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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
- ADSF-21-831381-C Alzheimer Drug Discovery Foundation
- R01 AG070864 NIA NIH HHS
- Wellcome Trust, UK
- 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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Wasay M, Awan S, Shahbaz N, Khan S, Sher K, Malik A, Mustafa S, Siddiqi AI, Barech S, Farooq A, Hameed S, Siddiqui M, Ahmad A, Asif A, Sherin A, Majid H, Nauman A, Soomro B, Subhan M, Rafique I, Saqib MAN. Neurological disorders and disability in Pakistan: A cross-sectional multicenter study. J Neurol Sci 2023; 452:120754. [PMID: 37562167 DOI: 10.1016/j.jns.2023.120754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 07/08/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND/OBJECTIVE The aim of this study is to identify frequencies of various neurological disorders (NDs) and associated disability in patients attending neurologic clinics in rural and urban centers in Pakistan. METHODS This is an observational study conducted in 39 neurological centers in both rural and urban areas, public and private health sectors all over Pakistan. This study was conducted between august 2017 to December 2019. RESULTS A total of 28,845 adults were enrolled. Mean age of the study participants was 46.2 ± 17.2 years, 15,252 (52.9%) were men and 13,593 (47.1%) were women. Most common comorbid medical condition was hypertension 7622(26.4%) followed by Diabetes 3409(11.8%). Among neurological diagnoses, vascular diseases (20%) were the most common followed by Headache disorders (18.6%), Epilepsy (12.5%), nerve and root diseases (12.4%), Psychiatric diseases (10%), Dementias (8%) and movement disorders (7.9%). Half of the patients 15,503(53.7%) had no neurological disability, while minor disability was present in 10,442(36.2%) of cases. Moderate to severe disability was present in 2876(10%) cases. Headache disorders, psychiatric diseases, muscle pain/muscle related disorders and demyelinating diseases were more common in women. Vascular diseases, movement disorders and Dementias were more common in 46 years and above age group whereas headache disorders, Epilepsy and Psychiatric disorders were more prevalent in <46 years age groups. CONCLUSION Vascular diseases are the most common presentation of patients in neurology clinics followed by headache disorders and epilepsies. Minor disability was present in 36% while moderate to severe disability was present in 10% cases.
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Affiliation(s)
- Mohammad Wasay
- Section of neurology, Department of Medicine, Aga Khan university, Karachi, Pakistan.
| | - Safia Awan
- Section of neurology, Department of Medicine, Aga Khan university, Karachi, Pakistan.
| | - Naila Shahbaz
- Dow University of Health Sciences, Karachi, Pakistan
| | - Sara Khan
- Section of neurology, Department of Medicine, Aga Khan university, Karachi, Pakistan
| | - Khalid Sher
- Jinnah post graduate medical center, Karachi, Pakistan
| | - Abdul Malik
- Section of neurology, Department of Medicine, Liaquat College of Medicine and Dentistry, Karachi, Pakistan
| | - Shahid Mustafa
- Section of neurology, Department of Medicine, Aga Khan university, Karachi, Pakistan
| | | | - Saleem Barech
- Bolan university of Medical and health Sciences, Quetta, Pakistan
| | - Anjum Farooq
- Bolan university of Medical and health Sciences, Quetta, Pakistan
| | - Sajid Hameed
- Section of neurology, Department of Medicine, Aga Khan university, Karachi, Pakistan
| | - Maimoona Siddiqui
- Shifa International Hospital, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Arsalan Ahmad
- Shifa International Hospital, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Ahmed Asif
- Liaquat National hospital, Karachi, Pakistan
| | - Akhtar Sherin
- Khyber Medical University, Institute of Medical Sciences Kohat, Pakistan
| | - Haris Majid
- Pakistan Institute of Medical sciences, Islamabad, Pakistan
| | - Ahsan Nauman
- King Edward Medical college and mayo hospital, Lahore, Pakistan
