Two-year remission in Nigerian epileptics.

Seizure profile of 208 male and 137 female Nigerian epileptic patients was studied. The mean age at onset was 21 years and partial seizures predominated at 53.3%. One hundred and forty eight out of the 255 patients (58%) followed up for more than two years attended clinics regularly and 107 defaulted. Only 88 patients (25.5%) were compliant with therapy. Factors associated with two-year seizure remission were: drug compliance (OR = 4.4; 95% CI: 2.0, 9.5) and less than six attacks before therapy commencement (OR = 2.3; 95% CI: 1.1, 4.7). The study revealed high clinic default rate and low therapy compliance as major problems in management of epileptic patients. Health education to improve these and early institution of therapy appear necessary to reduce the proportion of patients that could become chronic epileptics.

Profile of dementia in a Nigerian community--types, pattern of impairment, and severity rating.

Out of 2494 subjects screened in a Nigerian community, 28 patients with dementia were identified. Alzheimer's disease was diagnosed in 18 patients (64.3%), 16 of whom had probable Alzheimer's disease. Eight patients (28.6%) had vascular dementia while one patient each had parkinsonism with dementia and depression with dementia. Patients with Alzheimer's disease were significantly older, predominantly females and illiterates. Cognitive deficit commonly took the form of memory and judgment impairment while financial mismanagement was the most frequent impaired activity of daily living. More than half of the cases had mild disease on severity rating and were comprised mainly of Alzheimer's disease subjects. These results confirm the higher frequency of Alzheimer's disease over the other types as reported in other communities.

Profile of some risk factors for coronary heart disease in a developing country: Nigeria.

The profile of some risk factors for coronary heart disease was studied in 557 male and 325 female Nigerians aged 20 years and above from the low and medium income groups, respectively. Except for the weight of subjects in the low income level, values of all physical characteristics were significantly higher in females than males (P < 0.01). In the 20-39 years age group, the systolic blood pressure was higher in males than females, and among the medium income group than the low income group (P < 0.01); but this difference disappeared in the higher age groups. The mean diastolic blood pressure was higher (but not statistically significant) at medium income levels than low income levels (P > 0.05). In each age group, the mean plasma total cholesterol was significantly higher in the medium income group than in the low income group (P < 0.01). The percentage of smokers and alcohol consumers were higher in the high income group than the low income group (P < 0.01). A high percentage of the smokers and alcohol consumers were male subjects. Blood pressure was correlated with age, smoking and body fat, (P < 0.01). Waist to trochanter ratio, and percentage body fat were significantly related to plasma total cholesterol level (P < 0.01).

Prevalence of Alzheimer's disease and dementia in two communities: Nigerian Africans and African Americans.

OBJECTIVE: 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. METHOD: 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. RESULTS: 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. CONCLUSIONS: 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.

Lack of an association between apolipoprotein E epsilon 4 and Alzheimer's disease in elderly Nigerians.

As part of a community-based study of Alzheimer's Disease (AD) in a Nigerian population aged 65 years and over, we have determined apolipoprotein E (APOE) genotypes on 56 subjects (39 controls and 17 subjects with dementia, including 12 with AD). The epsilon 4 allele of APOE was not associated with AD or dementia in this community-based sample. The epsilon 4 allele frequency was 17.6% in demented patients and 16.7% in AD patients compared with 20.5% in the control subjects. These findings are in marked contrast to the strong association between the epsilon 4 allele and AD in our previously reported study with African Americans.

Carbohydrate tolerance in patients with tropical ataxic neuropathy--A human model of chronic cyanide intoxication.

Patients with tropical ataxic neuropathy (TAN) have been shown to have chronic cyanide intoxication. Glucose tolerance test data in a group of 88 patients with TAN and 88 matched controls who were studied several years ago were analysed. A standard glucose tolerance test (SGTT) with 50 gm dextrose preceded by 50 mgs cortisone acetate orally 8 1/2 and 2 hours before the tests were performed. The SGTT was considered abnormal if the capillary blood glucose at 0.60 and 120 were greater than 120, 200 and 140 mg/100 ml (6.6, 11.1, 7.8 mmol/l) respectively. Capillary blood glucose considered abnormal for CGTT were 205 and 155 mg/100 ml at 60 and 120 (113 and 8.6 mmol/I) respectively. The SGTT was abnormal in 1 of the TAN patients and 2 controls while CGTT was abnormal in 9 TAN patients and 7 controls. However, all controls with abnormal CGTT were older than 50 years while only 1 TAN patient was older than 50 and 6 were 30 years or younger (p = 0.0105), Fischer's probability test. The results suggest a greater statistical risk for subjects with TAN 30 years or younger to have an abnormal CGTT. While this does not predict the future development of diabetes, our observation indicates the need for better designed prospective studies among such patients in developing countries.

