Bébène Ndamba-Bandzouzi

Prevalence of peripheral artery disease in the elderly population in urban and rural areas of Central Africa: the EPIDEMCA study

Objective Data on peripheral artery disease in Africa are sparse and limited to urban areas. Given the urban/rural socio-economical gradient in these countries, we sought to determine the prevalence and risk factors of peripheral artery disease in urban and rural areas of two countries in Central Africa. Methods Individuals ≥65 years old living in two urban and rural areas of the Republic of Central Africa (ROC) and the Central African Republic (CAR) were invited. Demographic, clinical and biological data were collected. Ankle-brachial index ≤0.90 defined peripheral artery disease. Results Among the 1871 participants (age 73 years, 62% female) the prevalence of peripheral artery disease was 14.8%, higher in ROC than in CAR (17.4% vs. 12.2%, p = 0.007) and higher in females than males (16.6% vs. 11.9%, p = 0.012). The prevalence of peripheral artery disease increased with age, respectively at 10.9%, 14.9%, 15.1% and 22.2% for age bands of 65–69, 70–74, 75–79 and 80+years (p < 0.001). Higher rates of peripheral artery disease were found in urban areas in ROC (20.7% vs. 14.4% in rural areas, p = 0.011), but not in CAR (11.5% vs. 12.9%, p = NS). In multivariate analysis, peripheral artery disease was significantly associated with age (odds ratio (OR): 1.03; p = 0.004), dyslipidaemia (OR: 1.88; p = 0.003), smoking (OR: 1.78; p = 0.003), obesity (OR: 1.98; p = 0.034) and underweight (OR: 1.49; p = 0.023). Regular alcohol drinking was associated with decreased risk of peripheral artery disease (OR: 0.73; p = 0.044). Conclusion The prevalence of peripheral artery disease in the elderly is high in Africa, especially in females. In ROC, with a higher urban-rural socio-economic gradient, peripheral artery disease is more frequent in the urban areas.

Mutation in the 3’untranslated region of APP as a genetic determinant of cerebral amyloid angiopathy

Aβ-related cerebral amyloid angiopathy (CAA) is a major cause of primary non-traumatic brain hemorrhage. In families with an early onset of the disease, CAA can be due to amyloid precursor protein (APP) pathogenic variants or duplications. APP duplications lead to a ~1.5-fold increased APP expression, resulting in Aβ overproduction and deposition in the walls of leptomeningeal vessels. We hypothesized that rare variants in the 3’untranslated region (UTR) of APP might lead to APP overexpression in patients with CAA and no APP pathogenic variant or duplication. We performed direct sequencing of the whole APP 3’UTR in 90 patients with CAA and explored the functional consequences of one previously unreported variant. We identified three sequence variants in four patients, of which a two-base pair deletion (c.*331_*332del) was previously unannotated and absent from 175 controls of same ethnicity. This latter variant was associated with increased APP expression in vivo and in vitro. Bioinformatics and functional assays showed that the APP c.*331_*332del variant affected APP messenger RNA (mRNA) structure and binding of two microRNAs (miR-582-3p and miR-892b), providing a mechanism for the observed effects on APP expression. These results identify APP 3’UTR sequence variants as genetic determinants of Aβ-CAA.

Dementia-associated mortality and its predictors among older adults in sub-Saharan Africa: results from a 2-year follow-up in Congo (the EPIDEMCA-FU study)

BACKGROUND between 2011 and 2012, we carried out a study of dementia prevalence in central Africa throughout the EPIDEMCA (Epidemiology of Dementia in Central Africa) programme. OBJECTIVE to assess dementia-related mortality among Congolese older people from the EPIDEMCA study after 2 years of follow-up. DESIGN longitudinal population-based cohort study. SETTING Gamboma and Brazzaville, Republic of Congo. METHODS older participants were traced and interviewed in rural and urban Congo annually between 2012 and 2014. DSM-IV and NINCDS-ADRDA criteria were required for dementia diagnosis. Data on vital status were collected throughout the follow-up. Cox proportional hazards model was used to assess the link between baseline dementia diagnosis and mortality risk. RESULTS of 1,029 participants at baseline, 910 (88.4%) have a complete cognitive diagnosis. There were 791 participants (76.87%) with normal cognition, 56 (5.44%) with MCI and 63 (6.12%) with dementia. After 2 years of follow-up, 101 (9.8%) participants had died. Compared with participants with normal cognition, patients with dementia had 2.5 times higher mortality risk (HR = 2.53, 95% CI 1.42-4.49, P = 0.001). Among those with dementia, only clinical severity of dementia was associated with an additional increased mortality risk (HR = 1.91; CI 95%, 1.23-2.96; P = 0.004). Age (per 5-year increase), male sex and living in an urban area were independently associated with increased mortality risk across the full cohort. CONCLUSION among Congolese older adults, dementia is associated with increased mortality risk. Our results highlight the need for targeted health policies and strategies for dementia care in sub-Saharan Africa (SSA).

