Factors associated with neurocognitive impairment in treatment experienced HIV+ Adults: A perspective from a Tertiary Care Center in Ethiopia: factors associated with HAND in Ethiopia

Background: Given the improvement in life expectancy of people living with HIV (PLWH) in sub-Saharan Africa, the risk of asymptomatic HIV-associated neurocognitive disorder (HAND) has increased. The study objectives were to investigate the prevalence of HAND and associated factors among treatment experienced adults in Ethiopia. Methods: A single-center observational cross-sectional study was conducted between December 2019 and June2020 to investigate HAND. International HIV dementia scale (IHDS) was used to screen for the disorder. Both descriptive and analytical statistics were used to analyze the data. Results: Total of 324 PLWH (63% females) who were on combination antiretroviral therapy for median of 144months (IQR: 108-168) were investigated. The mean age was 42.5 years (1SD=12.2). The prevalence of HAND was 75.3% and the difference was significantly more in those above 40 years of age (65.8% vs. 80.7%, p=0.003). Age is the only risk factor identified with multivariable logistic regression analysis. A linear decrement in the total score of cognitive performance was observed as the patient's age increase; age was responsible for 9.4% variation observed in IHDS score (r= -0.31, R2=0.094, p<0.0001). Although statistically not-significant, the trend for cardio-metabolic and behavioral risk factors (hypertension, diabetes mellitus, dyslipidemia, smoking, alcohol and khat use) was higher in the group diagnosed with HAND. Conclusion: The occurrence of neurocognitive impairment was more pronounced in individuals aged 40 years and above who were HIV positive, compared to those below 40 years. Age was found to be an independent predictor of HAND. Cardiovascular and behavioral risk factors were observed more among patients with HAND compared to no-HAND

Screening for neurocognitive deficits in adult populations reliant on toxic cassava as the main source of food

Context and objective. Chronic dietary reliance on improperly processed cyanogenic toxic cassava is widespread in sub-Saharan Africa. The objective of the present study was to screen for neurocognition impairments and daily-life functioning in adults with dietary dependency on cyanogenic cassava as the main source of food. Methods. A cross-sectional design enrolled heads of households (in couples) in the rural district of Kahemba, Democratic Republic of Congo. Participants were screened for neurocognitive impairments using the Community Screening Interview for Dementia (CSID). Detailed neuropsychiatric evaluations were performed and disease entities classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria when applicable. Cassava cyanogenic exposure was ascertained by urinary concentrations of thiocyanate (SCN). Regression models were used to identify predictors of CSID performance at the 0.05 significance level. Results. For hundred and six households (203 couples, mean age 38.4 ± 11. 4 years) were involved. One hundred thirty-six subjects (33.5 %) [69 women and 67 men, mean age 39 ± 14.4 years)] and 13 (3.2 %) [7 women and 6 men, mean age: 32 ± 2.6 years] fulfilled the criteria for mild cognitive impairment (MCI) and Major Neurocognitive disorder (MNCD), respectively. The overall mean urinary concentration of SCN was 949.5+518.3 mol/l after adjusting Context and objective. Chronic dietary reliance on improperly processed cyanogenic toxic cassava is widespread in sub-Saharan Africa. The objective of the present study was to screen for neurocognition impairments and daily-life functioning in adults with dietary dependency on cyanogenic cassava as the main source of food. Methods. A cross-sectional design enrolled heads of households (in couples) in the rural district of Kahemba, Democratic Republic of Congo. Participants were screened for neurocognitive impairments using the Community Screening Interview for Dementia (CSID). Detailed neuropsychiatric evaluations were performed, and disease entities classified according to the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) criteria when applicable. Cassava cyanogenic exposure was ascertained by urinary concentrations of thiocyanate (SCN). Regression models were used to identify predictors of CSID performance at the 0.05 significance level. Results. For hundred and six households (203 couples, mean age 38.4 ± 11. 4 years) were involved. One hundred thirty-six subjects (33.5 %) [69 women and 67 men, mean age 39 ± 14.4 years)] and 13 (3.2 %) [7 women and 6 men, mean age: 32 ± 2.6 years] fulfilled the criteria for mild cognitive impairment (MCI) and Major Neurocognitive disorder (MNCD), respectively. The overall mean urinary concentration of SCN was . for age, gender, nutritional status, and history of konzo, neurocognition domain-specific deficits were independently associated with either hypertension or USCN (350mol / l incremental increase in excretion Functional impairments in daily-life activities increased as subjects poorly performed at the CSID screening (Spearman r = - .2, p < 0.01). Conclusion. Neurocognitive deficits in adults are common in Congolese adults relying on cyanogenic cassava as the main source of food. Our study findings warrant further studies to elucidate the overall lifespan brain/behavioral burden and mechanisms of cassava toxicity among adults with dietary dependency on cyanogenic cassava as the main source of food

Late-life depression and the family physician

Late-life depression (LLD) is a common disorder seen in clinical practice. Depression in this population group is often left undetected and untreated. The majority of elderly individuals who seek help present to the primary health care setting. The family physician is ideally placed to screen for symptoms of LLD, given that they often have longitudinal knowledge of the patient's history, premorbid personality, functioning and overall health status. An understanding of risk factors, differential diagnoses, appropriate opportunistic screening toolsand decision-making around management plans can assist the family physician in the early detection and treatment of these patients. In doing so, this may lead to a decrease in mortality and morbidity and enhance the patient's quality of life.Keywords: Late life; depression; older; geriatric mental health; major depressive disorder; antidepressants; cognitive impairment; dementia.

