1
|
Golan J, Thalacker-Mercer A, Hoddinott J. Feasibility, reliability, and validity of physical function tests and IADL survey questions in women living in rural, highland Ethiopia. PLoS One 2024; 19:e0288828. [PMID: 38923976 DOI: 10.1371/journal.pone.0288828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Physical function is the physical ability to fulfill one's daily roles and responsibilities. Poor physical function is detrimental to health and income-generating activities. Unfortunately, there is a lack of validated methods to measure physical function in adult women in low- and middle-income countries, including Ethiopia, the locus of this study. This study evaluated the feasibility, reliability, and validity of physical tests, including the sit-to-stand (STS) and usual gait speed (UGS) and a context-appropriate instrumental activities of daily living (IADL) survey. The results of the STS were used to calculate a muscle quality index (MQI, STS accounting for body mass and leg length). Feasibility was ascertained qualitatively based on reports from the enumerators on their ability to administer the tests. Reliability was assessed by comparing the results of the tests and questions between each visit using either Cohen's κ or Pearson's ρ. The validity of MQI was assessed using relevant participant characteristics such as age and self-reported disability. The validity of the IADL was assessed using MQI. Study participants comprised 316 women between the ages of 18 and 45 years, living in rural Tigray, Ethiopia, who had previously participated in an impact evaluation of a safety net program. Over a one-week period, participants completed the STS and UGS tests and responded to the IADL survey questions three times. MQI was determined to be a feasible, reliable, and valid physical function test for women in rural, highland Ethiopia. UGS lacked feasibility and reliability; validity was not ascertained. The IADL questions were feasible and reliable, but validity was inconclusive. In rural Ethiopia, the MQI will be a valuable tool to develop interventions for improving physical function, which will have positive impacts on health and quality of life.
Collapse
Affiliation(s)
- Jenna Golan
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| | - Anna Thalacker-Mercer
- Department of Cell, Development and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - John Hoddinott
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, United States of America
| |
Collapse
|
2
|
Galbraith-Olive MA, Safic S, Mwaipopo L, Ernest A, Gray WK, Urasa S, Dotchin C, Fisher E, Spector A, Walker R. Care needs of people with dementia in Tanzania and associated impact on carers: A cross-sectional, observational study. DEMENTIA 2024:14713012241262570. [PMID: 38887042 DOI: 10.1177/14713012241262570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Objectives: This study aimed to understand the care needs, care arrangements and burden of care for people with dementia in Northern Tanzania. Methods: This was a cross-sectional, observational study. People with dementia and their carers (n = 53) were recruited from an outpatient clinic, and data on carer burden and independence in activities of daily living were collected. Associations with carer burden and characteristics were explored through non-parametric tests and regression analyses. Results: Thirty-six carers were female (68%). Levels of impairment in instrumental activities of daily living were high, with a median score of 38 out of 44 on the Identification and Intervention for Dementia in Elderly Africans - Instrumental Activities of Daily Living (IDEA-IADL). Carer burden was moderate with a median Zarit Burden Interview (ZBI) score of 46 out of 88. Being a female carer was associated with higher carer burden (odds ratio 3.68, 95% CI 1.04-12.99). Discussion: Carer burden was found to be higher than in previous studies based in low-and-middle income countries. Further research is needed to explore this difference, and to identify interventions to support care needs and reduce carer burden.
Collapse
Affiliation(s)
| | | | | | | | - William Keith Gray
- Newcastle University and Northumbria Healthcare NHS Foundation Trust, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Tanzania
| | - Catherine Dotchin
- Newcastle University, UK
- Northumbria Healthcare NHS Foundation Trust, UK
| | | | | | - Richard Walker
- Newcastle University, UK
- Northumbria Healthcare NHS Foundation Trust, UK
| |
Collapse
|
3
|
Fotheringham L, Lawson RA, Urasa S, Boshe J, Mukaetova-Ladinska EB, Rogathi J, Howlett W, Dekker MCJ, Gray WK, Evans J, Walker RW, Makupa PC, Paddick SM. Neuropsychological tests associated with symptomatic HIV-associated neurocognitive disorder (HAND) in a cohort of older adults in Tanzania. J Int Neuropsychol Soc 2024:1-11. [PMID: 38766814 DOI: 10.1017/s1355617724000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
OBJECTIVE Human immunodeficiency virus (HIV)-associated neurocognitive disorder (HAND) prevalence is expected to increase in East Africa as treatment coverage increases, survival improves, and this population ages. This study aimed to better understand the current cognitive phenotype of this newly emergent population of older combination antiretroviral therapy (cART)-treated people living with HIV (PLWH), in which current screening measures lack accuracy. This will facilitate the refinement of HAND cognitive screening tools for this setting. METHOD This is a secondary analysis of 253 PLWH aged ≥50 years receiving standard government HIV clinic follow-up in Kilimanjaro, Tanzania. They were evaluated with a detailed locally normed low-literacy neuropsychological battery annually on three occasions and a consensus panel diagnosis of HAND by Frascati criteria based on clinical evaluation and collateral history. RESULTS Tests of verbal learning and memory, categorical verbal fluency, visual memory, and visuoconstruction had an area under the receiver operating characteristic curve >0.7 for symptomatic HAND (s-HAND) (0.70-0.72; p < 0.001 for all tests). Tests of visual memory, verbal learning with delayed recall and recognition memory, psychomotor speed, language comprehension, and categorical verbal fluency were independently associated with s-HAND in a logistic mixed effects model (p < 0.01 for all). Neuropsychological impairments varied by educational background. CONCLUSIONS A broad range of cognitive domains are affected in older, well-controlled, East African PLWH, including those not captured in widely used screening measures. It is possible that educational background affects the observed cognitive impairments in this setting. Future screening measures for similar populations should consider assessment of visual memory, verbal learning, language comprehension, and executive and motor function.
Collapse
Affiliation(s)
- Lachlan Fotheringham
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Cumbria Northumberland Tyne and Wear NHS Foundation Trust, UK
| | - Rachael A Lawson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Judith Boshe
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | | | - Jane Rogathi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - William Howlett
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Marieke C J Dekker
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | | | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Philip C Makupa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
- Mawenzi Regional Referral Hospital, Kilimanjaro, Tanzania
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Gateshead Health NHS Foundation Trust, Gateshead, UK
| |
Collapse
|
4
|
Davidson SL, Emmence L, Motraghi-Nobes SM, Bickerstaff E, Rayers G, Lyimo G, Kilasara J, Chuwa M, Kisheo F, Kisaruni E, Urasa S, Mitchell E, Dotchin CL, Walker RW. Assessing frailty amongst older people admitted to hospital in a low-income setting: a multicentre study in northern Tanzania. BMC Geriatr 2024; 24:190. [PMID: 38408948 PMCID: PMC10898155 DOI: 10.1186/s12877-024-04789-6] [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: 04/21/2023] [Accepted: 02/06/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Populations are ageing globally and Low- and Middle-Income Countries (LMICs) are experiencing the fastest rates of demographic change. Few studies have explored the burden of frailty amongst older people in hospital in LMICs, where healthcare services are having to rapidly adapt to align with the needs of older people. This study aimed to measure the prevalence of frailty amongst older people admitted to hospital in Tanzania and to explore their demographic and clinical characteristics. METHODS This study had a prospective observational design. Over a six-month period, all adults ≥ 60 years old admitted to medical wards in four hospitals in northern Tanzania were invited to participate. They were screened for frailty using the Clinical Frailty Scale (CFS) and the Frailty Phenotype (FP). Demographic and clinical characteristics of interest were recorded in a structured questionnaire. These included the Barthel Index, the Identification of Elderly Africans Instrumental Activities of Daily Living (IADEA-IADL) and Cognitive (IDEA-Cog) screens, the EURO-D depression scale and Confusion Assessment Method. RESULTS 540 adults aged ≥ 60 were admitted, and 308 completed assessment. Frailty was present in 66.6% using the CFS and participants with frailty were significantly older, with lower levels of education and literacy, greater disability, greater comorbidity, poorer cognition and higher levels of delirium. Using the FP, 57.0% of participants were classed as frail though a majority of participants (n = 159, 51.6%) could not be classified due to a high proportion of missing data. CONCLUSIONS This study indicates that the prevalence of frailty on medical wards in northern Tanzania is high according to the CFS. However, the challenges in operationalising the FP in this setting highlight the need for future work to adapt frailty screening tools for an African context. Future investigations should also seek to correlate frailty status with long-term clinical outcomes after admission in this setting.
Collapse
Affiliation(s)
- Sean L Davidson
- Newcastle University, Newcastle Upon Tyne, UK.
- Northumbria Healthcare NHS Foundation Trust, Morpeth, UK.
| | | | | | | | | | - Godrule Lyimo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Joseph Kilasara
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Mary Chuwa
- Mawenzi Regional Referral Hospital, Moshi, Tanzania
| | | | | | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Catherine L Dotchin
- Newcastle University, Newcastle Upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, Morpeth, UK
| | - Richard W Walker
- Newcastle University, Newcastle Upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, Morpeth, UK
| |
Collapse
|
5
|
Walker J. Patient and caregiver experiences of living with dementia in Tanzania. DEMENTIA 2023; 22:1900-1920. [PMID: 37879079 PMCID: PMC10644685 DOI: 10.1177/14713012231204784] [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: 10/27/2023]
Abstract
Introduction: Tanzania is a low-income country with an increasing prevalence of dementia, which provides challenges for the existing healthcare system. People with dementia often don't receive a formal diagnosis, and with a lack of formal healthcare, are often predominantly supported by family relatives. There are very few published data relating to lived experiences of people with dementia in Tanzania. This study aimed to understand people with dementia, and their caregivers' experiences of living with dementia in Tanzania and the perceived needs of people with dementia.Methods: Qualitative, semi-structured interviews were conducted with 14 people with dementia and 12 caregivers in Moshi, Tanzania. Interviews were audio-recorded, translated, transcribed and analysed using a Framework Analysis approach.Results: Three sub-themes were identified within data describing the experience of 'Living with Dementia in Tanzania': 'Deteriorations in Health', 'Challenges to living with Dementia in Tanzanian Culture', and 'Lack of Support': people with dementia faced challenges due to social isolation, stigmatisation, and lack of caregiver knowledge on how best to provide support. Collectively, these impacted on both the physical and mental health of people with dementia. Misconceptions about dementia aetiology related to age, stresses of daily life and other co-morbidities. People with dementia were motivated to access treatment, exhibiting pluralistic health-seeking behaviours. There was an overall preference for non-pharmacological interventions over medication, with high levels of trust in medical professional opinions.Conclusions: Living with dementia in Tanzania is influenced by both cultural and religious factors. More work is needed to target supplementary healthcare (with efforts to promote accessibility), support for caregivers and public health education about dementia to overcome existent misconceptions and stigma.
