Objectives
There is a knowledge gap on the impact of pre‐existing cognitive decline on poststroke decline in indigenous Africans. We describe the trajectories of domain‐specific cognitive and ...activities of daily life (ADL) functioning across the first year of stroke in Nigerians with pre‐existing cognitive decline.
Materials and Methods
Prospective observational study. Prestroke cognitive decline was ascertained retrospectively using the 16‐item Informant Questionnaire for Cognitive Decline in the Elderly (IQCODE). Assessments for global cognition, learning, memory, executive and ADL functioning were conducted at 3 time points using the Mini‐Mental state examination (MMSE), 10‐words list learning and delayed recall test (10 WDRT), Animal naming test and Barthel index, respectively.
Results
Among 150 stroke survivors, prestroke cognitive decline was found in 25 (16.7%, 95% C.I = 11.5%–23.6%). In linear regression analyses adjusting for the effect of age, education, stroke severity and comorbid diabetes mellitus, prestroke cognitive decline predicted poor memory scores at one year Adjusted standardized mean difference (SMD) = −0.6, 95% C.I = −1.1, −0.1, p = 0.016). The association of prestroke cognitive decline with poststroke poor memory was substantially mediated by age (SMD = −0.9, 95% C.I = −1.4, −0.4, p < 0.001).
Conclusion
Pre‐existing cognitive decline in this sample was associated with an age‐mediated poor memory function at one‐year poststroke. Early institution of targeted cognitive rehabilitation in stroke survivors with pre‐existing cognitive decline may reduce the neurocognitive burden of stroke in Black Africans.
Objectives:
There is a knowledge gap on the prognostic significance of subsyndromes of delirium. We describe the association of poststroke attenuated delirium syndrome (ADS) with cognitive, ...functional, and mortality outcomes at 3 months.
Methods:
A longitudinal observational study in which repeated assessments for delirium symptoms were conducted in the first week of stroke using the confusion assessment method. Attenuated delirium syndrome was characterized in survivors who were free of the full delirium syndrome but had ≥2 core features of delirium. Baseline and follow-up assessments were conducted using the Mini-Mental State Examination (MMSE), 10-word list learning and delayed recall test, Animal naming test, and Barthel index.
Results:
Among 150 participants recruited consecutively over 2 years, ADS was present in 32 (21.3%). Of 121 who were free of the full delirium syndrome, 21 (17.4%) had died by 3 months. Those who survived were more likely to be receiving treatment for systemic hypertension (88.5%, P = .007). In analyses adjusting for the effect of age, economic status, and systemic hypertension, ADS in the first week of stroke predicted cognitive decline at 3 months (mean difference (MD) in MMSE scores = −3.8, 95% CI = −7.0 to −0.7, P = .019). However, ADS was not associated with greater decline in activities of daily life (MD = −0.4, 95% CI = −2.8 to 2.0) or significant odds ratio (OR) of mortality (OR = 2.3, 95% CI = 0.8-6.3).
Conclusion:
Attenuated delirium syndrome may be an important marker of cognitive impairment at 3 months poststroke. Its detection may lead to identification of stroke survivors who are likely to benefit from evidence-based preventive interventions for poststroke cognitive decline.
Background:
There is limited information on new onset poststroke dementia (NPSD) in sub-Saharan Africa (SSA). We estimated incidence, cumulative incidence, risk factors and outcome of NPSD at 1 year ...in Nigerian survivors of a first-ever stroke.
Methods:
Hospital-based prospective observational study. Assessments for global cognition, learning, memory, executive and activities of daily life (ADL) functioning were conducted at 3 poststroke timepoints (Baseline, 3- and 12 months). NPSD was ascertained according to the “National Institute of Neurological Disorders and Stroke and the Association Internationale pour la Recherche et l’Enseignement en Neurosciences (NINDS-AIREN) criteria.” Outcomes were assessed using the modified Rankin Scale (mRS), center for epidemiologic studies depression scale (CES-D 10), health related quality of life in stroke patients (HRQOLISP-26) and caregivers strain index (CSI).
Results:
Among 144 stroke survivors who were free of dementia at baseline, we found a 1-year cumulative incidence of 4.52% (95% C.I = 3.20, 6.39). In multivariate Cox regression analyses, diabetes was associated with NPSD (Hazard Ratio = 2.10, 95% CI = 1.02, 4.35). NPSD at 3 months was independently associated with motor decline Mean difference (MD) in mRS = 1.6, 95% C.I = 0.9, 2.3), depression (MD in CES-D = 2.9, 95% C.I = 0.3, 5.4), caregivers burden (MD in CSI = 1.2, 95% C.I = 0.5, 1.8), and poor quality of life (MD in HRQOLISP-26 = −11.2, 95% C.I = −15.7, −6.8) at 1 year.