Diet, Alcohol Consumption and Cognitive Disorders in Central Africa: A Study from the EPIDEMCA Program.

Western research into dementia has focused on finding effective means of prevention, particularly through nutrition. To date, however, little is known about the relationship between diet and cognitive disorders in Africa, where the number of people with dementia is expected to increase most over the coming decades. The objective of the study was to investigate the relationship between diet and alcohol intake and cognitive disorders among elderly people in Central Africa. Between 2011 and 2012, a cross-sectional multicentre population-based study was carried out in rural and urban areas of the Central African Republic (CAR) and the Republic of Congo (ROC). Participants aged ≥65 years were interviewed using the Community Screening Interview for Dementia (CSI-D). Elderly people who performed poorly (COGSCORE≤24.5/30) were clinically assessed by neurologists and underwent further psychometric testing. DSM-IV and Petersen criteria were required for a diagnosis of dementia or mild cognitive impairment (MCI), respectively. A food frequency questionnaire assessed the intakes of dairy products, fruit, vegetables, starches, legumes, oleaginous foods, meat or fish, eggs and sweet foods over the previous three days. We also collected data on alcohol intake. Sociodemographic, vascular, and psychological factors were documented. Multivariate multinomial logistic regression models were used to estimate the associations. In fully adjusted models, a lower consumption of oleaginous foods was associated with MCI (OR=3.7 [1.4−9.9]) and dementia (OR=2.8 [1.0−7.7]) in a rural area of CAR. Alcohol consumption was associated with reduced probability of dementia in CAR (OR=0.3 [0.1−0.8]). In ROC, food groups and alcohol intake were not associated with MCI or dementia. In conclusion, our study provides new data about the association between diet and cognitive disorders in Africa. Further studies should investigate the relationship between diet and cognitive disorders at the level of specific foods rather than food groups.

Association between mild cognitive impairment and dementia and undernutrition among elderly people in Central Africa: some results from the EPIDEMCA (Epidemiology of Dementia in Central Africa) programme.

Several studies in Western countries have shown an association between cognitive disorders and low BMI or weight loss in elderly people. However, few data are available in Africa. We analysed the association between cognitive disorders and undernutrition among elderly people in Central Africa. A cross-sectional, multicentre, population-based study using a two-phase design was carried out in subjects aged 65 years and above in the Central African Republic (CAR) and the Republic of Congo (ROC). All subjects were interviewed using the Community Screening Interview for Dementia, and those with low performance were clinically assessed by a neurologist and underwent further psychometrical tests. Diagnostic and Statistical Manual-IV and Petersens criteria were required for the diagnoses of dementia and mild cognitive impairment (MCI), respectively. Undernutrition was evaluated using mid-upper arm circumference (MUAC) < 24 cm, BMI < 18.5 kg/m(2) and arm muscular circumference (AMC) < 5th percentile. Multivariate binary logistic regression models were used to estimate the associations. In CAR, MCI was associated with MUAC < 24 cm (OR 0.7, 95% CI 0.4, 1.0) and dementia with BMI < 18.5 kg/m(2) (OR 2.3, 95% CI 1.6, 3.1), AMC < 5th percentile (OR 2.3, 95% CI 1.1, 4.6) and MUAC < 24 cm (OR 1.8, 95% CI 1.4, 2.4). In ROC, both MCI and dementia were associated with all markers of undernutrition, but only AMC < 5th percentile was significantly associated with MCI (OR 3.1, 95% CI 1.9, 4.8). In conclusion, cognitive disorders were associated with undernutrition. However, further studies are needed to elucidate the relationship between MCI and undernutrition in CAR.

Violence and witchcraft accusations against older people in Central and Western Africa: toward a new status for the older individuals?

