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Tshimbombu TN, Shin M, Thesen T, Mesu’a Kabwa L, Blackmon K, Kashama JMKW, Jobst BC, Fontaine D, Olarinde I, Okitundu‐Luwa E‐Andjafono D. Review of epilepsy care in the Democratic Republic of the Congo. Epilepsia Open 2024; 9:467-474. [PMID: 38243880 PMCID: PMC10984300 DOI: 10.1002/epi4.12904] [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: 10/22/2023] [Revised: 01/04/2024] [Accepted: 01/11/2024] [Indexed: 01/22/2024] Open
Abstract
Epilepsy imposes a substantial burden on the Democratic Republic of Congo (DRC). These challenges encompass the lack of comprehensive disease surveillance, an unresolved understanding of its pathophysiology, economic barriers limiting access to essential care, the absence of epilepsy surgical capabilities, and deeply ingrained societal stigmas. Notably, the national prevalence of epilepsy remains undetermined, with research primarily concentrating on infectious factors like Onchocerca volvulus, leaving other potential causes underexplored. Most patients lack insurance, incurring out-of-pocket expenses that often lead them to opt for traditional medicine rather than clinical care. Social stigma, perpetuated by common misconceptions, intensifies the social isolation experienced by individuals living with epilepsy. Additionally, surgical interventions are unavailable, and the accessibility of anti-seizure medications and healthcare infrastructure remains inadequate. Effectively tackling these interrelated challenges requires a multifaceted approach, including conducting research into region-specific factors contributing to epilepsy, increasing healthcare funding, subsidizing the costs of treatment, deploying mobile tools for extensive screening, launching awareness campaigns to dispel myths and reduce stigma, and promoting collaborations between traditional healers and medical practitioners to enhance local understanding and epilepsy management. Despite the difficulties, significant progress can be achieved through sustained and compassionate efforts to understand and eliminate the barriers faced by epilepsy patients in the region. This review outlines essential steps for alleviating the epilepsy burden in the DRC. PLAIN LANGUAGE SUMMARY: There are not enough resources to treat epilepsy in the DRC. PWEs struggle with stigma and the lack of money. Many of them still use traditional medicine for treatment and hold wrong beliefs about epilepsy. That is why there is a need for more resources to make the lives of PWEs better in the DRC.
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Affiliation(s)
| | | | - Thomas Thesen
- Geisel School of Medicine at DartmouthHanoverNew HampshireUSA
| | - Luabeya Mesu’a Kabwa
- Department of Neurology and Neuropsychiatry, Center for Neuro‐Psycho‐Pathology of Mont‐Amba, Faculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of Congo
- Centre Hospitalier ValisanaBrusselsBelgium
| | - Karen Blackmon
- Department of Psychiatry and PsychologyMayo ClinicJacksonvilleFloridaUSA
| | - Jean Marie Kashama wa Kashama
- Department of Neurology and Neuropsychiatry, Center for Neuro‐Psycho‐Pathology of Mont‐Amba, Faculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of Congo
| | - Barbara C. Jobst
- Department of Neurology, Geisel School of Medicine at DartmouthDartmouth‐Hitchcock Medical CenterLebanonNew HampshireUSA
| | | | - Immanuel Olarinde
- Richmond Gabriel University College of MedicineBelairSaint Vincent and the Grenadines
| | - Daniel Okitundu‐Luwa E‐Andjafono
- Department of Neurology and Neuropsychiatry, Center for Neuro‐Psycho‐Pathology of Mont‐Amba, Faculty of MedicineUniversity of KinshasaKinshasaDemocratic Republic of Congo
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Ikanga J, Patrick SD, Schwinne M, Patel SS, Epenge E, Gikelekele G, Tshengele N, Kavugho I, Mampunza S, Yarasheski KE, Teunissen CE, Stringer A, Levey A, Rojas JC, Chan B, Lario Lago A, Kramer JH, Boxer AL, Jeromin A, Alonso A, Spencer RJ. Sensitivity of the African neuropsychology battery memory subtests and learning slopes in discriminating APOE 4 and amyloid pathology in adult individuals in the Democratic Republic of Congo. Front Neurol 2024; 15:1320727. [PMID: 38601333 PMCID: PMC11004441 DOI: 10.3389/fneur.2024.1320727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 03/14/2024] [Indexed: 04/12/2024] Open
Abstract
