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Malek-Ahmadi M, Nikkhahmanesh N. Meta-analysis of Montreal cognitive assessment diagnostic accuracy in amnestic mild cognitive impairment. Front Psychol 2024; 15:1369766. [PMID: 38414877 PMCID: PMC10896827 DOI: 10.3389/fpsyg.2024.1369766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 01/26/2024] [Indexed: 02/29/2024] Open
Abstract
Background The Montreal Cognitive Assessment (MoCA) is one of the most widely-used cognitive screening instruments and has been translated into several different languages and dialects. Although the original validation study suggested to use a cutoff of ≤26, subsequent studies have shown that lower cutoff values may yield fewer false-positive indications of cognitive impairment. The aim of this study was to summarize the diagnostic accuracy and mean difference of the MoCA when comparing cognitively unimpaired (CU) older adults to those with amnestic mild cognitive impairment (aMCI). Methods PubMed and EMBASE databases were searched from inception to 22 February 2022. Meta-analyses for area under the curve (AUC) and standardized mean difference (SMD) values were performed. Results Fifty-five observational studies that included 17,343 CU and 8,413 aMCI subjects were selected for inclusion. Thirty-nine studies were used in the AUC analysis while 44 were used in the SMD analysis. The overall AUC value was 0.84 (95% CI: 0.81, 0.87) indicating good diagnostic accuracy and a large effect size was noted for the SMD analysis (Hedge's g = 1.49, 95% CI: 1.33, 1.64). Both analyses had high levels of between-study heterogeneity. The median cutoff score for identifying aMCI was <24. Discussion and conclusion The MoCA has good diagnostic accuracy for detecting aMCI across several different languages. The findings of this meta-analysis also support the use of 24 as the optimal cutoff when the MoCA is used to screen for suspected cognitive impairment.
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Affiliation(s)
- Michael Malek-Ahmadi
- Banner Alzheimer’s Institute, Phoenix, AZ, United States
- College of Medicine, University of Arizona, Phoenix, AZ, United States
| | - Nia Nikkhahmanesh
- College of Medicine, University of Arizona, Phoenix, AZ, United States
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2
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Kihumuro RB, Kellen P, Chun S, Wakida EK, Obua C, Ainamani HE. Cognitive impairment and the associated factors among women with a history of pregnancy complications in rural southwestern Uganda. PLoS One 2023; 18:e0293258. [PMID: 37906567 PMCID: PMC10617700 DOI: 10.1371/journal.pone.0293258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/09/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Worldwide, there is a growing concern about the rising number of people with declining cognitive functioning. However, findings on this phenomenon are inconclusive. Our study aimed to assess the prevalence of cognitive impairment and the associated factors in women with a history of pregnancy complications in rural southwestern Uganda. METHODS This was a cross-sectional study carried out among women above 40 years of age in the greater Kabale district of southwestern Uganda between March and April 2022. Study participants were identified using a consecutive sampling method. Predictor variables included pregnancy complications and other social demographic factors that were assessed by semi-structured interviews while cognitive functioning as an outcome variable was assessed by Montreal Cognitive Assessment (MoCA-B) tool. Data were analyzed using STATA at a 95% Confidence level. Logistic regression analyses were selected for statistical modelling while odds ratios were calculated to assess the strength of associations between the predictor and outcome variables. RESULTS In total, 75% (212/280) of participants had some form of cognitive impairment, with 45% (123/280) falling into mild CI, 31% (86/280) moderate CI and 4% (10/280) severe CI. Twenty-three percent (68/280) of participants fell into category of normal cognitive functioning. Participants with >65 years of age had higher odds of developing cognitive impairment (OR = 2.94; 95%CI: 0.96-9.04, p = 0.06) than those with < 65 years of age. Protective factors to cognitive impairment include delivering from a health facility (OR = 0.31,95% CI:0.16-0.60, p = < .001), primary and post primary levels of education (OR = 0.05; 95% CI: 0.02-0.13, p<0.001, OR = 0.04; 95%CI: 0.02-0.23, p<0.001) respectively. CONCLUSION Results from this study show a high prevalence of cognitive impairment among women with a history of pregnancy complications in rural southwestern Uganda. Interventions geared toward preventing cognitive impairment among females with a history of pregnancy complications should be emphasized.