Social isolation and loss of social status increase the risk of dementia, particularly in Western culture. Prevalence of dementia seems higher in the West than in areas where more traditional culture predominates (Guerchet et al., 2009). However, environmental and social changes mean that this prevalence in traditional societies is likely to increase, particularly in urban regions (Guerchet et al., 2010), where traditional transgenerational family structures tend to disappear and lifestyles are becoming more Westernized. These changes threaten the privileged status of older people, and their relationships with other family members may be subsequently damaged. New diseases that affect young adults, such as AIDS, created a climate of fear and rejection of older people, and suggestions of witchcraft may lead to abuse. Older people had always been held in Africa as belonging to a sacred age group to be treated with reverence and respect and considered as the guardians of tradition and history of the clan (a familial grouping encompassing all the descendants of a unique ancestor). Their closeness to the spirits of the protecting ancestors was thought to enable them to prevent aggression by witchcraft involving harmful spirits. It has long been believed that sorcerers have the power to command harmful spirits and thereby damage health. Illnesses have been always considered to have a supernatural dimension, despite a recent acceptance of more rational explanations. Many revivalist churches (those in the evangelical tradition) are currently being established in Africa. Their leaders are essentially “gurus” who are supplanting the traditional sorcerers and their supposed power to bridge the gap between the real and the hidden (invisible). The quest for a magical/religious explanation for illnesses leads people to look for a culprit. The older people are often suspected to mobilize these ancestors’ spirits to bless individuals and considered as using witchcraft. Consequently, it is common practice to ask the healer about the supernatural origin of serious illness, and older people are easily mentioned as potentially having used witchcraft to do harm. It sometimes happens that an older individual, who is wrongly accused, nevertheless confesses to the accusations in order to relieve the social pressure and, subsequently, develop depressive disorders. Culturally, the older people were expected to be sources of information and training, facilitating the transmission of traditional knowledge and protecting individuals in the clan against invisible forces that can cause illnesses. These valuable qualities of the older people are lost when dementia occurs. In most African cultures, dementia has no name, although the symptoms are recognized and attributed (Faure et al., 2012). Thus, socio-behavioral disorders associated with progressive deterioration of mental functions were not recognized as being pathological. Rather, they are experienced by families as harmful, intentional, and carried out by someone whose role is, by definition, to protect the clan. It is in this context that acts of violence are actually committed against concerned older people, thus running counter to customs and traditions that made them being loved, protected, respected, and even feared because of their supposed powers. Now, the older people are subject to stigma, rejection, and sometimes physical or psychological abuse. It can be suggested that dementia be classified as a mental pathology of the older people and represents failure to compensate for stress imposed by a society in which they feel they have become useless (Sink et al., 2004). Preservation of a traditional culturalmilieu constitutes a defense against the developed culture of Western countries, where individuals who lose their social status immediately become isolated and unappreciated. Dementia can appear to foreshadow death, particularly given the progressive disappearance from modern societies of religious values (Pollitt, 1996). Many workers from voluntary associations report more and more examples of older people being abandoned in villages because they have been rejected. The rural exodus that depopulates the countryside also destroys transgenerational solidarity. Institutions to accommodate the older people—denominational, charitable, and private—are burgeoning in some African countries. Representations of dementia, marked with the projections and rejections of the older persons, run the risk to become worse, while knowledge of the populations

Association between Stressful Life Events and Cognitive Disorders in Central Africa: Results from the EPIDEMCA Program

Background: 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. Method: 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. Results: 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. Conclusion: SLEs were positively associated with MCI but not dementia. More comprehensive studies are needed to further investigate this relationship.

Violence and witchcraft accusations against older people in Central and Western Africa