Collapse
Affiliation(s)
- Jessica Walker
- Population Health Sciences Institute, Newcastle University, UK
| |
Collapse
|
6
|
Britton GB, Huang L, Villarreal AE, Levey A, Philippakis A, Hu C, Yang CC, Mushi D, Oviedo DC, Rangel G, Ho JS, Thompson L, Khemakhem M, Ross M, Carreira MB, Kim N, Joung P, Albastaki O, Kuo PC, Low S, Paddick S, Kuan Y, Au R. Digital phenotyping: An equal opportunity approach to reducing disparities in Alzheimer's disease and related dementia research. ALZHEIMER'S & DEMENTIA (AMSTERDAM, NETHERLANDS) 2023; 15:e12495. [PMID: 38034851 PMCID: PMC10687344 DOI: 10.1002/dad2.12495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 07/12/2023] [Accepted: 09/25/2023] [Indexed: 12/02/2023]
Abstract
A rapidly aging world population is fueling a concomitant increase in Alzheimer's disease (AD) and related dementias (ADRD). Scientific inquiry, however, has largely focused on White populations in Australia, the European Union, and North America. As such, there is an incomplete understanding of AD in other populations. In this perspective, we describe research efforts and challenges of cohort studies from three regions of the world: Central America, East Africa, and East Asia. These cohorts are engaging with the Davos Alzheimer's Collaborative (DAC), a global partnership that brings together cohorts from around the world to advance understanding of AD. Each cohort is poised to leverage the widespread use of mobile devices to integrate digital phenotyping into current methodologies and mitigate the lack of representativeness in AD research of racial and ethnic minorities across the globe. In addition to methods that these three cohorts are already using, DAC has developed a digital phenotyping protocol that can collect ADRD-related data remotely via smartphone and/or in clinic via a tablet to generate a common data elements digital dataset that can be harmonized with additional clinical and molecular data being collected at each cohort site and when combined across cohorts and made accessible can provide a global data resource that is more racially/ethnically represented of the world population.
Collapse
Affiliation(s)
- Gabrielle B. Britton
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP)Panamá CityPanama
- Universidad Santa María La Antigua, Vía Ricardo J. AlfaroPanamá CityPanama
| | - Li‐Kai Huang
- Taipei Medical University Shuang‐Ho HospitalTaipeiTaiwan
| | - Alcibiades E. Villarreal
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP)Panamá CityPanama
| | - Allan Levey
- Emory University School of MedicineAtlantaGeorgiaUSA
| | - Anthony Philippakis
- Broad Institute at Massachusetts Institute of Technology and Harvard UniversityCambridgeMassachusettsUSA
| | - Chaur‐Jong Hu
- Taipei Medical University Shuang‐Ho HospitalTaipeiTaiwan
| | | | - Declare Mushi
- Kilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Diana C. Oviedo
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP)Panamá CityPanama
- Universidad Santa María La Antigua, Vía Ricardo J. AlfaroPanamá CityPanama
| | - Giselle Rangel
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP)Panamá CityPanama
| | - Jor Sam Ho
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - Louisa Thompson
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
- Alpert Medical School of Brown UniversityProvidenceRhode IslandUSA
| | | | - Makayla Ross
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
- Boston University School of Public HealthBostonMassachusettsUSA
| | - María B. Carreira
- Instituto de Investigaciones Científicas y Servicios de Alta Tecnología (INDICASAT AIP)Panamá CityPanama
| | - Nicole Kim
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
| | - Philip Joung
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
| | | | - Po Chih Kuo
- National Tsing Hua University, East DistrictHsinChuTaiwan
| | - Spencer Low
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
- Boston University School of Public HealthBostonMassachusettsUSA
- Boston University Chobanian and Avedisian School of MedicineBostonMassachusettsUSA
- Boston University Alzheimer's Disease CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
| | | | - Yi‐Chun Kuan
- Taipei Medical University Shuang‐Ho HospitalTaipeiTaiwan
| | - Rhoda Au
- Davos Alzheimer's CollaborativeWaynePennsylvaniaUSA
- Boston University School of Public HealthBostonMassachusettsUSA
- Boston University Chobanian and Avedisian School of MedicineBostonMassachusettsUSA
- Boston University Alzheimer's Disease CenterBoston University Chobanian & Avedisian School of MedicineBostonMassachusettsUSA
- The Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine, Boston University School of Public HealthFraminghamMassachusettsUSA
| |
Collapse
|
7
|
Beyene DA, Berha AB. Management Practice and Clinical Outcomes of Dementia in Sub-Saharan Africa: A Systematic Review. Behav Neurol 2023; 2023:2307443. [PMID: 37533682 PMCID: PMC10393511 DOI: 10.1155/2023/2307443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 06/03/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
Background Dementia is a severe neurodegenerative disorder and it is a group of acquired symptoms associated with impaired cognitive functions. In low-income settings particularly in Sub-Saharan Africa (SSA), it is often seen as part of normal aging. Environmental, behavioral, and lifestyle interventions have the potential to alter the disease course of dementia. Objective This study is aimed to synthesize the literature/evidence(s) on the management practice and treatment outcomes of dementia in SSA. Method Comprehensive literature was searched in PubMed database, Cochrane Library, and Google Scholar. Eligibility has been set, and based on the criteria, initially, a total of 442 results were obtained, and from those around 183 articles were duplicated. After examining titles and abstracts of records 26 articles were identified. Finally, five randomized clinical trials (RCT) and three prospective cohort studies that were reported on the management practice and treatment outcome of dementia in SSA were eligible for analysis. RCT and prospective cohort studies were used to strengthen the quality of evidence. The quality of the included RCT studies was assessed by using the Cochrane Risk of Bias Tool. Result A total of 2781 patient data were included in the final analysis. Of these, 2354 patients were obtained from 5 RCTs and 427 patients from 3 prospective cohort studies, which were conducted in SSA countries. RCT studies were done on the feasibility and clinical effectiveness of cognitive stimulation therapy (CST) showed improvements in language memory domains and physical health. In addition, studies that focus on the management of human immunodeficiency virus-associated dementia (HIVAD) were reported to improve neurocognitively. Conclusion CST is applicable in low-resource settings and it shows improvements in cognitive function and quality of life. Early initiation of combination antiretroviral therapy in resource-limited settings has been associated with improvement in the cognitive function of HIVAD.
Collapse
Affiliation(s)
- Dessale Abate Beyene
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Alemseged Beyene Berha
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| |
Collapse
|
8
|
Roe C, Safic S, Mwaipopo L, Dotchin CL, Klaptocz J, Gray W, Joseph M, Spector A, Urasa S, Walker RW. Dementia Prevalence and Risk Factors: Data From Rural Tanzania. Alzheimer Dis Assoc Disord 2023; 37:229-236. [PMID: 37561952 DOI: 10.1097/wad.0000000000000564] [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: 01/08/2023] [Accepted: 04/19/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVES The burden of dementia is increasing in sub-Saharan Africa (SSA), but there are limited epidemiological data on dementia in SSA. This study investigated the prevalence and associations of dementia in older adults (less than 60 y) attending the outpatient department of Mount Meru Hospital in Tanzania. METHODS This one-phase cross-sectional study screened a sample using the Identification of Dementia in Elderly Africans (IDEA) cognitive screening tool. Those that screened as having possible and probable dementia were further assessed, and diagnosis of dementia was made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Demographic and risk factor data were collected. RESULTS Within those screened, 57/1141 (5.0%) (95% CI: 3.7-6.3) had dementia. Female sex [odds ratio (OR)=2.778, 95% CI: 1.074-7.189], having never attended school (OR=6.088, 95% CI: 1.360-27.256), alcohol (U/wk) (OR=1.080, 95% CI: 1.016-1.149), uncorrected visual impairment (OR=4.260, 95% CI: 1.623-11.180), body mass index <18.5 kg/m 2 (OR=6.588, 95% CI: 2.089-20.775), and stroke (OR=15.790, 95% CI: 3.48-74.475) were found to be significantly, independently associated with dementia. CONCLUSIONS The prevalence of dementia in this population is similar to a recent community-based rate in Tanzania and lower than a hospital-based rate in Senegal. This is the first time the association between visual impairment and dementia has been reported in SSA. Other associations are in keeping with previous literature.
Collapse
Affiliation(s)
| | | | | | - Catherine L Dotchin
- Newcastle Medical School
- Northumbria Healthcare NHS Trust, Newcastle upon Tyne
| | - Joanna Klaptocz
- Newcastle Medical School
- University College London, London, UK
| | - William Gray
- Northumbria Healthcare NHS Trust, Newcastle upon Tyne
| | - Marcyella Joseph
- Botswana Medical School, University of Botswana, Gaborone, Botswana
| | | | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | |
Collapse
|
9
|
Masika GM, Nyundo A, Msisiri L. Cognitive Impairment and the Associated Factors Among Older People in Rural Central Tanzania. Alzheimer Dis Assoc Disord 2023; 37:100-106. [PMID: 37253122 DOI: 10.1097/wad.0000000000000543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/28/2022] [Indexed: 06/01/2023]
Abstract
AIM This study examined the profile of cognitive impairment and associated factors among older people in rural central Tanzania. METHODS We conducted a cross-sectional study involving 462 community-dwelling older adults. We performed cognitive, psychosocial, and clinical assessments and face-to-face interviews with all older adults. Descriptive, bivariate and multivariate linear regression analyses were performed to determine the participant's cognitive performance and the associated factors. RESULTS The mean cognitive score on the Identification and Intervention for Dementia in Elderly Africans cognitive test was 11.04 (SD=2.89). Per the proposed cut-off scores to define probable and possible dementia, 13.2% of the population had probable dementia and another 13.9% had possible dementia. Increase in age was associated with poor cognitive performance (β=-0.076, 95% CI=-0.109 to -0.043, P<0.001); whereas male sex (β=0.989, 95% CI=0.333 to 1.645, P=0.003), higher educational attainment (β=2.575, 95% CI=0.557 to 4.594, P=0.013) and performance in instrumental activities of daily living (β=0.552, 95% CI=0.376 to 0.729, P<0.001) were associated with higher cognitive performance. DISCUSSION Older people in rural settings of central Tanzania have poor cognitive functions and are at high risk of further cognitive decline. Preventive and therapeutic programs for the affected older people are warranted to prevent further decline and maintain quality of life.