| | | | | | - Ibrar Rafique
- Health Research Institute (HRI), National Institutes of Health, Islamabad, Pakistan
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Ali S, Zehra M, Fatima T, Nadeem A. Advancing dementia care in Pakistan: challenges and the way forward. FRONTIERS IN DEMENTIA 2023; 2:1241927. [PMID: 39081985 PMCID: PMC11285558 DOI: 10.3389/frdem.2023.1241927] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 08/25/2023] [Indexed: 08/02/2024]
Abstract
Dementia encompasses a wide range of cognitive and psychological impairments that hinder individuals' ability to carry out daily tasks effectively. In the context of Pakistan, the prevalence of dementia patients currently stands at ~150,000-200,000, reflecting the impact of the country's significant population size. This increase in numbers poses a substantial socioeconomic challenge, emphasizing the need to prioritize dementia within Pakistan's healthcare system. However, the allocation of resources and attention to dementia remains relatively low, leading to considerable difficulties in both diagnosing and treating affected individuals. The provision of comprehensive dementia care faces numerous obstacles, including limited public awareness, insufficient research initiatives, inadequate infrastructure, and a lack of specialized training programs. To address these challenges, the Pakistani government must acknowledge and address the stringent regulations governing the neuroscience industry, with a specific emphasis on catering to the unique needs of dementia patients. By doing so, they can ensure the delivery of high-quality care, essential support, and necessary resources for individuals living with dementia in the country.
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Logan M, Leitch S, Bosakh Z, Beishon L, Quinn TJ. Comparing international dementia research priorities-Systematic review. Int J Geriatr Psychiatry 2022; 37:10.1002/gps.5836. [PMID: 36326065 PMCID: PMC9828247 DOI: 10.1002/gps.5836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 10/21/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVES Research priority setting aims to collate stakeholder opinion to determine the most pressing research questions. Priority setting exercises influence decisions around research funding, development and policy. We compared published dementia research priority setting exercises from international healthcare systems. METHODS Four multidisciplinary, international, electronic databases were searched for relevant studies (2010 until 2021). Priorities were extracted, coded and assigned to categories using thematic analysis. The Nine Common Themes of Good Practice (9CTGP) and the Reporting guideline for priority setting of health research (REPRISE) checklists were used to assess methodological and reporting quality respectively. RESULTS From 265 titles, 10 priority setting exercises (1179 participants, 147 priorities) were included. Studies spanned four continents and the majority included people living with dementia and their care-givers in the priority setting process (68%). Only one paper met all the best practice indicators. Issues around inclusiveness, implementation and evaluation of the priorities were apparent in nine papers. We categorised priorities under eight themes: caregivers (25%, n = 37), support (24%, n = 35), awareness and education (16%, n = 24), drugs and interventions (14%, n = 21), diagnosis (8%, n = 12), pathology (6%, n = 9), research design (5%, n = 7), and prevention (1%, n = 2). Priorities varied by geographical region, with awareness and education of higher priority in low-middle income countries, compared to caregivers and support in high income countries. CONCLUSIONS Key priorities were identified with some commonality around themes considered of greatest importance. There is scope to improve the process and reporting of priority setting. Priorities differed according to contextual factors and so, priorities specific to one healthcare setting may not be applicable to others.
