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Tsamou M, Roggen EL. Sex-associated microRNAs potentially implicated in sporadic Alzheimer's disease (sAD). Brain Res 2024; 1829:148791. [PMID: 38307153 DOI: 10.1016/j.brainres.2024.148791] [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: 09/22/2023] [Revised: 01/08/2024] [Accepted: 01/23/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The onset and pathology of sporadic Alzheimer's disease (sAD) seem to be affected by both sex and genetic mechanisms. Evidence supports that the high prevalence of sAD in women, worldwide, may be attributed to an interplay among aging, sex, and lifestyle, influenced by genetics, metabolic changes, and hormones. Interestingly, epigenetic mechanisms such as microRNAs (miRNAs), known as master regulators of gene expression, may contribute to this observed sexual dimorphism in sAD. OBJECTIVES To investigate the potential impact of sex-associated miRNAs on processes manifesting sAD pathology, as described by the Tau-driven Adverse Outcome Pathway (AOP) leading to memory loss. METHODS Using publicly available human miRNA datasets, sex-biased miRNAs, defined as differentially expressed by sex in tissues possibly affected by sAD pathology, were collected. In addition, sex hormone-related miRNAs were also retrieved from the literature. The compiled sex-biased and sex hormone-related miRNAs were further plugged into the dysregulated processes of the Tau-driven AOP for memory loss. RESULTS Several miRNAs, previously identified as sex-associated, were implicated in dysregulated processes associated with the manifestation of sAD pathology. Importantly, the described pathology processes were not confined to a particular sex. A mechanistic-based approach utilizing miRNAs was adopted in order to elucidate the link between sex and biological processes potentially involved in the development of memory loss. CONCLUSIONS The identification of sex-associated miRNAs involved in the early processes manifesting memory loss may shed light to the complex molecular mechanisms underlying sAD pathogenesis in a sex-specific manner.
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Affiliation(s)
- Maria Tsamou
- ToxGenSolutions (TGS), Oxfordlaan 70, 6229EV Maastricht, The Netherlands.
| | - Erwin L Roggen
- ToxGenSolutions (TGS), Oxfordlaan 70, 6229EV Maastricht, The Netherlands
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2
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Mfene XP, Pillay BJ. Screening for dementia and associated factors in older adults from low socioeconomic communities in iLembe, KwaZulu-Natal. Health SA 2024; 29:2437. [PMID: 38726059 PMCID: PMC11079343 DOI: 10.4102/hsag.v29i0.2437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/31/2023] [Indexed: 05/12/2024] Open
Abstract
Background Dementia is one of the leading non-communicable causes of disability and mortality in older adults, with recent research showing that it is increasing in low-middle-income countries compared to high-income countries. As such, multidisciplinary efforts are needed to effectively reduce the prevalence and risk of dementia through quick screening, diagnosis, and management of those with dementia and those at risk. Aim The study's objectives were to estimate the prevalence of dementia and measure the sociodemographic and clinical risks in older adults in low socioeconomic communities. Setting The study was conducted among older adults aged ≥ 60 years from the iLembe district in South Africa. Methods This cross-sectional, one-phased, household study was conducted to screen for dementia over 8 months between October 2018 and October 2019. Demographic and clinical data were collected using a semi-structured questionnaire. In addition, the Mini-Mental Status Exam, Ascertain Dementia Eight-item questionnaire and Instrumental Activities of Daily Living Scale were administered to a multi-stage cluster sample of 320 participants to ascertain dementia prevalence. Frequencies and multivariate logistic regression were conducted to determine risk factors correlated with dementia. Results The prevalence of dementia was 13.4%. Participants aged 80 years and above were 2.73 times more likely to develop dementia than participants younger than 80 years. Those with an education level of Grade 1-7 had a 69% less chance of developing dementia than those without formal education. Single participants showed an almost seven-fold increase in dementia. Lastly, depression increased the risk of dementia by two-fold. Conclusion Dementia was probable in over one-sixth of the sample. Dementia risk factors were both modifiable and non-modifiable. Contribution Dementia prevalence in South Africa is increasing and therefore it is crucial to develop a dementia plan that is specific to the South African context which will include strategies for early identification of the disease, reducing modifiable risks and strategic management of dementia associated medical conditions such as depression and vascular diseases.
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Affiliation(s)
- Xoli P Mfene
- Department of Psychology, Faculty of Applied Human Sciences, University of KwaZulu Natal, Pietermaritzburg, South Africa
| | - Basil J Pillay
- Department of Behavioural Medicine, Faculty of Nursing and Public Health, University of KwaZulu Natal, Durban, South Africa
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Veronese N, Smith L, Koyanagi A, Hoffman J, Snoussi M, Prokopidis K, Dominguez LJ, Barbagallo M. Prevalence of sarcopenia in Africa: a systematic review and meta-analysis of observational studies. Aging Clin Exp Res 2024; 36:12. [PMID: 38281246 PMCID: PMC10822818 DOI: 10.1007/s40520-023-02671-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/21/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Existing literature suggests that sarcopenia is a highly prevalent condition in older people. However, most studies to date reporting data on its prevalence have been mainly carried out in Western countries, while data on sarcopenia in Africa is scarce. With this systematic review and meta-analysis, we aimed to determine the prevalence of sarcopenia in African countries and to explore potential factors that could explain higher or lower prevalence of this condition in Africa. METHODS Major databases for studies reporting data on sarcopenia in African countries were searched from inception to June 2023. We conducted a meta-analysis of the prevalence [and 95% confidence intervals (95% CIs)] of sarcopenia in Africa, applying a random effect model. Several sensitivity and meta-regression analyses were run. RESULTS Among 147 articles initially screened, six articles (with seven cohorts) including a total of 10,656 participants were included. Mean age of participants was 66.9 years, and the majority were female (58.1%). The weighted prevalence of sarcopenia in the selected countries of Africa was 25.72% (95%CI: 18.90-32.55). This outcome was characterized by a high heterogeneity (I2 = 99%) and by publication bias. Among the factors investigated, sarcopenia was lower when assessed using only one anthropometric measure, or in South Africa. CONCLUSION Sarcopenia is a prevalent condition in Africa and thus research regarding this topic is a public health priority. Future studies that cover African countries for which data are not available and using standardized criteria are needed.
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Affiliation(s)
- Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy.
| | - Lee Smith
- Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Jaco Hoffman
- Optentia Research Unit, North-West University, Vanderbijlpark, South Africa
| | - Mouna Snoussi
- Department of Internal Medicine, Hedi Chaker Hospital, Medical School of Sfax, Sfax, Tunisia
| | - Konstantinos Prokopidis
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Ligia J Dominguez
- Faculty of Medicine and Surgery, University Kore of Enna, 94100, Enna, Italy
| | - Mario Barbagallo
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
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Taylor-Robinson SD, Taylor-Robinson AW. Are growing inequities leaving Africa behind in the post-pandemic public health landscape? Pan Afr Med J 2024; 47:16. [PMID: 38524111 PMCID: PMC10957726 DOI: 10.11604/pamj.2024.47.16.41653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/30/2023] [Indexed: 03/26/2024] Open
Affiliation(s)
- Simon David Taylor-Robinson
- Department of Medicine, Busitema University, Mbale, Uganda
- Department of Public Health, Busitema University, Mbale, Uganda
- Faculty of Engineering, Imperial College London, London, United Kingdom
| | - Andrew William Taylor-Robinson
- College of Health Sciences, VinUniversity, Hanoi, Vietnam
- Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
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Yenesew MA, Krell-Roesch J, Fekadu B, Nigatu D, Endalamaw A, Mekonnen A, Biyadgie M, Wubetu GY, Debiso AT, Beyene KM, Kelkile TS, Enquobahrie DA, Mersha TB, Eagan DE, Geda YE. Prevalence of Dementia and Cognitive Impairment in East Africa Region: A Scoping Review of Population-Based Studies and Call for Further Research. J Alzheimers Dis 2024; 100:1121-1131. [PMID: 38995792 PMCID: PMC11380225 DOI: 10.3233/jad-240381] [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] [Indexed: 07/14/2024]
Abstract
Background Population-based research on the prevalence and determinants of dementia, Alzheimer's disease, and cognitive impairment is scarce in East Africa. Objective To provide an overview of community- and population-based studies among older adults on the prevalence of dementia and cognitive impairment in East Africa, and identify research gaps. Methods We carried out a literature search using three electronic databases (PubMed, Scopus, Google Scholar) using pertinent search terms. Results After screening 445 publications, we identified four publications on the population-based prevalence of dementia, and three on cognitive impairment. Prevalence rates varied from 6- 23% for dementia, and 7- 44% for cognitive impairment, among participants aged≥50-70 years. Old age and a lower education level were risk factors for dementia and cognitive impairment. Physical inactivity, lack of a ventilated kitchen, and history of central nervous system infections and chronic headache were associated with increased odds of dementia. Female sex, depression, having no spouse, increased lifetime alcohol consumption, low income, rural residence, and low family support were associated with increased odds of cognitive impairment. Potential misclassification and non-standardized data collection methods are research gaps that should be addressed in future studies. Conclusions Establishing collaborative networks and partnering with international research institutions may enhance the capacity for conducting population-based studies on dementia and cognitive impairment in East Africa. Longitudinal studies may provide valuable insights on incidence, as well as potential risk and protective factors of dementia and cognitive impairment, and may inform the development of targeted interventions including preventive strategies in the region.
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Affiliation(s)
- Muluken A Yenesew
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Janina Krell-Roesch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Betelhem Fekadu
- Department of Psychiatry, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Dabere Nigatu
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Aklilu Endalamaw
- School of Public Health, University of Queensland, Brisbane, Australia
- School of Health Sciences, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Alemtsehay Mekonnen
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Mulugeta Biyadgie
- School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Alemu T Debiso
- College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Kassu M Beyene
- Department of Neurology, Barrow Neurological Institute, Phoenix, AZ, USA
| | | | - Daniel A Enquobahrie
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Tesfaye B Mersha
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Danielle E Eagan
- Department of Neuropsychology, Barrow Neurological Institute, Phoenix, AZ, USA
| | - Yonas E Geda
- Department of Neurology and the Franke Barrow Global Neuroscience Education Center, Barrow Neurological Institute, Phoenix, AZ, USA
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Ogbuagu C, Ogbuagu E, Emelumadu O, Okereke U, Okeke I, Chigbo G, Javendal S, Miller B, Valcour V, Allen IE, Goode C, Possin KL, Uwakwe R. Feasibility and Determinants of Performance for a Tablet-Based Cognitive Assessment Tool in Rural and Urban Southeast Nigeria. J Alzheimers Dis 2024; 101:175-182. [PMID: 39150829 DOI: 10.3233/jad-240518] [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] [Indexed: 08/18/2024]
Abstract
Background Cognitive assessment is a key component of clinical evaluations for patients with dementia and Alzheimer's disease in primary health care (PHC) settings. The need for well-validated, culturally appropriate, and easy-to-use assessments is especially urgent in low- and middle-income countries (LMICs) that are experiencing rapid growth in their older adult populations. Objective To examine the feasibility and demographic determinants of performance for a tablet-based cognitive assessment tool (TabCAT) battery, which includes subtests for four cognitive domains, among older PHC patients in southeastNigeria. Methods A cross-sectional mixed-method descriptive study evaluating the useability and performance of TabCAT. Results We enrolled 207 participants (mean age of 64.7±13.5 years; 52% with only primary, 41% secondary, and 7% tertiary education). Most (91%) who initiated the assessment were able to complete it, requiring 10-15 minutes to complete. More years of education was associated with better test scores across all tests (p < 0.001). Living in a rural location was also associated with better performance (p < 0.05). Male compared to female sex did not associate with performance on any of the tests (all ps > 0.05). Conclusions Tablet-based cognitive assessment was feasible in rural and urban settings of Nigeria. Better performance on cognitive subtests linked to more education and residing in a rural area; however, sex did not predict performance. Digital cognitive assessment tools hold potential for widespread use in healthcare and educational contexts, particularly in regions with varying levels of urbanization and educational access.
