Abstract
BackgroundThe worldwide population is ageing and the proportion of elderly aged 60 and over is expected to dramatically rise in Low and Middle Income Countries (LMIC). The epidemic of dementia will not spare those countries, where the largest increases in numbers of people affected are estimated. Besides, dementia is still understudied in sub-Saharan Africa (SSA) compared to other regions. This paper describes the protocol for the ‘Epidemiology of Dementia in Central Africa’ population-based study, which aims at estimating the prevalence of dementia in two countries of Central Africa and investigating possible risk factors.Methods/DesignA multicenter population-based study was carried out in Central African Republic and Republic of Congo between 2011 and 2012 including both urban and rural sites in each country. Around 2000 participants aged ≥65 years old were interviewed in total using the Community Screening Interview for Dementia (CSI-D), the GMS-AGECAT and the CERAD’s 10-word list. Elderly with low performance to the cognitive part of the CSI-D (COGSCORE ≤ 24.5) were then clinically assessed by neurologists and underwent further psychometrical tests. DSM-IV and NINCDS-ADRDA criteria were required for dementia and Alzheimer’s disease (AD) diagnoses respectively. The algorithmic 10/66 dementia diagnosis was also determined. Petersen’s criteria were required for the diagnosis of Mild Cognitive Impairment. Sociodemographic, and environmental factors including vascular, nutritional, biological, psychosocial and lifestyle factors were collected in each setting in order to investigate factors associated with dementia. Blood sampling was realized to investigate genetic variations that could modify the risk of dementia.DiscussionFor now, no large epidemiological study has been undertaken to compare the prevalence of dementia in both rural and urban areas within SSA countries. This programme will provide further evidence regarding the prevalence of dementia in SSA, and also the possible rural/urban disparities existing with associated factors. Furthermore, the genetics of AD in those populations will be addressed.
Highlights
The worldwide population is ageing and the proportion of elderly aged 60 and over is expected to dramatically rise in Low and Middle Income Countries (LMIC)
For no large epidemiological study has been undertaken to compare the prevalence of dementia in both rural and urban areas within sub-Saharan Africa (SSA) countries
This programme will provide further evidence regarding the prevalence of dementia in SSA, and the possible rural/urban disparities existing with associated factors
Summary
Methodological issues One-phase studies may be an ideal for dementia prevalence studies (Prince 2000) but two-phase studies, often preferred in low and middle-income countries, are a more pragmatic approach to research when carrying out a full clinical assessment of large populations is not possible due to practical and financial constraints. Abbreviations 10/66 DRG: 10/66 Dementia Research Group; ABI: Ankle-Brachial Index; AD: Alzheimer disease; ADI: Alzheimer’s Disease International; AGECAT: The automated geriatric examination for computer assisted taxonomy; AMC: Arm muscle circumference; APOE: Apolipoprotein E; APP: Amyloid beta precursor protein; BMI: Body mass index; BPSD: Behavorial and psychological symptoms of dementia; CAR: Central African Republic; CERAD: Consortium to establish a registry for Alzheimer’s disease; CERSSA: Comité d’Ethique de la recherche en sciences de santé; CNIL: Commission nationale de l’Informatique et des Libertés; CPPSOOM: Comité de protection des personnes sud-ouest outre-mer; CRP: C-Reactive protein; CSI-D: Community screening interview for dementia; DBP: Diastolic blood pressure; DNA: Deoxyribonucleic acid; DPD: Dependent personality disorders; DSM: Diagnostic and statistical manual of mental disorders; EDTA: ethylenediaminetetraacetic acid; EDAC: Epidemiologie des Démences en Afrique Centrale; EPIDEMCA: Epidemiology if dementia in Central Africa; GMS: Geriatric mental state; GWAS: Genome Wide Association Studies; HIC: High income countries; ICD: International classification of diseases; IQR: Interquartile range; LMIC: Low and middle income countries; MCI: Mild cognitive impairment; MUAC: Mid-upper arm circumference; NINCDS-ADRDA: National Institute of Neurological and Communicative Disorders and Stroke and the Alzheimer’s Disease and Related Disorders Association; NPI: NeuroPsychiatric inventory; PCR: Polymerase chain reaction; PS1: Presenilin-1; RGPH: Recensement de la Population et de l’Habitat; ROC: Republic of Congo; SBP: Systolic blood pressure; SD: Standard deviation; SOF: Study of osteoporotic fracture; SSA: Sub-Saharan Africa; WHO: World Health Organization; WHR: Waist hip ratio.
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