Social isolation and loss of social status increase the risk of dementia, particularly in Western culture. Prevalence of dementia seems higher in the West than in areas where more traditional culture predominates (Guerchet et al., 2009). However, environmental and social changes mean that this prevalence in traditional societies is likely to increase, particularly in urban regions (Guerchet et al., 2010), where traditional transgenerational family structures tend to disappear and lifestyles are becoming more Westernized. These changes threaten the privileged status of older people, and their relationships with other family members may be subsequently damaged. New diseases that affect young adults, such as AIDS, created a climate of fear and rejection of older people, and suggestions of witchcraft may lead to abuse. Older people had always been held in Africa as belonging to a sacred age group to be treated with reverence and respect and considered as the guardians of tradition and history of the clan (a familial grouping encompassing all the descendants of a unique ancestor). Their closeness to the spirits of the protecting ancestors was thought to enable them to prevent aggression by witchcraft involving harmful spirits. It has long been believed that sorcerers have the power to command harmful spirits and thereby damage health. Illnesses have been always considered to have a supernatural dimension, despite a recent acceptance of more rational explanations. Many revivalist churches (those in the evangelical tradition) are currently being established in Africa. Their leaders are essentially “gurus” who are supplanting the traditional sorcerers and their supposed power to bridge the gap between the real and the hidden (invisible). The quest for a magical/religious explanation for illnesses leads people to look for a culprit. The older people are often suspected to mobilize these ancestors’ spirits to bless individuals and considered as using witchcraft. Consequently, it is common practice to ask the healer about the supernatural origin of serious illness, and older people are easily mentioned as potentially having used witchcraft to do harm. It sometimes happens that an older individual, who is wrongly accused, nevertheless confesses to the accusations in order to relieve the social pressure and, subsequently, develop depressive disorders. Culturally, the older people were expected to be sources of information and training, facilitating the transmission of traditional knowledge and protecting individuals in the clan against invisible forces that can cause illnesses. These valuable qualities of the older people are lost when dementia occurs. In most African cultures, dementia has no name, although the symptoms are recognized and attributed (Faure et al., 2012). Thus, socio-behavioral disorders associated with progressive deterioration of mental functions were not recognized as being pathological. Rather, they are experienced by families as harmful, intentional, and carried out by someone whose role is, by definition, to protect the clan. It is in this context that acts of violence are actually committed against concerned older people, thus running counter to customs and traditions that made them being loved, protected, respected, and even feared because of their supposed powers. Now, the older people are subject to stigma, rejection, and sometimes physical or psychological abuse. It can be suggested that dementia be classified as a mental pathology of the older people and represents failure to compensate for stress imposed by a society in which they feel they have become useless (Sink et al., 2004). Preservation of a traditional culturalmilieu constitutes a defense against the developed culture of Western countries, where individuals who lose their social status immediately become isolated and unappreciated. Dementia can appear to foreshadow death, particularly given the progressive disappearance from modern societies of religious values (Pollitt, 1996). Many workers from voluntary associations report more and more examples of older people being abandoned in villages because they have been rejected. The rural exodus that depopulates the countryside also destroys transgenerational solidarity. Institutions to accommodate the older people—denominational, charitable, and private—are burgeoning in some African countries. Representations of dementia, marked with the projections and rejections of the older persons, run the risk to become worse, while knowledge of the populations

From the social representation of the people with dementia by the family carers in Republic of Congo towards their conviction by a customary jurisdiction, preliminary report from the EPIDEMCA-FU study.

For many people, dementia, its manifestations and absences, remains a mystery. Social representations, conceptions of the disease, and its images contribute, beyond medical knowledge, to the construction of the social reality of the ill person and all those who, directly or indirectly, informally or formally take care of them. They are an integral part of the disease and condition as much its management than attitudes towards those who are affected (Mushi et al., 2014). Indeed, stigma derives of social representations and is linked to negatives stereotypes (Goffman, 1963). The people with dementia (PWD) in our study come from a recent population-based survey, “Epidemiology of Dementia in Central Africa (EPIDEMCA)” (Guerchet et al., 2014). Based on the previous quantitative research in this population, we conducted a qualitative survey of an ethno-anthropological type, among PWD and representatives of customary jurisdiction of “Tenrikyo.” After we gained the confidence of interviewees (major element in a good field investigation), this survey was conducted through non-structured interviews, participant observation, and the analysis of official and personal “materials.” In total, 36 life narratives (19 in the urban area, Brazzaville, and 17 in the rural area, Gamboma) were collected among PWD and family carers speaking for some in French (official language) for others Lingala, Kituba (national languages), or even in Lari and Teke (vernacular languages). The customary jurisdiction of “Tenrikyo” or tribunal for witches (according to the Congolese jargon) only exists in urban area, Brazzaville (political capital of Congo). It is a customary jurisdiction that was created in 1972, which has been placed under the authority of a President, a retired health worker, for the last 15 years (Talani et al., 2015). Its organization and functioning were recognized and validated by a presidential decree. The filing of a complaint costs the equivalent of US

Is dependent personality disorder associated with mild cognitive impairment and dementia in Central Africa? A result from the EPIDEMCA programme

3.2. The price of the notification is US