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Affiliation(s)
- Chukwuanugo Ogbuagu
- Comprehensive Health Center, Nnamdi Azikiwe University Teaching Hospital, Neni, Nigeria
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Ekenechukwu Ogbuagu
- Family Medicine Department, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
| | - Obiageli Emelumadu
- Comprehensive Health Center, Nnamdi Azikiwe University Teaching Hospital, Neni, Nigeria
| | - Uzoma Okereke
- Comprehensive Health Center, Nnamdi Azikiwe University Teaching Hospital, Neni, Nigeria
| | - Irene Okeke
- Comprehensive Health Center, Nnamdi Azikiwe University Teaching Hospital, Neni, Nigeria
| | - Godswill Chigbo
- School of Public Health, University of Port-Harcourt, Port Harcourt, Nigeria
| | - Shireen Javendal
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Bruce Miller
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Victor Valcour
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Isabel Elaine Allen
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
- Biostatistics and Epidemiology Department, University of California San Francisco, San Francisco, CA, USA
| | - Collette Goode
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Katherine L Possin
- Memory and Aging Center, Global Brain Health Institute, University of California San Francisco, San Francisco, CA, USA
| | - Richard Uwakwe
- Department of Medicine, Mental Health Unit, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
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Awuol MDA, Innocent BK, Winfred A. Prevalence, factors associated and knowledge of probable dementia among adults 50 years and over attending a faith-based geriatric center in Uganda. Sci Rep 2023; 13:6737. [PMID: 37185948 PMCID: PMC10127194 DOI: 10.1038/s41598-023-33948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 04/21/2023] [Indexed: 05/17/2023] Open
Abstract
Dementia is on the rise due to increasing proportion of old people in sub-Saharan Africa (SSA). Although dementia is misattributed to normal ageing or supernatural causes in SSA, it is a brain disease with well-established etiologies. Limited knowledge and understanding of dementia means that many older people are suffering without seeking help and are undiagnosed and untreated. The aim of this study was to determine the prevalence and factors associated with probable dementia and to describe the knowledge of the disease among adults 50 years and over attending a faith-based geriatric center in Uganda. This was a cross-sectional study using quantitative methods. A total of 267 adults 50 years and over attending a faith-based geriatric center in Mukono, Uganda were interviewed between 1 April and 15 May 2022. Interviews were administered using the Early Dementia Questionnaire (EDQ) and Dementia Knowledge Assessment Scale (DKAS). Data on participants' socio-demographics, economic income, living arrangement, history of smoking, alcohol consumption, exercise and past medical history was collected using an additional questionnaire. Adults 50 years and over were included in the study. Logistic regression analyses were done. Probable dementia was 46.2% in the sample. The most common symptoms of probable dementia in the order of their severity were memory symptoms, (β co-efficient β 0.08, p < .001), physical symptoms (β 0.08, p < .001), sleep disturbances (β 0.81, p < .001) and emotions (β 0.04, p < .027). The final degree of association as determined by adjusted PR in the multivariable model revealed that only older age (aPR = 1.88, p < .001) and occasional/non-believer (aPR = 1.61, p = .001) remained significantly related to probable dementia. The study also found that 8.0% of the participants had optimal knowledge of dementia. There is high burden of probable dementia among adults 50 years and over attending a faith-based geriatric center in Mukono, Uganda. Factors associated with probable dementia are older age and being an occasional/non-believer. Knowledge of dementia among older adults is low. There is need to promote integrated early dementia screening, care and educational program in primary care to reduce the disease burden. Spiritual support would be a rewarding investment in the lives of the ageing population.
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Affiliation(s)
| | - Besigye K Innocent
- Department of Family Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ayenyo Winfred
- Soroti Regional Referral Hospital, Sororti District, Uganda
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Kintu TM, Katengeke V, Kamoga R, Nguyen T, Najjuma JN, Kitya D, Wakida EK, Obua C, Rukundo GZ. Cognitive impairment following traumatic brain injury in Uganda: Prevalence and associated factors. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001459. [PMID: 36962918 PMCID: PMC10021383 DOI: 10.1371/journal.pgph.0001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/13/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND As the burden of dementia continues to rise in sub-Saharan Africa, it is crucial to develop an evidence base for potentially modifiable risk factors such as Traumatic Brain Injury (TBI). Cognitive impairment may result from TBI and since it is an established prodromal form of dementia, we investigated the burden of cognitive impairment and associated factors in persons with a history of TBI in southwestern Uganda. METHODS This was a community-based quantitative study with a cross-sectional design among 189 persons with a history of TBI in southwestern Uganda. Data were collected by the research team in March and June 2022 and entered into Kobo Toolbox before being transferred to RStudio version 4.1.0 for cleaning and analysis. Data were analyzed at a 5% level of significance. RESULTS Most study participants had some form of cognitive impairment (56.1%), with 43.1% of the participants having mild cognitive impairment (MCI). Cognitive impairment was associated with older age (p-value<0.001); loss of consciousness following the TBI (p-value = 0.019) and a history of tobacco use (p-value = 0.003). As a measure of severity of the TBI, loss of consciousness (aOR = 4.09; CI = 1.57-11.76; p<0.01) and older age (aOR = 1.04; CI = 1.01-1.07; p<0.01) were identified as risk factors for cognitive impairment. CONCLUSION There is a high burden of cognitive impairment among individuals with a history of TBI in southwestern Uganda, and most associated risk factors are potentially modifiable. Long-term follow-up of TBI patients would enable early identification of some risks. Patients with TBI could benefit from behavioural modifications such as restriction of alcohol intake and tobacco use to slow down the progression into dementia.
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Affiliation(s)
- Timothy Mwanje Kintu
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Vanessa Katengeke
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Ronald Kamoga
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tricia Nguyen
- California University of Science and Medicine, Colton, California, United States of America
| | | | - David Kitya
- Department of Neurosurgery, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edith K. Wakida
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
- Department of Medical Education, California University of Science and Medicine, Colton, California, United States of America
| | - Celestino Obua
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
- Office of Research Administration, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Godfrey Zari Rukundo
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
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Mielke MM, Aggarwal NT, Vila‐Castelar C, Agarwal P, Arenaza‐Urquijo EM, Brett B, Brugulat‐Serrat A, DuBose LE, Eikelboom WS, Flatt J, Foldi NS, Franzen S, Gilsanz P, Li W, McManus AJ, van Lent DM, Milani SA, Shaaban CE, Stites SD, Sundermann E, Suryadevara V, Trani J, Turner AD, Vonk JMJ, Quiroz YT, Babulal GM. Consideration of sex and gender in Alzheimer's disease and related disorders from a global perspective. Alzheimers Dement 2022; 18:2707-2724. [PMID: 35394117 PMCID: PMC9547039 DOI: 10.1002/alz.12662] [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: 12/23/2021] [Revised: 02/15/2022] [Accepted: 02/20/2022] [Indexed: 01/31/2023]
Abstract
Sex or gender differences in the risk of Alzheimer's disease and related dementias (ADRD) differ by world region, suggesting that there are potentially modifiable risk factors for intervention. However, few epidemiological or clinical ADRD studies examine sex differences; even fewer evaluate gender in the context of ADRD risk. The goals of this perspective are to: (1) provide definitions of gender, biologic sex, and sexual orientation. and the limitations of examining these as binary variables; (2) provide an overview of what is known with regard to sex and gender differences in the risk, prevention, and diagnosis of ADRD; and (3) discuss these sex and gender differences from a global, worldwide perspective. Identifying drivers of sex and gender differences in ADRD throughout the world is a first step in developing interventions unique to each geographical and sociocultural area to reduce these inequities and to ultimately reduce global ADRD risk. HIGHLIGHTS: The burden of dementia is unevenly distributed geographically and by sex and gender. Scientific advances in genetics and biomarkers challenge beliefs that sex is binary. Discrimination against women and sex and gender minority (SGM) populations contributes to cognitive decline. Sociocultural factors lead to gender inequities in Alzheimer's disease and related dementias (ADRD) worldwide.
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Affiliation(s)
- Michelle M. Mielke
- Division of Epidemiology, Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Neelum T. Aggarwal
- Department of Neurological SciencesRush University Medical CenterChicagoIllinoisUSA
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Clara Vila‐Castelar
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
| | - Puja Agarwal
- Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
- Department of Internal MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Eider M. Arenaza‐Urquijo
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
| | - Benjamin Brett
- Department of NeurosurgeryMedical College of WisconsinWisconsinMilwaukeeUSA
| | - Anna Brugulat‐Serrat
- Barcelonaβeta Brain Research Center (BBRC)Pasqual Maragall FoundationBarcelonaSpain
- IMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
- CIBER Fragilidad y Envejecimiento Saludable (CIBERFES)MadridSpain
- Atlantic Fellow for Equity in Brain HealthThe University of California San FranciscoSan FranciscoCaliforniaUSA
| | - Lyndsey E. DuBose
- Department of Medicine, Division of GeriatricsUniversity of Colorado Anschutz Medical CampusAuroraColoradoUSA
| | - Willem S. Eikelboom
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Jason Flatt
- Social and Behavioral Health Program, School of Public HealthUniversity of Nevada, Las VegasLas VegasNevadaUSA
| | - Nancy S. Foldi
- Department of Psychology, Queens College and The Graduate CenterCity University of New YorkNew YorkUSA
- Department of PsychiatryNew York University Long Island School of MedicineNew YorkUSA
| | - Sanne Franzen
- Department of NeurologyErasmus MC University Medical CenterRotterdamThe Netherlands
| | - Paola Gilsanz
- Kaiser Permanente Division of ResearchOaklandCaliforniaUSA
| | - Wei Li
- Department of Clinical and Diagnostic SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Alison J. McManus
- Department of NeurologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Debora Melo van Lent
- UT Health San AntonioGlenn Biggs Institute for Alzheimer's and Neurodegenerative diseasesSan AntonioTexasUSA
- Framingham Heart StudyFraminghamMassachusettsUSA
- Department of NeurologyBoston University School of MedicineBostonMassachusettsUSA
| | - Sadaf Arefi Milani
- Division of Geriatrics & Palliative Medicine, Department of Internal MedicineUniversity of Texas Medical BranchGalvestonTexasUSA
| | - C. Elizabeth Shaaban
- Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Shana D. Stites
- Department of PsychiatryPerlman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Erin Sundermann
- Department of PsychiatryUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Vidyani Suryadevara
- Department of Orthopedic SurgeryRush University Medical CenterChicagoIllinoisUSA
| | - Jean‐Francoise Trani
- Department of Public HealthWashington University in St. LouisSt. LouisMissouriUSA
| | - Arlener D. Turner
- Department of Psychiatry & Behavioral SciencesUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Jet M. J. Vonk
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, College of Physicians and SurgeonsColumbia UniversityNew YorkNew YorkUSA
- Julius Center for Health Sciences and Primary CareDepartment of EpidemiologyUniversity Medical Center Utrecht and Utrecht UniversityUtrechtThe Netherlands
| | - Yakeel T. Quiroz
- Department of Psychiatry, Harvard Medical SchoolMassachusetts General HospitalMassachusettsBostonUSA
- Grupo de Neurociencias de Antioquia of Universidad de AntioquiaMedellinColumbiaUSA
| | - Ganesh M. Babulal
- Department of NeurologyWashington University in St. LouisSt. LouisMississippiUSA
- Department of Clinical Research and LeadershipThe George Washington University School of Medicine and Health SciencesWashingtonDCUSA
- Department of Psychology, Faculty of HumanitiesUniversity of JohannesburgJohannesburgSouth Africa
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Ayisi-Boateng NK, Opoku DA, Tawiah P, Owusu-Antwi R, Konadu E, Apenteng GT, Essuman A, Mock C, Barnie B, Donkor P, Sarfo FS. Carers’ needs assessment for patients with dementia in Ghana. Afr J Prim Health Care Fam Med 2022; 14:e1-e8. [PMID: 36073124 PMCID: PMC9453144 DOI: 10.4102/phcfm.v14i1.3595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- Nana K Ayisi-Boateng
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi.
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Oyeyinka BO, Afolayan AJ. Suitability of Banana and Plantain Fruits in Modulating Neurodegenerative Diseases: Implicating the In Vitro and In Vivo Evidence from Neuroactive Narratives of Constituent Biomolecules. Foods 2022; 11:foods11152263. [PMID: 35954031 PMCID: PMC9367880 DOI: 10.3390/foods11152263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 12/04/2022] Open
Abstract
Active principles in plant-based foods, especially staple fruits, such as bananas and plantains, possess inter-related anti-inflammatory, anti-apoptotic, antioxidative, and neuromodulatory activities. Neurodegenerative diseases affect the functionality of the central and peripheral nervous system, with attendant cognitive deficits being hallmarks of these conditions. The dietary constitution of a wide range of bioactive compounds identified in this review further iterates the significance of the banana and plantain in compromising, halting, or preventing the pathological mechanisms of neurological disorders. The neuroprotective mechanisms of these biomolecules have been identified by using protein expression regulation and specific gene/pathway targeting, such as the nuclear and tumor necrosis factors, extracellular signal-regulated and mitogen-activated protein kinases, activator protein-1, and the glial fibrillary acidic protein. This review establishes the potential double-edged neuro-pharmacological fingerprints of banana and plantain fruits in their traditionally consumed pulp and less utilized peel component for human nutrition.
