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Farfel JM, Capuano AW, Buchman AS, Schneider JA, Bennett DA. Association of Alzheimer's Disease and Other Neuropathologies With Functional Disability in Persons With and Without Dementia. J Gerontol A Biol Sci Med Sci 2024; 79:glae118. [PMID: 38757945 PMCID: PMC11350283 DOI: 10.1093/gerona/glae118] [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: 06/29/2023] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Dementia results from multiple neuropathologies causing cognitive impairment sufficiently severe to affect functional status. However, these pathologies and functional impairment are common in persons without dementia. We examined the association of Alzheimer's disease (AD) and multiple other neuropathologies with instrumental and basic activities of daily living in persons with and without dementia. METHODS Participants were 1 509 deceased from the Religious Orders Study or Rush Memory and Aging Project. Pathologic AD and 3 other AD indices were examined, in addition to 4 non-AD neurodegenerative pathologies: cerebral amyloid angiopathy (CAA), hippocampal sclerosis, TDP-43, and Lewy bodies, and 4 cerebrovascular pathologies: gross- and microinfarctions, athero- and arteriolosclerosis. Functional assessment included Lawton and Katz Index Instrumental and Basic Activities of Daily Living (IADL and BADL). Ordinal regression models adjusted for age, sex, and education were used to examine the association of neuropathologies with IADL and BADL. RESULTS Alzheimer's disease and the other neuropathologies were associated with impaired IADL (all ps < .001) and with impaired BADL (ps < .01), except for atherosclerosis and CAA, which were not associated with BADL. The effects of most neuropathologies were largely affected by dementia. However, small effects on IADL remained for PHF-tau tangles after adjusting models for dementia. Direct effects of gross infarcts on IADL and BADL and of microinfarcts on BADL remained unchanged after adjusting the models for dementia. CONCLUSIONS Alzheimer's disease and all other neuropathologies are strongly associated with functional disability. The association of most neuropathologies with disability was eliminated or attenuated by dementia, except for gross infarcts and microinfarcts.
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Affiliation(s)
- Jose M Farfel
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Ana W Capuano
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Aron S Buchman
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
| | - Julie A Schneider
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - David A Bennett
- Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
- Department of Neurological Sciences, Rush Medical College, Chicago, Illinois, USA
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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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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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Assunção MRSD, Pinto SIM, José HMG. Public and health policy for the aged in Africa to the South of Saara. Rev Bras Enferm 2021; 73Suppl 3:e20190313. [PMID: 32667415 DOI: 10.1590/0034-7167-2019-0313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 10/10/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to know the social and health responses for the elderly in sub-Saharan Africa. METHODS An integrative literature review. RESULTS There is a lack of specialized health care to meet the real needs of the elderly, and the shortage of health professionals does not contribute favorably to this situation. There is a small number of facilities for the elderly and most of them are inadequate. Although there are models of care as well as social and health support policies for the elderly, there are still inequities/inequalities in access to these policies, especially for the most disadvantaged populations. CONCLUSION Social and health policies for the elderly in Sub-Saharan Africa are below standard and appropriate economic, political and social intervention is required.
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Yue L, Chen L, Zhou R. The Efficacy of Whole-Body Vibration for Functional Improvement of
Stroke Patients: A Meta-Analysis of Randomized Controlled Trials. PHYSIKALISCHE MEDIZIN, REHABILITATIONSMEDIZIN, KURORTMEDIZIN 2020. [DOI: 10.1055/a-1023-4582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AbstractThe efficacy of whole-body vibration for functional improvement in stroke
patients remains controversial. We conduct a systematic review and meta-analysis
to explore the influence of whole-body vibration on functional improvement in
stroke patients.We search PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases
through June 2018 for randomized controlled trials (RCTs) assessing the effect
of whole-body vibration on functional improvement in stroke patients. This
meta-analysis is performed using the random-effect model.Eight RCTs are included in the meta-analysis. Overall, compared with control
group for stroke patients, whole-body vibration has no positive impact on
6 min walk test (6MWT) distance (standard mean difference (Std.
MD)=−0.28; 95% confidence interval
(CI)=−0.66 to 0.11; P=0.16), timed-up-and-go (TUG) test
(Std. MD=0.15; 95% CI=−0.54 to 0.84;
P=0.67), Fugl-Meyer assessment (Std. MD=0.33; 95%
CI=−0.23 to 0.89; P=0.25), Berg Balance Scale (Std.