Collapse
Affiliation(s)
- Golden M Masika
- Department of Clinical Nursing School of Nursing and Public Health
| | - Azan Nyundo
- Department of Psychiatry, School of Medicine and Dentistry, University of Dodoma, Dodoma, Tanzania
| | - Laidi Msisiri
- Department of Clinical Nursing School of Nursing and Public Health
| |
Collapse
|
10
|
Kamoga R, Mubangizi V, Owokuhaisa J, Muwanguzi M, Natakunda S, Rukundo GZ. Behavioral and Psychological Symptoms of Dementia: Prevalence, Symptom Severity, and Caregiver Distress in South-Western Uganda-A Quantitative Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2336. [PMID: 36767708 PMCID: PMC9916294 DOI: 10.3390/ijerph20032336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/24/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
The purpose of the study was to investigate behavioral and psychological symptoms (BPSD) prevalence, severity, and distress experienced by caregivers of people living with dementia (PLWD). A cross-sectional, population-based study was conducted in a rural area in southwestern Uganda. A Neuropsychiatric Inventory Questionnaire (NPI-Q) was used to determine the presence of BPSD as perceived by caregivers of PLWD. We carried out both descriptive and inferential data analysis. A total of 175 caregivers of PLWD were enrolled in this study. Among PLWD, 99% had presented BPSD in the past month. Hallucinations (75%) and dysphoria/depression (81%) were the two BPSD that occurred most frequently. Most participants (70%) stated that PLWD experienced hallucinations of significant severity. Aberrant motor activity was reported by 60% of the participants as the type of BPSD that caused severe distress. There was a high positive correlation (0.82) between the total severity score and total distress scores. Interventions aimed at addressing dysphoria and hallucinations may be essential for the reduction of caregiver distress. These findings point to the need for promoting early screening for BPSDs and the provision of support to caregivers.
Collapse
Affiliation(s)
- Ronald Kamoga
- Department of Anatomy, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Vincent Mubangizi
- Department of Community Practice and Family Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Judith Owokuhaisa
- Department of Physiotherapy, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Moses Muwanguzi
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Sylivia Natakunda
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara P.O. Box 1410, Uganda
| |
Collapse
|
11
|
Adewale BA, Coker MM, Ogunniyi A, Kalaria RN, Akinyemi RO. Biomarkers and Risk Assessment of Alzheimer's Disease in Low- and Middle-Income Countries. J Alzheimers Dis 2023; 95:1339-1349. [PMID: 37694361 DOI: 10.3233/jad-221030] [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: 09/12/2023]
Abstract
Dementia is a chronic syndrome which is common among the elderly and is associated with significant morbidity and mortality for patients and their caregivers. Alzheimer's disease (AD), the most common form of clinical dementia, is biologically characterized by the deposition of amyloid-β plaques and neurofibrillary tangles in the brain. The onset of AD begins decades before manifestation of symptoms and clinical diagnosis, underlining the need to shift from clinical diagnosis of AD to a more objective diagnosis using biomarkers. Having performed a literature search of original articles and reviews on PubMed and Google Scholar, we present this review detailing the existing biomarkers and risk assessment tools for AD. The prevalence of dementia in low- and middle-income countries (LMICs) is predicted to increase over the next couple of years. Thus, we aimed to identify potential biomarkers that may be appropriate for use in LMICs, considering the following factors: sensitivity, specificity, invasiveness, and affordability of the biomarkers. We also explored risk assessment tools and the potential use of artificial intelligence/machine learning solutions for diagnosing, assessing risks, and monitoring the progression of AD in low-resource settings. Routine use of AD biomarkers has yet to gain sufficient ground in clinical settings. Therefore, clinical diagnosis of AD will remain the mainstay in LMICs for the foreseeable future. Efforts should be made towards the development of low-cost, easily administered risk assessment tools to identify individuals who are at risk of AD in the population. We recommend that stakeholders invest in education, research and development targeted towards effective risk assessment and management.
Collapse
Affiliation(s)
- Boluwatife Adeleye Adewale
- Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Motunrayo Mojoyin Coker
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Rajesh N Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| | - Rufus Olusola Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training (IAMRAT), College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Translational and Clinical Research Institute, Newcastle University, United Kingdom
| |
Collapse
|
12
|
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: 5] [Impact Index Per Article: 2.5] [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.
Collapse
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
| |
Collapse
|
13
|
Kaddumukasa M, Bongomin F, Mugenyi L, Kiyingi M, Katabira E, Sajatovic M. Cognitive functioning and prevalence of seizures among older persons in Uganda: A hospital-based, cross-sectional study. Medicine (Baltimore) 2022; 101:e31012. [PMID: 36254004 PMCID: PMC9575713 DOI: 10.1097/md.0000000000031012] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/03/2022] Open
Abstract
There is limited data on the prevalence of seizures and dementia among older persons in Uganda. We evaluated cognitive functioning, and the prevalence and factors associated with seizures among older persons attending an outpatient medical clinic in Uganda. We randomly selected older adults (60 years and above) attending Kiruddu National Referral Hospital medical outpatient clinics between October 2020 and March 2021. We excluded individuals with a history of head injury, brain tumors, mental retardation, co-morbidity with HIV and patients who have had recent brain surgery. Cognitive functioning was assessed using the Identification for Dementia in Elderly Africans (IDEA) tool. We enrolled 407 participants, with a median (inter-quartile range) age of 67 (64-73) years. Majority were female (n = 292, 71.7%). The prevalence of seizure was 1.5% (95% confidence interval [CI]: 0.7-3.3). All 6 participants reported generalized tonic-clonic seizure type. Self-reported seizure was associated with being female (adjusted prevalence ratio [aPR]: 0.79, 95%CI: 0. 67-0.93, P = .02) and residing in Mukono district (aPR: 17.26, 95%CI: 1.64-181.55, P = .018). Overall, 114 (28.1%) participants had cognitive deficit; 9 (2.2%) dementia and 105 (25.9%) impaired cognition. Cognitive deficit was independently associated with female gender (aPR: 0.61, 95%CI: 0.44-0.85, P = .003), formal employment (aPR: 0.53, 95%CI: 0.35-0.81, P = .003), age 70-74 (aPR: 1.69, 95%CI: 1.00-2.86, P = .049), and ≥ 75 years (aPR: 2.81, 95%CI: 1.71-4.61, P = .001). Prevalence of seizures among participants with cognitive deficit was 5.3% (6/114). Among older persons attending a medical clinic in Uganda, almost one-third had cognitive deficit with seizure prevalence being higher among these individuals.
Collapse
Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- * Correspondence: Mark Kaddumukasa, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda (e-mail: )
| | - Felix Bongomin
- Department of Immunology & Medical Microbiology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Levicatus Mugenyi
- Biostatistics Department, The AIDS Support Organisation (TASO), Kampala, Uganda
| | - Micheal Kiyingi
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Elly Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, OH, USA
| |
Collapse
|
14
|
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]
|
15
|
Morrish J, Walker R, Dotchin C, Spector A, Orfanos S, Mkenda S, Shali EP. Group experiences of cognitive stimulation therapy (CST) in Tanzania: a qualitative study. Aging Ment Health 2022; 26:688-697. [PMID: 33459046 PMCID: PMC8959386 DOI: 10.1080/13607863.2021.1872489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Tanzania is a low-income country in which medication for dementia is largely unavailable. Cognitive Stimulation Therapy (CST) is a group-based psychological treatment for people with dementia (PwD), shown to improve cognition and quality of life (QoL). It has previously been culturally adapted and piloted in Tanzania, shown to produce similar outcomes. UK research into CST suggests processes inherent to the group nature are key to its success. This study sought to identify group processes within CST in Tanzania and understand their impact on CST principles and outcomes. METHODS Data collection took place in rural Hai District, through qualitative semi-structured interviews. Sixteen PwD and four facilitators were recruited through convenience sampling and interviewed about their experiences of CST. Interviews were audio-recorded, translated, transcribed and analysed by thematic analysis. RESULTS Two main themes emerged: 'Positive group experiences' and 'Negative group experiences'. From this, a number of group processes were identified, such as helping behaviours and feeling understood by the group. Positive processes supported CST principles and participant improvement. Facilitators were influential over group dynamics. The group processes identified impacted CST principles and treatment outcomes. CONCLUSIONS This is the first study on group mechanisms of CST in Tanzania. It provides deeper insight into participants' experiences of CST, thus identifying specific processes underlying the quantitatively measured positive outcomes of CST in Tanzania by previous studies. It also reveals further cultural barriers to implementation, enabling amendments for optimization of treatment efficacy.
Collapse
Affiliation(s)
- Jasmine Morrish
- Population & Health Sciences Institute, Newcastle University, UK,CONTACT Jasmine Morrish
| | - Richard Walker
- Population & Health Sciences Institute, Newcastle University, UK,Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Catherine Dotchin
- Population & Health Sciences Institute, Newcastle University, UK,Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Aimee Spector
- Division of Psychology & Language Sciences, University College, London, UK
| | - Stavros Orfanos
- Division of Psychology & Language Sciences, University College, London, UK
| | - Sarah Mkenda
- Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Esther Peniel Shali
- Hai District Hospital, Bomangombe, Hai District, Kilimanjaro Region, Tanzania
| |
Collapse
|
16
|
Akinyemi RO, Yaria J, Ojagbemi A, Guerchet M, Okubadejo N, Njamnshi AK, Sarfo FS, Akpalu A, Ogbole G, Ayantayo T, Adokonou T, Paddick SM, Ndetei D, Bosche J, Ayele B, Damas A, Coker M, Mbakile-Mahlanza L, Ranchod K, Bobrow K, Anazodo U, Damasceno A, Seshadri S, Pericak-Vance M, Lawlor B, Miller BL, Owolabi M, Baiyewu O, Walker R, Gureje O, Kalaria RN, Ogunniyi A. Dementia in Africa: Current evidence, knowledge gaps, and future directions. Alzheimers Dement 2022; 18:790-809. [PMID: 34569714 PMCID: PMC8957626 DOI: 10.1002/alz.12432] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 12/19/2022]
Abstract
In tandem with the ever-increasing aging population in low and middle-income countries, the burden of dementia is rising on the African continent. Dementia prevalence varies from 2.3% to 20.0% and incidence rates are 13.3 per 1000 person-years with increasing mortality in parts of rapidly transforming Africa. Differences in nutrition, cardiovascular factors, comorbidities, infections, mortality, and detection likely contribute to lower incidence. Alzheimer's disease, vascular dementia, and human immunodeficiency virus/acquired immunodeficiency syndrome-associated neurocognitive disorders are the most common dementia subtypes. Comprehensive longitudinal studies with robust methodology and regional coverage would provide more reliable information. The apolipoprotein E (APOE) ε4 allele is most studied but has shown differential effects within African ancestry compared to Caucasian. More candidate gene and genome-wide association studies are needed to relate to dementia phenotypes. Validated culture-sensitive cognitive tools not influenced by education and language differences are critically needed for implementation across multidisciplinary groupings such as the proposed African Dementia Consortium.
