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Paul O, Appiah-Brempong E, Singh A, Qanungo S, Donkor P, Mock C. Prevalence and risk factors for Alzheimer's disease and related dementias in Ghana: Evidence from a cross-sectional population-based study. COGENT PUBLIC HEALTH 2024; 11:2354393. [PMID: 39049873 PMCID: PMC11263803 DOI: 10.1080/27707571.2024.2354393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 05/08/2024] [Indexed: 07/27/2024]
Abstract
Alzheimer's disease and Related Dementia (ADRD) is a growing concern for low- and middle-income countries. Yet, studies on the prevalence and risk factors for dementia in sub-Saharan Africa are limited. This study estimated the prevalence and identified the risk factors for ADRD in Ghana. A cross-sectional design involving 384 participants aged 60 years or more completed the Brief Community Screening Instrument for Dementia (CSID) with an additional set of questions on risk factors. The prevalence of dementia was 16% (62/384). Age (AOR = 1.031 (95% CI 1.002-1.061, p=0.035), education (AOR = 0.689 (95% CI 0.517-0.919, p=0.011), and employment (AOR = 0.320 (95% CI 0.149-0.685, p=0.004) were associated with dementia. Also, "experience of stressful life event from age 16-64" (AOR = 1.325 (95% CI 1.034-1.698, p=0.024), "experience of stressful life event from age 65+" (AOR = 1.258 (95% CI 1.024-1.546, p=0.042), and "activities of daily living" (AOR = 0.925 (95% CI 0.868-0.986, p=0.037) identified as risk factors of dementia. The burden of ADRD was high. Urgent actions are needed to address this problem. There is a possibility that the burden of dementia may have been overestimated because of the study instrument. Findings should be interpreted in light of this limitation.
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Affiliation(s)
- Okyere Paul
- Department of Health Promotion and Disability Studies, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana
| | - Emmanuel Appiah-Brempong
- Department of Health Promotion and Disability Studies, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana
| | - Arti Singh
- Department of Epidemiology and Biostatistics, Kwame Nkrumah University of Science and Technology, Kumasi-Ghana
| | - Suparna Qanungo
- Department of Nursing, Medical University of South Carolina, United States
| | - Peter Donkor
- Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi -Ghana
| | - Charles Mock
- Harborview Injury Prevention and Research Center, University of Washington, Seattle – United States
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2
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Kalaria R, Maestre G, Mahinrad S, Acosta DM, Akinyemi RO, Alladi S, Allegri RF, Arshad F, Babalola DO, Baiyewu O, Bak TH, Bellaj T, Brodie‐Mends DK, Carrillo MC, Celestin K, Damasceno A, de Silva RK, de Silva R, Djibuti M, Dreyer AJ, Ellajosyula R, Farombi TH, Friedland RP, Garza N, Gbessemehlan A, Georgiou EE, Govia I, Grinberg LT, Guerchet M, Gugssa SA, Gumikiriza‐Onoria JL, Hogervorst E, Hornberger M, Ibanez A, Ihara M, Issac TG, Jönsson L, Karanja WM, Lee JH, Leroi I, Livingston G, Manes FF, Mbakile‐Mahlanza L, Miller BL, Musyimi CW, Mutiso VN, Nakasujja N, Ndetei DM, Nightingale S, Novotni G, Nyamayaro P, Nyame S, Ogeng'o JA, Ogunniyi A, de Oliveira MO, Okubadejo NU, Orrell M, Paddick S, Pericak‐Vance MA, Pirtosek Z, Potocnik FCV, Raman R, Rizig M, Rosselli M, Salokhiddinov M, Satizabal CL, Sepulveda‐Falla D, Seshadri S, Sexton CE, Skoog I, George‐Hyslop PHS, Suemoto CK, Thapa P, Udeh‐Momoh CT, Valcour V, Vance JM, Varghese M, Vera JH, Walker RW, Zetterberg H, Zewde YZ, Ismail O. The 2022 symposium on dementia and brain aging in low- and middle-income countries: Highlights on research, diagnosis, care, and impact. Alzheimers Dement 2024; 20:4290-4314. [PMID: 38696263 PMCID: PMC11180946 DOI: 10.1002/alz.13836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 05/04/2024]
Abstract
Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.
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Grants
- P30AG066506 National Institute of Aging (NIA)
- P01 HD035897 NICHD NIH HHS
- R13 AG066391 NIA NIH HHS
- International Society for Neurochemistry
- National Council for Scientific and Technological Development
- R01 AG075775 NIA NIH HHS
- Bluefield Project, the Olav Thon Foundation, the Erling-Persson Family Foundation, Stiftelsen för Gamla Tjänarinnor, Hjärnfonden, Sweden
- U19 AG074865 NIA NIH HHS
- UH3 NS100605 NINDS NIH HHS
- R01AG072547 Multi partner Consortium for Dementia Research in Latino America-Dominican Republic (LATAM-FINGERS)
- ASP/06/RE/2012/18 University of Sri Jayewardenepura, Sri Lanka
- D43 TW011532 FIC NIH HHS
- UF1 NS125513 NINDS NIH HHS
- 2019-02397 Swedish Research Council
- FLR/R1/191813 UK Royal Society/African Academy of Sciences
- R01 AG054076 NIA NIH HHS
- GOK: Government of Karnataka
- R56 AG074467 NIA NIH HHS
- R21 AG069252 NIA NIH HHS
- RF1 AG059421 NIA NIH HHS
- R56 AG061837 NIA NIH HHS
- Global Brain Health Institute (GBHI)
- 1R01AG068472-01 National Institute of Aging (NIA)
- FCG/R1/201034 UK Royal Society/African Academy of Sciences
- Appel à Projet des Equipes Émergentes et Labellisées scheme (APREL)
- Alzheimer's Drug Discovery Foundation (ADDF)
- R01 AG062588 NIA NIH HHS
- 1R01AG070883 University of Wisconsin, Madison
- U01 HG010273 NHGRI NIH HHS
- R25 TW011214 FIC NIH HHS
- ASP/06/RE/2013/28 University of Sri Jayewardenepura, Sri Lanka
- R01 AG052496 NIA NIH HHS
- R01 AG080468 NIA NIH HHS
- RBM: Rotary Bangalore Midtown
- U19 AG068054 NIA NIH HHS
- ADSF-21-831376-C Alzheimer Drug Discovery Foundation
- ADSF-21-831377-C Alzheimer Drug Discovery Foundation
- Canadian Institute of Health Research
- U19 AG078558 NIA NIH HHS
- 1P30AG066546-01A1 National Institutes of Health (NIH)
- RF1 AG059018 NIA NIH HHS
- National Research Foundation (NRF)
- P30 AG062422 NIA NIH HHS
- LSIPL: M/s Lowes Services India Private Limited
- UKDRI-1003 UK Dementia Research Institute at UCL
- U19AG074865 Multi partner Consortium for Dementia Research in Latino America-Dominican Republic (LATAM-FINGERS)
- P01 AG019724 NIA NIH HHS
- National Institute for Health and Care Research, United Kingdom
- R01 AG066524 NIA NIH HHS
- RF1 AG063507 NIA NIH HHS
- WCUP/Ph.D./19B 2013 University of Sri Jayewardenepura (USJ), Sri Lanka
- WCUP/Ph.D./19/2013 University of Sri Jayewardenepura (USJ), Sri Lanka
- GBHI ALZ UK-21-724359 Pilot Award for Global Brain Health Leaders
- R01AG080468-01 National Institute of Aging (NIA)
- U01 AG058589 NIA NIH HHS
- R01 AG057234 NIA NIH HHS
- SP/CIN/2016/02) Ministry of Primary Industries, Sri Lanka
- R01 AG072547 NIA NIH HHS
- U01 AG051412 NIA NIH HHS
- P30 AG059305 NIA NIH HHS
- Alzheimer's Association, USA
- R35 AG072362 NIA NIH HHS
- R01 NS050915 NINDS NIH HHS
- P30 AG066546 NIA NIH HHS
- 2022-01018 Swedish Research Council
- U19 AG063893 NIA NIH HHS
- ALFGBG-71320 Swedish State Support for Clinical Research
- U01 AG052409 NIA NIH HHS
- 1R13AG066391-01 National Institutes of Health (NIH)
- R01 AG21051 NIH and the Fogarty International Center [FIC]
- DP1AG069870 National Institutes of Health (NIH)
- Marie Skłodowska-Curie
- U19 AG078109 NIA NIH HHS
- Chinese Neuroscience Society, China
- RF1 AG061872 NIA NIH HHS
- DP1 AG069870 NIA NIH HHS
- P30 AG066506 NIA NIH HHS
- Wellcome Trust