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Affiliation(s)
| | - Peace Kellen
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Sarah Chun
- Department of Medicine, California University of Science and Medicine, Northridge, California, United States of America
| | - Edith K. Wakida
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medicine, California University of Science and Medicine, Northridge, California, United States of America
- California University of Science and Medicine, Northridge, California, United States of America
| | - Celestino Obua
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Pharmacology and Therapeutic, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Herbert E. Ainamani
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda
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Checkouri T, Missamou F, Pion SDS, Bikita P, Hemilembolo MC, Boussinesq M, Chesnais CB, Campillo JT. Association between altered cognition and Loa loa microfilaremia: First evidence from a cross-sectional study in a rural area of the Republic of Congo. PLoS Negl Trop Dis 2023; 17:e0011430. [PMID: 37339123 DOI: 10.1371/journal.pntd.0011430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/03/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Individuals with high Loa loa microfilarial densities are at risk of developing severe encephalopathy after administration of antiparasitic drugs. Apart from this finding, loiasis is considered benign with no effect on brain function. However, recent epidemiological data suggest an increased mortality and morbidity in L. loa infected individuals, underscoring the importance of studies on the possible neurological morbidity associated with loiasis. METHODOLOGY Using MoCA tests and neurological ultrasounds, we conducted a cross-sectional study to assess cognitive alteration in a population living in a rural area endemic for loiasis in the Republic of Congo. Fifty individuals with high microfilarial densities (MFD) were matched on sex, age and residency with 50 individuals with low MFD and 50 amicrofilaremic subjects. Analyses focused on individuals with MoCA scores indicating an altered cognition (i.e. < 23/30) and on the total MoCA score according to Loa loa MFD, sociodemographic characteristics and neurological ultrasound results. PRINCIPAL FINDINGS MoCA scores were very low in the studied population (mean of 15.6/30). Individuals with more than 15,000 microfilariae per milliliter of blood (mean predicted score:14.0/30) are more than twenty times more likely to have an altered cognition, compared to individuals with no microfilaremia (mean predicted score: 16.3/30). Years of schooling were strongly associated with better MoCA results. Extracranial and intracranial atheroma were not associated with L. loa MFD. CONCLUSION/SIGNIFICANCE Loaisis microfilaremia is probably involved in cognitive impairment, especially when the MFD are high. These results highlight the urgent need to better understand loaisis-induced morbidity. Further studies investigating neurological morbidity of loiasis are needed.
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Affiliation(s)
- Thomas Checkouri
- AP-HP, Service des Urgences Cérébro-Vasculaires, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - François Missamou
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - Sebastien D S Pion
- UMI 233 TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
| | - Paul Bikita
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
| | - Marlhand C Hemilembolo
- Programme National de Lutte contre l'Onchocercose, Direction de l'Épidémiologie et de la Lutte contre la Maladie, Ministère de la Santé et de la Population, Brazzaville, Republic of the Congo
- UMI 233 TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
| | - Michel Boussinesq
- UMI 233 TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
| | - Cédric B Chesnais
- UMI 233 TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
| | - Jérémy T Campillo
- UMI 233 TransVIHMI, Université Montpellier, Institut de Recherche pour le Développement (IRD), INSERM Unité, Montpellier, France