Collapse
Affiliation(s)
- Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Joseph Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Akin Ojagbemi
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Maëlenn Guerchet
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Njideka Okubadejo
- Neurology Unit, Department of Medicine, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi Araba, Lagos, Nigeria
| | - Alfred K Njamnshi
- Department of Neurology, Yaoundé Central Hospital/Faculty of Medicine and Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
- Brain Research Africa Initiative (BRAIN), Geneva, Switzerland/Yaoundé, Cameroon
| | - Fred S Sarfo
- Department of Medicine, Kwame Nkrumah University of Science & Technology, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Albert Akpalu
- Department of Medicine, University of Ghana Medical School/Korle Bu Teaching Hospital, Accra, Ghana
| | - Godwin Ogbole
- Department of Radiology, University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Temitayo Ayantayo
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Thierry Adokonou
- Department of Neurology, University Teaching Hospital, Parakou, Benin
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, UK/Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - David Ndetei
- Department of Psychiatry, University of Nairobi and African Meatal Health and Training Foundation, Nairobi, Kenya
| | - Judith Bosche
- Kilimanjaro Christian Medical College, Moshi, Tanzania
| | - Biniyam Ayele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Andrea Damas
- Mirembe Mental Health Hospital, Dodoma, Tanzania
| | - Motunrayo Coker
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Lingani Mbakile-Mahlanza
- Department of Psychology, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana
| | - Kirti Ranchod
- Lufuno Neuropsychiatry Centre, Johannesburg, South Africa
| | - Kirsten Bobrow
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Udunna Anazodo
- Lawson Health Research Institute / Department of Medical Biophysics, Western University, London, Ontario, Canada
| | - Albertino Damasceno
- Department of Cardiology, Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
| | - Sudha Seshadri
- Glenn Biggs Institute for Alzheimer's & Neurodegenerative Diseases, University of Texas Health Sciences Center, San Antonio, Texas, USA
| | - Margaret Pericak-Vance
- John T. Hussman Institute for Human Genomics and the Dr. John T. Macdonald Foundation Department of Human Genetics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Brian Lawlor
- Global Brain Health Institute, Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
| | - Bruce L Miller
- Global Brain Health Institute, Memory and Aging Center, University of California, San Francisco, California, USA
| | - Mayowa Owolabi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Centre for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Olusegun Baiyewu
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Richard Walker
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, North Tyneside General Hospital, North Shields, UK
| | - Oye Gureje
- Department of Psychiatry University College Hospital/College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Rajesh N Kalaria
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Adesola Ogunniyi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| |
Collapse
|
17
|
Mateen FJ, Massawe E, Mworia NA, Ismail S, Rice DR, Vogel AC, Kapina B, Mukyanuzi N, Buma DC, Gluckstein J, Wasserman M, Fasoli SE, Chiwanga F, Okeng’o K. Measuring Ambulation, Motor, and Behavioral Outcomes with Post-stroke Fluoxetine in Tanzania: The Phase II MAMBO Trial. Am J Trop Med Hyg 2022; 106:970-978. [PMID: 34872059 PMCID: PMC8922504 DOI: 10.4269/ajtmh.21-0653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 10/21/2021] [Indexed: 11/07/2022] Open
Abstract
We test the safety of fluoxetine post-ischemic stroke in sub-Saharan Africa. Adults with acute ischemic stroke, seen <14 days since new-onset motor deficits, were enrolled from November 2019 to October 2020 in a single-arm, open-label phase II trial of daily fluoxetine 20 mg for 90 days at Muhimbili National Hospital, Dar es Salaam, Tanzania. The primary outcome was safety with secondary outcomes of medication adherence and tolerability. Thirty-four patients were enrolled (11 were female; mean age 52.2 years, 65% < 60 years old; mean 3.3 days since symptom onset). Participants had hypertension (74%), diabetes (18%), and smoked cigarettes (18%). The median National Institutes of Health Stroke Scale score at enrollment was 10.5. The median Fugl-Meyer Motor Scale score was 28.5 (upper extremity 8, lower extremity 17.5). 32/34 participants (91%) survived to 90 days. There were eight serious and two nonserious adverse events. Deaths occurred due to gastrointestinal illness with low serum sodium (nadir 120 mmol/L) with seizure and gastrointestinal bleed from gastric cancer. The average sodium level at 90 days was 139 mmol/L (range 133-146) and alanine transaminase was 28 U/L (range 10-134). Fluoxetine adherence was 96%. The median modified Rankin Scale score among survivors at 90 days was 2 and Fugl-Meyer Motor Scale score was 66 (upper extremity 40, lower extremity 27). Median 90-day Patient Health Questionnaire-9 and Montgomery-Åsberg scores were 3.5 and 4 (minimal depression). Fluoxetine administration for 90 days poststroke in sub-Saharan Africa was generally safe and well-tolerated, but comorbid illness presentations were fatal in 2/34 cases, even after careful participant selection.
Collapse
Affiliation(s)
- Farrah J. Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts;,Address correspondence to Farrah Mateen, Department of Neurology, Massachusetts General Hospital, 165 Cambridge St., #627, Boston, MA 02114. E-mail:
| | - Emmanuel Massawe
- Department of Neurology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Notburga A. Mworia
- Department of Neurology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Seif Ismail
- Department of Neurology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Dylan R. Rice
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Andre C. Vogel
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Boniface Kapina
- Department of Neurology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Novath Mukyanuzi
- Department of Neurology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Deus C. Buma
- Department of Neurology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Jef Gluckstein
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Wasserman
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts
| | | | - Faraja Chiwanga
- Department of Neurology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| | - Kigocha Okeng’o
- Department of Neurology, Muhimbili National Hospital, Dar es Salaam, United Republic of Tanzania
| |
Collapse
|
18
|
George G, Murphy DC, Hogg HDJ, Boniface JB, Urasa S, Rwiza J, Uwemeye L, Bristow C, Hillsmith G, Rainey E, Walker R, Gray WK, Maria-Paddick S. Evaluation of a low-resource screening strategy for ophthalmic pathologies and associated neurological morbidity in an older Tanzanian HIV-positive population. Sci Rep 2022; 12:1434. [PMID: 35082308 PMCID: PMC8791939 DOI: 10.1038/s41598-022-04989-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/06/2021] [Indexed: 12/20/2022] Open
Abstract
Globally, 43 million people are living with HIV, 90% in developing countries. Increasing life expectancy with combination antiretroviral therapy (cART) results in chronic complications, including HIV-associated neurocognitive disorders (HAND) and eye diseases. HAND screening is currently challenging. Our aim was to evaluate clinical utility of retinopathy as a screening measure of HAND in older cART-treated individuals in Tanzania and feasibility of smartphone-based retinal screening in this low-resource setting. A cross-sectional systematic sample aged ≥ 50-years attending routine HIV follow-up in Tanzania were comprehensively assessed for HAND by American Academy of Neurology criteria and received ophthalmic assessment including smartphone-based retinal imaging. HAND and ophthalmic assessments were independent and blinded. Diagnostic accuracy was evaluated by AUROC curves. Of 129 individuals assessed, 69.8% were visually impaired. Thirteen had retinopathy. HAND prevalence was 66.7%. Retinopathy was significantly associated with HAND but HIV-disease factors (CD4, viral load) were not. Diagnostic accuracy of retinopathy for HAND was poor (AUROC 0.545-0.617) but specificity and positive predictive value were high. We conclude that ocular pathology and HAND appear highly prevalent in this low-resource setting. Although retinal screening cannot be used alone identify HAND, prioritization of individuals with abnormal retinal screening is a potential strategy in low-resource settings.
Collapse
Affiliation(s)
- Grace George
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Declan C Murphy
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - H D Jeffry Hogg
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Justus Rwiza
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Livin Uwemeye
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Clare Bristow
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Grace Hillsmith
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Emma Rainey
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Richard Walker
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - Stella Maria-Paddick
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.
- Department of Old Age Psychiatry, Gateshead Health NHS Foundation Trust, Bensham Hospital, Fontwell Drive, Gateshead, Tyne and Wear, UK.
| |
Collapse
|
19
|
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: 5] [Impact Index Per Article: 1.7] [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.
Collapse
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
| |
Collapse
|
20
|
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.
Collapse
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
| |
Collapse
|
21
|
Shalash A, Okubadejo NU, Doumbe J, Ojo OO, Hamid E, Kuate C, Calvo S, Helmi A, Agabi OP, Essam M, Aguado L, Elrassas H, Roushdy T, Tanner CM, Cubo E. Translation, Validation, Diagnostic Accuracy, and Reliability of Screening Questionnaire for Parkinsonism in Three African Countries. JOURNAL OF PARKINSON'S DISEASE 2021; 10:1113-1122. [PMID: 32568112 DOI: 10.3233/jpd-202040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Availability of validated Parkinson's disease (PD) questionnaires in languages spoken in Africa will enable the conduct of epidemiological studies. OBJECTIVE The aims of the current study were to develop cross-cultural translated and validated Arabic and French versions of a PD screening questionnaire, and determine its diagnostic accuracy for recognition of parkinsonism in early and moderate-advanced PD in three countries (Cameroon (French), Egypt (Arabic), and Nigeria (English)). METHODS This cross-sectional study screened 159 participants (81 PD and 78 controls) using the PD screening questionnaire. The questionnaire was translated into Arabic and French versions using standard protocols. Cognitive function was assessed using the Montreal Cognitive Assessment and the Identification and Intervention for Dementia in Elderly Africans cognitive screen. Co-morbidity burden was documented using the Charlson Comorbidity Index. PD severity and stage were evaluated using the MDS Unified Parkinson Disease Rating Scale and the Hoehn and Yahr scale respectively. RESULTS Both PD patients and controls were matched regarding age, gender, education, and co-morbidity burden. The PD screening questionnaire scores were significantly higher in PD (median 8.0, IQR 6.0-10.0) in contrast to controls (0.0, IQR 0.0-0.0) (p < 0.0001), with a similar pattern and level of significance across all country sites. In ROC analysis, the questionnaire demonstrated high diagnostic accuracy for PD overall, with an AUC of 0.992 (95% CI 0.981-1.002). CONCLUSION The Arabic, French, and English versions of this PD screening questionnaire are valid and accurate screening instruments for recognition of Parkinsonism. This paves the way for conducting epidemiological studies in many African countries.
Collapse
Affiliation(s)
- Ali Shalash
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Njideka U Okubadejo
- Neurology Unit, Department of Medicine, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Jacques Doumbe
- Department of Neurology, University of Douala, Douala, Cameroon
| | - Oluwadamilola O Ojo
- Neurology Unit, Department of Medicine, College of Medicine, University of Lagos & Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Eman Hamid
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Callixte Kuate
- Department of Neurology, University of Douala, Douala, Cameroon
| | - Sara Calvo
- Neurology Department, University Hospital, Burgos, Spain
| | - Asmaa Helmi
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Osigwe P Agabi
- Neurology Unit, Department of Medicine, Lagos University Teaching Hospital, Idi Araba, Lagos State, Nigeria
| | - Mohamed Essam
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Laura Aguado
- Neurology Department, University Hospital, Burgos, Spain
| | - Hanan Elrassas
- Okasha Institute of Psychiatry, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Tamer Roushdy
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Caroline M Tanner
- Department of Neurology, Weill Institute for Neurosciences, University of California - San Francisco, San Francisco, CA, USA
| | - Esther Cubo
- Neurology Department, University Hospital, Burgos, Spain
| |
Collapse
|
22
|
Kaddumukasa M, Najjuma J, Mbalinda SN, Kaddumukasa MN, Nakibuuka J, Burant C, Moore S, Blixen C, Katabira ET, Sajatovic M. Reducing stroke burden through a targeted self-management intervention for reducing stroke risk factors in high-risk Ugandans: A protocol for a randomized controlled trial. PLoS One 2021; 16:e0251662. [PMID: 34157024 PMCID: PMC8219138 DOI: 10.1371/journal.pone.0251662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Stroke burden is rapidly increasing globally. Modifiable risk factors offer an opportunity to intervene, and targeting hypertension is a key actionable target for stroke risk reduction in sub-Saharan Africa. This 3-site planned randomized controlled trial builds on promising preliminary data. METHODS A total of 246 Ugandan adults will be recruited randomized to experimental intervention vs. enhanced treatment control. Intervention participants will receive six weekly group-format stroke risk reduction self-management training sessions, and the controls will receive information on cardiovascular risk. The primary study outcome is systolic B.P. measured at baseline, 13-week, 24 weeks (6 months). Secondary outcomes include other biological and behavioral stroke risk factors. DISCUSSION The curriculum-guided self-management TargetEd MAnageMent Intervention (TEAM) program is anticipated to reduce the stroke burden in Uganda. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT04685408, registered on 28 December 2020.