MD=0.19; 95% CI=−0.43 to 0.80; P=0.55),
and activities specific balance (ABC) scale (Std. MD=−0.22;
95% CI=−0.62 to 0.17; P=0.26).Whole-body vibration shows no notable influence on 6MWT distance, TUG test,
Fugl-Meyer assessment, Berg Balance Scale, and ABC scale in stroke patients.
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Affiliation(s)
- Lin Yue
- Department of Emergency, Wenzhou People’s Hospital, The Wenzhou
Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou
Maternal and Child Health Care Hospital, Wenzhou, Zhejiang, P. R.
China
| | - Linglong Chen
- Department of Emergency, Wenzhou People’s Hospital, The Wenzhou
Third Clinical Institute Affiliated To Wenzhou Medical University, Wenzhou
Maternal and Child Health Care Hospital, Wenzhou, Zhejiang, P. R.
China
| | - Rongrong Zhou
- Medical Skill Training Center, Wenzhou People’s Hospital, The
Wenzhou Third Clinical Institute Affiliated To Wenzhou Medical University,
Wenzhou Maternal and Child Health Care Hospital, Wenzhou, Zhejiang, P. R.
China
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Rathnayake S, Moyle W, Jones C, Calleja P. Family carers’ needs related to management of functional disability in dementia care and use of mHealth applications in health information seeking: An online survey. Collegian 2020. [DOI: 10.1016/j.colegn.2019.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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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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8
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Prynn JE, Kuper H. Perspectives on Disability and Non-Communicable Diseases in Low- and Middle-Income Countries, with a Focus on Stroke and Dementia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3488. [PMID: 31546803 PMCID: PMC6766001 DOI: 10.3390/ijerph16183488] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 09/04/2019] [Accepted: 09/16/2019] [Indexed: 12/22/2022]
Abstract
Non-communicable diseases (NCD) and disability are both common, and increasing in magnitude, as a result of population ageing and a shift in disease burden towards chronic conditions. Moreover, disability and NCDs are strongly linked in a two-way association. People living with NCDs may develop impairments, which can cause activity limitations and participation restriction in the absence of supportive personal and environmental factors. In other words, NCDs may lead to disabilities. At the same time, people with disabilities are more vulnerable to NCDs, because of their underlying health condition, and vulnerability to poverty and exclusion from healthcare services. NCD programmes must expand their focus beyond prevention and treatment to incorporate rehabilitation for people living with NCDs, in order to maximize their functioning and well-being. Additionally, access to healthcare needs to be improved for people with disabilities so that they can secure their right to preventive, curative and rehabilitation services. These changes may require new innovations to overcome existing gaps in healthcare capacity, such as an increasing role for mobile technology and task-sharing. This perspective paper discusses these issues, using a particular focus on stroke and dementia in order to clarify these relationships.
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Affiliation(s)
- Josephine E Prynn
- Faculty of Population Health, University College London, 62 Huntley Street, London WC1E 6DD, UK.
| | - Hannah Kuper
- International Centre for Evidence in Disability, Clinical Research Department, London School of Hygiene & Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Spector A, Stoner CR, Chandra M, Vaitheswaran S, Du B, Comas-Herrera A, Dotchin C, Ferri C, Knapp M, Krishna M, Laks J, Michie S, Mograbi DC, Orrell MW, Paddick SM, Ks S, Rangawsamy T, Walker R. Mixed methods implementation research of cognitive stimulation therapy (CST) for dementia in low and middle-income countries: study protocol for Brazil, India and Tanzania (CST-International). BMJ Open 2019; 9:e030933. [PMID: 31434784 PMCID: PMC6707660 DOI: 10.1136/bmjopen-2019-030933] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In low/middle-income countries (LMICs), the prevalence of people diagnosed with dementia is expected to increase substantially and treatment options are limited, with acetylcholinesterase inhibitors not used as frequently as in high-income countries (HICs). Cognitive stimulation therapy (CST) is a group-based, brief, non-pharmacological intervention for people with dementia that significantly improves cognition and quality of life in clinical trials and is cost-effective in HIC. However, its implementation in other countries is less researched. This protocol describes CST-International; an implementation research study of CST. The aim of this research is to develop, test, refine and disseminate implementation strategies for CST for people with mild to moderate dementia in three LMICs: Brazil (upper middle-income), India (lower middle-income) and Tanzania (low-income). METHODS AND ANALYSIS Four overlapping phases: (1) exploration of barriers to implementation in each country using meetings with stakeholders, including clinicians, policymakers, people with dementia and their families; (2) development of implementation plans for each country; (3) evaluation of implementation plans using a study of CST in each country (n=50, total n=150). Outcomes will include adherence, attendance, acceptability and attrition, agreed parameters of success, outcomes (cognition, quality of life, activities of daily living) and cost/affordability; (4) refinement and dissemination of implementation strategies, enabling ongoing pathways to practice which address barriers and facilitators to implementation. ETHICS AND DISSEMINATION Ethical approval has been granted for each country. There are no documented adverse effects associated with CST and data held will be in accordance with relevant legislation. Train the trainer models will be developed to increase CST provision in each country and policymakers/governmental bodies will be continually engaged with to aid successful implementation. Findings will be disseminated at conferences, in peer-reviewed articles and newsletters, in collaboration with Alzheimer's Disease International, and via ongoing engagement with key policymakers.