- U01HG010273 Multi partner Consortium for Dementia Research in Latino America-Dominican Republic (LATAM-FINGERS)
- JPND2021-00694 European Union Joint Programme - Neurodegenerative Disease Research
- ASP/06/RE/2010/07 University of Sri Jayewardenepura, Sri Lanka
- Rainwater Charitable Foundation - The Bluefield project to cure FTD, and Global Brain Health Institute
- 101053962 European Union's Horizon Europe
- R01 AG058464 NIA NIH HHS
- R01 AG068472 NIA NIH HHS
- Michael J. Fox Foundation for Parkinson's Research, USA
- UL1 TR001873 NCATS NIH HHS
- SG-21-814756 National Institutes of Health (NIH)
- 201809-2016862 Alzheimer Drug Discovery Foundation
- UK National Health Service, Newcastle University,
- R01 AG058918 NIA NIH HHS
- National Institute for Health and Care Research University College London Hospitals Biomedical Research Centre
- Wellcome Trust, UK
- ADSF-21-831381-C Alzheimer Drug Discovery Foundation
- Health Professionals Education Partnership Initiative Ethiopia
- ANR-09-MNPS-009-01 French National Research Agency
- R01 AG062562 NIA NIH HHS
- AXA Research Fund
- ICMR: Indian Council for Medical Research
- R01 AG070883 NIA NIH HHS
- International Society for Neurochemistry
- French National Research Agency
- AXA Research Fund
- National Center for Advancing Translational Sciences
- National Council for Scientific and Technological Development
- Swedish Research Council
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Affiliation(s)
- Raj Kalaria
- Translational and Clinical Research InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Gladys Maestre
- Departments of Neuroscience and Human GeneticsUniversity of Texas Rio Grande ValleyOne W. University BlvdBrownsvilleTexasUSA
| | - Simin Mahinrad
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Daisy M. Acosta
- Universidad Nacional Pedro Henriquez Urena (UNPHU)Santo DomingoDominican Republic
| | - Rufus Olusola Akinyemi
- Neuroscience and Ageing Research UnitInstitute for Advanced Medical Research and TrainingCollege of MedicineUniversity of IbadanIbadanOyoNigeria
| | - Suvarna Alladi
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBengaluruKarnatakaIndia
| | - Ricardo F. Allegri
- Fleni Neurological InstituteBuenos AiresArgentina
- Department of NeurosciencesUniversidad de la Costa (CUC)BarranquillaColombia
| | - Faheem Arshad
- Department of NeurologyNational Institute of Mental Health and NeurosciencesBengaluruKarnatakaIndia
| | | | | | | | | | | | - Maria C. Carrillo
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Kaputu‐Kalala‐Malu Celestin
- Department of NeurologyCentre Neuropsychopathologique (CNPP)Kinshasa University Teaching HospitalUniversity of KinshasaKinshasaRepublic Democratic of the Congo
| | | | - Ranil Karunamuni de Silva
- Interdisciplinary Centre for Innovation in Biotechnology and NeuroscienceFaculty of Medical SciencesUniversity of Sri JayewardenepuraNugegodaSri Lanka
- Institute for Combinatorial Advanced Research and Education (KDU‐CARE)General Sir John Kotelawala Defence UniversityRatmalanaSri Lanka
| | - Rohan de Silva
- Reta Lila Weston Institute and Department of ClinicalMovement NeuroscienceUCL Queen Square Institute of NeurologyLondonUK
| | - Mamuka Djibuti
- Partnership for Research and Action for Health (PRAH)TbilisiGeorgia
| | | | - Ratnavalli Ellajosyula
- Cognitive Neurology ClinicManipal Hospitaland Annasawmy Mudaliar HospitalBengaluruKarnatakaIndia
- Manipal Academy of Higher Education (MAHE)ManipalKarnatakaIndia
| | | | | | - Noe Garza
- Department of Neuroscience and Human GeneticsUniversity of Texas Rio Grande ValleyHarlingenTexasUSA
| | - Antoine Gbessemehlan
- Inserm U1094, IRD U270University of LimogesCHU Limoges, EpiMaCT ‐ Epidemiology of Chronic Diseases in Tropical ZoneInstitute of Epidemiology and Tropical NeurologyOmegaHealthLimogesFrance
- Inserm, Bordeaux Population Health Research CenterUniversity of BordeauxBordeauxFrance
| | - Eliza Eleni‐Zacharoula Georgiou
- Department of PsychiatryPatras University General HospitalFaculty of Medicine, School of Health SciencesUniversity of PatrasPatrasGreece
| | - Ishtar Govia
- Caribbean Institute for Health ResearchThe University of the West Indies, JamaicaWest IndiesJamaica
- Institute for Global HealthUniversity College LondonLondonUK
| | - Lea T. Grinberg
- Department of Neurology and PathologyUniversity of California San FranciscoSan FranciscoCaliforniaUSA
- Department of PathologyUniversity of Sao PauloR. da Reitoria, R. Cidade UniversitáriaSão PauloSao PauloBrazil
| | - Maëlenn Guerchet
- Inserm U1094, IRD U270University of LimogesCHU Limoges, EpiMaCT ‐ Epidemiology of Chronic Diseases in Tropical ZoneInstitute of Epidemiology and Tropical NeurologyOmegaHealthLimogesFrance
| | - Seid Ali Gugssa
- Department of NeurologySchool of MedicineAddis Ababa UniversityAddis AbabaEthiopia
| | | | - Eef Hogervorst
- Loughborough UniversityLoughboroughUK
- Respati UniversityYogyakartaIndonesia
| | | | - Agustin Ibanez
- Latin American Institute for Brain Health (BrainLat)Universidad Adolfo IbanezPeñalolénSantiagoChile
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Cognitive Neuroscience Center (CNC)Universidad de San Andrés, and National Scientific and Technical Research Council (CONICET)VictoriaProvincia de Buenos AiresArgentina
| | - Masafumi Ihara
- Department of NeurologyNational Cerebral and Cardiovascular CenterSuitaOsakaJapan
| | - Thomas Gregor Issac
- Centre for Brain ResearchIndian Institute of Science (IISc)BengaluruKarnatakaIndia
| | - Linus Jönsson
- Department of NeurobiologyCare Science and Society, section for NeurogeriatricsKarolinska Institute, SolnavägenSolnaSweden
| | - Wambui M. Karanja
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Brain and Mind InstituteAga Khan UniversityNairobiKenya
| | - Joseph H. Lee
- Sergievsky CenterTaub Institute for Research on Alzheimer's Disease and the Aging BrainDepartments of Neurology and EpidemiologyColumbia UniversityNew YorkNew YorkUSA
| | - Iracema Leroi
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
| | | | - Facundo Francisco Manes
- Institute of Cognitive and Translational Neuroscience (INCYT)INECO FoundationFavaloro UniversityBuenos AiresArgentina
| | - Lingani Mbakile‐Mahlanza
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- University of BotswanaGaboroneBotswana
| | - Bruce L. Miller
- Department of NeurologyMemory and Aging CenterUniversity of California San Francisco Weill Institute for NeurosciencesSan FranciscoCaliforniaUSA
| | | | - Victoria N. Mutiso
- Africa Mental Health Research and Training FoundationNairobiKenya
- Department of PsychiatryUniversity of NairobiNairobiKenya
- World Psychiatric Association Collaborating Centre for Research and TrainingNairobiKenya
| | | | - David M. Ndetei
- Africa Mental Health Research and Training FoundationNairobiKenya
- Department of PsychiatryUniversity of NairobiNairobiKenya
- World Psychiatric Association Collaborating Centre for Research and TrainingNairobiKenya
| | - Sam Nightingale
- Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - Gabriela Novotni
- University Clinic of NeurologyMedical Faculty University Ss Cyril and Methodius Institute for Alzheimer's Disease and NeuroscienceSkopjeNorth Macedonia
| | - Primrose Nyamayaro
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Faculty of Medicine and Health SciencesUniversity of ZimbabweHarareZimbabwe