Collapse
Affiliation(s)
- Mark Kaddumukasa
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
- * E-mail:
| | - Josephine Najjuma
- Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | | | - Jane Nakibuuka
- Department of Medicine, Mulago Hospital, Kampala, Uganda
| | - Christopher Burant
- Louis Stokes VA Medical Center, Geriatric Research Education, and Clinical Center, Cleveland, OH, United States of America
| | - Shirley Moore
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States of America
| | - Carol Blixen
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Elly T. Katabira
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center & Case Western Reserve University School of Medicine, Cleveland, OH, United States of America
| |
Collapse
|
23
|
Yoseph M, Paddick SM, Gray WK, Andrea D, Barber R, Colgan A, Dotchin C, Urasa S, Kisoli A, Kissima J, Haule I, Rogathi J, Safic S, Mushi D, Robinson L, Walker RW. Prevalence estimates of dementia in older adults in rural Kilimanjaro 2009-2010 and 2018-2019: is there evidence of changing prevalence? Int J Geriatr Psychiatry 2021; 36:950-959. [PMID: 33480089 DOI: 10.1002/gps.5498] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 12/27/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Although limited, existing epidemiological data on dementia in sub-Saharan Africa indicate that prevalence may be increasing; contrasting with recent decreases observed in high-income countries. We have previously reported the age-adjusted prevalence of dementia in rural Tanzania in 2009-2010 as 6.4% (95% confidence interval [CI] 4.9-7.9) in individuals aged ≥70 years. We aimed to repeat a community-based dementia prevalence study in the same setting to assess whether prevalence has changed. METHODS This was a two-phase door-to-door community-based cross-sectional survey in Kilimanjaro, Tanzania. In Phase I, trained primary health workers screened all consenting individuals aged ≥60 years from 12 villages using previously validated, locally developed, tools (IDEA cognitive screen and IDEA-Instrumental Activities of Daily Living questionnaire). Screening was conducted using a mobile digital application (app) on a hand-held tablet. In Phase II, a stratified sample of those identified in Phase I were clinically assessed using the DSM-5 criteria and diagnoses subsequently confirmed by consensus panel. RESULTS Of 3011 people who consented, 424 screened positive for probable dementia and 227 for possible dementia. During clinical assessment in Phase II, 105 individuals met DSM-5 dementia criteria. The age-adjusted prevalence of dementia was 4.6% (95% CI 2.9-6.4) in those aged ≥60 years and 8.9% (95% CI 6.1-11.8) in those aged ≥70 years. Prevalence rates increased significantly with age. CONCLUSIONS The prevalence of dementia in this rural Tanzanian population appears to have increased since 2010, although not significantly. Dementia is likely to become a significant health burden in this population as demographic transition continues.
Collapse
Affiliation(s)
- Marcella Yoseph
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Stella-Maria Paddick
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - William K Gray
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | | | - Robyn Barber
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Aoife Colgan
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Dotchin
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Aloyce Kisoli
- 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
| | - Jane Rogathi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Declare Mushi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Louise Robinson
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard W Walker
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK.,Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| |
Collapse
|
24
|
Masika GM, Yu DSF, Li PWC. Accuracy of the Montreal Cognitive Assessment in Detecting Mild Cognitive Impairment and Dementia in the Rural African Population. Arch Clin Neuropsychol 2021; 36:371-380. [PMID: 31942599 DOI: 10.1093/arclin/acz086] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/22/2019] [Accepted: 12/22/2019] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The incidence of dementia in the sub-Saharan Africa is rising. However, screening tools for cognitive decline that fits their linguistic and cultural context are lacking. The aim of this study was to determine the accuracy of the Kiswahili version of Montreal Cognitive Assessment (K-MoCA) to detect mild cognitive impairment or dementia among older adults in the rural Tanzania. METHODS We recruited 259 community-dwelling older adults in Chamwino district, Tanzania. The concurrent validity and discriminatory power of K-MoCA were examined by comparing its score with IDEA cognitive screening and psychiatrist's diagnosis using DSM-V, respectively. All the questionnaires were administered in face-to-face interview. RESULTS K-MoCA demonstrated acceptable reliability (Cronbach's alpha = 0.780). Concurrent validity was evident by its significant correlation with the IDEA screening test (Pearson's r = 0.651, p < 0.001). Using the psychiatrist's rating as the reference, the optimal cut-off score for MCI and dementia was 19 and 15, respectively, which yielded the sensitivity of 70% and specificity of 60% for MCI, and sensitivity of 72% and specificity of 60% for dementia. Further analysis indicated that education and age influence performance on K-MoCA. CONCLUSION Overall, the K-MoCA is a reliable and valid tool for measuring cognitive decline. However, its limited discriminatory power for MCI and dementia may be compromised by the cultural irrelevance of some items.
Collapse
Affiliation(s)
- Golden M Masika
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,Department of Nursing and Midwifery, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
| | - Doris S F Yu
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Polly W C Li
- The Nethersole School of Nursing, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong.,School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| |
Collapse
|
25
|
Stoner CR, Lakshminarayanan M, Durgante H, Spector A. Psychosocial interventions for dementia in low- and middle-income countries (LMICs): a systematic review of effectiveness and implementation readiness. Aging Ment Health 2021; 25:408-419. [PMID: 31814427 PMCID: PMC8026009 DOI: 10.1080/13607863.2019.1695742] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Despite wide uptake in high-income countries (HICs), less is known about the effectiveness and implementation of psychological, social and cognitive interventions in low- and middle-income countries (LMICs). Despite this, such interventions are increasingly used. The aim of this review was to appraise the effectiveness and implementation readiness of psychosocial interventions for people with dementia in LMICs. METHODS A systematic search of databases from 1998-2019. Studies were rated on two scales assessing quality and implementation readiness. RESULTS Seventeen articles describing 11 interventions in six countries were evaluated. Interventions included Cognitive Stimulation Therapy (CST), a Multidisciplinary Cognitive Rehabilitation Programme (MCRP), singing interventions, occupational therapy and reminiscence therapy. The quality of included studies was variable, and many had low sample sizes. Evidence for improving both cognition and quality of life was found in two interventions: Cognitive Stimulation Therapy (CST) and a Multidisciplinary Cognitive Rehabilitation Programme (MCRP). Implementation issues were more likely to be explored in studies of Cognitive Stimulation Therapy (CST) than in any other intervention. CONCLUSIONS Of the included studies here, CST appears to be the most implementation ready, improving both cognition and quality of life with implementation readiness effectively explored in two LMIC countries: India and Tanzania.
Collapse
Affiliation(s)
- Charlotte R. Stoner
- Research Department of Clinical Educational and Health Psychology, University College London (UCL), London, UK,CONTACT Charlotte R. Stoner
| | - Monisha Lakshminarayanan
- Dementia Care in Schizophrenia Research Foundation (DEMCARES in SCARF), Chennai, Tamil Nadu, India
| | - Helen Durgante
- Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Aimee Spector
- Research Department of Clinical Educational and Health Psychology, University College London (UCL), London, UK
| |
Collapse
|
26
|
Screening for HIV-Associated Neurocognitive Disorder (HAND) in Adults Aged 50 and Over Attending a Government HIV Clinic in Kilimanjaro, Tanzania. Comparison of the International HIV Dementia Scale (IHDS) and IDEA Six Item Dementia Screen. AIDS Behav 2021; 25:542-553. [PMID: 32875460 PMCID: PMC7846532 DOI: 10.1007/s10461-020-02998-9] [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] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Validated screening tools for HIV-associated neurocognitive disorders (HAND) are lacking for the newly emergent ageing population of people living with HIV (PLWH) in sub-Saharan Africa (SSA). We aimed to validate and compare diagnostic accuracy of two cognitive screening tools, the International HIV dementia scale (IHDS), and the Identification and Interventions for Dementia in Elderly Africans (IDEA) screen, for identification of HAND in older PLWH in Tanzania. A systematic sample of 253 PLWH aged ≥ 50 attending a Government clinic in Tanzania were screened with the IHDS and IDEA. HAND were diagnosed by consensus American Academy of Neurology (AAN) criteria based on detailed clinical neuropsychological assessment. Strict blinding was maintained between screening and clinical evaluation. Both tools had limited diagnostic accuracy for HAND (area under the receiver operating characteristic (AUROC) curve 0.639–0.667 IHDS, 0.647–0.713 IDEA), which was highly-prevalent (47.0%). Accurate HAND screening tools for older PLWH in SSA are needed.
Collapse
|
27
|
Bristow C, George G, Hillsmith G, Rainey E, Urasa S, Koipapi S, Kisoli A, Boni J, Saria GA, Ranasinghe S, Joseph M, Gray WK, Dekker M, Walker RW, Dotchin CL, Mukaetova-Ladinska E, Howlett W, Makupa P, Paddick SM. Low levels of frailty in HIV-positive older adults on antiretroviral therapy in northern Tanzania. J Neurovirol 2021; 27:58-69. [PMID: 33432552 PMCID: PMC7921045 DOI: 10.1007/s13365-020-00915-3] [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] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 09/01/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.