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12
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Ayisi-Boateng NK, Sarfo FS, Opoku DA, Nakua EK, Konadu E, Tawiah P, Owusu-Antwi R, Essuman A, Barnie B, Mock C, Donkor P. Educational intervention to enhance the knowledge of Ghanaian health workers on Alzheimer's disease and related dementias. Afr J Prim Health Care Fam Med 2022; 14:e1-e7. [PMID: 35532111 PMCID: PMC9082276 DOI: 10.4102/phcfm.v14i1.3448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/09/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Alzheimer’s disease and related dementias (ADRDs) pose a major public health challenge in older adults. In sub-Saharan Africa, the burden of ADRD is projected to escalate amidst ill-equipped healthcare workers (HCWs). Aim This study aimed to assess ADRD knowledge amongst Ghanaian HCWs and improve gaps identified through a workshop. Setting Study was conducted among HCWs attending a workshop in Kumasi, Ghana. Methods On 18 August 2021, a workshop on ADRD was organised in Kumasi, Ghana, which was attended by 49 HCWs comprising doctors, nurses, pharmacists, social workers and nutritionists. On arrival, they answered 30 pre-test questions using the Alzheimer’s Disease Knowledge Scale (ADKS). A post-test using the same questionnaire was conducted after participants had been exposed to a 4-h in-person educational content on ADRD delivered by facilitators from family medicine, neurology, geriatrics, psychiatry and public health. Results The mean age of participants was 34.6 (± 6.82), mean years of practice was 7.7 (± 5.6) and 38.8% (n = 19) were nurses. The mean score of participants’ overall knowledge was 19.8 (± 4.3) at pre-test and 23.2 (± 4.0) at post-test. Participants’ pre-test and post-test scores improved in all ADKS domains. Factors associated with participants’ knowledge at baseline were profession, professional rank and the highest level of education attained. After adjusting for age and sex, participant’s rank, being a specialist (adjusted β = 14.44; 95% confidence interval [CI] = 7.03, 21.85; p < 0.001) was an independent predictor of knowledge on Alzheimer’s disease. Conclusion Existing knowledge gaps in ADRD could be improved via continuous medical education interventions of HCWs to prepare healthcare systems in Africa for the predicted ADRD epidemic.
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Affiliation(s)
- Nana K Ayisi-Boateng
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi.
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Oghagbon EK, Prieto-Pino J, Dogoh F, Ogiator M, Giménez-Llort L. Diabetes/Dementia in Sub-saharian Africa and Nigerian Women in the Eye of Storm. Curr Alzheimer Res 2021; 19:161-170. [PMID: 34784865 DOI: 10.2174/1567205018666211116093747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/01/2021] [Accepted: 08/22/2021] [Indexed: 11/22/2022]
Abstract
In the next few years, the prevalence of diabetes mellitus (DM) is projected to dramatically increase globally, but most of the cases will occur in low-to-middle-income countries. Some of the major risk factors for diabetes accelerate the development of dementia in African-Americans, thus leading to a higher prevalence of dementia than Caucasians. Sub-Saharan Africa women have a disproportionately two-to-eight fold increased prevalence of dementia. In the eye of this storm, Nigeria holds the highest number of diabetics on the African continent, and its prevalence is rising in parallel to obesity, hypertension, and the population's aging. The socio-economic impact of the rising prevalence of DM and dementia will be huge and unsustainable for the healthcare system in Nigeria, as has been recognized in developed economies. Here, we analyze the current situation of women's health in Nigeria and explore future perspectives and directions. The complex interplay of factors involved in diabetes and dementia in Nigerian women include key biological agents (metabolic syndrome, vascular damage, inflammation, oxidative stress, insulin resistance), nutritional habits, lifestyle, and anemia, that worsen with comorbidities. In addition, restricted resources, lack of visibility, and poor management result in a painful chain that increases the risk and burden of disease in Nigerian women from youth to elderly ages. Heath policies to increase the ra- tio of mental health professionals per number of patients, mostly in rural areas, foment of proactive primary care centers, and interventions targeting adolescents and adult women and other specific mothers-children pairs are strongly required for a sustainable development goal.
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Affiliation(s)
- Efosa K Oghagbon
- Department of Chemical Pathology, Faculty of Basic & Allied Medical Sciences, College of Health Sciences, Benue State University, Makurdi. Nigeria
| | - José Prieto-Pino
- Department of Psychiatry and Forensic Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona. Spain
| | - Faeren Dogoh
- Department of Chemical Pathology, Benue State University Teaching Hospital, Makurdi. Nigeria
| | - Monday Ogiator
- Department of Internal Medicine, Benue State University Teaching Hospital, Makurdi. Nigeria
| | - Lydia Giménez-Llort
- Department of Psychiatry and Forensic Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona. Spain
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14
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Ainamani HE, Bamwerinde WM, Rukundo GZ, Tumwesigire S, Kalibwani RM, Bikaitwaho EM, Tsai AC. Participation in gardening activity and its association with improved mental health among family caregivers of people with dementia in rural Uganda. Prev Med Rep 2021; 23:101412. [PMID: 34159048 PMCID: PMC8193614 DOI: 10.1016/j.pmedr.2021.101412] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/16/2021] [Accepted: 05/25/2021] [Indexed: 11/15/2022] Open
Abstract
Evidence from high-income settings suggests that gardening is associated with reductions in depression, anxiety, and stress. The benefits of gardening are less well understood by mental health practitioners and researchers from low- and middle-income countries. Our study estimated the association between participation in gardening and symptoms of depression, anxiety, and stress among caregivers of people living with dementia in rural, southwestern Uganda. In a cross-sectional study, we interviewed 242 family caregivers of people with dementia to elicit their gardening activities; symptoms of depression, anxiety, and stress (Depression Anxiety Stress Scales); and caregiving burden (Zarit Burden Interview). Linear multivariable regression models estimated the association between participation in gardening and symptoms of depression, anxiety, and stress. Out of 242 participants, 131 (54%) caregivers were involved in gardening. Severe to extremely severe symptoms of depression were less prevalent among those who were involved in gardening compared with those who were not (0 [0%] vs. 105 [95%], P < 0.001), as were severe to extremely severe symptoms of anxiety (36 [27%] vs. 110 [99%], P < 0.001) and stress (2 [2%] vs. 94 [85%], P < 0.001). In regression models adjusting for covariates,we found statistically significant associations between participation in gardening and symptoms of depression (b = -18.4; 95% CI, 20.5 to -16.3), anxiety (b = -16.6; 95% CI, -18.6 to -14.6), and stress (b = -18.6; 95% CI, -20.6 to -16.6). Caregivers of people with dementia who participate in gardening have lower symptoms of depression, anxiety, and stress. Gardening interventions in this at-risk population may ameliorate symptoms of depression, anxiety, and stress.
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Affiliation(s)
- Herbert E Ainamani
- Department of Mental Health, Kabale University School of Medicine, Kabale, Uganda
| | - Wilson M Bamwerinde
- Department of Environment and Natural Resources, Kabale University, Kabale, Uganda
| | | | - Sam Tumwesigire
- Department of Pediatrics, Kabale University School of Medicine, Kabale, Uganda
| | | | - Evard M Bikaitwaho
- Department of Public Health Kabale University School of Medicine, Kabale, Uganda
| | - Alexander C Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda.,Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, United States
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Kobayashi LC, Farrell MT, Langa KM, Mahlalela N, Wagner RG, Berkman LF. Incidence of Cognitive Impairment during Aging in Rural South Africa: Evidence from HAALSI, 2014 to 2019. Neuroepidemiology 2021; 55:100-108. [PMID: 33657567 PMCID: PMC8058235 DOI: 10.1159/000513276] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/20/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Despite rapid population aging, there are currently limited data on the incidence of aging-related cognitive impairment in sub-Saharan Africa. We aimed to determine the incidence of cognitive impairment and its distribution across key demographic, social, and health-related factors among older adults in rural South Africa. METHODS Data were from in-person interviews with 3,856 adults aged ≥40 who were free from cognitive impairment at baseline in the population-representative cohort, "Health and Aging in Africa: a Longitudinal Study of an INDEPTH Community in South Africa" (HAALSI), in Agincourt sub-district, Mpumalanga province, South Africa (2014-19). Cognitive impairment was defined as scoring <1.5 standard deviations below the mean of the baseline distribution of orientation and episodic memory scores. Incidence rates and rate ratios for cognitive impairment were estimated according to key demographic, social, and health-related factors, adjusted for age, sex/gender, and country of birth. RESULTS The incidence of cognitive impairment was 25.7/1,000 person-years (PY; 95% confidence interval [CI]: 23.0-28.8), weighted for mortality (12%) and attrition (6%) over the 3.5-year mean follow-up (range: 1.5-4.8 years). Incidence increased with age, from 8.9/1,000 PY (95% CI: 5.2-16.8) among those aged 40-44 to 93.5/1,000 PY (95% CI: 75.9-116.3) among those aged 80+, and age-specific risks were similar by sex/gender. Incidence was strongly associated with formal education and literacy, as well as marital status, household assets, employment, and alcohol consumption but not with history of smoking, hypertension, stroke, angina, heart attack, diabetes, or prevalent HIV. CONCLUSIONS This study presents some of the first incidence rate estimates for aging-related cognitive impairment in rural South Africa. Social disparities in incident cognitive impairment rates were apparent in patterns similar to those observed in many high-income countries.
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Affiliation(s)
- Lindsay C Kobayashi
- Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan, USA,
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA,
| | - Meagan T Farrell
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
| | - Kenneth M Langa
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Nomsa Mahlalela
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ryan G Wagner
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa F Berkman
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts, USA
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Spittel S, Kraus E, Maier A. Dementia Awareness Challenges in Sub-Saharan Africa: A Cross-Sectional Survey Conducted Among School Students in Ghana. Am J Alzheimers Dis Other Demen 2021; 36:15333175211055315. [PMID: 34985361 PMCID: PMC10581119 DOI: 10.1177/15333175211055315] [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] [Indexed: 01/15/2023]
Abstract
The survey focuses on identifying dementia awareness challenges among Ghanaian school students. Data were generated in a cross-sectional survey (n = 1137). 9.3% of school students showed dementia awareness whilst the community respondents, representing both higher age and level of education, showed greater awareness (32.2%, P < .001). 45% of respondents believed in witchcraft and 57% were afraid of potentially being harmed by witchcraft. Age and education did not influence people's belief in witchcraft. Moreover, dementia symptoms were often mistaken for witchcraft, especially by those who had encountered a person accused of witchcraft: "swearing at others" (24%), displaying "memory loss" and "confused speech" (22%), "forgetfulness" and who was seen "roaming around" (19%). Lack of dementia awareness was particularly evident among school students whereas belief in witchcraft was similar in both respondent groups. There was a correlation between low dementia awareness rates and misinterpretation of dementia symptoms with attribution to witchcraft.
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Affiliation(s)
- Susanne Spittel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Neurology, Berlin, Germany
- Universität Bremen, Department of Health Care Research, Institute for Public Health and Nursing Research, Bremen, Germany
| | - Elke Kraus
- Alice-Salomon University of Applied Sciences, Berlin, Germany
| | - André Maier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Neurology, Berlin, Germany
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17
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Comparing fluid biomarkers of Alzheimer's disease between African American or Black African and white groups: A systematic review and meta-analysis. J Neurol Sci 2020; 421:117270. [PMID: 33349466 DOI: 10.1016/j.jns.2020.117270] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 11/19/2020] [Accepted: 12/10/2020] [Indexed: 12/29/2022]
Abstract
RATIONALE Biomarker research for Alzheimer's disease (AD) has grown rapidly in recent years, ensuing the integration of the AD fluid biomarker profile: Aβ1-42, t-tau, and p-tau181, into clinical and research criteria. However, current insights of AD arise almost exclusively from studies on white individuals. Some studies have revealed that epidemiology, clinical features, and genetics of AD show variations between individuals from black and white backgrounds, conveying the importance of ethnoracial differences, and the possibility of such differences also influencing AD biomarker levels. This systematic review explored whether AD fluid biomarker levels differ between African American (AA) or Black African and white groups. AIM To compare AD fluid biomarkers (Aβ1-42, p-tau181, and t-tau) levels between AA or Black Africans and white individuals. METHOD PubMed, Scopus, and other sources were explored for studies that quantified AD biomarkers in biological fluid from whites and AA or Black African groups. Meta-analyses were performed to find the standardized mean difference for biomarkers that were quantified in ≥3 studies. RESULTS Five studies were included; studies on Black Africans were not found. The meta-analyses found CSF t-tau and p-tau181 were consistently lower in AA than white individuals, in samples with normal cognition or with mild cognitive impairment/dementia. CONCLUSIONS The meta-analyses found significant differences for CSF tau between AA and white individuals with normal cognition and within the dementia spectrum, expressing the importance of taking into account ethnoracial factors when interpreting CSF AD biomarkers levels. However, the generalisability of these differences is restricted by small samples' size, lack of unified methodologies and recruitment's biases within studies; further large multicentre studies with harmonized protocols and sufficient power are imperative to investigate the extent of ethnoracial differences across the spectrum of cognitive decline, with vaster efforts necessary to diversify recruitment.