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Affiliation(s)
- Monica Logan
- School of MedicineUniversity of GlasgowGlasgowUK
| | | | | | - Lucy Beishon
- Department of Cardiovascular SciencesUniversity of LeicesterLeicesterUK
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgowUK
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Leroi I, Karanja W, Adrion ER, Alladi S, Custodio N, Goswami SP, Guerchet M, Gubner J, Ibanez A, Ilinica S, Jafri H, Lawlor B, Mohamed AA, Ogunniyi A, Robertson I, Robinson L, Spector A, Varghese M, Weidner W, Caramelli P. Equity and balance in applied dementia research: A charter of conduct and checklist for global collaborations. Int J Geriatr Psychiatry 2022; 37. [PMID: 35703570 DOI: 10.1002/gps.5762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022]
Affiliation(s)
- Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Wambui Karanja
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Emily R Adrion
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,School of Social and Political Science at the University of Edinburgh, Edinburgh, Scotland
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Nilton Custodio
- Servicio de Neurología, Instituto Peruano de Neurociencias, Lima, Perú
| | - S P Goswami
- All India Institute of Speech & Hearing, Mysuru, India
| | - Maëlenn Guerchet
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
| | - Jennie Gubner
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA
| | - Agustin Ibanez
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, University of California San Francisco, San Francisco, California, USA.,Latin American Brain Health Institute (BrainLat), Universidad Adolfo Ibáñez, Santiago de Chile, Santiago, Chile.,Cognitive Neuroscience Center (CNC), Universidad de San Andrés, Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Buenos Aires, Argentina
| | - Stefania Ilinica
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Hussain Jafri
- Fatima Jinnah Medical University Lahore, Lahore, Pakistan
| | - Brian Lawlor
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Aya Ashour Mohamed
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.,Department of Neurology, Ain Shams University, Cairo, Egypt
| | - Adesola Ogunniyi
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Ian Robertson
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Louise Robinson
- Population Heath Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle Upon Tyne, UK
| | - Aimee Spector
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Paulo Caramelli
- Behavioral and Cognitive Neurology Research Group, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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6
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Dementia of the Ageing Population in Malaysia: A Scoping Review of Published Research. AGING AND HEALTH RESEARCH 2022. [DOI: 10.1016/j.ahr.2022.100077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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7
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Aurooj A, Mahmood Z. Subjective Experiences of Alzheimer's Disease in the Pakistani Cultural Context: An Exploratory Study. JOURNAL OF RELIGION AND HEALTH 2022; 61:125-138. [PMID: 34250570 DOI: 10.1007/s10943-021-01335-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
Studying Alzheimer's disease with the fluctuating environmental, individual, and cultural factors in pertinence to the Diagnostic Statistical Manual (DSM-5) requires information, awareness, and understanding of the disease. Studies have calibrated sociocultural factors to be imperative in the expression of functional symptomology of Alzheimer's disease. Pakistan as a sociocentric, predominantly Muslim country, calls for such efforts. The current research was conducted to study the functional symptomology and experiences of Alzheimer's disease. A qualitative approach was adopted in which in-depth interviews of three dyads of patients with Alzheimer's disease and their caregivers (N = 6) were conducted. Interpretative Phenomenological Analysis was applied to acquire the thematic analysis of data. Results showed sociocentricism as a forefront factor. Cognition, behavior, and emotions were found to be functionally expressed by religion, unawareness, respect of older people, stigmatization, and isolation within family dynamics. The study could be an instigator for further culture-oriented assessment and management providing services.
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Affiliation(s)
- Amna Aurooj
- University of Management and Technology, Lahore, Pakistan.
| | - Zahid Mahmood
- University of Management and Technology, Lahore, Pakistan
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8
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Leroi I, Vaitheswaran S, Sheikh S, Chaudhry N, Goswami SP, Miah J, Sakel M, Tofique S, Husain N. Capacity & capability building for applied dementia research in low- & middle-income countries: Two exemplars from South Asia. Indian J Med Res 2021; 152:614-625. [PMID: 34145101 PMCID: PMC8224155 DOI: 10.4103/ijmr.ijmr_2095_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background & objectives: Cognitive and other neurodegenerative conditions related to ageing have become public health priorities in low- and middle-income countries. However, contextually based, applied research to support the development of awareness, diagnosis and care pathways for people with dementia in South Asia is still largely undeveloped. This study was aimed to use applied research studies for dementia in South Asia as exemplars of how individual-level capacity and capability building for dementia research can be achieved. Methods: Using Theory of Change as a framework, we embedded capacity and capability building into the studies through six domains: people (human resources), research integrity and governance, study delivery skills, international collaborative working, patient and public involvement (PPI) (awareness raising, stigma and health literacy) and development of ‘pathways’. For each aspect, development goals were defined and how they would be achieved. Results: New principal investigators, research assistants (including outcome raters), study coordinators and intervention practitioners were trained across eight study sites in India, Pakistan, and Bangladesh, for dementia research. Training was delivered at study start, and through booster sessions, using workshops, face-to-face sessions, online training and video-link sessions. International collaborations were fostered, leading to a proposal for international funding. Each study site co-created PPI events to raise awareness and to inform the research. The recruitment pathways and study logistics fostered the development dementia diagnosis and care pathways. Interpretation & conclusions: Embedding capacity and capability building in applied dementia research in South Asia fosters the sustainability of dementia research, which is essential in developing diagnostic and care pathways.
