamun
- CHINTA Research Bangladesh (Centre for Health Innovation, Networking, Training, Action and Research – Bangladesh), Savar, Dhaka, 1342, Bangladesh
- Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Scholastic Ashaba
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Samuel Maling
- Department of Psychiatry, Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Wei J, Hou J, Su B, Jiang T, Guo C, Wang W, Zhang Y, Chang B, Wu H, Zhang T. The Prevalence of Frascati-Criteria-Based HIV-Associated Neurocognitive Disorder (HAND) in HIV-Infected Adults: A Systematic Review and Meta-Analysis. Front Neurol 2020; 11:581346. [PMID: 33335509 PMCID: PMC7736554 DOI: 10.3389/fneur.2020.581346] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022] Open
Abstract
Background: The HIV associated mortality is decreasing in most countries due to the widespread use of antiretroviral therapy. However, HIV-associated neurocognitive disorder (HAND) remains a problematic issue that lowers the quality of life and increases the public health burden among people living with HIV. The prevalence of HAND varies across studies and selected samples. Therefore, we aimed to quantitatively summarize the pooled prevalence of Frascati-criteria-based HAND and to explore the potential demographic, clinical, and immunological factors. Methods: A comprehensive literature search in PubMed/Medline, Web of Science, Embase, and PsycINFO was performed. A random-effects meta-analysis was conducted using the event rate (ER) for the estimation of the incidence of HAND. Subgroup meta-analyses were used to evaluate between-group differences in categorical variables. Meta-regression with the unrestricted maximum likelihood (ML) method was used to evaluate associations of continuous variables. Results: Eighteen studies whose sample sizes ranged from 206 to 1555 were included in the final analyses. The estimated prevalence of HAND, ANI, MND and HAD were 44.9% (95% CI 37.4-52.7%), 26.2% (95% CI 20.7-32.7%), 8.5% (95% CI 5.6-12.7%), 2.1% (95% CI 1.2-3.7%), respectively. Factors associated with HAND were percent female, current CD4 count, education level and country development level (all ps < 0.05). Conclusion: Longitudinal cohort and multimodal neuroimaging studies are needed to verify the clinical prognosis and the underlying neurocognitive mechanism of HAND. In addition, it is urgently necessary to establish a standardized HAND diagnostic process.
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Affiliation(s)
- Jiaqi Wei
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Jianhua Hou
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Bin Su
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Taiyi Jiang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Caiping Guo
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Wen Wang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yang Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Biru Chang
- Research Institute for International and Comparative Education, Shanghai Normal University, Shanghai, China.,Department of Psychology, Shanghai Normal University, Shanghai, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
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Rubin LH, Saylor D, Nakigozi G, Nakasujja N, Robertson K, Kisakye A, Batte J, Mayanja R, Anok A, Lofgren SM, Boulware DR, Dastgheyb R, Reynolds SJ, Quinn TC, Gray RH, Wawer MJ, Sacktor N. Heterogeneity in neurocognitive change trajectories among people with HIV starting antiretroviral therapy in Rakai, Uganda. J Neurovirol 2019; 25:800-813. [PMID: 31218522 DOI: 10.1007/s13365-019-00768-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/03/2019] [Accepted: 05/21/2019] [Indexed: 12/13/2022]
Abstract
Considerable heterogeneity exists in patterns of neurocognitive change in people with HIV (PWH). We examined heterogeneity in neurocognitive change trajectories from HIV diagnosis to 1-2 years post-antiretroviral therapy (ART). In an observational cohort study in Rakai, Uganda, 312 PWH completed a neuropsychological (NP) test battery at two-time points (ART-naïve, 1-2 years post-ART initiation). All NP outcomes were used in a latent profile analysis to identify subgroups of PWH with similar ART-related neurocognitive change profiles. In a subset, we examined subgroup differences pre-ART on cytokine and neurodegenerative biomarkers CSF levels. We identified four ART-related change subgroups: (1) decline-only (learning, memory, fluency, processing speed, and attention measures), (2) mixed (improvements in learning and memory but declines in attention and executive function measures), (3) no-change, or (4) improvement-only (learning, memory, and attention measures). ART-related NP outcomes that are most likely to change included learning, memory, and attention. Motor function measures were unchanged. Subgroups differed on eight of 34 pre-ART biomarker levels including interleukin (IL)-1β, IL-6, IL-13, interferon-γ, macrophage inflammatory protein-1β, matrix metalloproteinase (MMP)-3, MMP-10, and platelet-derived growth factor-AA. The improvement-only and mixed subgroups showed lower levels on these markers versus the no-change subgroup. These findings provide support for the need to disentangle heterogeneity in ART-related neurocognitive changes, to focus on higher-order cognitive processes (learning, memory, attention) as they were most malleable to change, and to better understand why motor function remained unchanged despite ART treatment. Group differences in pre-ART CSF levels provide preliminary evidence of biological plausibility of neurocognitive phenotyping.
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Affiliation(s)
- Leah H Rubin
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Meyer 6-113, Baltimore, MD, 21287-7613, USA. .,Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA. .,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Deanna Saylor
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Meyer 6-113, Baltimore, MD, 21287-7613, USA
| | | | | | - Kevin Robertson
- Department of Neurology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | | | - James Batte
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | - Aggrey Anok
- Rakai Health Sciences Program, Kalisizo, Uganda
| | | | | | - Raha Dastgheyb
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Meyer 6-113, Baltimore, MD, 21287-7613, USA
| | - Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA.,Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Thomas C Quinn
- Division of Intramural Research, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD, USA.,Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ronald H Gray
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria J Wawer
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ned Sacktor
- Department of Neurology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street/Meyer 6-113, Baltimore, MD, 21287-7613, USA
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