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18
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Spittel S, Maier A, Kraus E. Awareness challenges of mental health disorder and dementia facing stigmatisation and discrimination: a systematic literature review from Sub-Sahara Africa. J Glob Health 2019; 9:020419. [PMID: 31656607 PMCID: PMC6790232 DOI: 10.7189/jogh.09.020419] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background Mental health disorders (MHD) are leading causes of disabilities. Awareness of MHD in Sub-Saharan Africa (SSA) is crucial to both health care professionals and general community if those affected by MHD are to be allowed to live in dignity and be socially included, rather than being treated as outcasts or witches, as is presently the case. Therefore, this review aims to map and summarise the extent to which awareness of MHD and dementia in SSA challenges stigmatisation issues. Methods A systematic review was conducted using electronic databases (PubMed, CINAHL, PsycINFO). A content analysis of selected studies was performed. Findings on awareness challenges and stigmatisation were identified and categorised. Results A total of 230 publications were screened, 25 were selected for this review. The results demonstrate strong supernatural beliefs influencing peoples’ perceptions of diseases. These perceptions promote stigmatising attitudes towards people with MHD and dementia. The education level correlated with stigmatising attitudes, whereby higher educated people were less likely to distance themselves socially from people with MHD and from people living with dementia (PwD). Astonishingly, even people educated in health issues (eg, nurses, medical practitioners) tended to have strong beliefs in supernatural causations of diseases, like witchcraft, and hold negative attitudes towards MHD and PwD. Conclusions This review provides some evidence on the influence of traditional beliefs on MHDs in SSA. Those beliefs are powerful and exist in all segments in SSA-communities, promoting superstitious perceptions on diseases and stigmatisation. Awareness and education campaigns on MHD are absolutely mandatory to reduce stigmatisation.
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Affiliation(s)
- Susanne Spittel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany.,University of Bremen, Health Science Bremen - Institute for Public Health and Nursing Research (IPP), Bremen, Germany
| | - André Maier
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Neurology, Berlin, Germany
| | - Elke Kraus
- Alice Salomon University of Applied Sciences Berlin, Berlin, Germany
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19
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Adeloye D, Abaa DQ, Owolabi EO, Ale BM, Mpazanje RG, Dewan MT, Omoyele C, Ezeigwe N, Alemu W, Harhay MO, Auta A, Adewole IF. Prevalence of hypercholesterolemia in Nigeria: a systematic review and meta-analysis. Public Health 2019; 178:167-178. [PMID: 31698139 DOI: 10.1016/j.puhe.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 08/22/2019] [Accepted: 09/06/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Elevated blood cholesterol (hypercholesterolemia) is a significant cause of cardiovascular disease. We aimed to estimate national and zonal prevalence of hypercholesterolemia in Nigeria to help guide targeted public health programs. STUDY DESIGN This is a systematic review and synthesis of publicly available epidemiologic data on hypercholesterolemia in Nigeria. METHODS We systematically searched MEDLINE, EMBASE, Global Health, and Africa Journals Online for studies on the prevalence of hypercholesterolemia in Nigeria published between 1990 and 2018. We used a random-effects meta-analysis (Freeman-Tukey double arcsine transformation) and meta-regression model to estimate the prevalence of hypercholesterolemia in Nigeria in 1995 and 2015. RESULTS In total, 13 studies (n = 16,981) were retrieved. The pooled crude prevalence of hypercholesterolemia in Nigeria was 38% (95% confidence interval: 26-51), with prevalence in women slightly higher (42%, 23-63) compared with men (38%, 20-58). The prevalence was highest in the South-south (53%, 38-68) and lowest in the South-west (3%, 2-4) and North-east (4%, 2-7). Urban dwellers had a significantly higher rate (52%, 24-79) compared with rural dwellers (10%, 6-15). We estimated over 8.2 million persons (age-adjusted prevalence 16.5%) aged 20 years or more had hypercholesterolemia in Nigeria in 1995, increasing to 21.9 million persons (age-adjusted prevalence 25.9%) in 2015. CONCLUSIONS Our findings suggest a high prevalence of hypercholesterolemia in Nigeria. Urbanization, lifestyles, diets, and culture appear to be driving an increasing prevalence, especially among women. Population-wide awareness and education on reducing elevated cholesterol levels and associated risks should be prioritized.
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Affiliation(s)
- D Adeloye
- Centre for Global Health, Usher Institute, University of Edinburgh, UK; RcDavies Evidence-based Medicine, Lagos, Nigeria.
| | - D Q Abaa
- Solina Centre for International Development and Research (SCIDaR), Abuja, Nigeria
| | - E O Owolabi
- Department of Nursing Sciences, University of Fort Hare, East London, South Africa
| | - B M Ale
- INSERM UMR 1219, Bordeaux Population Health Research Center, Bordeaux, France; Holo Healthcare Limited, Nairobi, Kenya
| | | | - M T Dewan
- WHO Nigeria Country Office, Abuja, Nigeria
| | - C Omoyele
- Federal Ministry of Health, Abuja, Nigeria
| | - N Ezeigwe
- Federal Ministry of Health, Abuja, Nigeria
| | - W Alemu
- International Health Consultancy, LLC, Atlanta, Georgia, USA
| | - M O Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA; Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - A Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Fylde Road, Preston, UK
| | - I F Adewole
- College of Medicine, University of Ibadan, Ibadan, Nigeria
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20
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Olakehinde O, Adebiyi A, Siwoku A, Mkenda S, Paddick SM, Gray WK, Walker RW, Dotchin CL, Mushi D, Ogunniyi A. Managing dementia in rural Nigeria: feasibility of cognitive stimulation therapy and exploration of clinical improvements. Aging Ment Health 2019; 23:1377-1381. [PMID: 30246561 DOI: 10.1080/13607863.2018.1484883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objectives: We investigated the feasibility and clinical impact of a psychosocial intervention, Cognitive Stimulation Therapy (CST), to help manage dementia in a rural setting in Nigeria. Method: People with dementia were identified from a prevalence study in Lalupon in the south-west of Nigeria. Prior to this feasibility study CST was adapted for the setting and pilot by our team. Fourteen sessions of CST were provided over a 7-week period by a trained nurse specialist and occupational therapist. Change in quality of life was the main outcome. Results: Nine people were enrolled in CST. Significant improvements in cognitive function, quality of life (physical, psychosocial and environmental domains), physical function, neuro-psychiatric symptoms and carer burden were seen. Conclusions: CST appears to be feasible in this setting, although adaptation for low literacy levels, uncorrected visual and hearing impairment and work and social practices is needed. The clinical improvements seen were encouraging.
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Affiliation(s)
- Olaide Olakehinde
- a Institute for Health and Society, University College Hospital, University of Ibadan , Ibadan , Nigeria
| | - Akinpelu Adebiyi
- a Institute for Health and Society, University College Hospital, University of Ibadan , Ibadan , Nigeria
| | - Akeem Siwoku
- a Institute for Health and Society, University College Hospital, University of Ibadan , Ibadan , Nigeria
| | - Sarah Mkenda
- b Institute for Health and Society,Kilimanjaro Christian Medical University College , Moshi , Tanzania
| | - Stella-Maria Paddick
- c Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , North Shields , UK.,d Institute of Neuroscience, Newcastle University , Newcastle upon Tyne , UK
| | - William K Gray
- c Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , North Shields , UK
| | - Richard W Walker
- c Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , North Shields , UK.,e Institute of Health and Society, Newcastle University , Newcastle upon Tyne , UK
| | - Catherine L Dotchin
- c Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital , North Shields , UK.,f Institute for Ageing, Newcastle University , Newcastle upon Tyne , UK
| | - Declare Mushi
- b Institute for Health and Society,Kilimanjaro Christian Medical University College , Moshi , Tanzania
| | - Adesola Ogunniyi
- a Institute for Health and Society, University College Hospital, University of Ibadan , Ibadan , Nigeria
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Agbangla NF, Fraser SA, Albinet CT. An Overview of the Cardiorespiratory Hypothesis and Its Potential Contribution to the Care of Neurodegenerative Disease in Africa. ACTA ACUST UNITED AC 2019; 55:medicina55090601. [PMID: 31533346 PMCID: PMC6780802 DOI: 10.3390/medicina55090601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/11/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
Abstract
One hypothesis that could explain the beneficial effects of physical exercise on cognitive function is the cardiorespiratory hypothesis. This hypothesis proposes that improved cognitive functioning may be in part a result of the physiological processes that occur after physical exercise such as: Increased cerebral perfusion and regional cerebral blood flow. These processes ensure increased oxygenation and glucose transportation to the brain, which together can improve cognitive function. The objective of this narrative review is to examine the contribution of this hypothesis in the care of African older adults with neurodegenerative conditions (i.e., dementia (Alzheimer’s disease)) or with mild cognitive impairments. Although studies in developed countries have examined people of African descent (i.e., with African Americans), only the limited findings presented in this review reflect how these conditions are also important for the African continent. This review revealed that no studies have examined the effects of cardiorespiratory fitness on neurodegenerative disease in Africa. African nations, like many other developing countries, have an aging population that is growing and will face an increased risk of neurodegenerative declines. It is therefore imperative that new research projects be developed to explore the role of the cardiorespiratory fitness in neurodegenerative disease prevention in African nations.
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Affiliation(s)
- Nounagnon Frutueux Agbangla
- Unité de Recherche Pluridisciplinaire Sport Santé Société (URePSSS-EA 7369), Univ. Artois, Univ. Lille, Univ. Littoral Côte d'Opale, F-59000 Lille, France.
| | - Sarah A Fraser
- Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, K1S 5S9, Canada.
| | - Cédric T Albinet
- Laboratoire Sciences de la Cognition, Technologie, Ergonomie (SCoTE-EA7420), Université de Toulouse, INU Champollion, 81012 Albi, France.
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Adeloye D, Auta A, Ezejimofor M, Oyedokun A, Harhay MO, Rudan I, Chan KY. Prevalence of dementia in Nigeria: a systematic review of the evidence. JOURNAL OF GLOBAL HEALTH REPORTS 2019; 3. [PMID: 31528708 DOI: 10.29392/joghr.3.e2019014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background The burden of dementia is poorly understood in Nigeria. We sought to gather available epidemiologic evidence on dementia in Nigeria to provide country-wide estimates of its prevalence and associated risks. Methods We searched MEDLINE, EMBASE, Global Health, Africa Journals Online (AJOL) and Google Scholar for epidemiologic studies on dementia in Nigeria from 1990 to 2018. We pooled crude estimates using random effects meta-analysis. A meta-regression epidemiologic model, using the United Nations demographics for Nigeria, was used to estimate the absolute number of people living with dementia in Nigeria in 1995 and 2015. Results Our searches returned 835 studies, of which nine were selected. These included 10 820 individuals with a median age of 74.4 years. Heterogeneity (I 2 =98.8%, P<0.001) was high across studies. Five studies were conducted in the South-west, and four studies were rated as high quality. The pooled crude prevalence of dementia in Nigeria was 4.9% (95% CI: 3.0-6.9) with prevalence significantly higher in women (6.7%, 3.6-9.9) compared to men (3.1%, 1.2-5.0). Age 80+ (odds ratio (OR) 1.6, 1.3-1.9), female sex (OR 2.2, 1.4-3.4) and BMI ≤18.5 (OR 3.5, 1.2-10.1) were significant risks for dementia in Nigeria. Using our epidemiologic model, we estimated that the number of dementia cases increased by over 400% over a 20-year period, increasing from 63 512 in 1995 to 318 011 in 2015 among persons aged ≥60 years. Conclusion Our findings suggest the prevalence and cases of dementia have increased in Nigeria over the last two decades. Population-wide response to dementia is lacking.