Background The current study examined the sensitivity of two memory subtests and their corresponding learning slope metrics derived from the African Neuropsychology Battery (ANB) to detect amyloid pathology and APOEε4 status in adults from Kinshasa, the Democratic Republic of the Congo. Methods 85 participants were classified for the presence of β-amyloid pathology and based on allelic presence of APOEε4 using Simoa. All participants were screened using CSID and AQ, underwent verbal and visuospatial memory testing from ANB, and provided blood samples for plasma Aβ42, Aβ40, and APOE proteotype. Pearson correlation, linear and logistic regression were conducted to compare amyloid pathology and APOEε4 status with derived learning scores, including initial learning, raw learning score, learning over trials, and learning ratio. Results Our sample included 35 amyloid positive and 44 amyloid negative individuals as well as 42 without and 39 with APOEε4. All ROC AUC ranges for the prediction of amyloid pathology based on learning scores were low, ranging between 0.56-0.70 (95% CI ranging from 0.44-0.82). The sensitivity of all the scores ranged between 54.3-88.6, with some learning metrics demonstrating good sensitivity. Regarding APOEε4 prediction, all AUC values ranged between 0.60-0.69, with all sensitivity measures ranging between 53.8-89.7. There were minimal differences in the AUC values across learning slope metrics, largely due to the lack of ceiling effects in this sample. Discussion This study demonstrates that some ANB memory subtests and learning slope metrics can discriminate those that are normal from those with amyloid pathology and those with and without APOEε4, consistent with findings reported in Western populations.
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Affiliation(s)
- Jean Ikanga
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
- Department of Psychiatry, School of Medicine, University of Kinshasa and Catholic University of Congo, Kinshasa, Democratic Republic of Congo
| | - Sarah D. Patrick
- Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Megan Schwinne
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, GA, United States
| | - Saranya Sundaram Patel
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Emmanuel Epenge
- Department of Neurology, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Guy Gikelekele
- Department of Psychiatry, School of Medicine, University of Kinshasa and Catholic University of Congo, Kinshasa, Democratic Republic of Congo
| | - Nathan Tshengele
- Department of Psychiatry, School of Medicine, University of Kinshasa and Catholic University of Congo, Kinshasa, Democratic Republic of Congo
| | | | - Samuel Mampunza
- Department of Psychiatry, School of Medicine, University of Kinshasa and Catholic University of Congo, Kinshasa, Democratic Republic of Congo
| | | | - Charlotte E. Teunissen
- Neurochemistry Laboratory, Department of Clinical Chemistry, Amsterdam Neuroscience, Neurodegeneration, Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Anthony Stringer
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA, United States
| | - Allan Levey
- Department of Neurology, School of Medicine, Emory University, Atlanta, GA, United States
| | - Julio C. Rojas
- Department of Neurology, University of San Francisco, Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
| | - Brandon Chan
- Department of Neurology, University of San Francisco, Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
| | - Argentina Lario Lago
- Department of Neurology, University of San Francisco, Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
| | - Joel H. Kramer
- Department of Neurology, University of San Francisco, Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
| | - Adam L. Boxer
- Department of Neurology, University of San Francisco, Memory and Aging Center, Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, United States
| | | | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Robert J. Spencer
- Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, MI, United States
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Ikanga J, Patel SS, Roberts BR, Schwinne M, Hickle S, Verberk IMW, Epenge E, Gikelekele G, Tshengele N, Kavugho I, Mampunza S, Yarasheski KE, Teunissen CE, Stringer A, Levey A, Alonso A. Association of plasma biomarkers with cognitive function in persons with dementia and cognitively healthy in the Democratic Republic of Congo. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12496. [PMID: 37954546 PMCID: PMC10632676 DOI: 10.1002/dad2.12496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/15/2023] [Accepted: 09/26/2023] [Indexed: 11/14/2023]
