In sub-Saharan Africa, many older people experience vision impairment (VI) and its adverse health outcomes. In this study, we examined separately the association between VI and each adverse health ...conditions (cognitive disorders, vision-related quality of life VRQoL, and daily functioning interference DFI) among Congolese older people. We also explored whether VI had a significant effect on VRQoL components in our population.
We performed cross-sectional analyses on data from 660 Congolese people aged ≥65 years who participated in the 2013 survey of the EPIDEMCA population-based cohort study. VI was defined as having a near visual acuity <20/40 (assessed at 30 cm using a Parinaud chart). Cognitive disorders were assessed using neuropsychological tests and neurological examinations. VRQoL was assessed using a reduced version of the National Eye Institute Visual Function Questionnaire (VFQ-22) and DFI using 11 items of participation restrictions and activity limitations. Regarding our main objective, each association was explored separately using multivariable logistic and linear regression models. Additionally, the effects of VI on each VRQoL components were explored using univariable linear regression models.
VI was not associated with cognitive disorders after adjustment for residence area (adjusted odds ratio = 1.7; 95% confidence interval CI: 0.6; 4.7), but it was associated with a low VRQoL score (adjusted β = -12.4; 95% CI: -17.5; -7.3) even after controlling for several covariates. An interaction between VI and age (p = 0.007) was identified, and VI was associated with DFI only among people aged >73 years (adjusted β = 0.5; 95% CI: 0.2; 0.8). Our exploratory analysis showed that all components of VRQoL decreased with a decrease in visual acuity (corrected p ≤ 0.05).
VI was associated with poor VRQoL and high DFI. Residence area seems to play a confounding role in the association between VI and cognitive disorders. Our findings suggest that targeting interventions on vision could reduce DFI among older people and improve their well-being.
The rate of virological failure was assessed in 386 adult patients attending the Centre National Hospitalier Universitaire of Bangui, the capital city of the Central African Republic (CAR), receiving ...their first-line antiretroviral (ARV) drug regimen for 24 months, according to the World Health Organization (WHO) recommendations. In addition, genotypic resistance testing was carried out in 45 of 145 randomly selected patients whose plasma HIV-1 RNA load was detectable. Overall, 28.5% of ARV-treated patients were in virological failure (e.g., HIV-1 RNA >3.7 log(10) copies/ml). Twenty-four percent of patients in virological failure showed wild-type viruses, likely indicating poor adherence. Even after excluding the M184V mutation, all 76% of patients in virological failure displayed viruses harboring at least one major drug resistance mutation to nucleoside reverse transcriptase inhibitors (NRTI), non-NRTI, or protease inhibitors. Whereas the second-line regimen proposed by the 2010 WHO recommendations, including zidovudine, tenofovir, lopinavir, and atazanavir, could be effective in more than 90% of patients in virological failure with resistant viruses, the remaining patients showed genotypic profiles highly predictive of resistance to the usual WHO second-line regimen, including complex genotypic profiles diagnosed only by genotypic resistance tests in some patients. In conclusion, our observations highlight the high frequency of therapeutic failure in ARV-treated adults in this study, as well as the urgent and absolute need for improving viral load assessment in the CAR to prevent and/or, from now on, to monitor therapeutic failure.
Abstract INTRODUCTION The LIfestyle for BRAin Health (LIBRA) index yields a dementia risk score based on modifiable lifestyle factors and is validated in Western samples. We investigated whether the ...association between LIBRA scores and incident dementia is moderated by geographical location or sociodemographic characteristics. METHODS We combined data from 21 prospective cohorts across six continents ( N = 31,680) and conducted cohort‐specific Cox proportional hazard regression analyses in a two‐step individual participant data meta‐analysis. RESULTS A one‐standard‐deviation increase in LIBRA score was associated with a 21% higher risk for dementia. The association was stronger for Asian cohorts compared to European cohorts, and for individuals aged ≤75 years (vs older), though only within the first 5 years of follow‐up. No interactions with sex, education, or socioeconomic position were observed. DISCUSSION Modifiable risk and protective factors appear relevant for dementia risk reduction across diverse geographical and sociodemographic groups. Highlights A two‐step individual participant data meta‐analysis was conducted. This was done at a global scale using data from 21 ethno‐regionally diverse cohorts. The association between a modifiable dementia risk score and dementia was examined. The association was modified by geographical region and age at baseline. Yet, modifiable dementia risk and protective factors appear relevant in all investigated groups and regions.
Stressful life events (SLEs) are considered potential risk factors for cognitive disorders. Our objective was to investigate the association between SLEs and cognitive disorders among the elderly ...people in Central Africa.
A population-based study was conducted in the Central African Republic (CAR) and the Republic of Congo (ROC). Participants aged ≥65 were interviewed using the Community Screening Interview for Dementia. Those who performed poorly were clinically assessed by neurologists. DSM-IV and Petersen criteria were required for a diagnosis of dementia or mild cognitive impairment (MCI), respectively. SLEs were assessed through 18 questions about events that occurred during childhood, adulthood and late-life. Sociodemographic, vascular and psychological factors were also documented. Multivariate multinomial logistic regression models were used to estimate the associations.