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Affiliation(s)
- Aimee Spector
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Charlotte R Stoner
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Mina Chandra
- Department of Psychiatry, Centre of Excellence in Mental Health, Postgraduate Institute of Medical Education and Research (PGIMER) and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Bharath Du
- Department of Research, Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India
| | - Adelina Comas-Herrera
- Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science (LSE), London, UK
| | - Catherine Dotchin
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Cleusa Ferri
- Postgraduate Program of the Psychobiology Department, Universidade Federal de Sao Paulo, São Paulo, Brazil
| | - Martin Knapp
- Personal Social Services Research Unit (PSSRU), London School of Economics and Political Science (LSE), London, UK
| | - Murali Krishna
- Department of Research, Foundation for Research and Advocacy in Mental Health (FRAMe), Mysore, India
| | - Jerson Laks
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Susan Michie
- Research Department of Clinical, Educational and Health Psychology, University College London (UCL), London, UK
| | - Daniel C Mograbi
- Department of Psychology, PUC-Rio, Rio de Janeiro, Brazil
- Institute of Psychiatry, King's College London, London, UK
| | | | | | - Shaji Ks
- Department of Psychiatry, Government Medical College, Kerala, India
| | - Thara Rangawsamy
- Department of Research, Schizophrenia Research Fondation (SCARF), Chennai, India
| | - Richard Walker
- North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute for Health and Society, Newcastle University, Newcastle upon Tyne, UK
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10
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Rathnayake S, Moyle W, Jones CJ, Calleja P. Development of an mHealth application for family carers of people with dementia: A study protocol. Collegian 2019. [DOI: 10.1016/j.colegn.2018.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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11
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The impact of pre-existing conditions on functional outcome and mortality in geriatric hip fracture patients. INTERNATIONAL ORTHOPAEDICS 2017; 41:1995-2000. [DOI: 10.1007/s00264-017-3591-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 07/20/2017] [Indexed: 01/03/2023]
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Gray WK, Paddick SM, Collingwood C, Kisoli A, Mbowe G, Mkenda S, Lissu C, Rogathi J, Kissima J, Walker RW, Mushi D, Chaote P, Ogunniyi A, Dotchin CL. Community validation of the IDEA study cognitive screen in rural Tanzania. Int J Geriatr Psychiatry 2016; 31:1199-1207. [PMID: 26833889 DOI: 10.1002/gps.4415] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/26/2015] [Accepted: 12/03/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The dementia diagnosis gap in sub-Saharan Africa (SSA) is large, partly because of difficulties in screening for cognitive impairment in the community. As part of the Identification and Intervention for Dementia in Elderly Africans (IDEA) study, we aimed to validate the IDEA cognitive screen in a community-based sample in rural Tanzania METHODS: Study participants were recruited from people who attended screening days held in villages within the rural Hai district of Tanzania. Criterion validity was assessed against the gold standard clinical dementia diagnosis using DSM-IV criteria. Construct validity was assessed against, age, education, sex and grip strength and instrumental activities of daily living (IADLs). Internal consistency and floor and ceiling effects were also examined. RESULTS During community screening, the IDEA cognitive screen had high criterion validity, with an area under the receiver operating characteristic curve of 0.855 (95% CI 0.794 to 0.915). Higher scores on the screen were significantly correlated with lower age, male sex, having attended school, better grip strength and improved performance in activities of daily living. Factor analysis revealed a single factor with an eigenvalue greater than one, although internal consistency was only moderate (Cronbach's alpha = 0.534). CONCLUSIONS The IDEA cognitive screen had high criterion and construct validity and is suitable for use as a cognitive screening instrument in a community setting in SSA. Only moderate internal consistency may partly reflect the multi-domain nature of dementia as diagnosed clinically. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.