Body mass index, blood pressure, and cognitive impairment among type 2 diabetic patients in a primary care setting, North-Central Nigeria

The long-term effects of certain clinical factors on cognition cannot be overemphasized. The morbidity of Cognitive Impairment (CI) in patients with type 2 diabetes has been found to increase when associated with some clinical factors. The main objective of this study was to determine the relationship between CI and Body Mass Index (BMI) as well as CI and Blood Pressure (BP), among type 2 diabetic patients attending the primary care unit of a tertiary hospital. It was a descriptive hospital-based crosssectional study. Ethical approval was obtained from the Ethical Review Committee of the University of Ilorin Teaching Hospital (UITH) before the commencement of the study. Data was collected from 274 adult type 2 diabetic patients attending the Family Medicine clinics of the hospital, from March through May 2017. Interviewer-administered structured and semi-structured questionnaires were used to obtain information from the respondents. The Mini-Mental State Examination (MMSE) was used to assess CI among respondents. The BMI and BP of participants were obtained following standard procedure. Data was collated and analyzed using the Statistical Package for Social Sciences version 21 (SPSS- 21). The elderly constituted a higher proportion of participants 55.4%. Respondents were mainly females (70.8%), married (78.8%), and educated (78.1%). The clinical factor that had a statistically significant association with CI was the BMI of participants with a chi-square value (χ2) of 11.139 and a p-value of 0.048. Blood pressure had no statistically significant association with CI (χ2 of 5.181 and p-value of 0.159). CI is common in our clinics with a prevalence of 27% seen in this study. BMI had a statistically significant association with CI while BP was not. Hence, maintaining a normal weight may help in controlling CI. Physicians in primary care should routinely screen type 2 diabetic patients for CI as well as control risk factors for it.

Les troubles cognitifs dans les syndromes cliniquement isolés: Etude cas-témoins / Cognitive impairment in clinically isolated syndromes: A control-case study

ntroduction - L'atteinte cognitive est fréquente dans la Sclérose en Plaques (SEP) mais son diagnostic se fait souvent tardivement, au stade de désinsertion sociale et professionnelle. Les études portant sur les aspects cognitifs dans les formes pré-coces de la SEP tels que les syndromes cliniquement isolés (SCI) et les syndromes radiologiquement isolés (SRI) sont rares.Objectifs - Analyserles fonctions cognitives d'un premier événement démyélinisant et identifier les domainesqui seraient les plus précocement atteints.Patients et méthodes - Le profil cognitif d'une populationhomogène de 13 patients présentant unSCI a été évalué, eta été comparé à 15 témoins sains appareillés en fonction de l'âge, du sexe et du niveau d'éducation. Une batterie de tests neu-ropsychologiques(BCCogSEP, batterie courte d'évaluation cognitive de la SEP),vali-dée dans la SEP, a été utilisée. Ses composants explorent les capacités mnésiques et verbales, l'attention, la vitesse de traitement de l'information (VTI) et les fonctions exécutives.Résultats - Lesperformances cognitives globales étaient amoindries dans le groupe SCI, comparativement au groupe témoin. Sur les 13 patients atteints de SCI, cinq (38%) présentaient une altération cognitive globale qui a été objectivée par l'at-teinte d'au moins deux ou trois tests de la batterie. La PASAT (Paced Auditory Serial Addition Test)était le test le plus altéré (84,6% d'atteinte). La VTI et la mémoire de travail étaient les fonctions les plus atteintes chez les patients.Conclusion - Les dysfonctions cognitives peuvent se voir très précocement et peuvent grever lourdement le pronostic de la SEP.

Introduction - Cognitive impairment is common in multiple sclerosis (MS) but its diagnosis is often made late, at the stage of social and professional disinsertion. Studies of the cognitive aspects in early forms of MS such as clinically isolated syndrome (CIS) and radiologically isolated syndrome (RIS) are rare. Objectives - To analysis the cognitive functions of a first demyelinating event and identify the areas that would be most affected early. Patients and methods - The cognitive profile of a homogeneous population of 13 patients with a CIS was evaluated, and compared with 15 healthy controls, matched according to age, sex and level of education. A battery of neuropsychological tests (BCCogSEP, Short battery for cognitive assessment of MS) validated in MS,was used. Its components explore memory and verbal skills, attention, information processing speed (IPS) and executive functions. Results - The overall cognitive performance was reduced in the CIS group,compared to control group. Five out of thirteen CIS patients (38%) had an overall cognitive impairment, demonstrated by the achievement of at least two or three battery tests. The Paced Auditory Serial Addition Test (PASAT) was the most altered test (84.6% impairment). IPS and working memory were the most affected functions in the patients. Conclusion - Cognitive dysfunctions can be seen very early and can severely affect the prognosis of MS.