Collapse
Affiliation(s)
- Clare Bristow
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.
| | - Grace George
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Grace Hillsmith
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Emma Rainey
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Sengua Koipapi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Japhet Boni
- Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro, Tanzania
| | | | | | - Marcella Joseph
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Marieke Dekker
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Richard W Walker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Catherine L Dotchin
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Elizabeta Mukaetova-Ladinska
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.,Leicestershire Partnership NHS Trust, Leicester, UK
| | - William Howlett
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro, Tanzania
| | - Philip Makupa
- Mawenzi Regional Referral Hospital, Moshi, Kilimanjaro, Tanzania
| | - Stella-Maria Paddick
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
| |
Collapse
|
28
|
Yemm H, Robinson DL, Paddick SM, Dotchin C, Goodson ML, Narytnyk A, Poole M, Mc Ardle R. Instrumental Activities of Daily Living Scales to Detect Cognitive Impairment and Dementia in Low- and Middle-Income Countries: A Systematic Review. J Alzheimers Dis 2021; 83:451-474. [PMID: 34334407 PMCID: PMC8461665 DOI: 10.3233/jad-210532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The largest proportion of people with dementia worldwide live in low- and middle- income countries (LMICs), with dementia prevalence continuing to rise. Assessment and diagnosis of dementia involves identifying the impact of cognitive decline on function, usually measured by instrumental activities of daily living (IADLs). OBJECTIVE This review aimed to identify IADL measures which are specifically developed, validated, or adapted for use in LMICs to guide selection of such tools. METHODS A systematic search was conducted (fourteen databases) up to April 2020. Only studies reporting on development, validation, or adaptation of IADL measures for dementia or cognitive impairment among older adults (aged over 50) in LMICs were included. The QUADAS 2 was used to assess quality of diagnostic accuracy studies. RESULTS 22 papers met inclusion criteria; identifying 19 discrete IADL tools across 11 LMICs. These were either translated from IADL measures used in high-income countries (n = 6), translated and adapted for cultural differences (n = 6), or newly developed for target LMIC populations (n = 7). Seven measures were investigated in multiple studies; overall quality of diagnostic accuracy was moderate to good. CONCLUSION Reliability, validity, and accuracy of IADL measures for supporting dementia diagnosis within LMICs was reported. Key components to consider when selecting an IADL tool for such settings were highlighted, including choosing culturally appropriate, time-efficient tools that account for gender- and literacy-bias, and can be conducted by any volunteer with appropriate training. There is a need for greater technical and external validation of IADL tools across different regions, countries, populations, and cultures.
Collapse
Affiliation(s)
- Heather Yemm
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Helen McArdle Nursing and Care Research Institute, Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland, UK
| | - Dame Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Stella-Maria Paddick
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Gateshead Health NHS Foundation Trust, Gateshead, UK
| | - Catherine Dotchin
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Northumbria Healthcare NHS Foundation Trust, Tyne and Wear, UK
| | - Michaela Louise Goodson
- Medical Research Department, Faculty of Medical Sciences, Newcastle University Medicine, Iskandar Puteri, Malaysia
| | - Alla Narytnyk
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Marie Poole
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Ríona Mc Ardle
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| |
Collapse
|
29
|
Lewis EG, Whitton LA, Collin H, Urasa S, Howorth K, Walker RW, Dotchin C, Mulligan L, Shah B, Mohamed A, Mdegella D, Mkodo J, Zerd F, Gray WK. A brief frailty screening tool in Tanzania: external validation and refinement of the B-FIT screen. Aging Clin Exp Res 2020; 32:1959-1967. [PMID: 31811571 DOI: 10.1007/s40520-019-01406-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 10/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Identifying older people who are most vulnerable to adverse outcomes is important. This is particularly so in low-resource settings, such as those in sub-Saharan Africa (SSA), where access to social and healthcare services is often limited. AIM To validate and further refine a frailty screening tool for SSA. METHODS Phase I screening of people aged 60 years and over was conducted using the Brief Frailty Instrument for Tanzania (B-FIT). In phase II, a stratified, frailty-weighed sample was assessed across a range of variables covering cognition, physical function (including continence, mobility, weakness and exhaustion) nutrition, mood, co-morbidity, sensory impairment, polypharmacy, social support and self-rated health. The frailty-weighted sample was also assessed for frailty according to the comprehensive geriatric assessment (CGA), which we used as our 'gold standard' diagnosis. RESULTS Of 235 people in the frailty-weighted sample, 91 (38.7%) were frail according to CGA, the median age was 73 years and 136 (57.9%) were female. In multivariable modelling, physical disability (Barthel index), cognitive impairment (IDEA cognitive screen), calf circumference, poor distance vision and problems engaging in social activities were found to be associated with frailty. After developing a scoring system, based on regression coefficients, a modified B-FIT screen (B-FIT 2) had an area under the receiver operating characteristic curve of 0.925, a sensitivity of 86.2% and a specificity of 88.8%. DISCUSSION The inclusion of items assessing nutrition, social support and sensory impairment improved the performance of the B-FIT. CONCLUSIONS The B-FIT 2 should be externally validated.
Collapse
Affiliation(s)
- Emma Grace Lewis
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Louise A Whitton
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Harry Collin
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Kate Howorth
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
- Institute of Health and Society, 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
| | - Catherine Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Louise Mulligan
- South Metropolitan Health Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Bhavini Shah
- Chelsea and Westminster Hospital NHS Foundation Trust, West Middlesex University Hospital, London, UK
| | - Ali Mohamed
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Joyce Mkodo
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Francis Zerd
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.
- Department of Research and Development, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK.
| |
Collapse
|
30
|
Masika GM, Yu DSF, Li PWC, Wong A, Lin RSY. Psychometrics and diagnostic properties of the Montreal Cognitive Assessment 5-min protocol in screening for Mild Cognitive Impairment and dementia among older adults in Tanzania: A validation study. Int J Older People Nurs 2020; 16:e12348. [PMID: 32920984 DOI: 10.1111/opn.12348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 08/02/2020] [Accepted: 08/18/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The prevalence of dementia in Tanzania, as in other developing countries, is progressively increasing. Yet international screening instruments for mild cognitive impairment are lacking. OBJECTIVES The aim of this study was to determine the psychometrics and the diagnostic ability of the Montreal Cognitive Assessment 5 minutes protocol (MoCA-5-min) among older adults in the rural Tanzania. METHODS The MoCA-5-min and the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screening were concurrently administered through face to face to 202 community-dwelling older adults in Chamwino district. Exploratory factor analysis (EFA) using principal component method and oblique rotation was performed to determine the underlying factor structure of the scale. The concurrent and construct as well as predictive validities of the MoCA-5-min were examined by comparing its score with IDEA cognitive screening and psychiatrist's diagnosis using DSM-V criteria, respectively. RESULTS The EFA found that all the MoCA-5-min items highly loaded into one component, with factor loading ranging from 0.550 to 0.879. The intraclass correlation coefficient for 6 weeks test-retest reliability was 0.85. Its strong significant correlation with the IDEA screening (Pearson's r = 0.614, p < 0.001) demonstrated a good concurrent validity. Using the psychiatrist's rating as the gold standard, MoCA-5-min demonstrated the optimal cut-off score for MCI at 22, which yielded the sensitivity of 80% and specificity of 74%; and dementia at score of 16 giving a sensitivity of 90% and specificity of 80%. Upon stratifying the sample into different age groups, the optimal cut-off scores tended to decrease with the increase in age. CONCLUSION The MoCA-5-min is reliable and provides a valid and accurate measure of cognitive decline among older population in the rural settings of Tanzania. The use of varying cut-off scores across age groups may ensure more precise discriminatory power of the MoCA-5-min. IMPLICATIONS FOR PRACTICE Availability of the MoCA-5-min in Tanzania will facilitate clinicians to timely detect dementia at both pre-clinical and clinical stages. Its availability will also encourage further research and international collaborations in dementia prevention programs.
Collapse
Affiliation(s)
- Golden M Masika
- The Nethersole School of Nursing, Chinese University of Hong Kong, New Territories, Hong Kong.,Department of Nursing and Midwifery, College of Health Sciences, University of Dodoma, Dodoma, Tanzania
| | - Doris S F Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Polly W C Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| | - Adrian Wong
- Department of Medicine and Therapeutics, Therese Pei Fong Chow Research Centre for Prevention of Dementia, Lui Che Woo Institute of Innovative Medicine, Chinese University of Hong Kong, New Territories, Hong Kong
| | - Rose S Y Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, Hong Kong
| |
Collapse
|
31
|
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.
Collapse
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
| |
Collapse
|
32
|
Magklara E, Stephan BCM, Robinson L. Current approaches to dementia screening and case finding in low- and middle-income countries: Research update and recommendations. Int J Geriatr Psychiatry 2019; 34:3-7. [PMID: 30247787 DOI: 10.1002/gps.4969] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 08/06/2018] [Indexed: 12/21/2022]
Abstract
Approximately 47 million people have dementia worldwide, with this figure, it is expected to almost triple by 2050. Most people with dementia (approximately two-thirds) live in low- and middle-income countries (LMICs). This presents a significant challenge for such countries that often have limited financial resources and less well-developed health and social care systems. In the absence of a cure, reducing the future costs of dementia care and burden of disease may be best achieved by a greater emphasis on (1) more timely diagnosis with earlier intervention to maintain functional independence and (2) undertaking "screening" in groups at high risk of developing dementia, case finding, and using brief cognitive assessment instruments. In clinical settings, a wide range of instruments for dementia screening and diagnosis are currently available; however, few cognitive assessment tools have been developed specifically for clinical use within LMIC settings. Screening for dementia and cognitive impairment in LMICs largely relies on tools adapted from high-income countries (HICs); these often lack validation in these settings leading to education, literacy, and cultural biases. Research is urgently needed to develop cognitive assessment tools and dementia diagnostic approaches that are appropriate and feasible for clinical use in LMIC settings.
Collapse
Affiliation(s)
- Eleni Magklara
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Blossom C M Stephan
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Robinson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Newcastle Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
33
|
Lewis EG, Coles S, Howorth K, Kissima J, Gray W, Urasa S, Walker R, Dotchin C. The prevalence and characteristics of frailty by frailty phenotype in rural Tanzania. BMC Geriatr 2018; 18:283. [PMID: 30445919 PMCID: PMC6240208 DOI: 10.1186/s12877-018-0967-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/26/2018] [Indexed: 01/24/2023] Open
Abstract
Background The frailty phenotype is defined by the presence of three from the following five clinical features: weakness, slow walking speed, unintentional weight loss, exhaustion, and low physical activity. It has been widely applied in different research and clinical contexts, including across many low and middle-income countries. However, there is evidence that the operationalisation of each component of the frailty phenotype significantly alters its characteristics and predictive validity, and care is needed when applying the phenotype across settings. The study’s objective was to operationalise the frailty phenotype in a rural Tanzanian population of older community-dwelling adults. Methods Consenting adults aged ≥60 years, and resident in five randomly selected villages of Hai district Demographic Surveillance Site, were eligible to participate in this cross-sectional study. From a screened sample of 1207 older adults, 235 were randomised and consented to an assessment of their frailty status by the frailty phenotype. Trained research fieldworkers (Tanzanian medical doctors and nurses) carried out measurements and questionnaires at local village centres or at participants’ homes. Results The prevalence of the frailty phenotype, calculated from complete data for 196 participants, was 9.25% (95% CI 4.39–14.12) When missing data were counted as meeting frailty criterion (i.e. missing due to inability to perform an assessment), the prevalence increased to 11.22% (95% CI 7.11–15.32). Frailty by phenotype criteria was more common in older age groups, and was associated with self-assessed poor health and depression symptoms. Conclusions Frailty can be successfully estimated using the frailty phenotype, however there are challenges in its operationalisation cross-culturally. Further work is needed to explore the potential clinical application of the frailty phenotype in such settings. Electronic supplementary material The online version of this article (10.1186/s12877-018-0967-0) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Emma Grace Lewis
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK. .,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK. .,Education centre, North Tyneside General Hospital, Rake Lane, North Shields, NE29 8NH, UK.