MCI was positively associated with: the total number of SLEs (OR = 1.1, 95% CI: 1.0-1.2), the number of SLEs from the age of 65 (OR = 1.2, 95% CI: 1.0-1.3), the number of SLEs before the age of 16 among non-depressive participants (OR = 1.6, 95% CI: 1.2-2.2) and with a serious illness in a child experienced when the participant was aged 65 or more (OR = 2.8, 95% CI: 1.6-4.6). No association with dementia was observed.
SLEs were positively associated with MCI but not dementia. More comprehensive studies are needed to further investigate this relationship.
Les accidents vasculaires cérébraux constituent un enjeu de santé publique. Plus de 80 % des décès causés par cette affection intéressent les pays en développement, les facteurs associés à cette ...mortalité sont insuffisamment connus.
Évaluer la valeur pronostique du délai d’admission des patients victimes d’AVC sur la durée de survie à un mois d’hospitalisation dans les hôpitaux de Bangui.
Étude pronostique transversale de type prospectif réalisée à Bangui dans les services de neurologie de l’hôpital de l’Amitié, de médecine interne de l’hôpital communautaire et des unités de soins intensifs des ces hôpitaux, de février à août 2014.
Le recrutement des sujets était exhaustif à l’aide d’un questionnaire confectionné se basant sur celui modifié de l’OMS sur les désordres neurologiques. Le traitement et l’analyse des données ont été faits avec le logiciel Statview 5.0.
Un total de 154 patients a été inclus. L’âge moyen était de 63,15ans±10,98 avec des extrêmes allant de 38 et 91ans. Soixante-seize sujets (49,35 %) étaient pris en charge avec un délai d’admission inférieur ou égal à un jour. La moyenne du délai d’admission des patients pris en charge précocement était de 1,00 jour et celle des patients pris en charge tardivement était de 4,59±2,33jours (p<0,0001).
Le non-référencement systématique des patients dans le service spécialisé et le recours à la médecine traditionnelle en première intention étaient responsables d’une prise en charge tardive des patients et avaient un impact négatif sur la survie de ceux-ci. Bien que l’HTA soit un facteur de risque majeur, elle n’était pas associée à la survie contrairement aux antécédents d’AVC.
Le délai d’admission en milieu hospitalier des patients victimes d’AVC constitue un facteur pronostique. La prise en charge tardive des ces affections augmente le taux de mortalité.
OBJECTIVES
Neuropsychiatric symptoms are common in dementia. Limited data are available concerning their association with dementia in developing countries. Our aim was to describe the severity of ...neuropsychiatric symptoms among older people, evaluate the distress experienced by caregivers, and assess which neuropsychiatric symptoms were specifically associated with dementia among older adults in Central Africa.
DESIGN
This study is part of the EPIDEMCA program, a cross‐sectional multicenter population‐based study.
SETTING
The EPIDEMCA program was conducted from November 2011 to December 2012 in urban and rural areas of the Central African Republic and the Republic of the Congo.
PARTICIPANTS
Participants were older people (≥65 y) included in the EPIDEMCA program who underwent a neuropsychiatric evaluation. The sample included overall 532 participants, of whom 130 participants had dementia.
MEASUREMENTS
Neuropsychiatric symptoms were assessed with the brief version of the Neuropsychiatric Inventory including the evaluation of severity and associated distress. Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision, criteria were followed to diagnose dementia. A logistic regression model was used to identify associated neuropsychiatric symptoms.
RESULTS
The prevalence of neuropsychiatric symptoms was 89.9% (95% confidence interval = 84.6‐95.1) among people living with dementia. The overall median severity score for neuropsychiatric symptoms was 9 interquartile range IQR = 6‐12, and the overall median distress score was 7 IQR = 4‐10. Overall median scores of both severity and distress were significantly increased with the number of neuropsychiatric symptoms, the presence of dementia, and dementia severity. Depression, delusions, apathy, disinhibition, and aberrant motor behavior were associated with dementia after multivariate analysis.
CONCLUSION
This report is one of the few population‐based studies on neuropsychiatric symptoms among older people with dementia in Sub‐Saharan Africa and the first one evaluating the severity of those symptoms and distress experienced by caregivers. Individual neuropsychiatric symptoms were strongly associated with dementia in older people and require great attention considering their burden on populations. J Am Geriatr Soc 68:180–185, 2019
Objectives
To investigate the association between peripheral arterial disease (PAD) and dementia in native elderly African populations.
Design
Two successive door‐to‐door cross‐sectional surveys in ...the general population.
Settings
Representative districts of Bangui (Central African Republic) and Brazzaville (Republic of Congo).
Participants
Population aged 65 and older.
Measurements
Peripheral arterial disease was defined as an ankle–brachial index (ABI) of 0.90 or less. Cognitive screening was performed using the Community Screening Interview for Dementia and the Five‐Word Test. Diagnosis of dementia was confirmed after further neuropsychological tests and neurological examination according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria. Multivariate logistic regression models were used to quantify the association between PAD and dementia in those populations, with adjustments for cardiovascular disease (CVD) and other variables.
Results
A significant association was observed between PAD and prevalent dementia (odds ratio (OR) = 2.43, 95% confidence interval (CI) = 1.44–4.13, P = .001), even after adjustment for age, city, sex, CVD risk factors, education, and depressive disorders (OR = 2.37, 95% CI = 1.31–4.26, P = .004). This association was stronger with lower ABI.
Conclusion
These findings support the hypothesis of a link between atherosclerosis (represented by a low ABI) and cognitive disorders in native Africans and are similar to previous reports in African Americans and other ethnic groups.
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