Diabetes Mellitus and the Brain : Special Emphasis on Cognitive Function : Review

Diabetes mellitus (DM) is a major public health problem. Cognitive deficits are common with DM which range from subclinical or subtle to severe deficits such as dementia. Both hypoglycaemia and hyperglycaemia are causes of cognitive impairment with DM. In patients with DM; not only severe hypoglycaemia but also recurrent mild or moderate hypoglyacemia have deleterious effect on the brain. Recurrent mild/moderate hypoglycaemia is associated with intellectual decline; reduced attention; impaired mental abilities and memory deficits. Hypoglycaemia may result in abnormalities of neuronal plasticity; synaptic weakening and scattered neuronal death in the cerebral cortex and hippocampus. Chronic hyperglycaemia in type 1 and type 2 DM is associated with low IQ (verbal; performance and total) and abnormalities in testing for different domains of cognitive function such as verbal relations; comprehension; visual reasoning; pattern analysis; quantitation; memory; learning; mental control; psychomotor efficiency; mental and motor processing speed and executive function. The suggested mechanisms incriminated in the pathogenesis of hyperglycaemia-related cognitive dysfunction include; macro- and microvascular disease or vasculopathy; hyperlipidaemia; hypertension; insulin resistance and hyperinsulinaemia; stress response; direct toxic effect of chronic hyperglycaemia on the brain; advanced glycation end-products; inflammatory cytokines and oxidative stress. Hyperglycaemia causes oxidative stress; amyloidosis; angiopathy; abnormal lipid peroxidation; accumulation of ?-amyloid and tau phosphorylation; neuro-inflammation; mitochondrial pathology; apoptosis and neuronal degeneration in the cortex and hippocampus. Depression has been identified as a risk for accelerated cognitive decline with DM. The knowledge that diagnosis at an early age; frequency of hypoglycaemia; poor glycaemic control and presence of risk factors negatively affect cognitive functions in DM will have important implications for treatment and research purposes

Assessment of Mild Cognitive Impairment with Mini Mental State Examination among Adults in Southeast Nigeria

Mild cognitive impairment is a recently described neuropsychiatric entity with the possibility of evolving into overt dementia. It has been found to respond to therapeutic intervention; thus halting or significantly retarding the progression to dementia. Resource-poor countries like Nigeria can hardly afford to provide optimal care for dementia patients. Knowledge about mild cognitive impairment in Nigeria is limited. An appreciation of the probable burden may help stimulate and galvanize appropriate public health policies in response. Aim: This cross-sectional; descriptive study sought to determine the frequency of subclinical mental state abnormalities in a cohort of apparently normal adult Nigerians. Subjects and Methods: One hundred and thirty-five apparently normal adult Nigerians of both sexes seen at the University of Nigeria Teaching Hospital; Enugu; were interviewed. The Mini Mental State Examination (MMSE) of Folstein; Folstein; and McHugh was used to assess cognitive function in each subject at a single instance. The results obtained were analyzed using SPSS version 11.3 (Chicago; IL). Consent was obtained from each person and approval obtained from the hospital's ethics review board. Results: A cut-off score of ?17 was obtained for normal cognitive function in this population using the MMSE. Minimum score obtained was 12; while the maximum score was 30. A mean (2SD) of 24.84 (7.94) was obtained on analysis of the overall MMSE scores of the 135 individuals. Cognitive impairment was identified in 5.93 (8/135) of the subjects examined. These persons thus represent otherwise normal functional individuals with unrecognized mild cognitive impairment who may be at risk of developing overt dementia in future. Conclusion: The concept of mild cognitive impairment needs further large-scale studies in Nigerians with possible multi-centre participation to fully elucidate the scope of the problem. Strategies for the appropriate management of dementia need to be strengthened

Frequency of Cognitive Impairment and Depression in Parkinson's Disease: A Preliminary Case-Control Study

Background: This study aimed to determine the frequency of cognitive impairment and depression in our Parkinson's Disease (PD) and their relationship with disease severity and disability. Patients and Methods: A total of 40 PD patients and 40 age-; sex-; and educationally matched controls were studied. The Unified Parkinson Disease Rating Scale (UPDRS) Motor and Activities of Daily Living (ADL) scores and the Hoehn and Yahr (HY) stage were documented. Depression was assessed using the Zung Self-Rating Depression Scale (ZSDS); while cognition was evaluated using a composite score of the mini-mental state examination (MMSE) score and category fluency score. Results: A total of 55 (22/40) of PD and 10 (4 of 40) of controls had depression (P0.001). A total of 60 of PD (24/40) and 5 of controls (2/40) had cognitive impairment (P0.001). Both NMS coexisted in 16 of 40 PD (40) compared with none of the controls (P0.001). UPDRS (motor and ADL) scores and HY stage were significantly worse with impaired ZSDS scores - P 0.001. UPDRS ADL was significantly impaired by the presence of cognitive impairment. Coexisting depression and cognitive impairment were associated with significant worsening of all scores of severity and disability. Conclusion: Cognitive impairment and depression accompany our PD and are related to disability and worsening disease severity