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Affiliation(s)
- Iracema Leroi
- Department of Psychiatry, Global Brain Health Institute, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sridhar Vaitheswaran
- Department of Dementia Care, Schizophrenia Research Foundation, Chennai, Tamil Nadu, India
| | - Saima Sheikh
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Nasim Chaudhry
- Department of Psychiatry, Dow University of Health Sciences; Pakistan Institute of Living & Learning, Karachi, Pakistan
| | - S P Goswami
- Department of Speech-Language Pathology, Telecentre for Persons Communication Disorder, All India Institute of Speech & Hearing, Mysuru, Karnataka, India
| | - Jahanara Miah
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - Mohamed Sakel
- Department of Neuro-rehabilitation, East Kent University NHS FT Hospitals, Global Ambassador; Department of Health and Social Care, Sir William Beveridge Foundation, Dhaka, Bangladesh
| | - Sehrish Tofique
- Department of Psychiatry, Pakistan Institute of Living & Learning, Karachi, Pakistan
| | - Nusrat Husain
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
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9
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Sheikh S, Tofique S, Zehra N, Amjad R, Rasheed M, Usman M, Lal S, Hooper E, Miah J, Husain N, Jafri H, Chaudhry N, Leroi I. SENSE-Cog Asia: A Feasibility Study of a Hearing Intervention to Improve Outcomes in People With Dementia. Front Neurol 2021; 12:654143. [PMID: 34194381 PMCID: PMC8236518 DOI: 10.3389/fneur.2021.654143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/07/2021] [Indexed: 11/19/2022] Open
Abstract
Background: There are few evidence-based non-pharmacological interventions adapted for people with dementia (PwD) in lower- and middle-income countries (LMIC). Thus, there is value in culturally adapting existing interventions from other settings. One such intervention for PwD involves hearing rehabilitation, which may improve dementia-related outcomes. Objective: To culturally adapt and evaluate the feasibility and acceptability of a multi-faceted hearing support intervention to enhance quality of life in PwD for a LMIC setting, Pakistan. Design: This was a study in three phases: (1) training and capacity building to deliver the study, including Patient and Public Involvement (PPI); (2) cultural adaptation of the intervention; and (3) delivery of a single-group feasibility study with a pre-test post-test design. Setting: Home-based intervention, in two cities of Pakistan. Participants: Adults aged ≥ 60 with mild-moderate dementia and uncorrected or partially corrected hearing impairment, and their study partners (n = 14). Intervention: An adapted hearing support intervention (HSI) comprising a full assessment of hearing function, fitting of hearing aids, and home-based support from a “hearing support practitioner.” Outcomes: Ratings of the feasibility of the study procedures, and acceptability/tolerability of the adapted intervention were ascertained through questionnaires, participant diaries, therapist logbooks and semi-structured interviews. A signal of effectiveness of the intervention was also explored using a battery of dementia-related outcome measures. Results: Following cultural adaptation and capacity building for study conduct and delivery, we successfully implemented all intervention components in most participants, which were well-received and enacted by participant dyads. Acceptability (i.e., understanding, motivation, sense of achievement) and tolerability (i.e., effort, fatigue) ratings and safety of the intervention were within a priori target ranges. Recruitment and retention targets required improvement, due to the COVID-19 pandemic outbreak, as well as the lack of a clear clinical diagnostic pathway for dementia in both sites. Areas for future modification were clearly identified, including: the assessment/delivery logistics circuit; procedures for arranging visits; communication among referring clinicians and the study team. Conclusion: This is the first study in a LMIC of sensory enhancement to improve dementia outcomes. Positive feasibility, acceptability and tolerability findings suggest that a full-scale effectiveness trial, with certain modifications is warranted.
