Vision Impairment and Adverse Health Conditions in Congolese Older People: A Population-Based Study.

INTRODUCTION: 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. METHOD: 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. RESULTS: 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 ß = -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 ß = 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). CONCLUSION: 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.

Self-Reported Vision Impairment and Frailty among Older People with Low Cognitive Performance in Central Africa: EPIDEMCA Population-Based Study.

INTRODUCTION: Very little is known about the impact of vision impairment (VI) on physical health in late-life in sub-Saharan Africa populations, whereas many older people experience it. We investigated the association between self-reported VI and frailty in Central African older people with low cognitive performance. METHODS: It was cross-sectional analysis of data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) population-based study. After screening for cognitive impairment, older people with low cognitive performance were selected. Frailty was assessed using the Study of Osteoporotic Fracture index. Participants who met one of the 3 parameters assessed (unintentional weight loss, inability to do 5 chair stands, and low energy level) were considered as pre-frail, and those who met 2 or more parameters were considered as frail. VI was self-reported. Associations were investigated using multinomial logistic regression models. RESULTS: Out of 2,002 older people enrolled in EPIDEMCA, 775 (38.7%) had low cognitive performance on the screening test. Of them, 514 participants (sex ratio: 0.25) had available data on VI and frailty and were included in the analyses. In total, 360 (70%) self-reported VI. Prevalence of frailty was estimated at 64.9% [95% confidence interval: 60.9%-69.1%] and 23.7% [95% CI: 20.1%-27.4%] for pre-frailty. After full adjustment, self-reported VI was associated with frailty (adjusted odds ratio = 2.2; 95% CI: 1.1-4.3) but not with pre-frailty (adjusted odds ratio = 1.8; 95% CI: 0.9-3.7). CONCLUSION: In Central African older people with low cognitive performance, those who self-reported VI were more likely to experience frailty. Our findings suggest that greater attention should be devoted to VI among this vulnerable population in order to identify early frailty onset and provide adequate care management.

Apolipoprotein E ϵ4 allele and neuropsychiatric symptoms among older adults in Central Africa (EPIDEMCA study).

OBJECTIVES: To evaluate the association between neuropsychiatric symptoms and apolipoprotein E (APOE) ϵ4 allele among older people in Central African Republic (CAR) and the Republic of Congo (ROC). DESIGN: Multicenter population-based study following a two-phase design. SETTING: From 2011 to 2012, rural and urban areas of CAR and ROC. PARTICIPANTS: People aged 65 and over. MEASUREMENTS: Following screening using the Community Screening Interview for Dementia, participants with low cognitive scores (CSI-D ≤ 24.5) underwent clinical assessment. Dementia diagnosis followed the DSM-IV criteria and Peterson's criteria were considered for Mild Cognitive Impairment (MCI). Neuropsychiatric symptoms were evaluated through the brief version of the Neuropsychiatric Inventory (NPI-Q). Blood samples were taken from all consenting participants before APOE genotyping was performed by polymerase chain reaction (PCR). Logistic regression models were used to evaluate the association between the APOE ϵ4 allele and neuropsychiatric symptoms. RESULTS: Overall, 322 participants had complete information on both neuropsychiatric symptoms and APOE status. Median age was 75.0 years and 81.1% were female. Neuropsychiatric symptoms were reported by 192 participants (59.8%) and at least 1 APOE ϵ4 allele was present in 135 (41.9%). APOE ϵ4 allele was not significantly associated with neuropsychiatric symptoms but showed a trend toward a protective effect in some models. CONCLUSION: This study is the first one investigating the association between APOE ϵ4 and neuropsychiatric symptoms among older people in sub-Saharan Africa (SSA). Preliminary findings indicate that the APOE ϵ4 allele was not associated with neuropsychiatric symptoms. Further research seems, however, needed to investigate the protective trend found in this study.

Cardiovascular Health and Near Visual Impairment Among Older Adults in the Republic of Congo: A Population-Based Study.

BACKGROUND: Visual impairment (VI) and determinants of poor cardiovascular health are very common in Sub-Saharan Africa. However, we do not know whether these determinants are associated with VI among older adults in this region. This study aimed at investigating the association between the determinants of poor cardiovascular health and near VI among older adults living in Congo. METHODS: Participants were Congolese adults aged 65 or older included in Epidemiology of Dementia in Central Africa-Follow-up population-based cohort. Near VI was defined as visual acuity less than 20/40 measured at 30 cm. Associations between determinants of poor cardiovascular health collected at baseline and near visual acuity measured at first follow-up were investigated using multivariable logistic regression models. RESULTS: Among the 549 participants included, 378 (68.8%; 95% confidence interval [CI]: 64.9%-72.7%]) had near VI. Of the determinants of poor cardiovascular health explored, we found that having high body mass index of at least 25 kg/m2 (odds ratio [OR] = 2.15; 95% CI: 1.25-3.68), diabetes (OR = 2.12; 95% CI: 1.06-4.25) and hypertension (OR = 1.65; 95% CI: 1.02-2.64) were independently associated with near VI. CONCLUSIONS: Several determinants of poor cardiovascular health were associated with near VI in this population. This study suggests that promoting good cardiovascular health could represent a target for VI prevention among older adults.