| | - Stella Maria Paddick
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.,Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Aloyce Kisoli
- Hai District Medical Office, Boma'ngombe, Kilimanjaro, Tanzania
| | - Godfrey Mbowe
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Sarah Mkenda
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Carolyn Lissu
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Jane Rogathi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - John Kissima
- Hai District Medical Office, Boma'ngombe, Kilimanjaro, Tanzania
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.,Institute of Health and Society, Newcastle University, UK
| | - Declare Mushi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Paul Chaote
- Hai District Medical Office, Boma'ngombe, Kilimanjaro, Tanzania
| | | | - Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, Tyne and Wear, UK.,Institute of Ageing, Newcastle University, Newcastle upon Tyne, UK
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Carmo JFD, Oliveira ERA, Morelato RL. Functional disability and associated factors in elderly stroke survivors in Vitória, Brazil. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2016. [DOI: 10.1590/1809-98232016019.150215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: The aim of the present study was to estimate the prevalence of disability and associated factors in elderly stroke survivors. Methods: A cross-sectional study of 230 elderly persons was conducted in the 22 territories of the Estratégia de Saúde da Família (the Family Health Strategy) of Vitória, in the state of Espirito Santo. Patients were assessed using the modified Rankin Scale. Poisson regression with robust variance in crude and adjusted analyses was employed. Results: The majority of subjects were men (52.1%) aged between 60 to 98 years, with a mean age of 75.8 (sd±9.2). The prevalence of disability was 66%. Age ≥80 years, self-perceived limitations in bodily function, considering the physical structure of the street to be a barrier to leaving home and believing street lighting to be insufficient were positively associated with functional disability. Possessing 12 or more years of schooling was inversely associated with the outcome. Conclusions: The high prevalence of disability and associated factors in elderly stroke survivors reinforce the need for a health system that operates continuously and proactively, promoting active aging.
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Mkenda S, Olakehinde O, Mbowe G, Siwoku A, Kisoli A, Paddick SM, Adediran B, Gray WK, Dotchin CL, Adebiyi A, Walker RW, Mushi D, Ogunniyi A. Cognitive stimulation therapy as a low-resource intervention for dementia in sub-Saharan Africa (CST-SSA): Adaptation for rural Tanzania and Nigeria. DEMENTIA 2016; 17:515-530. [DOI: 10.1177/1471301216649272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Cognitive stimulation therapy is a non-pharmacological intervention for people with dementia. Its use has been associated with substantial improvements in cognition and quality of life in studies from high-income countries, equivalent to those achieved by pharmacological treatments. Cognitive stimulation therapy may be particularly suited to low resource settings, such as sub-Saharan Africa, because it requires little specialist equipment and can be delivered by non-specialist health workers. The aim of this study was to adapt cognitive stimulation therapy for use in sub-Saharan Africa taking into account socio-cultural differences and resource implications. Methods Cognitive stimulation therapy is a structured programme, originally developed in the United Kingdom. Substantial adaptations were required for use in sub-Saharan Africa. The formative method for adapting psychotherapy was used as a framework for the adaption process. The feasibility of using the adapted cognitive stimulation therapy programme to manage dementia was assessed in Tanzania and Nigeria in November 2013. Further adaptations were made following critical appraisal of feasibility. Results The adapted cognitive stimulation therapy intervention appeared feasible and acceptable to participants and carers. Key adaptations included identification of suitable treatment settings, task adaptation to accommodate illiteracy and uncorrected sensory impairment, awareness of cultural differences and usage of locally available materials and equipment to ensure sustainability. Conclusions Cognitive stimulation therapy was successfully adapted for use in sub-Saharan Africa. Future work will focus on a trial of cognitive stimulation therapy in each setting.