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Affiliation(s)
- Saima Sheikh
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Sehrish Tofique
- Department of Psychiatry, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Nosheen Zehra
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Rabia Amjad
- Department of Psychiatry, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Maham Rasheed
- Department of Psychiatry, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Maria Usman
- Department of Psychiatry, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Shanker Lal
- Department of Psychiatry, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Emma Hooper
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom.,Department of Health, Institute of Health, University of Cumbria, Lancaster, United Kingdom
| | - Jahanara Miah
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Nusrat Husain
- Division of Global Mental Health, University of Manchester, Manchester, United Kingdom
| | - Hussain Jafri
- Department of Health, Alzheimer Pakistan, Lahore, Pakistan.,Department of Health, Fatima Jinnah Medical University, Lahore, Pakistan
| | - Nasim Chaudhry
- Department of Psychiatry, Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Iracema Leroi
- Department of Psychiatry, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
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10
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Miah J, Sheikh S, Francis RC, Nagarajan G, Antony S, Tahir M, Sattar R, Naz A, Tofique S, Billah M, Saha S, Leroi I. Patient and Public Involvement for Dementia Research in Low- and Middle-Income Countries: Developing Capacity and Capability in South Asia. Front Neurol 2021; 12:637000. [PMID: 33833728 PMCID: PMC8021770 DOI: 10.3389/fneur.2021.637000] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/22/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Patient and public involvement (PPI) is an active partnership between the public and researchers in the research process. In dementia research, PPI ensures that the perspectives of the person with "lived experience" of dementia are considered. To date, in many lower- and middle-income countries (LMIC), where dementia research is still developing, PPI is not well-known nor regularly undertaken. Thus, here, we describe PPI activities undertaken in seven research sites across South Asia as exemplars of introducing PPI into dementia research for the first time. Objective: Through a range of PPI exemplar activities, our objectives were to: (1) inform the feasibility of a dementia-related study; and (2) develop capacity and capability for PPI for dementia research in South Asia. Methods: Our approach had two parts. Part 1 involved co-developing new PPI groups at seven clinical research sites in India, Pakistan and Bangladesh to undertake different PPI activities. Mapping onto different "rings" of the Wellcome Trust's "Public Engagement Onion" model. The PPI activities included planning for public engagement events, consultation on the study protocol and conduct, the adaptation of a study screening checklist, development and delivery of dementia training for professionals, and a dementia training programme for public contributors. Part 2 involved an online survey with local researchers to gain insight on their experience of applying PPI in dementia research. Results: Overall, capacity and capability to include PPI in dementia research was significantly enhanced across the sites. Researchers reported that engaging in PPI activities had enhanced their understanding of dementia research and increased the meaningfulness of the work. Moreover, each site reported their own PPI activity-related outcomes, including: (1) changes in attitudes and behavior to dementia and research involvement; (2) best methods to inform participants about the dementia study; (3) increased opportunities to share knowledge and study outcomes; and (4) adaptations to the study protocol through co-production. Conclusions: Introducing PPI for dementia research in LMIC settings, using a range of activity types is important for meaningful and impactful dementia research. To our knowledge, this is the first example of PPI for dementia research in South Asia.