Predictive formulas for estimation of height in sub-Saharan African older people: A new formula (EPIDEMCA study).

OBJECTIVES: Chumlea's formulas are a way of predicting height from knee height (KHt), including among individuals >60 y of age who cannot stand upright. However, the formulas were developed with white and African American people and have not yet been validated in native Africans >60 y of age. The aims of the study were to assess Chumlea's formulas in older people in central Africa and to propose a new validated formula for the same population. METHODS: Height (MHt) and KHt were measured in a population of individuals >65 y of age from the Republic of Congo and the central African Republic. Predicted height (PHt) was calculated using Chumlea's formulas for the American black population (CBP) and for whites (CC). The percentages of accurate predictions (±5 cm) were compared between MHt and PHt. A new formula was estimated after randomization in a derivation sample (n = 877) and assessed for accuracy in a validation sample (n = 877). RESULTS: The study included 1754 individuals. Prediction was accurate (±5 cm) in 66.8% and 63.2% of CBP and CC, respectively. Overestimation was as high as 24.1% and 29%, respectively. Because an overestimation is unacceptable in clinical practice and population surveys, a new formula was proposed: height (cm) = 72.75 + (1.86 × KHt [cm]) - (0.13 × age [y]) + 3.41 × sex (0: women; 1: men). This new formula significantly increases accuracy (71.3%) and decreases overestimation (14.7%). The nutritional status based on body mass index did not differ with the MHt and the PHt by the new formula. CONCLUSION: Chumlea's formulas provided a poor estimate of height in this population sample. The proposed formula more accurately estimates height in older native Africans. This formula should be tested in other sub-Saharan African countries to extend its use in clinical practice and in future studies.

Body mass index and peripheral arterial disease, a "U-shaped" relationship in elderly African population - the EPIDEMCA study.

Background: There is no study available concerning specifically the role of underweight in PAD prevalence. Patients and methods: Individuals ≥ 65 years living in urban and rural areas of two countries in Central Africa (Central African Republic and the Republic of Congo) were invited. Demographic, clinical and biological data were collected, and ankle-brachial index measured. BMI was calculated as weight/height2 and participants were categorized according to the World Health Organization as with underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). Results: Among the 1815 participants (age 73.0 years, 61.8 % females), the prevalence of underweight was 34.1 %, higher in subjects with PAD than in PAD free subjects (37.1 % vs. 33.5 %, p = 0.0333). The overall prevalence of PAD was 14.3 %. Underweight and obesity were still significantly associated with PAD after adjustment to all potential confounding factors (OR: 2.09, p = 0.0009 respectively OR: 1.90, p = 0.0336) while overweight was no more significantly associated with PAD after multivariate analysis. Conclusions: While obesity is a well-known PAD associated marker, low BMI provides novel independent and incremental information on African subject's susceptibility to present PAD, suggesting a "U-shaped" relationship between BMI and PAD in this population.

Severity of Neuropsychiatric Symptoms and Distress in Dementia among Older People in Central Africa (EPIDEMCA Study).

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.

People with Dementia in Sub-Saharan Africa: From Support to Abuse by Caregivers: Results of EPIDEMCA-FU Program in Congo.

BACKGROUND/AIMS: Dementia is an emerging public health problem in sub-Saharan Africa (SSA). In SSA, the stigma suffered by people with dementia (PWD) can be strongly linked to pejorative social representations, interfering in social relationships with informal caregivers. The objective of the study was to analyze the consequences of social representations of PWD in social interactions with informal caregivers. METHODS: A qualitative study was conducted in Republic of Congo among 93 interviewees. Nondirectional interviews were conducted in local languages and complemented by participating observations. The collected data were transcribed literally, synthesized, and then coded to allow extraction and organization of text segments. RESULTS: Informal caregivers, daughters-in-laws, were considered as abusers and granddaughters as benevolent. The leaders of syncretic churches and traditional healers were the first therapeutic itineraries of PWD, due to pejorative social representations of disease. Of these, some PWD have appeared at front of a customary jurisdiction for accusations of witchcraft. Dementia, perceived as a mysterious disease by informal caregivers, wasn't medicalized by leaders of syncretic churches, traditional healers, nurses, or general practitioners. Conclusion: Stigma, generated by social representations, can change the patient's behavior and the one of informal caregivers, leading to time delay in the search for appropriate help.