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Affiliation(s)
- Davies Adeloye
- Centre for Global Health Research, Usher Institute, University of Edinburgh, UK.,RcDavies Evidence-based Medicine, Lagos, Nigeria
| | - Asa Auta
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Fylde Road, Preston, UK
| | | | - Ayo Oyedokun
- Department of Elderly Medicine, Salisbury District Hospital, Odstock Road, Salisbury, UK
| | - Michael O Harhay
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA.,Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Igor Rudan
- Centre for Global Health Research, Usher Institute, University of Edinburgh, UK
| | - Kit Yee Chan
- Centre for Global Health Research, Usher Institute, University of Edinburgh, UK
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Akinyemi RO, Owolabi MO, Ihara M, Damasceno A, Ogunniyi A, Dotchin C, Paddick SM, Ogeng'o J, Walker R, Kalaria RN. Stroke, cerebrovascular diseases and vascular cognitive impairment in Africa. Brain Res Bull 2018; 145:97-108. [PMID: 29807146 DOI: 10.1016/j.brainresbull.2018.05.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 12/30/2022]
Abstract
With increased numbers of older people a higher burden of neurological disorders worldwide is predicted. Stroke and other cerebrovascular diseases do not necessarily present with different phenotypes in Africa but their incidence is rising in tandem with the demographic change in the population. Age remains the strongest irreversible risk factor for stroke and cognitive impairment. Modifiable factors relating to vascular disease risk, diet, lifestyle, physical activity and psychosocial status play a key role in shaping the current spate of stroke related diseases in Africa. Hypertension is the strongest modifiable risk factor for stroke but is also likely associated with co-inheritance of genetic traits among Africans. Somewhat different from high-income countries, strokes attributed to cerebral small vessel disease (SVD) are higher >30% among sub-Saharan Africans. Raised blood pressure may explain most of the incidence of SVD-related strokes but there are likely other contributing factors including dyslipidaemia and diabetes in some sectors of Africa. However, atherosclerotic and cardioembolic diseases combined also appear to be common subtypes as causes of strokes. Significant proportions of cerebrovascular diseases are ascribed to various forms of infectious disease including complications of human immunodeficiency virus. Cerebral SVD leads to several clinical manifestations including gait disturbance, autonomic dysfunction and depression. Pathological processes are characterized by arteriolosclerosis, lacunar infarcts, perivascular spaces, microinfarcts and diffuse white matter changes, which can now all be detected on neuroimaging. Except for isolated cases of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy or CADASIL, hereditary arteriopathies have so far not been reported in Africa. Prevalence estimates of vascular dementia (2-3%), delayed dementia after stroke (10-20%) and vascular cognitive impairment (30-40%) do not appear to be vastly different from those in other parts of the world. However, given the current demographic transition in both urban and rural settings these figures will likely rise. Wider application of neuroimaging modalities and implementation of stroke care in Africa will enable better estimates of SVD and other subtypes of stroke. Stroke survivors with SVD type pathology are likely to have low mortality and therefore portend increased incidence of dementia.
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Affiliation(s)
- Rufus O Akinyemi
- Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Nigeria; Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Mayowa O Owolabi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka, 565-8565, Japan
| | | | - Adesola Ogunniyi
- Department of Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Catherine Dotchin
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Stella-Maria Paddick
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom
| | - Julius Ogeng'o
- Department of Human Anatomy, University of Nairobi, Nairobi, Kenya
| | - Richard Walker
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, NE2 4AX, United Kingdom
| | - Raj N Kalaria
- Institute of Neuroscience, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, United Kingdom.
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Adaptation and validation of the Alzheimer's Disease Assessment Scale - Cognitive (ADAS-Cog) in a low-literacy setting in sub-Saharan Africa. Acta Neuropsychiatr 2017; 29:244-251. [PMID: 28345494 DOI: 10.1017/neu.2016.65] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to assess the feasibility of a low-literacy adaptation of the Alzheimer's Disease Assessment Scale - Cognitive (ADAS-Cog) for use in rural sub-Saharan Africa (SSA) for interventional studies in dementia. No such adaptations currently exist. METHODS Tanzanian and Nigerian health professionals adapted the ADAS-Cog by consensus. Validation took place in a cross-sectional sample of 34 rural-dwelling older adults with mild/moderate dementia alongside 32 non-demented controls in Tanzania. Participants were oversampled for lower educational level. Inter-rater reliability was conducted by two trained raters in 22 older adults (13 with dementia) from the same population. Assessors were blind to diagnostic group. RESULTS Median ADAS-Cog scores were 28.75 (interquartile range (IQR), 22.96-35.54) in mild/moderate dementia and 12.75 (IQR 9.08-16.16) in controls. The area under the receiver operating characteristic curve (AUC) was 0.973 (95% confidence interval (CI) 0.936-1.00) for dementia. Internal consistency was high (Cronbach's α 0.884) and inter-rater reliability was excellent (intra-class correlation coefficient 0.905, 95% CI 0.804-0.964). CONCLUSION The low-literacy adaptation of the ADAS-Cog had good psychometric properties in this setting. Further evaluation in similar settings is required.
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Cova I, Markova A, Campini I, Grande G, Mariani C, Pomati S. Worldwide trends in the prevalence of dementia. J Neurol Sci 2017; 379:259-260. [PMID: 28716255 DOI: 10.1016/j.jns.2017.06.030] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 06/19/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ilaria Cova
- Center for Research and Treatment on Cognitive Dysfunctions, Biomedical and Clinical Sciences Department, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, University of Milan, Italy.
| | - Anna Markova
- Center for Research and Treatment on Cognitive Dysfunctions, Biomedical and Clinical Sciences Department, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, University of Milan, Italy
| | - Isabella Campini
- Center for Research and Treatment on Cognitive Dysfunctions, Biomedical and Clinical Sciences Department, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, University of Milan, Italy
| | - Giulia Grande
- Center for Research and Treatment on Cognitive Dysfunctions, Biomedical and Clinical Sciences Department, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, University of Milan, Italy
| | - Claudio Mariani
- Center for Research and Treatment on Cognitive Dysfunctions, Biomedical and Clinical Sciences Department, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, University of Milan, Italy
| | - Simone Pomati
- Center for Research and Treatment on Cognitive Dysfunctions, Biomedical and Clinical Sciences Department, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, University of Milan, Italy
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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.
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Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, Carter A, Casey DC, Charlson FJ, Chen AZ, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Dilegge T, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming T, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kassebaum NJ, Kawashima T, Kemmer L, Khalil IA, Kinfu Y, Kyu HH, Leung J, Liang X, Lim SS, Lopez AD, Lozano R, Marczak L, Mensah GA, Mokdad AH, Naghavi M, Nguyen G, Nsoesie E, Olsen H, Pigott DM, Pinho C, Rankin Z, Reinig N, Salomon JA, Sandar L, Smith A, Stanaway J, Steiner C, Teeple S, Thomas BA, Troeger C, Wagner JA, Wang H, Wanga V, Whiteford HA, Zoeckler L, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, Abraham B, Abubakar I, Abu-Raddad LJ, Abu-Rmeileh NME, Ackerman IN, Adebiyi AO, Ademi Z, Adou AK, Afanvi KA, Agardh EE, Agarwal A, Kiadaliri AA, Ahmadieh H, Ajala ON, Akinyemi RO, Akseer N, Al-Aly Z, Alam K, Alam NKM, Aldhahri SF, Alegretti MA, Alemu ZA, Alexander LT, Alhabib S, Ali R, Alkerwi A, Alla F, Allebeck P, Al-Raddadi R, Alsharif U, Altirkawi KA, Alvis-Guzman N, Amare AT, Amberbir A, Amini H, Ammar W, Amrock SM, Andersen HH, Anderson GM, Anderson BO, Antonio CAT, Aregay AF, Ärnlöv J, Artaman A, Asayesh H, Assadi R, Atique S, Avokpaho EFGA, Awasthi A, Quintanilla BPA, Azzopardi P, Bacha U, Badawi A, Balakrishnan K, Banerjee A, Barac A, Barker-Collo SL, Bärnighausen T, Barregard L, Barrero LH, Basu A, Bazargan-Hejazi S, Beghi E, Bell B, Bell ML, Bennett DA, Bensenor IM, Benzian H, Berhane A, Bernabé E, Betsu BD, Beyene AS, Bhala N, Bhatt S, Biadgilign S, Bienhoff K, Bikbov B, Biryukov S, Bisanzio D, Bjertness E, Blore J, Borschmann R, Boufous S, Brainin M, Brazinova A, Breitborde NJK, Brown J, Buchbinder R, Buckle GC, Butt ZA, Calabria B, Campos-Nonato IR, Campuzano JC, Carabin H, Cárdenas R, Carpenter DO, Carrero JJ, Castañeda-Orjuela CA, Rivas JC, Catalá-López F, Chang JC, Chiang PPC, Chibueze CE, Chisumpa VH, Choi JYJ, Chowdhury R, Christensen H, Christopher DJ, Ciobanu LG, Cirillo M, Coates MM, Colquhoun SM, Cooper C, Cortinovis M, Crump JA, Damtew SA, Dandona R, Daoud F, Dargan PI, das Neves J, Davey G, Davis AC, Leo DD, Degenhardt L, Gobbo LCD, Dellavalle RP, Deribe K, Deribew A, Derrett S, Jarlais DCD, Dharmaratne SD, Dhillon PK, Diaz-Torné C, Ding EL, Driscoll TR, Duan L, Dubey M, Duncan BB, Ebrahimi H, Ellenbogen RG, Elyazar I, Endres M, Endries AY, Ermakov SP, Eshrati B, Estep K, Farid TA, Farinha CSES, Faro A, Farvid MS, Farzadfar F, Feigin VL, Felson DT, Fereshtehnejad SM, Fernandes JG, Fernandes JC, Fischer F, Fitchett JRA, Foreman K, Fowkes FGR, Fox J, Franklin RC, Friedman J, Frostad J, Fürst T, Futran ND, Gabbe B, Ganguly P, Gankpé FG, Gebre T, Gebrehiwot TT, Gebremedhin AT, Geleijnse JM, Gessner BD, Gibney KB, Ginawi IAM, Giref AZ, Giroud M, Gishu MD, Giussani G, Glaser E, Godwin WW, Gomez-Dantes H, Gona P, Goodridge A, Gopalani SV, Gotay CC, Goto A, Gouda HN, Grainger R, Greaves F, Guillemin F, Guo Y, Gupta R, Gupta R, Gupta V, Gutiérrez RA, Haile D, Hailu AD, Hailu GB, Halasa YA, Hamadeh RR, Hamidi S, Hammami M, Hancock J, Handal AJ, Hankey GJ, Hao Y, Harb HL, Harikrishnan S, Haro JM, Havmoeller R, Hay RJ, Heredia-Pi IB, Heydarpour P, Hoek HW, Horino M, Horita N, Hosgood HD, Hoy DG, Htet AS, Huang H, Huang JJ, Huynh C, Iannarone M, Iburg KM, Innos K, Inoue M, Iyer VJ, Jacobsen KH, Jahanmehr N, Jakovljevic MB, Javanbakht M, Jayaraman SP, Jayatilleke AU, Jee SH, Jeemon P, Jensen PN, Jiang Y, Jibat T, Jimenez-Corona A, Jin Y, Jonas JB, Kabir Z, Kalkonde Y, Kamal R, Kan H, Karch A, Karema CK, Karimkhani C, Kasaeian A, Kaul A, Kawakami N, Keiyoro PN, Kemp AH, Keren A, Kesavachandran CN, Khader YS, Khan AR, Khan EA, Khang YH, Khera S, Khoja TAM, Khubchandani J, Kieling C, Kim P, Kim CI, Kim D, Kim YJ, Kissoon N, Knibbs LD, Knudsen AK, Kokubo Y, Kolte D, Kopec JA, Kosen S, Kotsakis GA, Koul PA, Koyanagi A, Kravchenko M, Defo BK, Bicer BK, Kudom AA, Kuipers EJ, Kumar GA, Kutz M, Kwan GF, Lal A, Lalloo R, Lallukka T, Lam H, Lam JO, Langan SM, Larsson A, Lavados PM, Leasher JL, Leigh J, Leung R, Levi M, Li Y, Li Y, Liang J, Liu S, Liu Y, Lloyd BK, Lo WD, Logroscino G, Looker KJ, Lotufo PA, Lunevicius R, Lyons RA, Mackay MT, Magdy M, Razek AE, Mahdavi M, Majdan M, Majeed A, Malekzadeh R, Marcenes W, Margolis DJ, Martinez-Raga J, Masiye F, Massano J, McGarvey ST, McGrath JJ, McKee M, McMahon BJ, Meaney PA, Mehari A, Mejia-Rodriguez F, Mekonnen AB, Melaku YA, Memiah P, Memish ZA, Mendoza W, Meretoja A, Meretoja TJ, Mhimbira FA, Millear A, Miller TR, Mills EJ, Mirarefin M, Mitchell PB, Mock CN, Mohammadi A, Mohammed S, Monasta L, Hernandez JCM, Montico M, Mooney MD, Moradi-Lakeh M, Morawska L, Mueller UO, Mullany E, Mumford JE, Murdoch ME, Nachega JB, Nagel G, Naheed A, Naldi L, Nangia V, Newton JN, Ng M, Ngalesoni FN, Nguyen QL, Nisar MI, Pete PMN, Nolla JM, Norheim OF, Norman RE, Norrving B, Nunes BP, Ogbo FA, Oh IH, Ohkubo T, Olivares PR, Olusanya BO, Olusanya JO, Ortiz A, Osman M, Ota E, PA M, Park EK, Parsaeian M, de Azeredo Passos VM, Caicedo AJP, Patten SB, Patton GC, Pereira DM, Perez-Padilla R, Perico N, Pesudovs K, Petzold M, Phillips MR, Piel FB, Pillay JD, Pishgar F, Plass D, Platts-Mills JA, Polinder S, Pond CD, Popova S, Poulton RG, Pourmalek F, Prabhakaran D, Prasad NM, Qorbani M, Rabiee RHS, Radfar A, Rafay A, Rahimi K, Rahimi-Movaghar V, Rahman M, Rahman MHU, Rahman SU, Rai RK, Rajsic S, Ram U, Rao P, Refaat AH, Reitsma MB, Remuzzi G, Resnikoff S, Reynolds A, Ribeiro AL, Blancas MJR, Roba HS, Rojas-Rueda D, Ronfani L, Roshandel G, Roth GA, Rothenbacher D, Roy A, Sagar R, Sahathevan R, Sanabria JR, Sanchez-Niño MD, Santos IS, Santos JV, Sarmiento-Suarez R, Sartorius B, Satpathy M, Savic M, Sawhney M, Schaub MP, Schmidt MI, Schneider IJC, Schöttker B, Schwebel DC, Scott JG, Seedat S, Sepanlou SG, Servan-Mori EE, Shackelford KA, Shaheen A, Shaikh MA, Sharma R, Sharma U, Shen J, Shepard DS, Sheth KN, Shibuya K, Shin MJ, Shiri R, Shiue I, Shrime MG, Sigfusdottir ID, Silva DAS, Silveira DGA, Singh A, Singh JA, Singh OP, Singh PK, Sivonda A, Skirbekk V, Skogen JC, Sligar A, Sliwa K, Soljak M, Søreide K, Sorensen RJD, Soriano JB, Sposato LA, Sreeramareddy CT, Stathopoulou V, Steel N, Stein DJ, Steiner TJ, Steinke S, Stovner L, Stroumpoulis K, Sunguya BF, Sur P, Swaminathan S, Sykes BL, Szoeke CEI, Tabarés-Seisdedos R, Takala JS, Tandon N, Tanne D, Tavakkoli M, Taye B, Taylor HR, Ao BJT, Tedla BA, Terkawi AS, Thomson AJ, Thorne-Lyman AL, Thrift AG, Thurston GD, Tobe-Gai R, Tonelli M, Topor-Madry R, Topouzis F, Tran BX, Truelsen T, Dimbuene ZT, Tsilimbaris M, Tura AK, Tuzcu EM, Tyrovolas S, Ukwaja KN, Undurraga EA, Uneke CJ, Uthman OA, van Gool CH, Varakin YY, Vasankari T, Venketasubramanian N, Verma RK, Violante FS, Vladimirov SK, Vlassov VV, Vollset SE, Wagner GR, Waller SG, Wang L, Watkins DA, Weichenthal S, Weiderpass E, Weintraub RG, Werdecker A, Westerman R, White RA, Williams HC, Wiysonge CS, Wolfe CDA, Won S, Woodbrook R, Wubshet M, Xavier D, Xu G, Yadav AK, Yan LL, Yano Y, Yaseri M, Ye P, Yebyo HG, Yip P, Yonemoto N, Yoon SJ, Younis MZ, Yu C, Zaidi Z, Zaki MES, Zeeb H, Zhou M, Zodpey S, Zuhlke LJ, Murray CJL. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016; 388:1545-1602. [PMID: 27733282 PMCID: PMC5055577 DOI: 10.1016/s0140-6736(16)31678-6] [Citation(s) in RCA: 4522] [Impact Index Per Article: 565.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/11/2016] [Accepted: 08/16/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. METHODS We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. FINDINGS We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4-19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30-2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35-2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20-30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. INTERPRETATION Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available. FUNDING Bill & Melinda Gates Foundation.