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Nyundo AA. Correlates of the HIV-associated neurocognitive disorders among adults living with HIV in Dodoma region, central Tanzania: A cross-sectional study. PLoS One 2023; 18:e0285761. [PMID: 37228133 PMCID: PMC10212098 DOI: 10.1371/journal.pone.0285761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 05/02/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND HIV-associated neurocognitive disorders (HAND) continue to manifest despite advancements and improved antiretroviral therapy coverage. Neurocognitive impairment is a significant predictor of poor prognosis related to poor antiretroviral therapy adherence and retention in HIV care. METHODS This cross-sectional study examined 397 participants attending cared for and treatment at Dodoma Regional Referral Hospital (DRRH) and selected by systematic sampling. The combination of Montreal Cognitive Assessment (MoCA), International HIV Dementia Scale (IHDS), and The Lawton Instrumental Activity of Daily Living (IADL) were used to assess HIV-associated neurocognitive disorders. Factors associated with HAND were determined using univariate and multivariable logistic regression. RESULTS Of 397 participants, 234(59.1%) met the criteria for HAND with 231(58.2%) comprising asymptomatic neurocognitive disorder (ANI) or mild neurocognitive disorders (MND), and 3 (0.76%) HIV- associated dementia (HAD). Participants with HAND had significantly poorer performance in each cognitive domain on both MoCA and IHDS. Under multivariable regression, age of 55 years or above with Adjusted Odds Ratio (AOR): 3.5 (95%CI: 1.1, 11.6), p = 0.041 and female gender (AOR): 2.7 (95%CI: 1, 6, 4.5), p<0.001 were significantly associated with HAND. Adherence to antiretroviral therapy AOR: 0.4(95%CI: 0.2, 1.0), p = 0.044, and attaining primary education AOR: 0.3(95%CI: 0.1, 0.8), p = 0.01 or secondary education AOR: 0.1(95%CI: 0.03, 0.2), p<0.001 compared to having no formal education showed good cognitive performance. CONCLUSION HIV-associated neurocognitive disorders are common in HIV, especially ANI and MND, are common in HIV infected Tanzanians. Both socio-demographic and clinical variables influence neurocognitive functioning in this population. Screening for mild neurocognitive disorders may be indicated if effective treatment becomes available.
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Affiliation(s)
- Azan A. Nyundo
- Department of Psychiatry and Mental Health, School of Medicine, The University of Dodoma, Dodoma, Tanzania
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5
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Georgiou E(EZ, Prapiadou S, Thomopoulos V, Skondra M, Charalampopoulou M, Pachi A, Anagnostopoulou Α, Vorvolakos T, Perneczky R, Politis A, Alexopoulos P. Naming ability assessment in neurocognitive disorders: a clinician's perspective. BMC Psychiatry 2022; 22:837. [PMID: 36585667 PMCID: PMC9801565 DOI: 10.1186/s12888-022-04486-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Detecting impaired naming capacity is valuable in diagnosing neurocognitive disorders (ND). A. clinical practice- oriented overview of naming tests validated in ND is not available yet. Here, features of naming tests with validated utility in ND which are open access or available for purchase are succinctly presented and compared. METHODS Searches were carried out across Pubmed, Medline and Google Scholar. Additional studies were identified by searching reference lists. Only peer-reviewed journal articles were eligible. A narrative- and tabullar synthesis was used to summarize different aspects of the naming assessment instruments used in patients with ND such as stimuli type, administration time, assessment parameters and accessibility. Based on computational word frequency calculations, the tests were compared in terms of the average frequency of their linguistic content. RESULTS Twelve naming tests, relying either on visual or auditory stimuli have been validated in ND. Their content and administration time vary between three and 60 items and one and 20 minutes, respectively. The average frequency of the words of each considered test was two or lower, pointing to low frequency of most items. In all but one test, scoring systems are exclusively based on correctly named items. Seven instruments are open access and four are available in more than one language. CONCLUSIONS Gaining insights into naming tests' characteristics may catalyze the wide incorporation of those with short administration time but high diagnostic accuracy into the diagnostic workup of ND at primary healthcare and of extensive, visual or auditory ones into the diagnostic endeavors of memory clinics, as well as of secondary and tertiary brain healthcare settings.