Abstract
Introduction This study investigates whether plasma biomarkers (Aβ42/40 and p-tau 181), APS, as well as apolipoprotein E (APOE) proteotype predict cognitive deficits in elderly adults from the Democratic Republic of Congo. Methods Forty-four with possible AD (pAD) and 41 healthy control (HC) subjects were screened using CSID and AQ, underwent cognitive assessment with the African Neuropsychology Battery (ANB), and provided blood samples for plasma Aβ42, Aβ40, Aβ42/40, and APOE proteotype. Linear and logistic regression were used to evaluate the associations of plasma biomarkers with ANB tests and the ability of biomarkers to predict cognitive status. Results Patients with pAD had significantly lower plasma Aβ42/40 levels, higher APS, and higher prevalence of APOE E4 allele compared to HC. Groups did not differ in levels of Aβ40, Aβ42, or P-tau 181. Results showed that Aβ42/40 ratio and APS were significantly associated with African Naming Test (ANT), African List Memory Test (ALMT), and African Visuospatial Memory Test (AVMT) scores, while the presence of APOE E4 allele was associated with ANT, ALMT, AVMT, and APT scores. P-tau 181 did not show any significant associations while adjusting for age, education, and gender. APS showed the highest area under the curve (AUC) value (AUC = 0.78, 95% confidence interval [CI]: 0.68-0.88) followed by Aβ42/40 (AUC = 0.75, 95% CI: 0.66-0.86) and APOE E4 (AUC = 0.69 (CI 0.57-0.81) in discriminating pAD from HC. Discussion These results demonstrate associations between select plasma biomarker of AD pathology (Aβ42/40), APS, and APOE E4 allele) and ANB test scores and the ability of these biomarkers to differentiate pAD from cognitively normal SSA individuals, consistent with findings reported in other settings.
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Affiliation(s)
- Jean Ikanga
- Department of Rehabilitation MedicineEmory University School of MedicineAtlantaGeorgiaUSA
- Department of PsychiatrySchool of MedicineUniversity of Kinshasa and Catholic University of CongoKinshasaDemocratic Republic of Congo
| | - Saranya Sundaram Patel
- Department of Rehabilitation MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Blaine R. Roberts
- Department of BiochemistryDepartment of neurologySchool of MedicineEmory UniversityAtlantaGeorgiaUSA
| | - Megan Schwinne
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Sabrina Hickle
- Department of Rehabilitation MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Inge M. W. Verberk
- Neurochemistry laboratoryDepartment of Clinical ChemistryAmsterdam Neuroscience, NeurodegenerationAmsterdam University Medical Centers, Vrije UniversitietAmsterdamThe Netherlands
| | - Emmanuel Epenge
- Department of neurologyUniversity of KinshasaKinshasaDemocratic Republic of Congo
| | - Guy Gikelekele
- Department of PsychiatrySchool of MedicineUniversity of Kinshasa and Catholic University of CongoKinshasaDemocratic Republic of Congo
| | - Nathan Tshengele
- Department of PsychiatrySchool of MedicineUniversity of Kinshasa and Catholic University of CongoKinshasaDemocratic Republic of Congo
| | | | - Samuel Mampunza
- Department of PsychiatrySchool of MedicineUniversity of Kinshasa and Catholic University of CongoKinshasaDemocratic Republic of Congo
| | | | - Charlotte E. Teunissen
- Neurochemistry laboratoryDepartment of Clinical ChemistryAmsterdam Neuroscience, NeurodegenerationAmsterdam University Medical Centers, Vrije UniversitietAmsterdamThe Netherlands
| | - Anthony Stringer
- Department of Rehabilitation MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Allan Levey
- Department of NeurologyEmory University School of MedicineAtlantaGeorgiaUSA
| | - Alvaro Alonso
- Department of EpidemiologyRollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