The correlates of cortical sulci atrophy and central atrophy in a cohort of schizophrenia and manic subjects in Nigeria.

The prevalence of brain cortical sulci atrophy and central (subcortical) atrophy among Nigerian psychiatric patients is highlighted and compared with findings from developed countries. The relationship between these indices of brain atrophy and clinical parameters is also examined. Visual ratings of cortical sulci atrophy and central (subcortical) atrophy, assessed on the computed tomography (CT) image console, were compared among 50 patients with schizophrenia, 14 patients with mania and 41 healthy control subjects. The patients with schizophrenia and the patients with mania had a significantly higher prevalence of brain atrophy than normal subjects. Among the patients with schizophrenia, indices of brain atrophy were not significantly associated with disease outcome, and the presence of negative symptoms. In view of the findings from a parallel study of the same patients that psychiatric patient groups showed other evidence of CT abnormalities, the findings of this study indicate that the so-called functional psychiatric states in developing countries--as in developed countries--are probably associated with some diffuse neuropathological process.

De novo myotonic dystrophy mutation in a Nigerian kindred.

An expansion of an unstable (CTG)n trinucleotide repeat in the 3' UTR of a gene encoding a putative serine/threonine protein kinase (DMPK) on human chromosome 19q13.3 has been shown to be specific for the myotonic dystrophy (DM) disease phenotype. In addition, a single haplotype composed of nine alleles within and flanking DMPK over a physical distance of 30 kb has been shown to be in complete linkage disequilibrium with DM. This has led to two hypotheses: (1) predisposition for (CTG)n instability results from a founder effect that occurred only once or a few times in human evolution; and (2) elements within the disease haplotype may predispose the (CTG)n repeat to instability. A detailed haplotype analysis of the DM region was conducted on a Nigerian (Yoruba) DM family, the only indigenous sub-Saharan DM case reported to date. Each affected member of this family had an expanded (CTG)n repeat in one of his or her DMPK alleles. However, unlike all other DM populations studied thus far, disassociation of the (CTG)n repeat expansion from other alleles of the putative predisposing haplotype was found. We conclude that the expanded (CTG)n repeat in this family is the result of an independent mutational event. Consequently, the origin of DM is unlikely to be a single mutational event, and the hypothesis that a single ancestral haplotype predisposes to repeat expansion is not compelling.

Schizophrenic and manic brains in Nigerians. Computerised tomography findings.

BACKGROUND: We highlight the profile of brain computerised tomography (CT) measures among Nigerian psychiatric patients for comparison with findings from developed countries, and study of the relationship between CT values and clinical variables. METHOD: Seven brain ventricle measures of 50 schizophrenic patients, 14 manic patients, and 41 healthy control subjects were compared. RESULTS: Patients had a significantly higher mean Sylvian fissure area. The third ventricle of schizophrenic patients was significantly larger than those of control subjects. CT measures were not significantly correlated with duration of illness. CONCLUSION: The so-called functional psychotic states are most probably associated with non-specific brain abnormality.

Autopsy survey for Alzheimer's disease in Nigerian Africans: a preliminary report.

We carried out an autopsy survey on 198 brains of Nigerians aged 40 years and above to determine the occurrence of (neuropathognomonic) changes of Alzheimer's disease (AD) in our elderly patients. Forty five patients (23%) were above 65 years of age. Appropriately stained histological sections of various parts of the brains showed mild cortical neuronal loss and absence of neurofibrillary tangles, senile plaques and amyloid angiopathy--hallmarks of Alzheimer's disease and ageing reported in the Caucasians and Japanese.

A pilot study of dementia in Ibadan, Nigeria.

The initiation of collaborative research involving investigators in developing and developed nations is a complex task. Four key areas to consider in collaborative, international research studies are discussed: administrative concerns, resources, understanding the research design, and problem solving. An example of a successful, international collaborative study of dementia in Ibadan, Nigeria is presented. Factors contributing to the successful outcome are detailed. The importance of the four key areas in the effective implementation of a research project are illustrated.

The CERAD Neuropsychological Test Battery: norms from a Yoruba-speaking Nigerian sample.

One-hundred normal, healthy, Yoruba-speaking Nigerian men and women aged 65 and above completed the Consortium to establish a Registry for Alzheimer's Disease-Neuropsychological Battery (CERAD-NB), a cognitive screening battery used in the evaluation of elderly patients with suspected dementia. Correlational analyses indicated pervasive education-influences on test performance. Gender-effects on the CERAD-NB were accounted for by education and there were essentially no age-effects. Education-stratified normative data are presented for all tests. Factor analysis revealed a one factor solution which accounted for 54.7% of the variance.

Computed tomographic density changes in schizophrenic and manic Nigerian subjects.