| | - Solomon Nyame
- Kintampo Health Research CentreGhana Health ServiceHospital RoadNear Kintampo‐north Municipal HospitalKintampoGhana
| | | | | | - Maira Okada de Oliveira
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
- Department of Psychiatry at Massachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
- Cognitive Neurology and Behavioral Unit (GNCC)University of Sao PauloR. da Reitoria, R. Cidade UniversitáriaSão PauloSao PauloBrazil
| | - Njideka U. Okubadejo
- Neurology UnitDepartment of MedicineFaculty of Clinical SciencesCollege of MedicineUniversity of LagosYabaLagosNigeria
| | - Martin Orrell
- Institute of Mental HealthUniversity of NottinghamNottinghamUK
| | - Stella‐Maria Paddick
- Newcastle UniversityNewcastle upon TyneUK
- Gateshead Health NHS Foundation TrustSheriff HillTyne and WearUK
| | - Margaret A. Pericak‐Vance
- John P Hussman Institute for Human GenomicsMiller School of MedicineUniversity of MiamiCoral GablesFloridaUSA
- Dr. John T Macdonald Foundation Department of Human GeneticsUniversity of Miami Miller School of MedicineCoral GablesFloridaUSA
| | - Zvezdan Pirtosek
- Faculty of MedicineUniversity Medical Centre LjubljanaLjubljanaSlovenia
| | - Felix Claude Victor Potocnik
- Old Age Psychiatry Unit, Depth PsychiatryStellenbosch UniversityWestern Cape, Stellenbosch CentralStellenboschSouth Africa
| | - Rema Raman
- Alzheimer's Therapeutic Research InstituteUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mie Rizig
- Department of Neuromuscular DiseasesUCL Queen Square Institute of NeurologyQueen SquareLondonUK
| | - Mónica Rosselli
- Department of PsychologyCharles E. Schmidt College of ScienceFlorida Atlantic UniversityBoca RatonFloridaUSA
- Florida Alzheimer's Disease Research CenterGainesvilleFloridaUSA
| | | | - Claudia L. Satizabal
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative DiseasesUniversity of Texas Health Sciences CenterSan AntonioTexasUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyFraminghamMassachusettsUSA
| | - Diego Sepulveda‐Falla
- Molecular Neuropathology of Alzheimer's DiseaseInstitute of NeuropathologyUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases and South Texas ADRCUT Health San AntonioSan AntonioTexasUSA
- University of Texas Health Sciences CenterSan AntonioTexasUSA
| | - Claire E. Sexton
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
| | - Ingmar Skoog
- Institute of Neuroscience and FysiologySahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Peter H. St George‐Hyslop
- Taub Institute for Research on Alzheimer's Disease and the Aging BrainDepartment of NeurologyColumbia University Irving Medical CenterNew YorkNew YorkUSA
- Cambridge Institute for Medical Research and Department of Clinical NeurosciencesSchool of Clinical MedicineUniversity of CambridgeAddenbrookes Biomedical CampusTrumpingtonCambridgeUK
- Department of Medicine (Neurology)Temerty Faculty of MedicineUniversity of Torontoand University Health Network27 King's College CirTorontoOntarioCanada
| | - Claudia Kimie Suemoto
- Division of GeriatricsUniversity of Sao Paulo Medical SchoolR. da Reitoria, R. Cidade UniversitáriaSão PauloSao PauloBrazil
| | - Prekshy Thapa
- Global Brain Health Institute (GBHI)Trinity College DublinLloyd Building Trinity College DublinDublinIreland
| | - Chinedu Theresa Udeh‐Momoh
- Global Brain Health Institute (GBHI)University California San Francisco (UCSF)San FranciscoCaliforniaUSA
- FINGERS Brain Health Institutec/o Stockholms SjukhemStockholmSweden
- Department of Epidemiology and PreventionWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
- Department of NeurobiologyCare Sciences and Society (NVS)Division of Clinical GeriatricsKarolinska Institute, SolnavägenSolnaSweden
- Imarisha Centre for Brain health and AgingBrain and Mind InstituteAga Khan UniversityNairobiKenya
| | - Victor Valcour
- Memory and Aging CenterDepartment of NeurologyUniversity of CaliforniaSan FranciscoCaliforniaUSA
| | - Jeffery M. Vance
- John P Hussman Institute for Human GenomicsMiller School of MedicineUniversity of MiamiCoral GablesFloridaUSA
| | - Mathew Varghese
- St. John's Medical CollegeSarjapur ‐ Marathahalli Rd, beside Bank Of Baroda, John Nagar, KoramangalaBengaluruKarnatakaIndia
| | - Jaime H. Vera
- Department of Global Health and InfectionBrighton and Sussex Medical SchoolBrightonUK
| | - Richard W. Walker
- Population Health Sciences InstituteNewcastle UniversityNewcastle upon TyneUK
| | - Henrik Zetterberg
- Department of Psychiatry and NeurochemistryInstitute of Neuroscience and Physiologythe Sahlgrenska Academy at the University of GothenburgGöteborgSweden
- Clinical Neurochemistry LaboratorySahlgrenska University HospitalMölndalSweden
- Department of Neurodegenerative DiseaseUCL Institute of NeurologyQueen Square, Queen SquareLondonUK
- UK Dementia Research Institute at UCLUniversity College LondonLondonUK
- Hong Kong Center for Neurodegenerative DiseasesClear Water BayHong KongChina
- Wisconsin Alzheimer's Disease Research CenterUniversity of Wisconsin School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Yared Z. Zewde
- Department of NeurologySchool of MedicineAddis Ababa UniversityAddis AbabaEthiopia
| | - Ozama Ismail
- Division of Medical and Scientific RelationsAlzheimer's AssociationChicagoIllinoisUSA
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Flack KA, Rainey ES, Urasa SJ, Koipapi S, Kalaria RN, Howlett WP, Mukaetova-Ladinska EB, Dekker MCJ, Gray WK, Walker RW, Dotchin CL, Mtwaile H, Lewis TCD, Stone LG, McNally RJQ, Makupa PC, Paddick SM. Lack of Association of Vascular Risk Factors with HIV-Associated Neurocognitive Disorders in cART-Treated Adults Aged ≥ 50 Years in Tanzania. Viruses 2024; 16:819. [PMID: 38932112 PMCID: PMC11209468 DOI: 10.3390/v16060819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 05/07/2024] [Accepted: 05/16/2024] [Indexed: 06/28/2024] Open
Abstract
HIV-associated neurocognitive disorders (HAND) are highly prevalent in those ageing with HIV. High-income country data suggest that vascular risk factors (VRFs) may be stronger predictors of HAND than HIV-disease severity, but data from sub-Saharan Africa are lacking. We evaluated relationships of VRFs, vascular end-organ damage and HAND in individuals aged ≥ 50 in Tanzania. c-ART-treated individuals were assessed for HAND using consensus criteria. The prevalence of VRFs and end organ damage markers were measured. The independent associations of VRFs, end organ damage and HAND were examined using multivariable logistic regression. Data were available for 153 individuals (median age 56, 67.3% female). HAND was highly prevalent (66.7%, 25.5% symptomatic) despite well-managed HIV (70.5% virally suppressed). Vascular risk factors included hypertension (34%), obesity (10.5%), hypercholesterolemia (33.3%), diabetes (5.3%) and current smoking (4.6%). End organ damage prevalence ranged from 1.3% (prior myocardial infarction) to 12.5% (left ventricular hypertrophy). Measured VRFs and end organ damage were not independently associated with HAND. The only significant association was lower diastolic BP (p 0.030, OR 0.969 (0.943-0.997). Our results suggest that vascular risk factors are not major drivers of HAND in this setting. Further studies should explore alternative aetiologies such as chronic inflammation.