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Ikanga J, Reyes A, Zhao L, Hill-Jarrett TG, Hammers D, Epenge E, Esambo H, Kavugho I, Esselakoy C, Gikelekele G, Tshengele N, Alonso A, Robinson-Lane SG. Exploring factors contributing to caregiver burden in family caregivers of congolese adults with suspected dementia. Int J Geriatr Psychiatry 2023; 38:e6004. [PMID: 37712695 PMCID: PMC10901182 DOI: 10.1002/gps.6004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/05/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Predicting caregiver burden in individuals with suspected dementia - is critical due to the debilitating nature of these disorders and need for caregiver support. While some examination of the factors affecting burden has been undertaken in Sub-Saharan Africa, each country presents with its own unique challenges and obstacles. This pilot study investigates predictors of caregiver burden in family caregivers of individuals with suspected dementia living in the Democratic Republic of the Congo (DRC). METHODS Linear and multiple regression analyses were conducted to explore factors associated with caregiver burden in 30 patient-caregiver dyads with the Zarit Burden Interview (ZBI) for caregiver burden evaluation. Cognitive impairments of patients were assessed using the Community Screening Instrument for Dementia, Alzheimer's Questionnaire (AQ), the African Neuropsychology Battery, and the Neuropsychiatric Symptoms Inventory (NPI). RESULTS Average caregiver burden on the ZBI was 36.1 (SD = 14.6; range = 12-58). Greater impairments in patient cognition (orientation, visuospatial, memory, executive functioning), fragility, and neuropsychiatric symptoms (delirium, agitation, depression) were predictive of caregiver burden. After controlling for AQ scores and caregiver gender, greater symptoms of depression, and worse performances on verbal memory and problem solving were associated with greater caregiver burden. CONCLUSION Worsening patient fragility, cognition, functioning, and neuropsychiatric symptoms influenced caregiver burden in caregivers of individuals with suspected cognitive impairment in the DRC. These findings are consistent with the prior literature. Future studies may wish to explore supportive factors and caregiver specific characteristics that buffer against perceived burden.
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Affiliation(s)
- Jean Ikanga
- Emory University School of Medicine, Department of Rehabilitation Medicine, Georgia, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA
- University of Kinshasa and Catholic University of Congo, School of Medicine, Department of Psychiatry, Kinshasa, B.P. 7463 Kinshasa, Democratic Republic of Congo
| | - Anny Reyes
- Emory University School of Medicine, Department of Rehabilitation Medicine, Georgia, 1441 Clifton Rd NE, Atlanta, GA, 30322, USA
| | - Liping Zhao
- Emory University, Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta GA 30322, USA
| | - Tanisha G. Hill-Jarrett
- University of South Florida, Department of Neurosurgery and Brain Repair, Tampa, Florida, 33613, USA
- University of California, Global Brain Health Institute, San Francisco, California, 94158, USA
| | - Dustin Hammers
- Indiana university, department of neurology, Indiana, Indianapolis, IN 46202, USA
| | - Emmanuel Epenge
- University of Kinshasa, department of neurology, BP 7463 Kinshasa, Democratic Republic of Congo
| | - Herve Esambo
- University of Kinshasa, department of neurology, BP 7463 Kinshasa, Democratic Republic of Congo
| | - Immaculée Kavugho
- Memory Clinic of Kinshasa, BP 7463 Kinshasa, Democratic Republic of Congo
| | - Christian Esselakoy
- University of Montreal, Department of psychology, PO BOX 6128 Centre-ville STN Montreal QC H3C 3J, CANADA
| | - Guy Gikelekele
- University of Kinshasa and Catholic University of Congo, School of Medicine, Department of Psychiatry, Kinshasa, B.P. 7463 Kinshasa, Democratic Republic of Congo
| | - Nathan Tshengele
- University of Kinshasa and Catholic University of Congo, School of Medicine, Department of Psychiatry, Kinshasa, B.P. 7463 Kinshasa, Democratic Republic of Congo
| | - Alvaro Alonso
- Emory University, School of Public Health, department of epidemiology, Georgia, Atlanta, GA, 30307, USA
| | - Sheria G. Robinson-Lane
- University of Michigan, School of Nursing, Department of Systems, Populations, and Leadership, Ann Arbor, Michigan, 48109, USA