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Affiliation(s)
- Eliza ( Eleni-Zacharoula) Georgiou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Savvina Prapiadou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Vasileios Thomopoulos
- grid.11047.330000 0004 0576 5395Large-Scale Machine Learning & Cloud Data Engineering Laboratory (ML@Cloud-Lab), Faculty of Computer Engineering & Informatics, School of Engineering, University of Patras, Patras, Greece
| | - Maria Skondra
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Marina Charalampopoulou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Asimina Pachi
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece
| | - Αlexandra Anagnostopoulou
- grid.11047.330000 0004 0576 5395Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece ,General Hospital of Zakynthos “Saint Dionysios”, Zakynthos, Greece
| | - Theofanis Vorvolakos
- grid.12284.3d0000 0001 2170 8022Department of Psychiatry, Faculty of Medicine, School of Health Sciences, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece
| | - Robert Perneczky
- grid.5252.00000 0004 1936 973XDivision of Mental Health in Older Adults and Alzheimer Therapy and Research Center, Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany ,grid.7445.20000 0001 2113 8111Ageing Epidemiology (AGE) Research Unit, School of Public Health, Faculty of Medicine, The Imperial College of Science, Technology and Medicine, London, UK ,grid.424247.30000 0004 0438 0426German Center for Neurodegenerative Diseases (DZNE) Munich, Munich, Germany ,grid.452617.3Munich Cluster for Systems Neurology (SyNergy), Munich, Germany ,grid.11835.3e0000 0004 1936 9262Sheffield Institute for Translational Neurosciences (SITraN), University of Sheffield, Sheffield, UK
| | - Antonios Politis
- grid.5216.00000 0001 2155 0800First Department of Psychiatry, Eginition Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece ,grid.21107.350000 0001 2171 9311Department of Psychiatry, Division of Geriatric Psychiatry and Neuropsychiatry, Johns Hopkins Medical School, Baltimore, USA
| | - Panagiotis Alexopoulos
- Department of Psychiatry, Patras University General Hospital, Faculty of Medicine, School of Health Sciences, University of Patras, Patras, Greece. .,Global Brain Health Institute, Medical School, Trinity College Dublin, The University of Dublin, Dublin, Republic of Ireland. .,Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, Faculty of Medicine, Technical University of Munich, Munich, Germany. .,Patras Dementia Day Care Center, Corporation for Succor and Care of Elderly and Disabled - FRODIZO, Patras, Greece.
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6
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George G, Fricker M, Todd O, Makowa D, Tembo C, Dotchin C, Gray WK, Walker RW, Mbwele B, Paddick SM. Screening for delirium and dementia in older hospitalised adults in Zambia. J Neurol Sci 2022; 436:120186. [DOI: 10.1016/j.jns.2022.120186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 01/27/2022] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
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Daniel B, Agenagnew L, Workicho A, Abera M. Psychometric Properties of the Montreal Cognitive Assessment (MoCA) to Detect Major Neurocognitive Disorder Among Older People in Ethiopia: A Validation Study. Neuropsychiatr Dis Treat 2022; 18:1789-1798. [PMID: 36035074 PMCID: PMC9416441 DOI: 10.2147/ndt.s377430] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cognition is one of the most complex functions of the human brain, and major neurocognitive disorders affect this function causing a wide array of problems in an individual's life. Screening for major neurocognitive disorders can be helpful in designing and implementing early interventions. PURPOSE This study was designed to assess the reliability and validity of the Montreal Cognitive Assessment (MoCA) tool to detect major neurocognitive disorders among older people in Ethiopia. METHODS One hundred and sixteen randomly selected older adults in Ethiopia were involved in a cross-sectional study. The Diagnostic and Statistical Manual of Mental Disorders criteria for major neurocognitive disorders was used as a gold standard. Data were analyzed using STATA v16 statistical software. Receiver operating curve analysis was performed, and inter-rater, internal consistency reliabilities, content, criterion and construct validities were determined. Statistically significance was declared at a p-value of <0.05. RESULTS The study had a 100% response rate. The mean age of the study participants was 69.87 ± 7.8. The inter-rater reliability value was 0.96, and Cronbach's alpha was 0.79. The optimal cutoff value was ≤21, and Montreal Cognitive Assessment has an area under curve value of 0.89. The sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values of MoCA are 87.18%, 74.03%, 3.35, 0.17, 63%, and 91.9%, respectively. The tool also has good concurrent and construct validities. CONCLUSION The Montreal Cognitive Assessment tool was a reliable and valid tool to detect major neurocognitive disorder. It can be incorporated into the clinical and research practices in developing countries.