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Affiliation(s)
- Katherine A. Flack
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Emma S. Rainey
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - Sarah J. Urasa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Sengua Koipapi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Rajesh N. Kalaria
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - William P. Howlett
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - Elizabeta B. Mukaetova-Ladinska
- Department of Neuroscience, Behaviour and Psychology, University of Leicester, Leicester LE1 7HA, UK
- The Evington Centre, Leicester General Hospital, Leicester LE5 4QF, UK
| | - Marieke C. J. Dekker
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro PO Box 2240, Tanzania
| | - William K. Gray
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Richard W. Walker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Catherine L. Dotchin
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields NE29 8NH, UK
| | - Himidi Mtwaile
- Department of Radiology, NSK Hospital, Arusha P.O. Box 3114, Tanzania
| | - Thomas C. D. Lewis
- Department of Old Age Psychiatry, Cumbria Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne NE4 6BE, UK
| | - Lydia G. Stone
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | | | - Philip C. Makupa
- HIV Care and Treatment Centre (CTC), Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro P.O Box 3054, Tanzania
| | - Stella-Maria Paddick
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
- Department of Old Age Psychiatry, Gateshead Health NHS Foundation Trust, Gateshead NE8 4YL, UK
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4
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Prynn JE, Davey C, Davis D, Kuper H, Mugisha J, Seeley J. Cognition in older adults in Uganda: Correlates, trends over time and association with mortality in prospective population study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001798. [PMID: 37922221 PMCID: PMC10624290 DOI: 10.1371/journal.pgph.0001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 09/11/2023] [Indexed: 11/05/2023]
Abstract
Dementia is an important and growing issue in sub-Saharan Africa, but epidemiological data are lacking. Risk factors may differ from other regions due to high stroke incidence and HIV prevalence. Understanding the epidemiology of cognition in older adults in Africa is crucial for informing public health strategies to improve the lives of people with dementia and their carers. The Wellbeing of Older People Study in Uganda is an open cohort of adults aged 50+ with and without HIV, established in 2009. Detailed socio-demographic and health data have been collected at four waves spanning 10 years, including cognitive assessment using internationally validated WHO-recommended tests: verbal recall, digit span, and verbal fluency. Mortality data was collected until the end of the fourth wave (2019). We examined associations of low baseline cognition scores and changes in cognition score over time using random effects modelling, care needs of people with lower cognition scores, and the relationship between cognition score and mortality. Data were collected on 811 participants. Older age, lower educational attainment, lower socio-economic position, and extremes of BMI were associated with lower cognition scores. Cognition scores declined faster at older ages, but rate of decline was not associated with cardiovascular disease or HIV at baseline. People with lower cognition scores required more assistance with Activities of Daily Living, but mortality rates were similar across the range of cognition scores. The crucial next step will be to investigate types and presentation of clinical dementia in this cohort, so we can better understand the clinical relevance of these findings to inform public health planning.
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Affiliation(s)
- Josephine E. Prynn
- Institute of Cardiovascular Sciences, University College London, London, United Kingdom
| | - Calum Davey
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Davis
- MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom
| | - Hannah Kuper
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Janet Seeley
- MRC/UVRI & LSHTM Uganda Research Unit, Entebbe, Uganda
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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5
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Britton GB, Huang L, Villarreal AE, Levey A, Philippakis A, Hu C, Yang CC, Mushi D, Oviedo DC, Rangel G, Ho JS, Thompson L, Khemakhem M, Ross M, Carreira MB, Kim N, Joung P, Albastaki O, Kuo PC, Low S, Paddick S, Kuan Y, Au R. Digital phenotyping: An equal opportunity approach to reducing disparities in Alzheimer's disease and related dementia research. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12495. [PMID: 38034851 PMCID: PMC10687344 DOI: 10.1002/dad2.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/12/2023] [Accepted: 09/25/2023] [Indexed: 12/02/2023]
Abstract
A rapidly aging world population is fueling a concomitant increase in Alzheimer's disease (AD) and related dementias (ADRD). Scientific inquiry, however, has largely focused on White populations in Australia, the European Union, and North America. As such, there is an incomplete understanding of AD in other populations. In this perspective, we describe research efforts and challenges of cohort studies from three regions of the world: Central America, East Africa, and East Asia. These cohorts are engaging with the Davos Alzheimer's Collaborative (DAC), a global partnership that brings together cohorts from around the world to advance understanding of AD. Each cohort is poised to leverage the widespread use of mobile devices to integrate digital phenotyping into current methodologies and mitigate the lack of representativeness in AD research of racial and ethnic minorities across the globe. In addition to methods that these three cohorts are already using, DAC has developed a digital phenotyping protocol that can collect ADRD-related data remotely via smartphone and/or in clinic via a tablet to generate a common data elements digital dataset that can be harmonized with additional clinical and molecular data being collected at each cohort site and when combined across cohorts and made accessible can provide a global data resource that is more racially/ethnically represented of the world population.
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Affiliation(s)
- Gabrielle B. Britton
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP)Panamá CityPanama
- Universidad Santa María La Antigua, Vía Ricardo J. AlfaroPanamá CityPanama
| | - Li‐Kai Huang
- Taipei Medical University Shuang‐Ho HospitalTaipeiTaiwan
| | - Alcibiades E. Villarreal
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP)Panamá CityPanama
| | - Allan Levey
- Emory University School of MedicineAtlantaGeorgiaUSA
| | - Anthony Philippakis
- Broad Institute at Massachusetts Institute of Technology and Harvard UniversityCambridgeMassachusettsUSA
| | - Chaur‐Jong Hu
- Taipei Medical University Shuang‐Ho HospitalTaipeiTaiwan
| | | | - Declare Mushi
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Diana C. Oviedo
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP)Panamá CityPanama
- Universidad Santa María La Antigua, Vía Ricardo J. AlfaroPanamá CityPanama
| | - Giselle Rangel
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP)Panamá CityPanama
| | - Jor Sam Ho
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Louisa Thompson
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | | | - Makayla Ross
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - María B. Carreira
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP)Panamá CityPanama
| | - Nicole Kim
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
| | - Philip Joung
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
| | | | - Po Chih Kuo
- National Tsing Hua University, East DistrictHsinChuTaiwan
| | - Spencer Low
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
- Boston University School of Public HealthBostonMassachusettsUSA
- Boston University Chobanian and Avedisian School of MedicineBostonMassachusettsUSA
- Boston University Alzheimer's Disease CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | | | - Yi‐Chun Kuan
- Taipei Medical University Shuang‐Ho HospitalTaipeiTaiwan
| | - Rhoda Au
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
- Boston University School of Public HealthBostonMassachusettsUSA
- Boston University Chobanian and Avedisian School of MedicineBostonMassachusettsUSA
- Boston University Alzheimer's Disease CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine, Boston University School of Public HealthFraminghamMassachusettsUSA
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6
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Onohuean H, Akiyode AO, Akiyode O, Igbinoba SI, Alagbonsi AI. Epidemiology of neurodegenerative diseases in the East African region: A meta-analysis. Front Neurol 2022; 13:1024004. [PMID: 36468051 PMCID: PMC9718573 DOI: 10.3389/fneur.2022.1024004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 10/18/2022] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION There is a scarcity of epidemiological data on neurodegenerative diseases (NDs) in East Africa. This meta-analysis provides the regional prevalence of NDs, their contributing factors, and evidence of change over time concerning gender per age or year. METHODS Articles were retrieved from electronic databases following the PRISMA standard. RESULTS Forty-two studies were reviewed, and 25 were meta-analyzed with a random-effects model. The pool estimate proportion of 15.27%, 95% CI (0.09-0.23) (I2 = 98.25%), (Q = 1,369.15, p < 0.0001) among a population of 15,813 male/female and 1,257 with NDs. Epidemiological characteristics associated with NDs include Dyskinesias prevalence 55.4%, 95% CI (13.5; 90.9), I2 (96%) and subsistence farming prevalence 11.3%, 95% CI (5.8; 20.9), I2 (99%). Publication bias by Egger test was (z = 4.1913, p < 0.0001), while rank correlation test using Kendall's model was (tau = 0.1237, p = 0.3873). Heterogeneity (R2 design = 5.23%, p design < 0.0001; R2 size = 52.163%, p size < 0.001; and R2 period = 48.13, p period < 0.0001. Covariates (R2 design + size + period = 48.41%, p < 0.001). CONCLUSION There is a high prevalence of NDs in the East African region, which could impact life expectancy, morbidity, and quality of life. Thus, early screening and regular surveillance could assist in management strategies.