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Ikanga J, Hickle S, Schwinne M, Epenge E, Gikelekele G, Kavugho I, Tsengele N, Samuel M, Zhao L, Qiu D, Stringer A, Saindane AM, Alonso A, Drane DL. Association Between Hippocampal Volume and African Neuropsychology Memory Tests in Adult Individuals with Probable Alzheimer's Disease in Democratic Republic of Congo. J Alzheimers Dis 2023; 96:395-408. [PMID: 37781799 PMCID: PMC10903367 DOI: 10.3233/jad-230206] [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] [Indexed: 10/03/2023]
Abstract
BACKGROUND Western studies indicate potential associations between hippocampal volume and memory in the trajectory of Alzheimer's disease (AD). However, limited availability of neuroimaging technology and neuropsychological tests appropriate for sub-Saharan African (SSA) countries makes it difficult to establish neuroanatomical associations of hippocampus and memory in this locale. OBJECTIVE This study examined hippocampal volumes and memory in healthy control (HC) and probable AD groups in the Democratic Republic of Congo (DRC). METHODS Forty-six subjects with probable AD and 29 HC subjects were screened using the Community Instrument for Dementia and the Alzheimer Questionnaire. Participants underwent neuroimaging in Kinshasa, DRC, and memory was evaluated using the African Neuropsychology Battery (ANB). Multiple linear regression was used to determine associations between hippocampal volumes and memory. RESULTS Patients with probable AD performed significantly worse than HCs on ANB memory measures, and exhibited greater cerebral atrophy, which was significantly pronounced in the medial temporal lobe region (hippocampus, entorhinal cortex). Both AD and HC subjects exhibited high rates of white matter hyperintensities compared to international base rate prevalence, which was significantly worse for probable AD. Both also exhibited elevated rates of microhemorrhages. Regression analysis demonstrated a significant association between hippocampal volume and ANB memory tests. Hippocampal atrophy discriminated probable AD from the HC group. CONCLUSIONS This study establishes the feasibility of conducting neuroimaging research in the SSA, demonstrates many known neuroimaging findings in probable AD patients hold up using culturally appropriate memory tasks, and suggest cardiovascular problems are a greater issue in SSA than in Western countries.
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Affiliation(s)
- Jean Ikanga
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, Georgia, 30322, USA
- University of Kinshasa and Catholic University of Congo, School of Medicine, Kinshasa, Department of Psychiatry, B.P. 7463 Kinshasa I, Democratic Republic of Congo
| | - Sabrina Hickle
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, Georgia, 30322, USA
| | - Megan Schwinne
- Emory University, Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Emmanuel Epenge
- University of Kinshasa, Department of neurology, Kinshasa, B.P. 7463 Kinshasa I, Democratic Republic of Congo
| | - Guy Gikelekele
- University of Kinshasa and Catholic University of Congo, School of Medicine, Kinshasa, Department of Psychiatry, B.P. 7463 Kinshasa I, Democratic Republic of Congo
| | - Immaculee Kavugho
- Memory clinic of Kinshasa, Kinshasa, B.P. 7463 Kinshasa I, Democratic Republic of Congo
| | - Nathan Tsengele
- University of Kinshasa and Catholic University of Congo, School of Medicine, Kinshasa, Department of Psychiatry, B.P. 7463 Kinshasa I, Democratic Republic of Congo
- University of Kikwit, Faculty of Medicine, Democratic Republic of Congo
| | - Mampunza Samuel
- University of Kinshasa and Catholic University of Congo, School of Medicine, Kinshasa, Department of Psychiatry, B.P. 7463 Kinshasa I, Democratic Republic of Congo
| | - Liping Zhao
- Emory University, Department of biostatistics and Bioinformatics, Rollins School of Public Health, Atlanta, GA, USA
| | - Deqiang Qiu
- Emory University, School of Medicine, Department of Radiology and Imaging Sciences & Department of Biomedical Engineering, Atlanta, GA, USA
| | - Anthony Stringer
- Emory University School of Medicine, Department of Rehabilitation Medicine, Atlanta, Georgia, 30322, USA
| | - Amit M Saindane
- Emory University, School of Medicine, Departments of Radiology and Imaging Sciences and Neurosurgery, Atlanta, GA, USA
| | - Alvaro Alonso
- Emory University, Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, 30322, USA
| | - Daniel L. Drane
- Emory University, School of Medicine, Departments of Neurology and Pediatrics, Atlanta, Georgia 30322, USA
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