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Affiliation(s)
- Beniam Daniel
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
| | | | | | - Mubarek Abera
- Department of Psychiatry, Jimma University, Jimma, Ethiopia
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8
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Paddick SM, Yoseph M, Gray WK, Andrea D, Barber R, Colgan A, Dotchin C, Urasa S, Kissima J, Haule I, Kisoli A, Rogathi J, Safic S, Mushi D, Robinson L, Walker RW. Effectiveness of App-Based Cognitive Screening for Dementia by Lay Health Workers in Low Resource Settings. A Validation and Feasibility Study in Rural Tanzania. J Geriatr Psychiatry Neurol 2021; 34:613-621. [PMID: 32964799 PMCID: PMC8600584 DOI: 10.1177/0891988720957105] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The majority of people with dementia live in low-and middle-income countries (LMICs). In sub-Saharan Africa (SSA) human-resource shortages in mental health and geriatric medicine are well recognized. Use of technological solutions may improve access to diagnosis. We aimed to assess the diagnostic accuracy of a brief dementia screening mobile application (app) for non-specialist workers in rural Tanzania against blinded gold-standard diagnosis of DSM-5 dementia. The app includes 2 previously-validated culturally appropriate low-literacy screening tools for cognitive (IDEA cognitive screen) and functional impairment (abbreviated IDEA-IADL questionnaire). METHODS This was a 2-stage community-based door-to-door study. In Stage1, rural primary health workers approached all individuals aged ≥60 years for app-based dementia screening in 12 villages in Hai district, Kilimanjaro Tanzania.In Stage 2, a stratified sub-sample were clinically-assessed for dementia blind to app screening score. Assessment included clinical history, neurological and bedside cognitive assessment and collateral history. RESULTS 3011 (of 3122 eligible) older people consented to screening. Of these, 610 were evaluated in Stage 2. For the IDEA cognitive screen, the area under the receiver operating characteristic (AUROC) curve was 0.79 (95% CI 0.74-0.83) for DSM-5 dementia diagnosis (sensitivity 84.8%, specificity 58.4%). For those 358 (44%) completing the full app, AUROC was 0.78 for combined cognitive and informant-reported functional assessment. CONCLUSIONS The pilot dementia screening app had good sensitivity but lacked specificity for dementia when administered by non-specialist rural community workers. This technological approach may be a promising way forward in low-resource settings, specialist onward referral may be prioritized.
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Affiliation(s)
- Stella-Maria Paddick
- Newcastle University, Newcastle upon
Tyne, United Kingdom,Stella-Maria Paddick, Campus for Ageing and
Vitality Newcastle University, Westgate Road, Newcastle upon Tyne NE4 6BE,
Tanzania.