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Affiliation(s)
- Hope Onohuean
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University Western Campus, Ishaka, Uganda
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
| | - Abraham Olutumininu Akiyode
- Department of Biology, College of Arts and Sciences, University of Texas of the Permian Odessa, TX, United States
| | - Oluwole Akiyode
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
- Biological and Environmental Sciences Department, Kampala International University, Kampala, Uganda
| | - Sharon Iyobor Igbinoba
- Biopharmaceutics Unit, Department of Pharmacology and Toxicology, Kampala International University Western Campus, Ishaka, Uganda
- Biomolecules, Metagenomics, Endocrine and Tropical Disease Research Group (BMETDREG), Kampala International University Western Campus, Ishaka, Uganda
- Department of Clinical Pharmacy and Pharmacy Administration, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Abdullateef Isiaka Alagbonsi
- Department of Clinical Biology (Physiology Unit), School of Medicine and Pharmacy, College of Medicine and Health Sciences, University of Rwanda, Huye, Rwanda
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Walker R. Osuntokun Award Lecture 2021: Challenges of Measuring the Burden of Stroke in Africa. J Stroke Cerebrovasc Dis 2022; 31:106386. [PMID: 35317913 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Over recent years non-communicable diseases have dramatically increased in low- and middle-income countries, including those of sub-Saharan Africa. With continuing high levels of infectious disease, these countries now face the double burden of disease. Stroke has emerged as a major cause of hospital admission, disability, and mortality for which the major modifiable risk factor is hypertension, which is often not diagnosed and, even if diagnosed, not treated and, even if treated, not controlled. METHODS In this award lecture paper I outline my personal experience of measuring the burden of, and risk factors for, stroke in sub-Saharan Africa, along with the challenges faced. I will specifically describe the measurement of mortality and case fatality, prevalence and incidence as well as commenting on aetiology and risk factors and reflect on future initiatives and directions. RESULTS Over the past 5 decades there has been a dramatic increase in numbers of stroke patients admitted to hospital throughout sub-Saharan Africa, with high in hospital mortality rates, also reflected in high case fatality rates in those cohorts followed up following discharge from hospital. Community-based surveys assessing mortality from stroke using verbal autopsy have demonstrated very high age-adjusted rates. Age adjusted prevalence rates assessed by door-to-door surveys have generally shown lower prevalence than high income countries. The Tanzanian stroke incidence study, which incorporated verbal autopsy for those patients dying before reaching hospital, demonstrated some of the highest age-adjusted stroke incidence rates in the world. There were high rates of stroke in younger ages and high rates of intracranial haemorrhage though not as high as previously shown in hospital-based studies. Hypertension is the main modifiable risk factor but other risk factors such as HIV are important while, certainly in rural populations, raised cholesterol remains rare as does carotid artery stenosis and history of transient ischemic attack. Other vascular disease such as ischemic heart disease and peripheral vascular disease is also less common. CONCLUSIONS There is already a large burden relating to stroke in sub-Saharan Africa and this will only escalate further as the population ages. Hypertension is the biggest risk factor for mortality worldwide and in sub-Saharan Africa prevalence rates are very high with the majority of people suffering with stroke not being diagnosed with their hypertension prior to their stroke. The most important challenge is to improve primary prevention for which improving diagnosis and control rates for hypertension is the number one priority. For those who do have stroke there is a need to increase the number of suitably staffed stroke units as these have been shown to have a very large impact on improving both mortality and morbidity in high income countries. There are still many unanswered questions and a need for more research throughout sub-Saharan Africa on risk factors, and treatment, for stroke.
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Affiliation(s)
- Richard Walker
- Northumbria Healthcare NHS Foundation Trust, UK; Population Health Sciences Institute, Newcastle University, UK.
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8
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Akinyemi RO, Yaria J, Ojagbemi A, Guerchet M, Okubadejo N, Njamnshi AK, Sarfo FS, Akpalu A, Ogbole G, Ayantayo T, Adokonou T, Paddick SM, Ndetei D, Bosche J, Ayele B, Damas A, Coker M, Mbakile-Mahlanza L, Ranchod K, Bobrow K, Anazodo U, Damasceno A, Seshadri S, Pericak-Vance M, Lawlor B, Miller BL, Owolabi M, Baiyewu O, Walker R, Gureje O, Kalaria RN, Ogunniyi A. Dementia in Africa: Current evidence, knowledge gaps, and future directions. Alzheimers Dement 2022; 18:790-809. [PMID: 34569714 PMCID: PMC8957626 DOI: 10.1002/alz.12432] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 12/19/2022]
Abstract
In tandem with the ever-increasing aging population in low and middle-income countries, the burden of dementia is rising on the African continent. Dementia prevalence varies from 2.3% to 20.0% and incidence rates are 13.3 per 1000 person-years with increasing mortality in parts of rapidly transforming Africa. Differences in nutrition, cardiovascular factors, comorbidities, infections, mortality, and detection likely contribute to lower incidence. Alzheimer's disease, vascular dementia, and human immunodeficiency virus/acquired immunodeficiency syndrome-associated neurocognitive disorders are the most common dementia subtypes. Comprehensive longitudinal studies with robust methodology and regional coverage would provide more reliable information. The apolipoprotein E (APOE) ε4 allele is most studied but has shown differential effects within African ancestry compared to Caucasian. More candidate gene and genome-wide association studies are needed to relate to dementia phenotypes. Validated culture-sensitive cognitive tools not influenced by education and language differences are critically needed for implementation across multidisciplinary groupings such as the proposed African Dementia Consortium.