Conclusion:
Approximately 4.5% of stroke survivors in Nigeria had NPSD at 1 year. Diabetes, which can be prevented, represent a primary prevention target for NPSD and its consequences in SSA.
This article reports on a prevalence study of dementia and Alzheimer's disease among two groups of subjects with the same ethnic background but widely differing environments.
The study was conducted ...among residents aged 65 years and older in two communities: Yorubas (N = 2,494) living in Ibadan, Nigeria, and African Americans (N = 2,212 in the community and N = 106 in nursing homes) living in Indianapolis, Indiana. The study design consisted of a screening stage followed by a clinical assessment stage for selected subjects on the basis of their performance on the screening tests.
The age-adjusted prevalence rates of dementia (2.29%) and Alzheimer's disease (1.41%) in the Ibadan sample were significantly lower than those in the Indianapolis sample, both in the community-dwelling subjects alone (4.82% and 3.69%, respectively) and in the combined nursing home and community samples (8.24% and 6.24%, respectively). The prevalence rates of dementia and Alzheimer's disease increased consistently with advancing age in both study groups.
To the authors' knowledge, this is the first study, using the same research method at the two sites, to report significant differences in rates of dementia and Alzheimer's disease in two different communities with similar ethnic origins.
There is a knowledge gap on resilience and its impact on mental health of Africans who survive a stroke. We describe the trajectory of psychological resilience and its association with depression and ...quality of life (QoL) across the first poststroke year in Nigeria.
Prospective observational study of 150 survivors of a first ever stroke. Resilience was ascertained at 3 time-points prospectively over 12 months using the 25-items Resilience Scale (RS). Depression and QoL were also assessed at baseline and follow-up, respectively using the centre for epidemiologic studies depression scale (CES-D 10) and health related quality of life in stroke patients (HRQOLISP-26). Associations were investigated using regression models and presented as adjusted odds ratios (OR) and Wald test coefficients within 95% confidence intervals (CI).
Resilience improved across time points of measurement (
< 0.001). In multivariate logistic regression analyses adjusted for the effect of age, education, alcohol use, and hypertension, higher resilience was associated with male sex (OR = 5.3, 95% CI= 1.7, 17.2), younger age (OR = 4.8, 95% CI = 1.5,15.7), and baseline hypertension (OR= 0.2, 95% CI ≤ 0.1,0.8). In similarly adjusted mixed effect linear regression analyses, higher resilience was associated with improvement in depression (months 12= -4.2, 95% CI= -5.6, -2.8) and quality of life (months twelve = 5.2, 95% CI = 2.2, 8.2) overtime.
Resilience, which was associated with better mental health and wellbeing of stroke survivors, was less likely with hypertension. Results suggest an important role for control of vascular risk factors as part of resilience interventions to promote poststroke recovery.
Abstract
Background
Phenotyping dementia is a major problem in low resource settings like Nigeria and it has implication for research and management of people with dementia. Challenges associated ...with phenotyping dementia are embedded in poor health financing and lack of health personnel. This study aimed at scoping studies on dementia in Nigeria to identify those related to frontotemporal dementia (FTD) and describe the pattern of its presentation in a memory clinic as a means of highlighting challenges of phenotyping.
Method
A literature search of studies on dementia that reported FTDs as a phenotype and or described profile or pattern of FTDs in Nigeria was conducted. In addition, a review of hospital records of all persons clinically diagnosed with dementia (PWD) using the ICD 10 criteria was conducted. Those with FTD phenotypes were identified. The cohort comes from a memory clinic in University College Hospital, Ibadan, Nigeria. Records of these individuals with FTDs were reviewed and data (including sociodemographic details, clinical profile and pattern of presentation) extracted for case series report.
Results
Literature search yielded 2 studies; a retrospective study that reported dementia phenotypes including FTD and a case report. From a total of 216 PWD, we identified and included 14 persons with FTDs (6.5%) in this case series. Initially, 32 records of tentative diagnosis of FTD were identified, however, 18 persons with incomplete evaluation after the initial assessment were excluded. The mean age (±S.D) of those included (n = 14) is 67.7(±8.4). The main presenting complaints were behavioral with 57.1% presenting to the hospital at least a year after onset of symptoms. The most common behavioral problem identified was personality change accompanied with disinhibition in 9 persons (64.3%). Symptoms started before age 60 years in only one person. Two of the 14 persons had an initial diagnosis of schizophrenia until subsequent review with neuroimaging. Delay in carrying out neuroimaging due to financial constraint was a major challenge in making a diagnosis.
Conclusion
There is paucity of data on FTDs in Nigeria. Out‐of‐pocket payment for assessment is a major setback in phenotyping dementia and it has implication on both clinical practice and research.
The relationship between late-life depression, poverty, social network, and perceived health is little studied in Africa; the magnitude of the problem remains largely unknown and there is an urgent ...need to research into this area.