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Mkenda S, Olakehinde O, Mbowe G, Siwoku A, Kisoli A, Paddick SM, Adediran B, Gray WK, Dotchin CL, Adebiyi A, Walker RW, Mushi D, Ogunniyi A. Cognitive stimulation therapy as a low-resource intervention for dementia in sub-Saharan Africa (CST-SSA): Adaptation for rural Tanzania and Nigeria. DEMENTIA 2016; 17:515-530. [DOI: 10.1177/1471301216649272] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Cognitive stimulation therapy is a non-pharmacological intervention for people with dementia. Its use has been associated with substantial improvements in cognition and quality of life in studies from high-income countries, equivalent to those achieved by pharmacological treatments. Cognitive stimulation therapy may be particularly suited to low resource settings, such as sub-Saharan Africa, because it requires little specialist equipment and can be delivered by non-specialist health workers. The aim of this study was to adapt cognitive stimulation therapy for use in sub-Saharan Africa taking into account socio-cultural differences and resource implications. Methods Cognitive stimulation therapy is a structured programme, originally developed in the United Kingdom. Substantial adaptations were required for use in sub-Saharan Africa. The formative method for adapting psychotherapy was used as a framework for the adaption process. The feasibility of using the adapted cognitive stimulation therapy programme to manage dementia was assessed in Tanzania and Nigeria in November 2013. Further adaptations were made following critical appraisal of feasibility. Results The adapted cognitive stimulation therapy intervention appeared feasible and acceptable to participants and carers. Key adaptations included identification of suitable treatment settings, task adaptation to accommodate illiteracy and uncorrected sensory impairment, awareness of cultural differences and usage of locally available materials and equipment to ensure sustainability. Conclusions Cognitive stimulation therapy was successfully adapted for use in sub-Saharan Africa. Future work will focus on a trial of cognitive stimulation therapy in each setting.
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Affiliation(s)
- Sarah Mkenda
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Godfrey Mbowe
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Aloyce Kisoli
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Stella-Maria Paddick
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | | | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
| | | | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK; Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Declare Mushi
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Adesola Ogunniyi
- University College Hospital (University of Ibadan), Ibadan, Nigeria
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Shindler-Itskovitch T, Ravona-Springer R, Leibovitz A, Muhsen K. A Systematic Review and Meta-Analysis of the Association between Helicobacterpylori Infection and Dementia. J Alzheimers Dis 2016; 52:1431-42. [PMID: 27079725 DOI: 10.3233/jad-160132] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND A positive association between Helicobacter pylori infection and dementia has been reported, yet findings are inconsistent. OBJECTIVE To examine the association between H. pylori infection and dementia. METHODS A literature search was performed using the databases OVID-Medline, Institute of Scientific Information Web of Science, and EMBASE. The meta-analysis was conducted using the random effects model. The primary analysis included studies in which the exposure variable was presence of H. pylori infection (yes versus no) and the outcome was incident dementia (yes versus no), which was pre-selected as the end-result of gradual cognitive decline overtime. Publication bias was explored using funnel plot and the Egger regression intercept. RESULTS A total of 260 records were identified; 13 addressed cognition and/or dementia in relation to H. pylori infection, of which only seven were included in the meta-analysis. The primary analysis showed a significant positive association between H. pylori infection and dementia; pooled odds ratio 1.71 (95% CI 1.17-2.49) (pv = 0.01). No significant evidence of publication bias was found. CONCLUSIONS H. pylori may play a role in the etiology of dementia. Identification of the biological mechanisms of such association is needed, as well as assessment of the impact of H. pylori therapy on the risk and progression of dementia.
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Affiliation(s)
- Tali Shindler-Itskovitch
- Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Ramit Ravona-Springer
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Memory Clinic, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - Arthur Leibovitz
- Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Geriatric Medical Division, Meuchedet Health Maintenance Organization, Israel
| | - Khitam Muhsen
- Department of Epidemiology and Preventive Medicine, School of Public Health, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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Karikari TK, Cobham AE, Ndams IS. Building sustainable neuroscience capacity in Africa: the role of non-profit organisations. Metab Brain Dis 2016; 31:3-9. [PMID: 26055077 PMCID: PMC4718937 DOI: 10.1007/s11011-015-9687-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 05/18/2015] [Indexed: 10/26/2022]
Abstract
While advances in neuroscience are helping to improve many aspects of human life, inequalities exist in this field between Africa and more scientifically-advanced continents. Many African countries lack the infrastructure and appropriately-trained scientists for neuroscience education and research. Addressing these challenges would require the development of innovative approaches to help improve scientific competence for neuroscience across the continent. In recent years, science-based non-profit organisations (NPOs) have been supporting the African neuroscience community to build state-of-the-art scientific capacity for sustainable education and research. Some of these contributions have included: the establishment of training courses and workshops to introduce African scientists to powerful-yet-cost-effective experimental model systems; research infrastructural support and assistance to establish research institutes. Other contributions have come in the form of the promotion of scientific networking, public engagement and advocacy for improved neuroscience funding. Here, we discuss the contributions of NPOs to the development of neuroscience in Africa.
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Affiliation(s)
- Thomas K Karikari
- Neuroscience, School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK.
- Midlands Integrative Biosciences Training Partnership (MIBTP), University of Warwick, Coventry, CV4 7AL, UK.
| | - Ansa E Cobham
- Department of Anatomy, Faculty of Basic Medical Sciences, University of Calabar, Calabar, Nigeria.
| | - Iliya S Ndams
- Department of Biological Sciences, Ahmadu Bello University, Zaria, Nigeria.
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Quansah E, Karikari TK. Neuroscience-related research in Ghana: a systematic evaluation of direction and capacity. Metab Brain Dis 2016; 31:11-24. [PMID: 26344503 PMCID: PMC4718959 DOI: 10.1007/s11011-015-9724-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/24/2015] [Indexed: 12/01/2022]
Abstract
Neurological and neuropsychiatric diseases account for considerable healthcare, economic and social burdens in Ghana. In order to effectively address these burdens, appropriately-trained scientists who conduct high-impact neuroscience research will be needed. Additionally, research directions should be aligned with national research priorities. However, to provide information about current neuroscience research productivity and direction, the existing capacity and focus need to be identified. This would allow opportunities for collaborative research and training to be properly explored and developmental interventions to be better targeted. In this study, we sought to evaluate the existing capacity and direction of neuroscience-related research in Ghana. To do this, we examined publications reporting research investigations authored by scientists affiliated with Ghanaian institutions in specific areas of neuroscience over the last two decades (1995-2015). 127 articles that met our inclusion criteria were systematically evaluated in terms of research foci, annual publication trends and author affiliations. The most actively-researched areas identified include neurocognitive impairments in non-nervous system disorders, depression and suicide, epilepsy and seizures, neurological impact of substance misuse, and neurological disorders. These studies were mostly hospital and community-based surveys. About 60% of these articles were published in the last seven years, suggesting a recent increase in research productivity. However, data on experimental and clinical research outcomes were particularly lacking. We suggest that future investigations should focus on the following specific areas where information was lacking: large-scale disease epidemiology, effectiveness of diagnostic platforms and therapeutic treatments, and the genetic, genomic and molecular bases of diseases.
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Affiliation(s)
- Emmanuel Quansah
- Pharmacology, Faculty of Health and Life Sciences, De Montfort University, Leicester, LE1 9BH, UK.
- Department of Molecular Biology and Biotechnology, School of Biological Science, University of Cape Coast, Cape Coast, Ghana.
| | - Thomas K Karikari
- Neuroscience, School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK.
- Midlands Integrative Biosciences Training Partnership, University of Warwick, Coventry, CV4 7AL, UK.
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Rudan I, Campbell H, Marušić A, Sridhar D, Nair H, Adeloye D, Theodoratou E, Chan KY. Assembling GHERG: Could "academic crowd-sourcing" address gaps in global health estimates? J Glob Health 2015; 5:010101. [PMID: 26445671 PMCID: PMC4593291 DOI: 10.7189/jogh.05.010101] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In recent months, the World Health Organization (WHO), independent academic researchers, the Lancet and PLoS Medicine journals worked together to improve reporting of population health estimates. The new guidelines for accurate and transparent health estimates reporting (likely to be named GATHER), which are eagerly awaited, represent a helpful move that should benefit the field of global health metrics. Building on this progress and drawing from a tradition of Child Health Epidemiology Reference Group (CHERG)'s successful work model, we would like to propose a new initiative - "Global Health Epidemiology Reference Group" (GHERG). We see GHERG as an informal and entirely voluntary international collaboration of academic groups who are willing to contribute to improving disease burden estimates and respect the principles of the new guidelines - a form of "academic crowd-sourcing". The main focus of GHERG will be to identify the "gap areas" where not much information is available and/or where there is a lot of uncertainty present about the accuracy of the existing estimates. This approach should serve to complement the existing WHO and IHME estimates and to represent added value to both efforts.