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Affiliation(s)
- Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Joseph Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Akin Ojagbemi
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Maëlenn Guerchet
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Njideka Okubadejo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi Araba, Lagos, Nigeria
| | - Alfred K Njamnshi
- Department of Neurology, Yaoundé Central Hospital/Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
- Brain Research Africa Initiative (BRAIN), Geneva, Switzerland/Yaoundé, Cameroon
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School/Korle Bu Teaching Hospital, Accra, Ghana
| | - Godwin Ogbole
- Department of Radiology, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Temitayo Ayantayo
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Thierry Adokonou
- Department of Neurology, University Teaching Hospital, Parakou, Benin
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, UK/Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - David Ndetei
- Department of Psychiatry, University of Nairobi and African Meatal Health and Training Foundation, Nairobi, Kenya
| | - Judith Bosche
- Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Biniyam Ayele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andrea Damas
- Mirembe Mental Health Hospital, Dodoma, Tanzania
| | - Motunrayo Coker
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lingani Mbakile-Mahlanza
- Department of Psychology, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | - Kirti Ranchod
- Lufuno Neuropsychiatry Centre, Johannesburg, South Africa
| | - Kirsten Bobrow
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Udunna Anazodo
- Lawson Health Research Institute / Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Albertino Damasceno
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Margaret Pericak-Vance
- John T. Hussman Institute for Human Genomics and the Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brian Lawlor
- Global Brain Health Institute, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Bruce L Miller
- Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Mayowa Owolabi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Olusegun Baiyewu
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Richard Walker
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, North Tyneside General Hospital, North Shields, UK
| | - Oye Gureje
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rajesh N Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
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Olakehinde O, Adebiyi A, Siwoku A, Mkenda S, Paddick SM, Gray WK, Walker RW, Dotchin CL, Mushi D, Ogunniyi A. Managing dementia in rural Nigeria: feasibility of cognitive stimulation therapy and exploration of clinical improvements. Aging Ment Health 2019; 23:1377-1381. [PMID: 30246561 DOI: 10.1080/13607863.2018.1484883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: We investigated the feasibility and clinical impact of a psychosocial intervention, Cognitive Stimulation Therapy (CST), to help manage dementia in a rural setting in Nigeria. Method: People with dementia were identified from a prevalence study in Lalupon in the south-west of Nigeria. Prior to this feasibility study CST was adapted for the setting and pilot by our team. Fourteen sessions of CST were provided over a 7-week period by a trained nurse specialist and occupational therapist. Change in quality of life was the main outcome. Results: Nine people were enrolled in CST. Significant improvements in cognitive function, quality of life (physical, psychosocial and environmental domains), physical function, neuro-psychiatric symptoms and carer burden were seen. Conclusions: CST appears to be feasible in this setting, although adaptation for low literacy levels, uncorrected visual and hearing impairment and work and social practices is needed. The clinical improvements seen were encouraging.
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Affiliation(s)
- Olaide Olakehinde
- a Institute for Health and Society, University College Hospital, University of Ibadan , Ibadan , Nigeria
| | - Akinpelu Adebiyi
- a Institute for Health and Society, University College Hospital, University of Ibadan , Ibadan , Nigeria
| | - Akeem Siwoku
- a Institute for Health and Society, University College Hospital, University of Ibadan , Ibadan , Nigeria
| | - Sarah Mkenda
- b Institute for Health and Society,Kilimanjaro Christian Medical University College , Moshi , Tanzania
| | - Stella-Maria Paddick
- c Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , North Shields , UK.,d Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK
| | - William K Gray
- c Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , North Shields , UK
| | - Richard W Walker
- c Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , North Shields , UK.,e Institute of Health and Society, Newcastle University , Newcastle upon Tyne , UK
| | - Catherine L Dotchin
- c Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , North Shields , UK.,f Institute for Ageing, Newcastle University , Newcastle upon Tyne , UK
| | - Declare Mushi
- b Institute for Health and Society,Kilimanjaro Christian Medical University College , Moshi , Tanzania
| | - Adesola Ogunniyi
- a Institute for Health and Society, University College Hospital, University of Ibadan , Ibadan , Nigeria
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10
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Kobayashi LC, Mateen FJ, Montana L, Wagner RG, Kahn K, Tollman SM, Berkman LF. Cognitive Function and Impairment in Older, Rural South African Adults: Evidence from "Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in Rural South Africa". Neuroepidemiology 2018; 52:32-40. [PMID: 30476911 DOI: 10.1159/000493483] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 09/02/2018] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND/AIMS We aimed to estimate the prevalence of cognitive impairment, and the sociodemographic and comorbid predictors of cognitive function among older, rural South African adults. METHODS Data were from a population-based study of 5,059 adults aged ≥40 years in rural South Africa in 2015. Cognitive impairment was defined as scoring ≤1.5 SDs below the mean composite time orientation and memory score, or requiring a proxy interview with "fair" or "poor" proxy-reported memory. Multiple linear regression estimated the sociodemographic and comorbid predictors of cognitive score, with multiplicative statistical interactions between each of age and sex with education. RESULTS Cognitive impairment increased with age, from 2% of those aged 40-44 (11/516) to 24% of those aged ≥75 years (214/899). The independent predictors of lower cognitive score were being older, female, unmarried, not working, having low education, low household wealth, and a history of cardiovascular conditions. Education modified the negative associations between female sex, older age, and cognitive function score. CONCLUSIONS The prevalence of cognitive impairment increased with age and is comparable to rates of dementia reported in other sub-Saharan African countries. Age and sex differences in cognitive function scores were minimized as education increased, potentially reflecting the power of even poor-quality education to improve cognitive reserve.
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Affiliation(s)
- Lindsay C Kobayashi
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA.,Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Livia Montana
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Global Health Research, Umeå University, Umeå, Sweden
| | - Kathleen Kahn
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Global Health Research, Umeå University, Umeå, Sweden.,INDEPTH Network, Accra, Ghana
| | - Stephen M Tollman
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA.,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Centre for Global Health Research, Umeå University, Umeå, Sweden.,INDEPTH Network, Accra, Ghana
| | - Lisa F Berkman
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA, .,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa,
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11
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A longitudinal study of cognitive decline in rural Tanzania: rates and potentially modifiable risk factors. Int Psychogeriatr 2018; 30:1333-1343. [PMID: 29559014 DOI: 10.1017/s1041610217002861] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:The number of people living with dementia in sub-Saharan Africa (SSA) is expected to increase rapidly in the coming decades. However, our understanding of how best to reduce dementia risk in the population is very limited. As a first step in developing intervention strategies to manage dementia risk in this setting, we investigated rates of cognitive decline in a rural population in Tanzania and attempted to identify associated factors. METHODS The study was conducted in the rural Hai district of northern Tanzania. In 2014, community-dwelling people aged 65 years and over living in six villages were invited to take part in a cognitive screening program. All participants from four of the six villages were followed-up at two years and cognitive function re-tested. At baseline and follow-up, participants were assessed for functional disability, hypertension, and grip strength (as a measure of frailty). At follow-up, additional assessments of visual acuity, hearing impairment, tobacco and alcohol consumption, and clinical assessment for stroke were completed. RESULTS Baseline and follow-up data were available for 327 people. Fifty people had significant cognitive decline at two-year follow-up. Having no formal education, low grip strength at baseline, being female and having depression at follow-up were independently associated with cognitive decline. CONCLUSIONS This is one of the first studies of cognitive decline conducted in SSA. Rates of decline at two years were relatively high. Future work should focus on identification of specific modifiable risk factors for cognitive decline with a view to developing culturally appropriate interventions.
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12
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Akinyemi RO, Owolabi MO, Ihara M, Damasceno A, Ogunniyi A, Dotchin C, Paddick SM, Ogeng'o J, Walker R, Kalaria RN. Stroke, cerebrovascular diseases and vascular cognitive impairment in Africa. Brain Res Bull 2018; 145:97-108. [PMID: 29807146 DOI: 10.1016/j.brainresbull.2018.05.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 12/30/2022]
Abstract
With increased numbers of older people a higher burden of neurological disorders worldwide is predicted. Stroke and other cerebrovascular diseases do not necessarily present with different phenotypes in Africa but their incidence is rising in tandem with the demographic change in the population. Age remains the strongest irreversible risk factor for stroke and cognitive impairment. Modifiable factors relating to vascular disease risk, diet, lifestyle, physical activity and psychosocial status play a key role in shaping the current spate of stroke related diseases in Africa. Hypertension is the strongest modifiable risk factor for stroke but is also likely associated with co-inheritance of genetic traits among Africans. Somewhat different from high-income countries, strokes attributed to cerebral small vessel disease (SVD) are higher >30% among sub-Saharan Africans. Raised blood pressure may explain most of the incidence of SVD-related strokes but there are likely other contributing factors including dyslipidaemia and diabetes in some sectors of Africa. However, atherosclerotic and cardioembolic diseases combined also appear to be common subtypes as causes of strokes. Significant proportions of cerebrovascular diseases are ascribed to various forms of infectious disease including complications of human immunodeficiency virus. Cerebral SVD leads to several clinical manifestations including gait disturbance, autonomic dysfunction and depression. Pathological processes are characterized by arteriolosclerosis, lacunar infarcts, perivascular spaces, microinfarcts and diffuse white matter changes, which can now all be detected on neuroimaging. Except for isolated cases of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy or CADASIL, hereditary arteriopathies have so far not been reported in Africa. Prevalence estimates of vascular dementia (2-3%), delayed dementia after stroke (10-20%) and vascular cognitive impairment (30-40%) do not appear to be vastly different from those in other parts of the world. However, given the current demographic transition in both urban and rural settings these figures will likely rise. Wider application of neuroimaging modalities and implementation of stroke care in Africa will enable better estimates of SVD and other subtypes of stroke. Stroke survivors with SVD type pathology are likely to have low mortality and therefore portend increased incidence of dementia.