| | - Selina Coles
- The Medical school, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Kate Howorth
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - John Kissima
- Hai District Hospital, Boma Ng'ombe, Hai, Kilimanjaro, Tanzania
| | - William Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi, Kilimanjaro, Tanzania
| | - Richard Walker
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Catherine Dotchin
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| |
Collapse
|
34
|
A longitudinal study of cognitive decline in rural Tanzania: rates and potentially modifiable risk factors. Int Psychogeriatr 2018; 30:1333-1343. [PMID: 29559014 DOI: 10.1017/s1041610217002861] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED ABSTRACTBackground:The number of people living with dementia in sub-Saharan Africa (SSA) is expected to increase rapidly in the coming decades. However, our understanding of how best to reduce dementia risk in the population is very limited. As a first step in developing intervention strategies to manage dementia risk in this setting, we investigated rates of cognitive decline in a rural population in Tanzania and attempted to identify associated factors. METHODS The study was conducted in the rural Hai district of northern Tanzania. In 2014, community-dwelling people aged 65 years and over living in six villages were invited to take part in a cognitive screening program. All participants from four of the six villages were followed-up at two years and cognitive function re-tested. At baseline and follow-up, participants were assessed for functional disability, hypertension, and grip strength (as a measure of frailty). At follow-up, additional assessments of visual acuity, hearing impairment, tobacco and alcohol consumption, and clinical assessment for stroke were completed. RESULTS Baseline and follow-up data were available for 327 people. Fifty people had significant cognitive decline at two-year follow-up. Having no formal education, low grip strength at baseline, being female and having depression at follow-up were independently associated with cognitive decline. CONCLUSIONS This is one of the first studies of cognitive decline conducted in SSA. Rates of decline at two years were relatively high. Future work should focus on identification of specific modifiable risk factors for cognitive decline with a view to developing culturally appropriate interventions.
Collapse
|
35
|
Stone L, Heward J, Paddick SM, Dotchin CL, Walker RW, Collingwood C, Thornton J, Yarwood V, McCartney J, Irwin C, Mkenda S, Kissima J, Swai B, Gray WK. Screening for Instrumental Activities of Daily Living in Sub-Saharan Africa: A Balance Between Task Shifting, Simplicity, Brevity, and Training. J Geriatr Psychiatry Neurol 2018; 31:248-255. [PMID: 30049234 DOI: 10.1177/0891988718790400] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Task shifting has been suggested as one way to help manage the increasing burden of dementia in sub-Saharan Africa (SSA). However, brief, easy-to-use and valid screening tools are needed to support this approach. Our team has developed an 11-item questionnaire to assess instrumental activities of daily living (IADLs) in SSA, the Identification and Intervention for Dementia in Elderly Africans (IDEA)-IADL questionnaire. We aimed to externally validate the questionnaire and develop a shorter, more efficient version. METHODS A community-based sample of 329 older adults in 4 rural villages was screened for dementia using the validated IDEA cognitive screen and the 11-item IDEA-IADL questionnaire. A stratified sample was assessed for Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) dementia by a United Kingdom-based doctor, who was blinded to the results of screening. Area under the receiver operating characteristic (AUROC) curve analysis was used to assess validity, and factor analysis and regression modeling were used to develop a shorter version of the questionnaire. RESULTS A 3-item IDEA-IADL questionnaire was developed and externally validated in the study sample. The questionnaire was deemed to be valid and enhanced screening performance in 2 villages (AUROC: 0.857 and 0.895) but detracted from the accuracy of the IDEA cognitive screen in the other 2 villages (AUROC: 0.591 and 0.639). These differences appeared to be due to differences in interpretation of responses to questions by the assessors. CONCLUSIONS A brief IDEA-IADLs scale was developed and worked well in some villages. However, our study highlights a training need if brief screening tools to assess IADLs are to be effectively used by nonspecialists in low-resource settings.
Collapse
Affiliation(s)
- Lydia Stone
- 1 The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jessica Heward
- 1 The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Stella-Maria Paddick
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,3 Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Catherine L Dotchin
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,4 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Richard W Walker
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom.,4 Institute of Health and Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Cecilia Collingwood
- 1 The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Jessica Thornton
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Vanessa Yarwood
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Judith McCartney
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Charlotte Irwin
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| | - Sarah Mkenda
- 5 Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - John Kissima
- 6 Hai District Medical Centre, Boman'gombe, Kilimanjaro Region, Tanzania
| | - Bernadette Swai
- 6 Hai District Medical Centre, Boman'gombe, Kilimanjaro Region, Tanzania
| | - William K Gray
- 2 Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, United Kingdom
| |
Collapse
|
36
|
Lewis EG, Wood G, Howorth K, Shah B, Mulligan L, Kissima J, Dotchin C, Gray W, Urasa S, Walker R. Prevalence of Frailty in Older Community-Dwelling Tanzanians According to Comprehensive Geriatric Assessment. J Am Geriatr Soc 2018; 66:1484-1490. [DOI: 10.1111/jgs.15433] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 04/06/2018] [Accepted: 04/10/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Emma G. Lewis
- Institute of Health and Society, Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - Greta Wood
- Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
| | - Kate Howorth
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - Bhavini Shah
- West Middlesex University Hospital; Chelsea and Westminster Hospital National Health Service Foundation Trust; Middlesex United Kingdom
| | - Louise Mulligan
- Fiona Stanley Hospital; South Metropolitan Health Service; Murdoch Western Australia Australia
| | - John Kissima
- Hai District Hospital, Boma Ng'ombe, Hai; Kilimanjaro Tanzania
| | - Catherine Dotchin
- Institute of Health and Society, Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - William Gray
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| | - Sarah Urasa
- Kilimanjaro Christian Medical Centre, Moshi; Kilimanjaro Tanzania
| | - Richard Walker
- Institute of Health and Society, Faculty of Medical Sciences; Newcastle University; Newcastle upon Tyne United Kingdom
- Northumbria Healthcare National Health Service Foundation Trust; North Tyneside General Hospital; North Shields United Kingdom
| |
Collapse
|
37
|
Putnam HWI, Jones R, Rogathi J, Gray WK, Swai B, Dewhurst M, Dewhurst F, Walker RW. Hypertension in a resource-limited setting: Is it associated with end organ damage in older adults in rural Tanzania? J Clin Hypertens (Greenwich) 2018; 20:217-224. [PMID: 29446219 DOI: 10.1111/jch.13187] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 11/06/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022]
Abstract
Few data from sub-Saharan Africa exist on the effects of hypertension on the organs of the human body. We aimed to establish the prevalence of hypertensive end organ damage (EOD) in an elderly cohort of Tanzanians. The population aged 70 years and over of 2 villages in northern Tanzania (n = 246), had blood pressure (BP) data available from 2010 and 2013, and underwent in-depth follow-up for markers of hypertensive EOD in 2016. Assessment included ankle-brachial pressure index, lying-standing BP, electrocardiogram, and mid-stream urine dip. Sustained hypertension (those with hypertension at all 3 assessments) was found in 129 (52.4% subjects). Of the entire cohort, 13.9% had left ventricular hypertrophy and 26.4% had peripheral arterial disease, both of which were associated with sustained hypertension, although orthostatic hypotension, stroke, proteinuria, and arterial stiffening were not. Further investigation, particularly in younger age groups, is merited if hypertension-associated morbidity is to be controlled.
Collapse
Affiliation(s)
- Harry W I Putnam
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Rebecca Jones
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - Jane Rogathi
- Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - William K Gray
- Northumbria Healthcare, NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | | | - Matthew Dewhurst
- Northumbria Healthcare, NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Felicity Dewhurst
- Northumbria Healthcare, NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.,Institute of Health and Society, 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
| |
Collapse
|
38
|
Paddick SM, Lewis EG, Duinmaijer A, Banks J, Urasa S, Tucker L, Kisoli A, Cletus J, Lissu C, Kissima J, Dotchin C, Gray WK, Muaketova-Ladinska E, Cosker G, Walker RW. Identification of delirium and dementia in older medical inpatients in Tanzania: A comparison of screening and diagnostic methods. J Neurol Sci 2017; 385:156-163. [PMID: 29406898 DOI: 10.1016/j.jns.2017.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 11/20/2017] [Accepted: 12/05/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND In sub-Saharan Africa, there are no validated screening tools for delirium in older adults. This study assesses clinical utility of two instruments, the IDEA cognitive screen and the Confusion Assessment Method (CAM) for identification of delirium in older adults admitted to medical wards of a tertiary referral hospital in Tanzania. METHOD The IDEA cognitive screen and CAM were administered to a consecutive cohort of older individuals on admission to Kilimanjaro Christian Medical Centre using a blinded protocol. Consensus diagnosis for delirium was established against DSM-5 criteria and dementia by DSM-IV criteria. RESULTS Of 507 admission assessments, 95 (18.7%) had DSM-5 delirium and 95 (18.7%) had DSM-IV dementia (33 (6.5%) delirium superimposed on dementia). The CAM and IDEA cognitive screen had very good diagnostic accuracy for delirium (AUROC curve 0.94 and 0.87 respectively). However, a number of participants (10.5% and 16.4% respectively) were unable to complete these screening assessments due to reduced consciousness, or other causes of reduced verbal response and were excluded from this analysis; many of whom met DSM-5 criteria for delirium. Secondary analysis suggests that selected cognitive and observational items from the CAM and IDEA cognitive screen may be as effective as the full screening tools in identifying delirium even in unresponsive patients. CONCLUSION Both instruments appeared useful for delirium screening in this inpatient setting, but had significant limitations. The combination of assessment items identified may form the basis of a brief, simple delirium screening tool suitable for use by non-specialist clinicians. Further development work is needed.