| | - Marcella Yoseph
- Kilimanjaro Christian Medical University
College, Moshi, Tanzania
| | - William K. Gray
- Northumbria Healthcare NHS Foundation
Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | | | - Robyn Barber
- Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Aofie Colgan
- Newcastle University, Newcastle upon
Tyne, United Kingdom
| | - Catherine Dotchin
- Newcastle University, Newcastle upon
Tyne, United Kingdom,Northumbria Healthcare NHS Foundation
Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Sarah Urasa
- Kilimanjaro Christian Medical University
College, Moshi, Tanzania
| | - John Kissima
- Hai District Hospital, Boman’gombe,
Kilimanjaro, Tanzania
| | - Irene Haule
- Hai District Hospital, Boman’gombe,
Kilimanjaro, Tanzania
| | - Aloyce Kisoli
- Kilimanjaro Christian Medical University
College, Moshi, Tanzania
| | - Jane Rogathi
- Kilimanjaro Christian Medical University
College, Moshi, Tanzania
| | | | - Declare Mushi
- Kilimanjaro Christian Medical University
College, Moshi, Tanzania
| | | | - Richard W. Walker
- Newcastle University, Newcastle upon
Tyne, United Kingdom,Northumbria Healthcare NHS Foundation
Trust, North Tyneside General Hospital, North Shields, United Kingdom
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Gray WK, Paddick SM, Ogunniyi A, Olakehinde O, Dotchin C, Kissima J, Urasa S, Kisoli A, Rogathi J, Mushi D, Adebiyi A, Haule I, Robinson L, Walker R. Population normative data for three cognitive screening tools for older adults in sub-Saharan Africa. Dement Neuropsychol 2021; 15:339-349. [PMID: 34630921 PMCID: PMC8485647 DOI: 10.1590/1980-57642021dn15-030005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 04/28/2021] [Indexed: 01/11/2023] Open
Abstract
In sub-Saharan Africa (SSA),cognitive screening is complicated by both cultural and educational factors, and the existing normative values may not be applicable. The Identification of Dementia in Elderly Africans (IDEA) cognitive screen is a low-literacy measure with good diagnostic accuracy for dementia.
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Affiliation(s)
- William Keith Gray
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom
| | - Stella-Maria Paddick
- Newcastle University Institute of Population Health Sciences and Clinical and Translational Medicine, Framlington Place, Newcastle upon Tyne, United Kingdom
| | - Adesola Ogunniyi
- University of Ibadan, Department of Medicine, Ibadan, Oyo State, Nigeria
| | - Olaide Olakehinde
- University of Ibadan, Department of Medicine, Ibadan, Oyo State, Nigeria
| | - Catherine Dotchin
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom.,Newcastle University Institute of Population Health Sciences and Clinical and Translational Medicine, Framlington Place, Newcastle upon Tyne, United Kingdom
| | - John Kissima
- Hai District Hospital, District Medical Office, Boman'gombe, Kilimanjaro, Tanzania
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Department of Medicine, Moshi, Tanzania
| | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College, Department of Medicine, Moshi, Tanzania
| | - Jane Rogathi
- Kilimanjaro Christian Medical University College, Department of Medicine, Moshi, Tanzania
| | - Declare Mushi
- Kilimanjaro Christian Medical University College, Department of Medicine, Moshi, Tanzania
| | - Akindele Adebiyi
- University of Ibadan, Department of Medicine, Ibadan, Oyo State, Nigeria
| | - Irene Haule
- Hai District Hospital, District Medical Office, Boman'gombe, Kilimanjaro, Tanzania
| | - Louise Robinson
- Newcastle University Institute of Population Health Sciences and Clinical and Translational Medicine, Framlington Place, Newcastle upon Tyne, United Kingdom
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, North Shields, United Kingdom.,Newcastle University Institute of Population Health Sciences and Clinical and Translational Medicine, Framlington Place, Newcastle upon Tyne, United Kingdom
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10
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Hendriks S, Peetoom K, Bakker C, van der Flier WM, Papma JM, Koopmans R, Verhey FRJ, de Vugt M, Köhler S. Global Prevalence of Young-Onset Dementia: A Systematic Review and Meta-analysis. JAMA Neurol 2021; 78:1080-1090. [PMID: 34279544 PMCID: PMC8290331 DOI: 10.1001/jamaneurol.2021.2161] [Citation(s) in RCA: 137] [Impact Index Per Article: 45.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 04/24/2021] [Indexed: 12/22/2022]
Abstract