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Affiliation(s)
- Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Mayowa O Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | | | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Catherine Dotchin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Stella-Maria Paddick
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Julius Ogeng'o
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Richard Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom.
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Paddick SM, Lewis EG, Duinmaijer A, Banks J, Urasa S, Tucker L, Kisoli A, Cletus J, Lissu C, Kissima J, Dotchin C, Gray WK, Muaketova-Ladinska E, Cosker G, Walker RW. Identification of delirium and dementia in older medical inpatients in Tanzania: A comparison of screening and diagnostic methods. J Neurol Sci 2017; 385:156-163. [PMID: 29406898 DOI: 10.1016/j.jns.2017.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 11/20/2017] [Accepted: 12/05/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND In sub-Saharan Africa, there are no validated screening tools for delirium in older adults. This study assesses clinical utility of two instruments, the IDEA cognitive screen and the Confusion Assessment Method (CAM) for identification of delirium in older adults admitted to medical wards of a tertiary referral hospital in Tanzania. METHOD The IDEA cognitive screen and CAM were administered to a consecutive cohort of older individuals on admission to Kilimanjaro Christian Medical Centre using a blinded protocol. Consensus diagnosis for delirium was established against DSM-5 criteria and dementia by DSM-IV criteria. RESULTS Of 507 admission assessments, 95 (18.7%) had DSM-5 delirium and 95 (18.7%) had DSM-IV dementia (33 (6.5%) delirium superimposed on dementia). The CAM and IDEA cognitive screen had very good diagnostic accuracy for delirium (AUROC curve 0.94 and 0.87 respectively). However, a number of participants (10.5% and 16.4% respectively) were unable to complete these screening assessments due to reduced consciousness, or other causes of reduced verbal response and were excluded from this analysis; many of whom met DSM-5 criteria for delirium. Secondary analysis suggests that selected cognitive and observational items from the CAM and IDEA cognitive screen may be as effective as the full screening tools in identifying delirium even in unresponsive patients. CONCLUSION Both instruments appeared useful for delirium screening in this inpatient setting, but had significant limitations. The combination of assessment items identified may form the basis of a brief, simple delirium screening tool suitable for use by non-specialist clinicians. Further development work is needed.
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Affiliation(s)
- S M Paddick
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
| | - E G Lewis
- Charité - Universitätsmedizin Berlin, CVK: Campus Virchow-Klinikum, Institute of Tropical Medicine and International Health, Berlin, Germany
| | - A Duinmaijer
- Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania
| | - J Banks
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - S Urasa
- Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - L Tucker
- The London School of Hygiene & Tropical Medicine, London, UK
| | - A Kisoli
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - J Cletus
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Lissu
- Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - J Kissima
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - W K Gray
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - E Muaketova-Ladinska
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Institute of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK and Leicestershire Partnership NHS Trust, Leicester, UK
| | - G Cosker
- Institute of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK and Leicestershire Partnership NHS Trust, Leicester, UK
| | - R W Walker
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Adaptation and validation of the Alzheimer's Disease Assessment Scale - Cognitive (ADAS-Cog) in a low-literacy setting in sub-Saharan Africa. Acta Neuropsychiatr 2017; 29:244-251. [PMID: 28345494 DOI: 10.1017/neu.2016.65] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess the feasibility of a low-literacy adaptation of the Alzheimer's Disease Assessment Scale - Cognitive (ADAS-Cog) for use in rural sub-Saharan Africa (SSA) for interventional studies in dementia. No such adaptations currently exist. METHODS Tanzanian and Nigerian health professionals adapted the ADAS-Cog by consensus. Validation took place in a cross-sectional sample of 34 rural-dwelling older adults with mild/moderate dementia alongside 32 non-demented controls in Tanzania. Participants were oversampled for lower educational level. Inter-rater reliability was conducted by two trained raters in 22 older adults (13 with dementia) from the same population. Assessors were blind to diagnostic group. RESULTS Median ADAS-Cog scores were 28.75 (interquartile range (IQR), 22.96-35.54) in mild/moderate dementia and 12.75 (IQR 9.08-16.16) in controls. The area under the receiver operating characteristic curve (AUC) was 0.973 (95% confidence interval (CI) 0.936-1.00) for dementia. Internal consistency was high (Cronbach's α 0.884) and inter-rater reliability was excellent (intra-class correlation coefficient 0.905, 95% CI 0.804-0.964). CONCLUSION The low-literacy adaptation of the ADAS-Cog had good psychometric properties in this setting. Further evaluation in similar settings is required.
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Cognitive stimulation therapy as a sustainable intervention for dementia in sub-Saharan Africa: feasibility and clinical efficacy using a stepped-wedge design. Int Psychogeriatr 2017; 29:979-989. [PMID: 28222815 DOI: 10.1017/s1041610217000163] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cognitive stimulation therapy (CST) is a psychosocial group-based intervention for dementia shown to improve cognition and quality of life with a similar efficacy to cholinesterase inhibitors. Since CST can be delivered by non-specialist healthcare workers, it has potential for use in low-resource environments, such as sub-Saharan Africa (SSA). We aimed to assess the feasibility and clinical effectiveness of CST in rural Tanzania using a stepped-wedge design. METHODS Participants and their carers were recruited through a community dementia screening program. Inclusion criteria were DSM-IV diagnosis of dementia of mild/moderate severity following detailed assessment. No participant had a previous diagnosis of dementia and none were taking a cholinesterase inhibitor. Primary outcomes related to the feasibility of conducting CST in this setting. Key clinical outcomes were changes in quality of life and cognition. The assessing team was blind to treatment group membership. RESULTS Thirty four participants with mild/moderate dementia were allocated to four CST groups. Attendance rates were high (85%) and we were able to complete all 14 sessions for each group within the seven week timeframe. Substantial improvements in cognition, anxiety, and behavioral symptoms were noted following CST, with smaller improvements in quality of life measures. The number needed to treat was two for a four-point cognitive (adapted Alzheimer's Disease Assessment Scale-Cognitive) improvement. CONCLUSIONS This intervention has the potential to be low-cost, sustainable, and adaptable to other settings across SSA, particularly if it can be delivered by non-specialist health workers.