There is paucity of computed tomography (CT) studies from developing countries, where schizophrenia is said to have more favourable outcome and present predominantly with positive symptoms. We highlight the densitometric analysis of frontal and parietal areas, assessed by tracing of regions of interest on the slice that passes through the foramen of Monro and the pineal gland. The relationships of the density values with clinical and CT measures were investigated. Fifty schizophrenics, 14 manic and 41 normal subjects were compared. The schizophrenics were assessed with Andreasen's scale for negative symptoms, and outcome was based on the social and clinical condition in the past year. There were no significant differences in mean ages and brain slice area across the groups. In analysis of variance, schizophrenics and manics had significantly higher frontal density than normals. Schizophrenics had significantly higher parietal density than manics and normals (p < 0.001). Parietal density was significantly higher than frontal density, for schizophrenics and normals (p < 0.001). For the patients, density values were not significantly correlated with linear CT measures of atrophy (e.g. ventricle: brain area ratio) and duration of illness. Density values were not significantly associated with outcome, presence of negative symptoms, and visual ratings of cortical sulci and central atrophy. Our findings indicate that schizophrenia in developing countries is also associated with non-specific brain abnormalities.

The diagnosis of dementia associated with alcoholism: a preliminary report of a new approach.

The historical, clinical, neurological and neuropsychological features of 13 subjects with independently diagnosed dementia associated with alcoholism (AlcD) were compared to 13 subjects with probable Alzheimer's disease (AD), matched for age and severity of dementia. Neurological abnormalities were present in all the subjects with AlcD even though the diagnosis of Wernicke-Korsakoff was recorded in only one of these subjects. Only one subject with probable AD demonstrated any neurological abnormality. There was no difference between the AD and AlcD subjects in either the total scores of the Mini-Mental State Examination (MMSE) or in any of the subscores. The presence of neurological signs does appear to be a useful method to assist in the diagnosis of AlcD.

Do young schizophrenics with recent onset of illness show evidence of hypofrontality?

Young schizophrenic patients (n=43), manic controls (n=32), both groups diagnosed according to the Research Diagnostic Criteria and on remission from acute illness, and 53 normal subjects were given a battery of neuropsychologic tests selected to assess different functional areas in the brain. Compared with normal controls, patient groups showed evidence of impaired functioning of many cortical areas but with the schizophrenics having the worst performance. In addition, schizophrenic patients performed poorly in tests designed to assess frontotemporal cortical functioning. This pattern of deficits differentiated schizophrenics from both manic and normal subjects. The results suggest that widespread cognitive deficits are a feature of both schizophrenia and mania but that frontal lobe dysfunction may be more specific to the former. It would also appear that these impairments are not artefacts of age, chronicity or of institutionalization, and are present even in schizophrenic patients who may have an illness with putative better outcome than those studied in previous reports.

Xenobiotic metabolism in idiopathic Parkinson's disease in Nigerian Africans.

The acetylator phenotype using sulphadimidine as a probe drug was studied in 20 idiopathic Parkinson's disease (IPD) patients and 21 control subjects. 10(50%) of the IPD patients belonged to the slow acetylator phenotype but this did not differ significantly from the proportion 7 (33%) of control subjects who were slow acetylators. The result does not suggest a role for acetylation in the aetiopathogenesis of IPD in Nigerian African.

Determination of ages of elderly Nigerians through historical events: validation of Ajayi-Igun 1963 listing.

We compared ages of 59 elderly Nigerians subjects determined independently by records and historical events to validate the Ajayi-Igun listing of 1963. There was no statistically difference between the mean ages of the subjects as determined by the 2 methods (p > 0.05). In almost 50% of the subjects, the ages were exactly the same by both methods and in 93.2%, the difference in ages was 3 years. There was a high significant correlation between the two methods of age determination (Spearman correlation coefficient rs = 0.989, p < 10(-5)). Our study validate the use of historical listing for accurate age determination in Nigerians and its use is advocated for epidemiologic studies and other demographic needs in circumstances where written records of births are lacking.

Clinically-diagnosed dementing illnesses in Ibadan: features, types and associated conditions.

In this hospital-based study of dementing illnesses in Ibadan, 37 cases were seen over a 6 year period from 1984 to 1989 out of 57,440 cases admitted. The average hospital frequency was 64 cases per 100,000 admissions. Eighteen cases (48.7%) had vascular dementia. The other types encountered were: secondary dementias (8), mixed (5), probable primary degenerative (1) and the remaining 5 cases were unclassifiable. The associated conditions were mainly hypertension, parkinsonism, diabetes mellitus and benign prostatic hyperplasia. The findings confirm the relative rarity of primary degenerative dementia in Nigeria and raise the possibility of prevention of the predominant type by identifying the stroke-prone individuals early and intervening.