Importance Reliable prevalence estimates are lacking for young-onset dementia (YOD), in which symptoms of dementia start before the age of 65 years. Such estimates are needed for policy makers to organize appropriate health care. Objective To determine the global prevalence of YOD. Data Sources The PubMed, Embase, CINAHL, and PsycInfo databases were systematically searched for population-based studies on the prevalence of YOD published between January 1, 1990, and March 31, 2020. Study Selection Studies containing data on the prevalence of dementia in individuals younger than 65 years were screened by 2 researchers for inclusion in a systematic review and meta-analysis. Data Extraction and Synthesis Prevalence estimates on 5-year age bands, from 30 to 34 years to 60 to 64 years, were extracted. Random-effects meta-analyses were conducted to pool prevalence estimates. Results were age standardized for the World Standard Population. Heterogeneity was assessed by subgroup analyses for sex, dementia subtype, study design, and economic status based on the World Bank classification and by meta-regression. Main Outcomes and Measures Prevalence estimates of YOD for 5-year age bands. Results A total of 95 unique studies were included in this systematic review, of which 74 with 2 760 379 unique patients were also included in 5-year age band meta-analyses. Studies were mostly conducted in Europe and in older groups in Asia, North America, and Oceania. Age-standardized prevalence estimates increased from 1.1 per 100 000 population in the group aged 30 to 34 years to 77.4 per 100 000 population in the group aged 60 to 64 years. This gives an overall global age-standardized prevalence of 119.0 per 100 000 population in the age range of 30 to 64 years, corresponding to 3.9 million people aged 30 to 64 years living with YOD in the world. Subgroup analyses showed prevalence between men and women to be similar (crude estimates for men, 216.5 per 100 000 population; for women, 293.1 per 100 000 population), whereas prevalence was lower in high-income countries (crude estimate, 663.9 per 100 000 population) compared with upper-middle-income (crude estimate, 1873.6 per 100 000 population) and lower-middle-income (crude estimate, 764.2 per 100 000 population) countries. Meta-regression showed that age range (P < .001), sample size (P < .001), and study methodology (P = .02) significantly influenced heterogeneity between studies. Conclusions and Relevance This systematic review and meta-analysis found an age-standardized prevalence of YOD of 119.0 per 100 000 population, although estimates of the prevalence in low-income countries and younger age ranges remain scarce. These results should help policy makers organize sufficient health care for this subgroup of individuals with dementia. Study Registration PROSPERO CRD42019119288.
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Affiliation(s)
- Stevie Hendriks
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Kirsten Peetoom
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Christian Bakker
- Department of Primary and Community Care, Radboud University Medical Center, Radboud, the Netherlands
- Groenhuysen, Center for Specialized Geriatric Care, Roosendaal, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Wiesje M. van der Flier
- Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC (University Medical Center), Amsterdam, the Netherlands
- Department of Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, the Netherlands
| | - Janne M. Papma
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Raymond Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Radboud, the Netherlands
- Radboudumc Alzheimer Center, Nijmegen, the Netherlands
| | - Frans R. J. Verhey
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Marjolein de Vugt
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
| | - Sebastian Köhler
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Alzheimer Centre Limburg, Maastricht University, Maastricht, the Netherlands
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Epilepsy-associated neurocognitive disorders (EAND) in an onchocerciasis-endemic rural community in Cameroon: A population-based case-control study. Epilepsy Behav 2020; 112:107437. [PMID: 32920377 DOI: 10.1016/j.yebeh.2020.107437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/16/2020] [Accepted: 08/16/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Epilepsy affects at least 50 million individuals worldwide, especially in sub-Saharan Africa (sSA). Cognitive impairment is common in people with epilepsy (PWE) yet, little is known on the burden of cognitive impairment in people with epilepsy in sSA. This study was thus designed to assess cognitive impairment in PWE or epilepsy-associated neurocognitive disorders (EAND) in a rural population in Cameroon. METHODS This was a case-control study including PWE and