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Affiliation(s)
- Igor Rudan
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Harry Campbell
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Ana Marušić
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK ; Croatian Centre for Global Health, University of Split School of Medicine, Split, Croatia ; Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Devi Sridhar
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Harish Nair
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Davies Adeloye
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Evropi Theodoratou
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
| | - Kit Yee Chan
- Centre for Global Health Research, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Scotland, UK
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Paddick SM, Kisoli A, Dotchin CL, Gray WK, Chaote P, Longdon A, Walker RW. Mortality rates in community-dwelling Tanzanians with dementia and mild cognitive impairment: a 4-year follow-up study. Age Ageing 2015; 44:636-41. [PMID: 25918185 DOI: 10.1093/ageing/afv048] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/31/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND we have previously conducted a community-based prevalence study of dementia in older adults living in the rural Hai district of Tanzania. The aim of this study was to record mortality rates at 4 years post-diagnosis, of those with dementia, mild cognitive impairment (MCI) and no cognitive impairment. METHODS during Phase I of the prevalence study, 1,198 people aged 70 years and over were screened, and a stratified sample of 296 was assessed for the presence of dementia or MCI in Phase II. Seventy-eight people had dementia and 46 had MCI. Four years after diagnosis, we attempted to follow-up all those seen in Phase II and record all deaths. RESULTS of the 296, follow-up data were available for 287 (97.0%), including 77 with dementia and 45 with MCI. Of the 172 with no cognitive impairment, 165 (95.9%) were followed up and a sample of 89 people selected as representative of the background population. Forty-eight people with dementia (62.3%), 19 with MCI (42.2%) and 11 with no cognitive impairment (12.4%) had died at 4-year follow-up. After adjusting for the effects of age, gender and education, the hazard ratio was 6.33 (95% CI 3.19-12.58) for dementia and 3.57 (95% CI 1.64-7.79) for MCI relative to people with no cognitive impairment. Mortality rates were highest in those with vascular dementia. CONCLUSION dementia and MCI were associated with excess mortality relative to those with no cognitive impairment.
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Affiliation(s)
- Stella-Maria Paddick
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK Institute of Neuroscience, Newcastle University, Newcastle Upon Tyne, UK
| | - Aloyce Kisoli
- Hai District Hospital, Boman'gombe, Kilimanjaro, Tanzania
| | - Catherine L Dotchin
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK Institute for Ageing, Newcastle University, Newcastle-upon-Tyne, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK
| | - Paul Chaote
- District Medical Office, Hai District Hospital, Boman'gombe, Hai, Tanzania
| | - Anna Longdon
- South Devon Healthcare NHS Foundation Trust, Torquay, UK
| | - Richard W Walker
- Northumbria Healthcare NHS Foundation Trust, Department of Medicine, North Tyneside General Hospital, Tyne and Wear, UK Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Allain TJ, Mwambelo M, Mdolo T, Mfune P. Falls and other geriatric syndromes in Blantyre, Malawi: a community survey of older adults. Malawi Med J 2014; 26:105-8. [PMID: 26167258 PMCID: PMC4325343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND The prevalence of geriatric syndromes (falls, immobility, intellectual or memory impairment, and incontinence) is unknown in many resource-poor countries. With an aging population such knowledge is essential to develop national policies on the health and social needs of older people. The aim of this study was to provide a preliminary survey to explore the prevalence of falls and other geriatric syndromes and their association with known risk factors in people aged > 60 years in urban Blantyre, Malawi. METHODS This was a cross-sectional, community survey of adults aged > 60 years. Subjects were recruited at home or in the waiting areas of chronic care clinics. They were interviewed to complete a questionnaire on age-associated syndromes and comorbid problems. The Abbreviated Mental Test (AMT) and Timed Up and Go (TUG) tests were carried out. RESULTS Ninety-eight subjects were studied; 41% reported falling in the past 12 months, 33% of whom (13% of all subjects) were recurrent fallers. Twenty-five percent reported urine incontinence, 66% self-reported memory difficulties, and 11% had an AMT score < 7. A history of falling was significantly associated with urine incontinence (p=0.01), self-reported memory problems (p=0.004) and AMT score < 7 (p=0.02). CONCLUSIONS Geriatric syndromes, including falls, appear to be prevalent in older people in Blantyre, Malawi. Falling is associated with cognitive impairment and urinary incontinence. There is an urgent need for more understanding of geriatric problems in this setting to develop national policies on health and social needs of older people. It is likely that many of the contributory factors to falls would be amenable to multifactorial interventions similar to those found to be effective in developed countries.
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Affiliation(s)
- T J Allain
- University Hospitals Bristol NHS Foundation Trust - Older Persons Health Services, Bristol, United Kingdom
| | - M Mwambelo
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - T Mdolo
- Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - P Mfune
- Kamuzu Central Hospital, Lilongwe, Malawi
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Paddick SM, Kalaria RN, Mukaetova-Ladinska EB. The prevalence and clinical manifestations of delirium in sub-Saharan Africa: a systematic review with inferences. J Neurol Sci 2014; 348:6-17. [PMID: 25466692 DOI: 10.1016/j.jns.2014.10.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 09/30/2014] [Accepted: 10/27/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND In high-income countries with ageing populations, delirium is most prevalent in older adults and in palliative and intensive care settings. The prevalence and aetiology of delirium are likely to differ in low income countries, including sub-Saharan Africa (SSA), due to different population demographics, disease burden and exposure to pathogens. We reviewed published literature relating to the prevalence, clinical features and underlying causes of delirium in SSA and compare this with that published in high-income countries in order to identify knowledge and clinical service gaps, and priorities for further research. METHODS We performed a narrative review by comprehensively searching the following databases: Medline, PsychInfo, Embase and PubMed. Studies published between January 1 1975 and December 31 2013 in all languages, including the terms 'delirium', 'acute brain syndrome', 'organic brain syndrome', or 'acute confusion' originating from SSA were included. In addition, reference lists of included articles and online databases of African medical literature were hand-searched. We also included case series and case reports due to paucity of published studies. RESULTS We identified a total of 46 relevant studies. Delirium was the main focus of only one cross-sectional study, whereas most included delirium in studies on neuropsychiatric conditions. Only two studies reported prevalence in older adults. Most studies reported very low (<2%) delirium prevalence, whereas delirium in psychiatric inpatient and outpatient settings was higher than expected (18.2%-29.9%). Descriptive studies of 'bouffee delirante' from psychiatry settings were often describing delirium. Infection and HIV seropositivity were common associations of delirium throughout these studies. There were no studies of intensive, critical or surgical care settings or of management strategies. CONCLUSIONS We currently know very little about the prevalence, presentation and aetiology of delirium in developing countries. This knowledge gap should be tackled with some urgency, in order to address questions of screening, diagnosis, prevention and management in this setting.
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Affiliation(s)
- S-M Paddick
- Institute for Ageing and Health, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, UK; Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - R N Kalaria
- Institute for Ageing and Health, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, UK.
| | - E B Mukaetova-Ladinska
- Institute for Ageing and Health, Newcastle University, Campus for Ageing & Vitality, Newcastle upon Tyne NE4 5PL, UK
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Brucki SMD, Nitrini R. Cognitive impairment in individuals with low educational level and homogeneous sociocultural background. Dement Neuropsychol 2014; 8:345-350. [PMID: 29213924 PMCID: PMC5619182 DOI: 10.1590/s1980-57642014dn84000007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 04/11/2014] [Indexed: 12/02/2022] Open
Abstract
Prevalence studies of dementia and cognitive impairment in different cultures and environments are necessary. OBJECTIVE To verify the prevalence of cognitive impairment and dementia in a rural homogeneous population from flooded areas in the Amazonian Basin. METHODS A total of 163 subjects were interviewed with neurological, cognitive and functional evaluation. The individuals were classified as demented or cognitive impairment no dementia (CIND). RESULTS cognitive impairment was observed in 11.4% (n=18 individuals). Ten out of the 18 were diagnosed as CIND and eight with dementia. The prevalence rate of dementia was 4.9% in subjects aged 50 years or over and of CIND was 6.1%. Considering only the elder group (>64 years of age), there was a 12.3% prevalence of dementia and 7.7% of CIND. CONCLUSION In a homogeneous population, we observed a similar prevalence of dementia to rates reported by studies in Brazil and in other developed and developing countries.
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Affiliation(s)
- Sonia Maria Dozzi Brucki
- MD, PhD. Cognitive and Behavioral Neurology Group - University
of São Paulo, São Paulo SP, Brazil
| | - Ricardo Nitrini
- MD, PhD. Cognitive and Behavioral Neurology Group - University
of São Paulo, São Paulo SP, Brazil
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Drug utilization pattern in patients with different types of dementia in Western India. Int J Alzheimers Dis 2014; 2014:435202. [PMID: 25243092 PMCID: PMC4163299 DOI: 10.1155/2014/435202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 08/15/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Dementia is one of the most frequent disorders among elderly patients, reaching to epidemic proportions with an estimated 4.6 million new cases globally annually. Partially effective treatments are available for dementia. Aims & Objectives. We aim to study drugs used in dementia and find out frequency of types of Dementia. Method. This was an observational study conducted at rurally based tertiary care hospital. Prospective data was collected from outpatient department, while retrospective data was collected from medical records. Descriptive statistics were used to analyze data.
Result. Total 125 prescriptions of patients diagnosed with dementia were analyzed. Alzheimer's dementia was most common (65.6%), followed by vascular dementia (21.6%), and frontotemporal dementia (10.4%), with the rarest being Lewy body dementia in (2.4%) cases. 60.57% of patients were males. Mini Mental Score Examination mean score was 15.93 ± 1.37. Frontal Battery Assessment mean score was 4.75 ± 1.01.
Prescribed drugs were Donepezil (68.49%), Rivastigmine (13.63%), Donepezil + Memantine (6.43%) and Galantamine (12.83%), Quetiapine (38.46%), Lorazepam (23.07%), Clozapine (11.53%), Escitalopram (10.25%), Haloperidol (3.84%), Zolpidem, Sertraline, Olanzepine (2.56%), Nitrazepine, Lamotrigine, Fluoxetine, Tianeptine (1.28%), Folic acid, and Vitamin B12, respectively. Conclusion. Alzheimer's is the most common type of dementia while Donepezil was the most frequent drug.
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Kim YJ, Han JW, So YS, Seo JY, Kim KY, Kim KW. Prevalence and trends of dementia in Korea: a systematic review and meta-analysis. J Korean Med Sci 2014; 29:903-12. [PMID: 25045221 PMCID: PMC4101777 DOI: 10.3346/jkms.2014.29.7.903] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 04/24/2014] [Indexed: 11/20/2022] Open
Abstract
Through a systematic review and meta-analysis of epidemiological studies on dementia, we assessed the prevalence of dementia and its subtypes-Alzheimer' disease (AD) and vascular dementia (VaD)-in Korea. We searched for epidemiological studies on dementia published in 1990-2013 using PubMed, Scopus, EMBASE, KoreaMed, KISS, and RiCH. Dementia prevalence in elderly patients (aged≥65 yr) was 9.2% (95% confidence interval [CI], 8.2%-10.4%) from 11 studies, which was higher than those from Western and other Asian countries. AD was the most prevalent dementia type, with a prevalence of 5.7% (95% CI, 5.0%-6.4%) from 10 studies compared with 2.1% (95% CI, 1.6%-2.7%) for VaD from 9 studies. The age-specific prevalence of dementia approximately doubled with each 5.8-yr increase of age. Although a significant increasing trend of dementia prevalence was not observed, it increased slightly from 7.3% to 8.7% after 2005; AD prevalence increased after 1995 and VaD prevalence decreased after the early 2000s. The AD/VaD ratio increased from 1.96 in the early 1990s to 4.13 in the 2010s, similar to the worldwide ratio. Owing to this high prevalence in the aging population, dementia will impose significant economic burdens to Korean society.