Collapse
Affiliation(s)
- S M Paddick
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
| | - E G Lewis
- Charité - Universitätsmedizin Berlin, CVK: Campus Virchow-Klinikum, Institute of Tropical Medicine and International Health, Berlin, Germany
| | - A Duinmaijer
- Haydom Lutheran Hospital, Mbulu, Manyara, Tanzania
| | - J Banks
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - S Urasa
- Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - L Tucker
- The London School of Hygiene & Tropical Medicine, London, UK
| | - A Kisoli
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - J Cletus
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Lissu
- Kilimanjaro Christian Medical Centre, Kilimanjaro, Tanzania
| | - J Kissima
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - C Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - W K Gray
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - E Muaketova-Ladinska
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK; Institute of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK and Leicestershire Partnership NHS Trust, Leicester, UK
| | - G Cosker
- Institute of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK and Leicestershire Partnership NHS Trust, Leicester, UK
| | - R W Walker
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
39
|
Cognition, Health, and Well-Being in a Rural Sub-Saharan African Population. EUROPEAN JOURNAL OF POPULATION-REVUE EUROPEENNE DE DEMOGRAPHIE 2017; 34:637-662. [PMID: 30381778 DOI: 10.1007/s10680-017-9445-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Cognitive health is an important dimension of well-being in older ages, but few studies have investigated the demography of cognitive health in sub-Saharan Africa's (SSA) growing population of mature adults (= persons age 45+). We use data from the Malawi Longitudinal Study of Families and Health (MLSFH) to document the age and gender patterns of cognitive health, the contextual and life-course correlates of poor cognitive health, and the understudied linkages between cognitive and physical/mental well-being. Surprisingly, the age-pattern of decline in cognitive health is broadly similar to that observed in the U.S. We also find that women have substantially worse cognitive health than men, and experience a steeper age-gradient in cognitive ability. Strong social ties and exposure to socially complex environments are associated with higher cognitive health, as is higher socioeconomic status. Poor cognitive health is associated with adverse social and economic well-being outcomes such as less nutrition intake, lower income, and reduced work efforts even in this subsistence agriculture context. Lower levels of cognitive health are also strongly associated with increased levels of depression and anxiety, and are associated with worse physical health measured through both self-reports and physical performance. Our findings suggest that cognition plays a key-but understudied-role in shaping late-life well-being in low-income populations.
Collapse
|
40
|
Rosli R, Tan MP, Gray WK, Subramanian P, Mohd Hairi NN, Chin AV. How Can We Best Screen for Cognitive Impairment in Malaysia? A Pilot of the IDEA Cognitive Screen and Picture-Based Memory Impairment Scale and Comparison of Criterion Validity with the Mini Mental State Examination. Clin Gerontol 2017; 40:249-257. [PMID: 28459304 DOI: 10.1080/07317115.2017.1311978] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To pilot two new cognitive screening tools for use in an urban Malaysian population and to compare their criterion validity against a gold standard, the well-established Mini-Mental State Examination (MMSE). METHODS The IDEA cognitive screen, Picture-based Memory Impairment Scale (PMIS), and MMSE were administered to a convenience sample of elderly (≥ 65 years) from the community and outpatient clinics at an urban teaching hospital. Consensus diagnosis was performed by two geriatricians blinded to PMIS and IDEA cognitive screen scores using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) clinical criteria. The MMSE performance was used as a reference. RESULTS The study enrolled 66 participants, with a median age of 78.5 years (interquartile range [IQR], 72.5-83.0) years and 11.0 median years of education (IQR, 9.0-13.0). Forty-three (65.2%) were female, and 32 (48.4%) were Chinese. The area under the receiver operating characteristic (AUROC) curve values were .962 (IDEA cognitive screen), .970 (PMIS), and .935 (MMSE). The optimal cutoff values for sensitivity and specificity were: IDEA cognitive screen: ≤ 11, 90.9% and 89.7%; PMIS: ≤ 6, 97.3% and 69.0%; and MMSE: ≤ 23, 84.6% and 76.0%. Although the sample size was small, multivariable logistic regression modelling suggested that all three screen scores did not appear to be educationally biased. CONCLUSION The IDEA and PMIS tools are potentially valid screening tools for dementia in urban Malaysia, and perform at least as well as the MMSE. Further work on larger representative, cohorts is needed to further assess the psychometric properties. CLINICAL IMPLICATIONS Study provides alternative screening tools for dementia for both non-specialists and specialists.
Collapse
Affiliation(s)
| | - Maw Pin Tan
- a University of Malaya , Kuala Lumpur , Malaysia
| | - William K Gray
- b Northumbria Healthcare NHS Foundation Trust , North Tyneside General Hospital , UK
| | | | | | - Ai-Vyrn Chin
- a University of Malaya , Kuala Lumpur , Malaysia
| |
Collapse
|
41
|
Integrated Care: Enhancing the Role of the Primary Health Care Professional in Preventing Functional Decline: A Systematic Review. J Am Med Dir Assoc 2017; 18:489-494. [DOI: 10.1016/j.jamda.2017.03.015] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 03/28/2017] [Indexed: 11/18/2022]
|
42
|
Cognitive stimulation therapy as a sustainable intervention for dementia in sub-Saharan Africa: feasibility and clinical efficacy using a stepped-wedge design. Int Psychogeriatr 2017; 29:979-989. [PMID: 28222815 DOI: 10.1017/s1041610217000163] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cognitive stimulation therapy (CST) is a psychosocial group-based intervention for dementia shown to improve cognition and quality of life with a similar efficacy to cholinesterase inhibitors. Since CST can be delivered by non-specialist healthcare workers, it has potential for use in low-resource environments, such as sub-Saharan Africa (SSA). We aimed to assess the feasibility and clinical effectiveness of CST in rural Tanzania using a stepped-wedge design. METHODS Participants and their carers were recruited through a community dementia screening program. Inclusion criteria were DSM-IV diagnosis of dementia of mild/moderate severity following detailed assessment. No participant had a previous diagnosis of dementia and none were taking a cholinesterase inhibitor. Primary outcomes related to the feasibility of conducting CST in this setting. Key clinical outcomes were changes in quality of life and cognition. The assessing team was blind to treatment group membership. RESULTS Thirty four participants with mild/moderate dementia were allocated to four CST groups. Attendance rates were high (85%) and we were able to complete all 14 sessions for each group within the seven week timeframe. Substantial improvements in cognition, anxiety, and behavioral symptoms were noted following CST, with smaller improvements in quality of life measures. The number needed to treat was two for a four-point cognitive (adapted Alzheimer's Disease Assessment Scale-Cognitive) improvement. CONCLUSIONS This intervention has the potential to be low-cost, sustainable, and adaptable to other settings across SSA, particularly if it can be delivered by non-specialist health workers.
Collapse
|
43
|
Gray WK, Orega G, Kisoli A, Rogathi J, Paddick SM, Longdon AR, Walker RW, Dewhurst F, Dewhurst M, Chaote P, Dotchin C. Identifying Frailty and its Outcomes in Older People in Rural Tanzania. Exp Aging Res 2017; 43:257-273. [DOI: 10.1080/0361073x.2017.1298957] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
44
|
Hindley G, Kissima J, L Oates L, Paddick SM, Kisoli A, Brandsma C, K Gray W, Walker RW, Mushi D, Dotchin CL. The role of traditional and faith healers in the treatment of dementia in Tanzania and the potential for collaboration with allopathic healthcare services. Age Ageing 2017; 46:130-137. [PMID: 28181644 DOI: 10.1093/ageing/afw167] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/06/2016] [Indexed: 12/13/2022] Open
Abstract
Background Low diagnostic rates are a barrier to improving care for the growing number of people with dementia in sub-Saharan Africa. Many people with dementia are thought to visit traditional healers (THs) and Christian faith healers (FHs) and these groups may have a role in identifying people with dementia. We aimed to explore the practice and attitudes of these healers regarding dementia in rural Tanzania and investigate attitudes of their patients and their patients’ carers. Methods This was a qualitative study conducted in Hai district, Tanzania. Semi-structured interviews were conducted with a convenience sample of THs and FHs and a purposive-stratified sample of people with dementia and their carers. Interview guides were devised which included case vignettes. Transcripts of interviews were subject to thematic analysis. Findings Eleven THs, 10 FHs, 18 people with dementia and 17 carers were recruited. Three themes emerged: (i) conceptualisation of dementia by healers as a normal part of the ageing process and no recognition of dementia as a specific condition; (ii) people with dementia and carer reasons for seeking help and experiences of treatment and the role of prayers, plants and witchcraft in diagnosis and treatment; (iii) willingness to collaborate with allopathic healthcare services. FHs and people with dementia expressed concerns about any collaboration with THs. Conclusions Although THs and FHs do not appear to view dementia as a specific disease, they may provide a means of identifying people with dementia in this setting.
Collapse
Affiliation(s)
- Guy Hindley
- The Medical School, Newcastle University, Newcastle upon Tyne, UK
| | - John Kissima
- Hai District Hospital, Boman'gombe, Kilimanjaro Region, United Republic of Tanzania
| | - Lloyd L Oates
- Research & Development, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Stella-Maria Paddick
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro Region, United Republic of Tanzania
| | - Christine Brandsma
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro Region, United Republic of Tanzania
| | - William K Gray
- Research & Development, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Richard W Walker
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Declare Mushi
- Kilimanjaro Christian Medical University College, Moshi, Kilimanjaro Region, United Republic of Tanzania
| | - Catherine L Dotchin
- Department of Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
45
|
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.
Collapse
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
| |
Collapse
|
46
|
Ogunniyi A, Adebiyi AO, Adediran AB, Olakehinde OO, Siwoku AA. Prevalence estimates of major neurocognitive disorders in a rural Nigerian community. Brain Behav 2016; 6:e00481. [PMID: 27458545 PMCID: PMC4951621 DOI: 10.1002/brb3.481] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 03/15/2016] [Accepted: 03/18/2016] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE There is paucity of information on major neurocognitive disorders in sub-Saharan Africa where the number of individuals with neurocognitive disorders is expected to increase due to demographic transition. This study aims to report on the prevalence estimates of dementia and MCI (mild cognitive impairment) in a rural community in southwest Nigeria. MATERIALS AND METHODS This was a two-stage cross-sectional study of persons aged 65 years and above resident in Lalupon community, Oyo State. The Identification and IDEA (Intervention for Dementia in Elderly Africans) Study Questionnaire was used for initial screening by trained community health care workers, utilized followed by cognitive assessment using the validated IDEA cognitive screen. Functional and cognitive assessment of selected individuals was carried out during the second stage. Information obtained was used for consensus diagnosis and participants were categorized into normal, MCI and dementia using standard criteria. RESULTS Six hundred and thirteen participants completed the study with 111 (18.1%) diagnosed as MCI while 17 (2.8%) had dementia. The age-adjusted prevalence estimates were 18.4% (95% CI: 14.9-21.9%) and 2.9% (95% CI 1.6-4.4%) for MCI and dementia, respectively. Probable Alzheimer's disease and amnestic MCI predominated. Individuals with dementia were older than both MCI and normal cases while those with MCI had significantly fewer years of schooling than the other diagnostic categories. CONCLUSION Almost one out of five older persons in Lalupon community had major neurocognitive impairment with MCI being six-times more common than dementia. Alzheimer's disease was the most common dementia sub-type.
Collapse
Affiliation(s)
- Adesola Ogunniyi
- Department of Medicine College of Medicine University of Ibadan Ibadan Nigeria
| | - Akindele O Adebiyi
- Department of Community Medicine College of Medicine University of Ibadan Ibadan Nigeria
| | - Ade B Adediran
- Department of Community Medicine College of Medicine University of Ibadan Ibadan Nigeria
| | - Olaide O Olakehinde
- Department of Medicine College of Medicine University of Ibadan Ibadan Nigeria
| | - Akeem A Siwoku
- Department of Psychiatry College of Medicine University of Ibadan Ibadan Nigeria
| |
Collapse
|