We interviewed community dwelling elderly persons of two rural areas in Nigeria using Mini-Mental State Examination (MMSE) and Geriatric Depression Scale (GDS-30). Those who scored 11 and above on the GDS-30 were further interviewed using Geriatric Mental State Schedule (GMSS). Diagnosis of depression was based on the International Classification of Diseases 10th edition (ICD-10) and GMSS-Automated Geriatric Examination for Computer Assisted Taxonomy (GMMS-AGECAT).
A total of 458 community dwelling elderly persons participated in the study of which 57% were females. Mean age of the participants was 73.65(±7.8) years (95% CI 72.93-74.37). The mean GDS-30 and MMSE scores were 4.15(±4.80) and 21.73(±4.67), respectively. A total of 59 and 58 participants had depression based on ICD-10 criteria and GMSS-AGECAT, respectively. Agreement between ICD-10 and AGECAT diagnoses was κ = 0.931. By multiple logistic regression analysis, late-life depression was significantly associated with financial difficulties (Odds ratio 4.52 and bereavement Odds ratio 2.70).
Late-life depression in this cohort is associated with health and socio-economic factors that are worth paying attention to, in a region of economic deprivation and inadequate healthcare.
Undetected acute phase delirium contributes to high poststroke mortality in sub-Saharan Africa (SSA). The present study adds to existing literature by examining the association of prestroke ...psychiatric symptoms with poststroke mortality at 3 and 12 months in Nigeria.
A prospective observational study with repeated delirium assessments conducted using the Confusion Assessment Method (CAM). Delirium was characterised in participants meeting criteria in the Fifth edition of the Diagnostic and Statistical Manual of mental disorders (DSM-V) as well as in those with ≥two core delirium features. Prestroke psychiatric symptoms were ascertained using the Neuropsychiatric Inventory Questionnaire (NPI-Q). Information on mortality was obtained by research supervisors during medical follow-up. Associations were investigated using multivariate logistic regression analyses and presented as odds ratios (O.R) within 95% confidence intervals (C.I).
Forty-five (30%) of 150 participants who provided data in the first week of stroke died by one-year follow-up. Those who died were more likely to have had a prestroke psychiatric symptom (64.4%, p=0.005) and delirium in the acute phase (60.0%, p=0.002). In analyses adjusting for the effect of age, education, tobacco smoking and stroke severity, prestroke psychiatric symptoms (O.R=3.3, 95% C.I=1.3,8.2; O.R=2.2, 95% C.I=1.0,4.6) and acute phase delirium (O.R=3.1, 95% C.I= 1.2,7.6; O.R=3.4, 95% C.I=1.5, 7.6) predicted mortality at 3 and 12 months poststroke, respectively.
This study found that prestroke psychiatric symptoms and acute phase delirium independently predicted post-stroke mortality at 3- and 12 months. Detection and treatment of mental health conditions in the population at increased risk of stroke may help reduce poststroke mortality in SSA.
In tandem with the ever‐increasing aging population in low and middle‐income countries, the burden of dementia is rising on the African continent. Dementia prevalence varies from 2.3% to 20.0% and ...incidence rates are 13.3 per 1000 person‐years with increasing mortality in parts of rapidly transforming Africa. Differences in nutrition, cardiovascular factors, comorbidities, infections, mortality, and detection likely contribute to lower incidence. Alzheimer's disease, vascular dementia, and human immunodeficiency virus/acquired immunodeficiency syndrome–associated neurocognitive disorders are the most common dementia subtypes. Comprehensive longitudinal studies with robust methodology and regional coverage would provide more reliable information. The apolipoprotein E (APOE) ε4 allele is most studied but has shown differential effects within African ancestry compared to Caucasian. More candidate gene and genome‐wide association studies are needed to relate to dementia phenotypes. Validated culture‐sensitive cognitive tools not influenced by education and language differences are critically needed for implementation across multidisciplinary groupings such as the proposed African Dementia Consortium.
Abstract Background To compare dementia incidence of African-American and Yoruba cohorts aged ≥70 years enrolled in 1992 and 2001. Methods African-Americans residing in Indianapolis and Yoruba in ...Ibadan, Nigeria without dementia were enrolled in 1992 and 2001 and evaluated every 2–3 years until 2009. The cohorts consist of 1440 African-Americans, 1774 Yoruba in 1992 and 1835 African-Americans and 1895 Yoruba in the 2001 cohorts aged ≥70 years. Results In African-Americans, dementia and Alzheimer's disease (AD) incidence rates were significantly lower in 2001 than 1992 for all age groups except the oldest group. The overall standardized annual dementia incidence rates were 3.6% (95% confidence interval CI, 3.2%–4.1%) in the 1992 cohort and 1.4% (95% CI, 1.2%–1.7%) in the 2001 cohort. There was no significant difference in dementia or AD incidence between the Yoruba cohorts. Conclusions Future research is needed to explore the reasons for the differential changes in incidence rates in these two populations.
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