Ankle Brachial Index (ABI) predicts 2-year mortality risk among older adults in the Republic of Congo: The EPIDEMCA-FU study.

BACKGROUND AND AIMS: Peripheral artery disease (PAD) is known to be associated with mortality in high income countries but no data regarding Sub-Saharan Africa (SSA) populations are documented. This study aimed at assessing the prognostic value of the Ankle Brachial Index (ABI) among older adults in the Republic of Congo. METHODS: Congolese subjects ≥65 years were included in a longitudinal population-based survey (EPIDEMCA-FU). Demographic, biological, and clinical data were collected at baseline. PAD was defined by an ABI≤0.90. Information on mortality was collected from key informants in participants' households. Cox proportional hazard models, adjusted for traditional and cardiovascular risk factors, were fitted to evaluate the association between an ABI≤0.90 and death. RESULTS: 1029 participants were recruited at baseline. ABI measurement was obtained from 927 participants, of whom 17.4% presented an ABI≤0.90. During a 2-year follow-up, a total of 83 (9.1%) deaths were recorded. Mortality was higher in the low-ABI group with 23 deaths (14.7%) vs. 57 (7.8%) and 3 (12.0%), respectively among those with 0.90 < ABI<1.4 and ABI≥1.40 (p = 0.039). After adjustment, an ABI≤0.90 was associated with an increased risk of mortality (HR = 1.86; 95%CI 1.04-3.87). Mortality was also independently associated with increasing age (HR = 1.05; 95%CI 1.02-1.09), dementia (HR = 2.73; 95% CI 1.15-8.05), alcohol use (HR = 0.51; 95%CI 0.29-0.88) and female sex (HR = 0.37; 95%CI 0.19-0.72). CONCLUSIONS: In this study, a low ABI predicted an increased mortality risk among older people. ABI may represent a simple and inexpensive tool to identify older people at high risk of death in SSA.

Development of the Central Africa Daily Functioning Interference Scale for Dementia Diagnosis in Older Adults: The EPIDEMCA Study.

BACKGROUND: There are a few validated tools capable of assessing the dimensions essential for the diagnosis of dementia and cognitive disorders in sub-Saharan Africa. OBJECTIVES: Our aim was to develop an adapted tool, the Central African - Daily Functioning Interference (DFI) scale. METHODS: An initial 16-item scale of activity limitations and participation restrictions was completed by 301 participants with low cognitive performances to assess their level of DFI. A psychometric evaluation was performed using Item Response Theory. RESULTS: A unidimensional 10-item scale emerged with a reasonable coverage of DFI (thresholds range: -1.067 to 1.587) with good item discrimination properties (1.397-4.076) and a high reliability (Cronbach's al pha = 0.92). The cutoff for detecting 96% of those with dementia was with a latent score ≥0.035 that corresponds to the LAUNDRY limitation. CONCLUSIONS: These results provide valuable support for the reliability and internal validity of an operational 10-item scale for DFI assessment used in Central Africa for the diagnosis of dementia in the elderly.

Neuropsychiatric symptoms among older adults living in two countries in Central Africa (EPIDEMCA study).

OBJECTIVES: Our study aimed at estimating the prevalence of neuropsychiatric symptoms and investigating associated factors among older adults living in two countries in Central Africa (Central African Republic [CAR] and Republic of Congo [ROC]). METHODS: The EPIDEMCA multicentre population-based study was carried out in rural and urban areas of CAR and ROC between 2011 and 2012 among people aged 65 and over. After cognitive screening using the Community Screening Interview for Dementia, participants with low performances underwent neurological examination including the brief version of the Neuropsychiatric Inventory Questionnaire (NPI-Q). Multivariate logistic regression analyses were performed to identify factors independently associated with neuropsychiatric symptoms in this population. RESULTS: NPI-Q data were available for 532 participants. Overall, 333 elderly people (63.7%) reported at least one neuropsychiatric symptom. The prevalence of neuropsychiatric symptoms was 89.9% (95% CI, 84.6-95.1) in participants with dementia, 73.4% (95% CI, 65.1-81.7) in participants with mild cognitive impairment (MCI), and 48.7% (95% CI, 42.9-54.6) in participants with no MCI nor dementia after neurological examination (P < 0.0001). The most common symptoms were depression, anxiety, and irritability. Participants living in Gamboma, with normal hearing and with friends in the community, were less likely to present neuropsychiatric symptoms. Physical disability, difficulties in eating, female sex, and dementia were significantly associated with neuropsychiatric symptoms. CONCLUSION: Neuropsychiatric symptoms are common among older people with neurocognitive disorders in CAR and ROC. Our results confirm those from previous studies in Nigeria and Tanzania. Nevertheless, knowledge of these symptoms remains limited in sub-Saharan Africa, hampering their appropriate management.