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Affiliation(s)
- Jahanara Miah
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Saima Sheikh
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, United Kingdom
| | - Rachel C. Francis
- Department of Speech Language Pathology, All India Institute of Speech & Hearing, Mysuru, India
| | | | - Sojan Antony
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengluru, India
| | - Maryam Tahir
- Division for Neurocognitive Disorder, Pakistan Institute of Living & Learning, Karachi, Pakistan
| | - Rabia Sattar
- Division for Neurocognitive Disorder, Pakistan Institute of Living & Learning, Karachi, Pakistan
| | - Anum Naz
- Division for Neurocognitive Disorder, Pakistan Institute of Living & Learning, Karachi, Pakistan
| | - Sehrish Tofique
- Division for Neurocognitive Disorder, Pakistan Institute of Living & Learning, Karachi, Pakistan
| | - Mostazir Billah
- Hearing Care Center Ltd., Renaissance Hospital & Research Institute, Dhaka, Bangladesh
| | - Sajib Saha
- Hearing Care Center Ltd., Renaissance Hospital & Research Institute, Dhaka, Bangladesh
| | - Iracema Leroi
- School of Medicine, Global Brain Health Institute, Trinity College, Dublin, Ireland
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Abstract
In India, increasing lifespan and decreasing fertility rates have resulted in a growing number of older persons. By 2050, people over 60 years of age are predicted to constitute 19.1% of the total population. This ageing of the population is expected to be accompanied by a dramatic increase in the prevalence of dementia. The aetiopathogenesis of dementia has been the subject of a number of prospective longitudinal studies in North America and Europe; however, the findings from these studies cannot simply be translated to the Indian population. The population of India is extremely diverse in terms of socio-economic, cultural, linguistic, geographical, lifestyle-related and genetic factors. Indeed, preliminary data from recently initiated longitudinal studies in India indicate that the prevalence of vascular and metabolic risk factors, as well as white matter hyperintensities, differs between urban and rural cohorts. More information on the complex role of vascular risk factors, gender and genetic influences on dementia prevalence and progression in Indian populations is urgently needed. Low-cost, culturally appropriate and scalable interventions need to be developed expeditiously and implemented through public health measures to reduce the growing burden of dementia. Here, we review the literature concerning dementia epidemiology and risk factors in the Indian population and discuss the future work that needs to be performed to put in place public health interventions to mitigate the burden of dementia.
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12
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Chaudhry N, Tofique S, Husain N, Couture D, Glasgow P, Husain M, Kiran T, Memon R, Minhas S, Qureshi A, Shuber F, Leroi I. Montessori intervention for individuals with dementia: feasibility study of a culturally adapted psychosocial intervention in Pakistan (MIRACLE). BJPsych Open 2020; 6:e69. [PMID: 32611476 PMCID: PMC7443909 DOI: 10.1192/bjo.2020.49] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Globally, nearly two-thirds of people with dementia reside in low- and middle-income countries (LMICs), yet research on how to support people with dementia in LMIC settings is sparse, particularly regarding the management of behavioural and psychological symptoms of dementia. Understanding how best to manage these symptoms of dementia with non-specialist approaches in LMICs is critical. One such approach is a non-pharmacological intervention based on the Montessori method. AIMS To evaluate the feasibility and acceptability of a culturally adapted, group-based Montessori intervention for care home residents with dementia and their study partners, who were paid care workers in Pakistan. METHOD This was a two-stage study: a cultural adaptation of the Montessori intervention and a single-arm, open-label, feasibility and acceptability study of 12 participant dyads. Feasibility and tolerability of the intervention and study procedures were determined through the recruitment rate, adherence to the protocol and acceptance of the intervention. Qualitative interviews were undertaken with the study partners. A pre-post exploratory analysis of ratings of behavioural and psychological symptoms of dementia, functional ability and quality of life were also conducted. RESULTS The recruitment and retention rates of people with dementia were acceptable, and the intervention was well tolerated by participant dyads. Findings show a reduction in agitation levels and improvement in mood and interest for the activities. CONCLUSIONS Feasibility studies of low-cost, easy-to-deliver and culturally adapted interventions are essential in laying the groundwork for subsequent definitive effectiveness and/or implementation trials for dementia in LMICs, where awareness and resources for dementia are limited.
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Affiliation(s)
| | - Sehrish Tofique
- Division of Older Adult's Mental Health, Pakistan Institute of Living and Learning, Pakistan
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, UK
| | | | | | | | - Tayyeba Kiran
- Division of Self Harm and Suicide Prevention, Pakistan Institute of Living and Learning, Pakistan
| | | | | | - Afshan Qureshi
- Department of Qualitative Studies, Pakistan Institute of Living and Learning, Pakistan
| | | | - Iracema Leroi
- School of Medicine, Global Brain Health Institute, Trinity College Dublin, Ireland
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