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Paddick SM, Kisoli A, Samuel M, Higginson J, Gray WK, Dotchin CL, Longdon AR, Teodorczuk A, Chaote P, Walker RW. Mild Cognitive Impairment in Rural Tanzania: Prevalence, Profile, and Outcomes at 4-Year Follow-up. Am J Geriatr Psychiatry 2015; 23:950-9. [PMID: 25579049 DOI: 10.1016/j.jagp.2014.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/05/2014] [Accepted: 12/05/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Mild cognitive impairment (MCI) is recognized as a high-risk condition for conversion to dementia, although data on outcomes of MCI in sub-Saharan Africa are scarce. We investigated outcomes of MCI over a 4-year period in Tanzania and considered risk factors for conversion to dementia. METHODS In a longitudinal cohort study in the Hai district, Tanzania, patients with MCI were identified during a two-phase prevalence study carried out in 2010. Of 1,198 people aged 70 years and over screened in phase I, a stratified sample of 296 were fully assessed in phase II. MCI was defined according to international consensus criteria. DSM-IV criteria were used for dementia diagnosis. Background demographic and risk factor data were collected, and neuropsychiatric symptoms were assessed using the neuropsychiatric inventory. Patients were followed-up in 2011, 2012 and 2014. RESULTS Forty-six MCI patients were identified. After adjusting for stratification, the crude prevalence of MCI was 7.0% (95% CI: 3.6-10.4). Over a 4-year period, 15 patients (32.6%) progressed to dementia, 2 patients (4.3%) returned to normal cognition, 1 developed late-onset schizophrenia, 8 patients (17.4%) had stable MCI, 19 patients (41.3%) died, and 1 refused assessment. Age, sex, education levels, body mass index, hypertension, and comorbidity were not associated with progression to dementia. CONCLUSION In this rural Tanzanian population, rates of conversion from MCI to DSM-IV dementia were similar to those reported in high-income countries. Over a third of all patients had died at the 4-year follow-up.
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Affiliation(s)
- Stella-Maria Paddick
- Northumbria Healthcare National Health Service Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom.
| | - Aloyce Kisoli
- Hai District Hospital, Boma'ngombe, Kilimanjaro, Tanzania
| | - Maria Samuel
- Northumbria Healthcare National Health Service Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom
| | - Janice Higginson
- Health Education North East, Newcastle upon Tyne, United Kingdom
| | - William K Gray
- Northumbria Healthcare National Health Service Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom
| | - Catherine L Dotchin
- Northumbria Healthcare National Health Service Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom; Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anna R Longdon
- South Devon National Health Service Foundation Trust, Department of Medicine, Torbay Hospital, Torquay, United Kingdom
| | - Andrew Teodorczuk
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, United Kingdom; Northumberland, Tyne and Wear National Health Service Foundation Trust, St Nicholas Hospital, Newcastle upon Tyne, United Kingdom
| | - Paul Chaote
- Hai District Hospital, Boma'ngombe, Kilimanjaro, Tanzania
| | - Richard W Walker
- Northumbria Healthcare National Health Service Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
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17
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Paddick SM, Kisoli A, Longdon A, Dotchin C, Gray WK, Chaote P, Teodorczuk A, Walker R. The prevalence and burden of behavioural and psychological symptoms of dementia in rural Tanzania. Int J Geriatr Psychiatry 2015; 30:815-23. [PMID: 25351844 DOI: 10.1002/gps.4218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 08/26/2014] [Accepted: 09/04/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Behavioural and psychological symptoms (BPS) in dementia are common in high-income countries, but there are few data from sub-Saharan Africa. Our aim was to estimate the prevalence and pattern of BPS and associated caregiver distress in rural Tanzania. METHODS Prevalent cases of dementia (aged 70 and over) were identified during a community-based door-to-door study in six rural villages in Tanzania. Following cognitive screening, a stratified sample (over-sampled for people with dementia) of cases underwent a detailed clinical assessment including the brief 12 item neuropsychiatric inventory (NPI-Q), which assesses BPS and associated caregiver distress over the preceding 30 days. RESULTS Of 78 people with dementia, at least one current BPS was reported by 69 (88.4%), with 40 (51.3%) reporting 3 or more symptoms. In 172 people with no cognitive impairment, 110 (64.0%) reported at least one symptom and 48 (27.9%) reported 3 or more. In dementia cases, the most frequent symptoms reported were anxiety (47.4%), agitation/aggression (38.5%), night-time behavioural disturbance (34.6%), irritability (33.3%) and depression (33.3%). CONCLUSION The frequency of BPS in dementia in this rural Tanzanian population is high and comparable to that reported in prevalence studies from high income countries. Symptoms were also common, although to a lesser degree, amongst cognitively intact subjects. BPS are likely to have a significant impact on quality of life for elderly persons and their carers in low-income settings. Low-cost interventions, such as community-based therapy and education, are needed.
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Affiliation(s)
- S-M Paddick
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - A Kisoli
- Hai District Hospital, Boma'ngombe, Tanzania
| | - A Longdon
- South Devon Healthcare Trust, Torquay, UK
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - W K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK
| | - P Chaote
- Hai District Hospital, Boma'ngombe, Tanzania
| | - A Teodorczuk
- Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK.,Northumberland, Tyne and Wear NHS Trust, Newcastle Upon Tyne, UK
| | - R Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, North Shields, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Levels of functional disability in elderly people in Tanzania with dementia, stroke and Parkinson's disease. Acta Neuropsychiatr 2015; 27:206-12. [PMID: 25777617 DOI: 10.1017/neu.2015.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Disability is associated with increasing age and poverty, yet there are few reliable data regarding disability amongst the elderly in low-income countries. The aim of this study was to compare disability levels for three of the most common neurological, non-communicable diseases: dementia, stroke and Parkinson's disease (PD). METHODS We performed a community-based study of people aged 70 years and over in 12 randomly selected villages in the rural Hai district of Tanzania. Participants underwent disability assessment using the Barthel Index, and clinical assessment for dementia, stroke and PD. RESULTS In a representative cohort of 2232 people aged 70 years and over, there were 54 cases of stroke, 12 cases of PD and estimated (by extrapolation from a sub-sample of 1198 people) to be 112 cases of dementia. People with stroke were the most disabled, with 62.9% having moderate or severe disability. Levels of moderate or severe disability were 41.2% in people with dementia and 50.0% in people with PD. However, the higher prevalence of dementia meant that, at a population level, it was associated with similar levels of disability as stroke, with 18.5% of 249 people identified as having moderate or severe disability having dementia, compared to 13.7% for stroke and 2.4% for PD. CONCLUSIONS Levels of disability from these conditions is high and is likely to increase with demographic ageing. Innovative, community-based strategies to reduce disability levels should be investigated.
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Paddick SM, Kisoli A, Dotchin CL, Gray WK, Chaote P, Longdon A, Walker RW. Mortality rates in community-dwelling Tanzanians with dementia and mild cognitive impairment: a 4-year follow-up study. Age Ageing 2015; 44:636-41. [PMID: 25918185 DOI: 10.1093/ageing/afv048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/31/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND we have previously conducted a community-based prevalence study of dementia in older adults living in the rural Hai district of Tanzania. The aim of this study was to record mortality rates at 4 years post-diagnosis, of those with dementia, mild cognitive impairment (MCI) and no cognitive impairment. METHODS during Phase I of the prevalence study, 1,198 people aged 70 years and over were screened, and a stratified sample of 296 was assessed for the presence of dementia or MCI in Phase II. Seventy-eight people had dementia and 46 had MCI. Four years after diagnosis, we attempted to follow-up all those seen in Phase II and record all deaths. RESULTS of the 296, follow-up data were available for 287 (97.0%), including 77 with dementia and 45 with MCI. Of the 172 with no cognitive impairment, 165 (95.9%) were followed up and a sample of 89 people selected as representative of the background population. Forty-eight people with dementia (62.3%), 19 with MCI (42.2%) and 11 with no cognitive impairment (12.4%) had died at 4-year follow-up. After adjusting for the effects of age, gender and education, the hazard ratio was 6.33 (95% CI 3.19-12.58) for dementia and 3.57 (95% CI 1.64-7.79) for MCI relative to people with no cognitive impairment. Mortality rates were highest in those with vascular dementia. CONCLUSION dementia and MCI were associated with excess mortality relative to those with no cognitive impairment.
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Affiliation(s)
- Stella-Maria Paddick
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Aloyce Kisoli
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK Institute for Ageing, Newcastle University, Newcastle-upon-Tyne, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK
| | - Paul Chaote
- District Medical Office, Hai District Hospital, Boman'gombe, Hai, Tanzania
| | - Anna Longdon
- South Devon Healthcare NHS Foundation Trust, Torquay, UK
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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