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Affiliation(s)
- Sarah Mkenda
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Godfrey Mbowe
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Stella-Maria Paddick
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | | | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Declare Mushi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Adesola Ogunniyi
- University College Hospital (University of Ibadan), Ibadan, Nigeria
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15
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Mokaya J, Dotchin CL, Gray WK, Hooker J, Walker RW. The Accessibility of Parkinson's Disease Medication in Kenya: Results of a National Survey. Mov Disord Clin Pract 2016; 3:376-381. [PMID: 30363517 DOI: 10.1002/mdc3.12294] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 09/28/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background There is a dearth of knowledge about the availability and affordability of the different drug treatments for Parkinson's disease (PD) across sub-Saharan Africa (SSA). We aimed to determine the availability and affordability of drugs for treating PD in Kenya. Methods A facility-based survey was conducted in selected medicine outlets (pharmacies) in what were formerly the headquarter towns of the eight provinces of Kenya. We used the World Health Organization/Health Action International methodology to obtain data for drugs used to treat PD. Unit price for each drug was obtained. Results Forty-eight outlets were visited in total, six in each of Kenya's eight provinces. Levodopa (L-dopa) was available in only 24 (50.0%) outlets. Only one public pharmacy sold l-dopa (14 were private and nine were other types of outlet). Ergot-derived dopamine agonists (DAs) and anticholinergics were available in 37 and 35 outlets, respectively. Monoamine-oxidase inhibitors, non-ergot-derived DAs, and catechol-O-methyl transferase inhibitors were available in four, two and zero outlets, respectively. Mean cost of 100 l-dopa tablets was $48.2, though costs varied widely (range, $28.2-$82.4). Only five outlets considered l-dopa affordable, all of which sold 100 tablets for less than $31. Conclusion There is a lack of availability of PD drugs in Kenya, particularly in public pharmacies, where costs are generally lower. Few pharmacists consider the drugs available to be affordable. If PD is to be effectively managed in Kenya, then strategies are needed to increase the availability and affordability of medication.
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Affiliation(s)
| | - Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields United Kingdom.,Institute for Ageing Newcastle University Newcastle upon Tyne United Kingdom
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields United Kingdom
| | | | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields United Kingdom.,Institute of Health and Society Newcastle University Newcastle upon Tyne United Kingdom
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16
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Walker RW, Wakefield K, Gray WK, Jusabani A, Swai M, Mugusi F. Case-fatality and disability in the Tanzanian Stroke Incidence Project cohort. Acta Neurol Scand 2016; 133:49-54. [PMID: 25939728 PMCID: PMC4737228 DOI: 10.1111/ane.12422] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2015] [Indexed: 11/28/2022]
Abstract
Objectives The burden of stroke on healthcare services in sub‐Saharan Africa (SSA) is increasing. However, long‐term outcomes from stroke in SSA are not well described. We aimed to investigate case‐fatality and health outcomes for stroke survivors at 7‐ to 10‐year follow‐up. Materials and methods The Tanzanian Stroke Incidence Project (TSIP) recruited incidence stroke cases between 2003 and 2006. We followed up cases in 2013, recording date of death in those who had died. Results Of 130 stroke cases included in this study, case‐fatality and date of death data were available for 124 at 7–10 years post‐stroke. Of these, 102 (82.3%) had died by 7 years post‐stroke. Functional disability, as measured by the Barthel index immediately post‐stroke, was a significant predictor of case‐fatality at seven‐year follow‐up with those with severe disability having an almost four‐fold increase in the odds of death compared with those with no, mild or moderate disability. Conclusions Case‐fatality rates are higher than reported in high‐income countries, with post‐stroke disability a significant predictor of death. Sustainable interventions to reduce post‐stroke disability in this setting should be investigated.
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Affiliation(s)
- R. W. Walker
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields Tyne and Wear UK
- Institute of Health and Society Newcastle University, Newcastle‐upon‐Tyne UK
| | - K. Wakefield
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields Tyne and Wear UK
| | - W. K. Gray
- Northumbria Healthcare NHS Foundation Trust North Tyneside General Hospital North Shields Tyne and Wear UK
| | - A. Jusabani
- Kilimanjaro Christian Medical Centre Moshi Tanzania
| | - M. Swai
- Kilimanjaro Christian Medical Centre Moshi Tanzania
| | - F. Mugusi
- Department of Medicine Muhimbili University College Hospital Dar‐es‐Salaam Tanzania
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