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Affiliation(s)
| | - Ji Won Han
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Yoon Seop So
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Young Seo
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ka Young Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ki Woong Kim
- National Institute of Dementia, Seongnam, Korea
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea
- Department of Brain and Cognitive Science, Seoul National University College of Natural Sciences, Seoul, Korea
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Lekoubou A, Echouffo-Tcheugui JB, Kengne AP. Epidemiology of neurodegenerative diseases in sub-Saharan Africa: a systematic review. BMC Public Health 2014; 14:653. [PMID: 24969686 PMCID: PMC4094534 DOI: 10.1186/1471-2458-14-653] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 05/19/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Sub-Saharan African (SSA) countries are experiencing rapid transitions with increased life expectancy. As a result the burden of age-related conditions such as neurodegenerative diseases might be increasing. We conducted a systematic review of published studies on common neurodegenerative diseases, and HIV-related neurocognitive impairment in SSA, in order to identify research gaps and inform prevention and control solutions. METHODS We searched MEDLINE via PubMed, 'Banque de Données de Santé Publique' and the database of the 'Institut d'Epidemiologie Neurologique et de Neurologie Tropicale' from inception to February 2013 for published original studies from SSA on neurodegenerative diseases and HIV-related neurocognitive impairment. Screening and data extraction were conducted by two investigators. Bibliographies and citations of eligible studies were investigated. RESULTS In all 144 publications reporting on dementia (n = 49 publications, mainly Alzheimer disease), Parkinsonism (PD, n = 20), HIV-related neurocognitive impairment (n = 47), Huntington disease (HD, n = 19), amyotrophic lateral sclerosis (ALS, n = 15), cerebellar degeneration (n = 4) and Lewy body dementia (n = 1). Of these studies, largely based on prevalent cases from retrospective data on urban populations, half originated from Nigeria and South Africa. The prevalence of dementia (Alzheimer disease) varied between <1% and 10.1% (0.7% and 5.6%) in population-based studies and from <1% to 47.8% in hospital-based studies. Incidence of dementia (Alzheimer disease) ranged from 8.7 to 21.8/1000/year (9.5 to 11.1), and major risk factors were advanced age and female sex. HIV-related neurocognitive impairment's prevalence (all from hospital-based studies) ranged from <1% to 80%. Population-based prevalence of PD and ALS varied from 10 to 235/100,000, and from 5 to 15/100,000 respectively while that for Huntington disease was 3.5/100,000. Equivalent figures for hospital based studies were the following: PD (0.41 to 7.2%), ALS (0.2 to 8.0/1000), and HD (0.2/100,000 to 46.0/100,000). CONCLUSIONS The body of literature on neurodegenerative disorders in SSA is large with regard to dementia and HIV-related neurocognitive disorders but limited for other neurodegenerative disorders. Shortcomings include few population-based studies, heterogeneous diagnostic criteria and uneven representation of countries on the continent. There are important knowledge gaps that need urgent action, in order to prepare the sub-continent for the anticipated local surge in neurodegenerative diseases.
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Affiliation(s)
| | | | - Andre P Kengne
- Department of Medicine, University of Cape Town, Cape Town, South Africa.
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Rizzi L, Rosset I, Roriz-Cruz M. Global epidemiology of dementia: Alzheimer's and vascular types. BIOMED RESEARCH INTERNATIONAL 2014; 2014:908915. [PMID: 25089278 PMCID: PMC4095986 DOI: 10.1155/2014/908915] [Citation(s) in RCA: 362] [Impact Index Per Article: 36.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 04/03/2014] [Accepted: 06/10/2014] [Indexed: 11/30/2022]
Abstract
The prevalence of dementia varies substantially worldwide. This is partially attributed to the lack of methodological uniformity among studies, including diagnostic criteria and different mean population ages. However, even after considering these potential sources of bias, differences in age-adjusted dementia prevalence still exist among regions of the world. In Latin America, the prevalence of dementia is higher than expected for its level of population aging. This phenomenon occurs due to the combination of low average educational attainment and high vascular risk profile. Among developed countries, Japan seems to have the lowest prevalence of dementia. Studies that evaluated the immigration effect of the Japanese and blacks to USA evidenced that acculturation increases the relative proportion of AD cases compared to VaD. In the Middle East and Africa, the number of dementia cases will be expressive by 2040. In general, low educational background and other socioeconomic factors have been associated with high risk of obesity, sedentarism, diabetes, hypertension, dyslipidemia, and metabolic syndrome, all of which also raise the risk of VaD and AD. Regulating these factors is critical to generate the commitment to make dementia a public health priority.
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Affiliation(s)
- Liara Rizzi
- Division of Geriatric Neurology, Service of Neurology, “Hospital de Clínicas de Porto Alegre” (HCPA), Ramiro Barcelos Street 2.350, 90035-903 Porto Alegre, RS, Brazil
- Department of Internal Medicine, “Universidade Federal do Rio Grande do Sul” (UFRGS), Ramiro Barcelos Street 2.350, 90035-903 Porto Alegre, RS, Brazil
| | - Idiane Rosset
- Division of Gerontological Nursing, Faculty of Nursing, Universidade Federal do Rio Grande do Sul (UFRGS), São Manoel Street 963, 90620-110 Porto Alegre, RS, Brazil
| | - Matheus Roriz-Cruz
- Division of Geriatric Neurology, Service of Neurology, “Hospital de Clínicas de Porto Alegre” (HCPA), Ramiro Barcelos Street 2.350, 90035-903 Porto Alegre, RS, Brazil
- Department of Internal Medicine, “Universidade Federal do Rio Grande do Sul” (UFRGS), Ramiro Barcelos Street 2.350, 90035-903 Porto Alegre, RS, Brazil
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Paddick SM, Longdon A, Gray WK, Dotchin C, Kisoli A, Chaote P, Walker R. The association between educational level and dementia in rural Tanzania. Dement Neuropsychol 2014; 8:117-125. [PMID: 29213892 PMCID: PMC5619118 DOI: 10.1590/s1980-57642014dn82000006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The majority of people with dementia worldwide live in developing countries. Studies from the developed world have reported an association between lower educational attainment and dementia, but there are few data from the developing world where literacy and educational levels are frequently much lower. In this study we assessed the association between education and dementia prevalence in a rural Tanzanian setting. Methods In phase I, 1198 individuals aged 70 and over were assessed using the Community Screening Instrument for Dementia (CSI-D). In phase Ii a stratified sample of those seen in phase I were fully assessed and a clinical diagnosis based on DSM-IV criteria was made where appropriate. Information regarding literacy, highest attained educational level and occupation were also collected. Results The median subject cognitive score on the CSI-D was 25.7 (IQR 22.7 to 28.0) for females and 27.7 (IQR 25.7 to 29.4) for males. This difference was significant (U=117770.0, z= -9.880, p<0.001). In both males and females a lower CSI-D subject cognitive score was significantly associated with having had no formal education (U=34866.5, z= -6.688, p<0.001, for females; U=20757.0, z= -6.278, p<0.001, for males). After adjusting for the effect of age, having no formal education was significantly associated with greater odds of having 'probable dementia' by CSI-D, as was illiteracy. Amongst those interviewed in phase II, there was no significant difference in literacy or education between those with diagnosed DSM-IV dementia and those without. Conclusion In this rural Tanzanian population, we found a significant association between low levels of education and dementia by CSI-D. This relationship was not significant in cases meeting DSM-IV criteria for dementia.
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Affiliation(s)
- Stella-Maria Paddick
- Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | | | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Catherine Dotchin
- Institute of Ageing and Health, Newcastle University, Newcastle upon Tyne, UK.,Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK
| | - Aloyce Kisoli
- Hai District Hospital, Boma'ngombe, Kilimanjaro, Tanzania
| | - Paul Chaote
- Hai District Hospital, Boma'ngombe, Kilimanjaro, Tanzania
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, North Shields, UK.,Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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Mushi D, Rongai A, Paddick SM, Dotchin C, Mtuya C, Walker R. Social representation and practices related to dementia in Hai District of Tanzania. BMC Public Health 2014; 14:260. [PMID: 24642112 PMCID: PMC3994576 DOI: 10.1186/1471-2458-14-260] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 03/10/2014] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND With the increasing number of people surviving into old age in Africa, dementia is becoming an important public health problem. Understanding the social dynamics of dementia in resource-poor settings is critical for developing effective interventions. We explored the socio-cultural beliefs surrounding dementia and the life experience of people with dementia (PWD) and their caregivers in the Hai District of Kilimanjaro, Tanzania. METHODS Cross-sectional qualitative design. Forty one PWD were purposively sampled from the Hai District of Kilimanjaro. Twenty five paired interviews with PWD and with caregivers, and 16 with caregivers alone, were conducted. Interviews were tape recorded, transcribed verbatim and analyzed using content analysis approach. RESULTS Forty one PWD (26 females), aged 70 years and older, were recruited but due to speech difficulties only 25 participated in the interviews. Married were 13, widow in 22 and widower 6. The majority, 33/41 were illiterate. PWD and carers perceived memory problems as a normal part of ageing. Dementia was commonly referred as "ugonjwa wa uzeeni" (disease of old people) or memory loss disease. The majority of PWD 13/12 and carers 7/16 did not know what dementia is or what causes it. Dementia was felt to be associated with stroke, high blood pressure, diabetes, old age, curse/witchcraft and life stress. Half of the participants had used modern care and alternative care such as herbs, prayers or traditional healers. Caregivers complained about the burden of caring for PWD and suggested that community organizations should be involved in addressing the problem. CONCLUSIONS Knowledge about dementia is low and the symptoms are accepted as a problem of old age. PWD and carers demonstrate pluralistic behaviour in seeking help from modern care, prayers and traditional healers. The disease adds significant burden to family members. Family and caregivers need more education on early recognition of symptoms and cost effective management of dementia at family level. Faith-based organizations could play an important role in dementia interventions. At a national level effective policy and improvement of the health care system to address the needs of PWD and their families are imperative.
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Affiliation(s)
- Declare Mushi
- Kilimanjaro Christian Medical University College, Box 2240, Moshi, Tanzania.
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Chan KY, Wang W, Wu JJ, Liu L, Theodoratou E, Car J, Middleton L, Russ TC, Deary IJ, Campbell H, Wang W, Rudan I. Epidemiology of Alzheimer's disease and other forms of dementia in China, 1990-2010: a systematic review and analysis. Lancet 2013; 381:2016-23. [PMID: 23746902 DOI: 10.1016/s0140-6736(13)60221-4] [Citation(s) in RCA: 480] [Impact Index Per Article: 43.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND China is increasingly facing the challenge of control of the growing burden of non-communicable diseases. We assessed the epidemiology of Alzheimer's disease and other forms of dementia in China between 1990, and 2010, to improve estimates of the burden of disease, analyse time trends, and inform health policy decisions relevant to China's rapidly ageing population. METHODS In our systematic review we searched for reports of Alzheimer's disease or dementia in China, published in Chinese and English between 1990 and 2010. We searched China National Knowledge Infrastructure, Wanfang, and PubMed databases. Two investigators independently assessed case definitions of Alzheimer's disease and dementia: we excluded studies that did not use internationally accepted case definitions. We also excluded reviews and viewpoints, studies with no numerical estimates, and studies not done in mainland China. We used Poisson regression and UN demographic data to estimate the prevalence (in nine age groups), incidence, and standardised mortality ratio of dementia and its subtypes in China in 1990, 2000, and 2010. FINDINGS Our search returned 12,642 reports, of which 89 met the inclusion criteria (75 assessed prevalence, 13 incidence, and nine mortality). In total, the included studies had 340,247 participants, in which 6357 cases of Alzheimer's disease were recorded. 254,367 people were assessed for other forms of dementia, of whom 3543 had vascular dementia, frontotemporal dementia, or Lewy body dementia. In 1990 the prevalence of all forms of dementia was 1·8% (95% CI 0·0-44·4) at 65-69 years, and 42·1% (0·0-88·9) at age 95-99 years. In 2010 prevalence was 2·6% (0·0-28·2) at age 65-69 years and 60·5% (39·7-81·3) at age 95-99 years. The number of people with dementia in China was 3·68 million (95% CI 2·22-5·14) in 1990, 5·62 million (4·42-6·82) in 2000, and 9·19 million (5·92-12·48) in 2010. In the same period, the number of people with Alzheimer's disease was 1·93 million (1·15-2·71) in 1990, 3·71 million (2·84-4·58) people in 2000, and 5·69 million (3·85-7·53) in 2010. The incidence of dementia was 9·87 cases per 1000 person-years, that of Alzheimer's disease was 6·25 cases per 1000 person-years, that of vascular dementia was 2·42 cases per 1000 person-years, and that of other rare forms of dementia was 0·46 cases per 1000 person-years. We retrieved mortality data for 1032 people with dementia and 20,157 healthy controls, who were followed up for 3-7 years. The median standardised mortality ratio was 1·94:1 (IQR 1·74-2·45). INTERPRETATION Our analysis suggests that previous estimates of dementia burden, based on smaller datasets, might have underestimated the burden of dementia in China. The burden of dementia seems to be increasing faster than is generally assumed by the international health community. Rapid and effective government responses are needed to tackle dementia in low-income and middle-income countries. FUNDING Nossal Institute of Global Health (University of Melbourne, Australia), the National 12th Five-Year Major Projects of China, National Health and Medical Research Council Australia-China Exchange Fellowship, Importation and Development of High-Calibre Talents Project of Beijing Municipal Institutions, and the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Kit Yee Chan
- Nossal Institute for Global Health, University of Melbourne, Australia
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Chan KY, Adeloye D, Grant L, Kolčić I, Marušić A. How big is the 'next big thing'? Estimating the burden of non-communicable diseases in low- and middle-income countries. J Glob Health 2013; 2:020101. [PMID: 23289068 PMCID: PMC3529319 DOI: 10.7189/jogh.02.020101] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kit Yee Chan
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia ; Department of Health Policy and Management, School of Public Health, Peking University Health Science Centre, Beijing, China
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