age/sex-matched healthy controls from July to September 2017 in Bilomo, a village in the Mbam and Kim Division. The Montreal Cognitive Assessment (MoCA), International HIV Dementia Scale (IHDS), Dubois' Five Word testing, Frontal Assessment Battery (FAB), Isaac's Set Test and the Clock drawing test were administered to the study participants to evaluate global and specific cognitive functions. RESULTS Eighty participants were included (40 cases and 40 controls) with a mean age of 25.78 years. Using the MoCA, 87.5% of cases had cognitive impairment, against 37.5% of controls (p < 0.001; OR 11.67; CI 3.40-45.09). Using the IHDS, the prevalence of global cognitive impairment was 84.6% among the cases against 40% for the controls (p = <0.001; OR 7.07; CI 2.29-29.19). Specifically, executive function deficits (92.5% of cases vs 40.0% of controls p = <0.001 OR = 18.50 CI; 4.48-105.08) and decreased verbal fluency (100% of cases against 45% of controls p < 0.001) were the most affected cognitive domains. Longer duration of epilepsy and higher seizure frequency were associated with global cognitive impairment. Low level of education was associated with both decreased verbal fluency and executive dysfunction while a longer stay in Bilomo correlated with poor results on the Isaac's Set Test. CONCLUSION The prevalence of cognitive impairment appears to be much higher in PWE in the Mbam valley, particularly decreased executive function and verbal fluency, than in people without epilepsy. Longer disease duration, higher seizure frequency, low level of education and length of stay in Bilomo are associated with poorer cognitive performance. More studies are needed to refine evaluation tools to better characterize and manage EAND in sSA.
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Mohamed AA, Oduor C, Kinyanjui D. HIV-associated neurocognitive disorders at Moi teaching and referral hospital, Eldoret, Kenya. BMC Neurol 2020; 20:280. [PMID: 32664858 PMCID: PMC7359564 DOI: 10.1186/s12883-020-01857-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 07/07/2020] [Indexed: 11/21/2022] Open
Abstract
Background Human Immunodeficiency Virus (HIV) infection causes a myriad of neurological complications including cognitive deficits referred to as HIV-Associated Neurocognitive Disorders (HAND). With the introduction of combination antiretroviral therapy, there has been an epidemiological shift in cognitive disorders with a decline in the more severe HIV-Associated Dementia (HAD) to an increase in the less severe HAND: Asymptomatic Neurocognitive Impairment (ANI) and HIV-associated Mild Neurocognitive Disorder (MND). Central Nervous System (CNS) involvement in HIV interferes with cognitively demanding activities of daily living and hence a worse quality of life. Early diagnosis is delayed until symptoms are overt. Methods We conducted a cross sectional analytical study of HIV infected persons on antiretroviral therapy attending HIV clinic. A systematic random sampling was done to select 360 patients. An interviewer administered structured questionnaire was used to collect socio-demographic data while the CD4 count and viral load were retrieved from the Academic Model Providing Access to Healthcare (AMPATH) database. Pearson’s Chi Square test was used to compare proportions while independent sample t- test was used to compare continuous variables between the patients diagnosed with HAND and those without HAND. Logistic regression model was used to assess the factors associated with HAND. Results The mean age of the study participants was 40.2 years. The overall prevalence of HAND was (81.1%) N = 292. Mild HAND (ANI and MND) was present (78.6%) N = 283, Severe HAND (HAD) (2.5%) N = 9. The factors associated with HAND were older age OR: 1.06 (95% CI: 1.03, 1.10), male gender OR: 0.48 (95% CI: 0.24, 0.97), Advanced WHO clinical staging OR: 2.45 (95% CI: 1.20, 5.01) and a higher level of education; secondary/tertiary OR: 0.16 (95% CI: 0.07, 0.38); 0.11 (95% CI: 0.04, 0.35). Conclusion The prevalence of HAND in this study population was found to be high (81.1%). Older age and advanced WHO clinical staging were associated with an increased risk of hand while higher level of education and male gender were protective.
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Affiliation(s)
- Amina Ali Mohamed
- Department of Medicine, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya.
| | - Chrispine Oduor
- Department of Medicine, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya
| | - Daniel Kinyanjui
- Department of Mental Health, Moi University School of Medicine, P.O. Box 4606-30100, Eldoret, Kenya
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