Prevalence of toxoplasmosis and its association with dementia in older adults in Central Africa: a result from the EPIDEMCA programme.

OBJECTIVE: We aimed at estimating the seroprevalence of Toxoplasma gondii (T. gondii) infection in older adults living in Central Africa and investigating its association with dementia using data from the Epidemiology of Dementia in Central Africa (EPIDEMCA) programme. METHODS: A cross-sectional multicentre population-based study was carried out among participants aged 73 (±7) years on average, living in rural and urban areas of the Central African Republic and the Republic of Congo between November 2011 and December 2012. Blood samples were collected from each consenting participant. The detection of anti-T. gondii immunoglobulin G antibodies was performed in 2014 in France using a commercially available ELISA kit. Participants were interviewed using a standardised questionnaire including sociodemographic characteristics. DSM-IV criteria were required for a diagnosis of dementia. Multivariate binary logistic regression models were used to assess the association between toxoplasmosis infection and dementia. RESULTS: Among 1662 participants, the seroprevalence of toxoplasmosis was 63.0% (95% confidence interval (CI): 60.7-65.3) overall, 66.6% (95%CI: 63.4-69.8) in Central African Republic and 59.4% (95%CI: 56.1-62.7) in the Republic of Congo. In multivariate analyses, toxoplasmosis status was significantly associated with increasing age (P = 0.006), Republic of Congo (P = 0.002), urban area (P = 0.001) and previous occupation (P = 0.002). No associations between dementia and toxoplasmosis status or anti-T. gondii IgG titres were found. CONCLUSION: Toxoplasma gondii infection was not associated with dementia among older adults in Central Africa. Our findings are consistent with previous studies and add to the knowledge on the relationship between T. gondii infection and neurological disorders.

Ankle-Brachial Index: An Ubiquitous Marker of Cognitive Impairment-The EPIDEMCA Study.

Epidemiological research on the implication of atherosclerosis in the development of cognitive impairment is lacking in low- and middle-income countries, where two-thirds of the individuals affected by dementia live. Individuals aged ≥65 years living in urban and rural areas of 2 countries in Central Africa were invited. Demographic, clinical, and biological data were collected, and the ankle-brachial index (ABI) was measured. Cognitive impairment was defined according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Among 1662 participants (age 72.9 years, 59.3% females), the prevalence of cognitive impairment was 13.6%, which is higher in individuals with ABI ≤ 0.90 and ABI ≥ 1.40 than those with 0.90 < ABI < 1.40 (20.1% and 17% vs 12%, P = .0024). Cognitive impairment was significantly associated with the factors such as age (odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.07-1.12, P < .0001), female gender (OR: 2.36, 95% CI: 1.59-3.49, P < .0001), smoking (OR: 1.54, 95% CI: 1.06-2.23, P = .0026), and low ABI (≤0.90; OR: 1.52, 95% CI: 1.03-2.25, P = .0359). The ABI, a ubiquitous marker of atherosclerosis, provides independent and incremental information on susceptibility to present with cognitive disorders.

Prevalence, awareness, treatment, and control of hypertension in older people in Central Africa: the EPIDEMCA study.

Hypertension represents a major global health burden. While older individuals of African descent are at higher risk of hypertension in western countries, epidemiologic data on hypertension in older native Africans are scarce. We assessed the prevalence and the level of awareness and control of hypertension among older adults in Central Africa. A total of 1990 individuals aged 65 years and older from the Republic of Congo and the Central African Republic participated into a cross-sectional population-based survey. Hypertension was defined by self-reporting of ongoing treatment and/or systolic blood pressure/diastolic blood pressure at rest being ≥140 and/or 90 mm Hg. Controlled hypertension was defined as treated hypertension with systolic blood pressure <140 mm Hg and diastolic blood pressure <90 mm Hg. The overall prevalence of hypertension was 61.1%. Among hypertensive people, 46.7% were aware of their condition and 17.3% were treated. Among the latter, 23.8% had their hypertension controlled. Correlates of hypertension were increasing age and body mass index, living in the Republic of Congo, occupation other than employee, no tobacco use, sedentary lifestyle, and ≥3 meals a day. Our findings indicate a need for the implementation of public health policies to reduce hypertension in older Africans and to prevent the subsequent burden of cardiovascular diseases.

Erratum to: Epidemiology of dementia in Central Africa (EPIDEMCA): protocol for a multicentre population-based study in rural and urban areas of the Central African Republic and the Republic of Congo.

[This corrects the article DOI: 10.1186/2193-1801-3-338.].

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).

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

Aß-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 Aß 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 Aß-CAA.

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 Petersen's 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.

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.