Neuropsychiatric symptoms among older adults living in two countries in Central Africa (EPIDEMCA study)
Inès Yoro-Zohoun
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
Laboratory of Chronic Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, School of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
Search for more papers by this authorPhilippe Nubukpo
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
CHU Esquirol, Addictology Department, Limoges, France
Search for more papers by this authorDismand Houinato
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
Laboratory of Chronic Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, School of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
Search for more papers by this authorPascal Mbelesso
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
Department of Neurology, Amitié Hospital, Bangui, Central African Republic
Search for more papers by this authorBébène Ndamba-Bandzouzi
Department of Neurology, Brazzaville University Hospital, Brazzaville, Republic of Congo
Search for more papers by this authorJean-Pierre Clément
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
CHU Esquirol Hospital and University Federation of Adult and Geriatric Psychiatry, Limoges, France
Search for more papers by this authorJean-Francois Dartigues
Inserm U1219, Bordeaux Population Health Research Centre, Bordeaux, France
Search for more papers by this authorPierre-Marie Preux
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
Department of Medical Information and Evaluation, Clinical Research and Biostatistic Unit, Limoges University Hospital, Limoges, France
Search for more papers by this authorCorresponding Author
Maëlenn Guerchet
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neurosciences, London, UK
Correspondence
Dr M. Guerchet, INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, 2 rue du Dr Marcland, Limoges-Cedex 87025, France.
Email: [email protected]
Search for more papers by this authorfor the EPIDEMCA Group
Search for more papers by this authorInès Yoro-Zohoun
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
Laboratory of Chronic Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, School of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
Search for more papers by this authorPhilippe Nubukpo
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
CHU Esquirol, Addictology Department, Limoges, France
Search for more papers by this authorDismand Houinato
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
Laboratory of Chronic Diseases Epidemiology (LEMACEN), Faculty of Health Sciences, School of Health Sciences, University of Abomey-Calavi, Cotonou, Benin
Search for more papers by this authorPascal Mbelesso
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
Department of Neurology, Amitié Hospital, Bangui, Central African Republic
Search for more papers by this authorBébène Ndamba-Bandzouzi
Department of Neurology, Brazzaville University Hospital, Brazzaville, Republic of Congo
Search for more papers by this authorJean-Pierre Clément
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
CHU Esquirol Hospital and University Federation of Adult and Geriatric Psychiatry, Limoges, France
Search for more papers by this authorJean-Francois Dartigues
Inserm U1219, Bordeaux Population Health Research Centre, Bordeaux, France
Search for more papers by this authorPierre-Marie Preux
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
Department of Medical Information and Evaluation, Clinical Research and Biostatistic Unit, Limoges University Hospital, Limoges, France
Search for more papers by this authorCorresponding Author
Maëlenn Guerchet
INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, Limoges, France
Institute of Neuroepidemiology and Tropical Neurology, School of Medicine, University of Limoges, Limoges, France
King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neurosciences, London, UK
Correspondence
Dr M. Guerchet, INSERM UMR1094, Tropical Neuroepidemiology, University of Limoges, 2 rue du Dr Marcland, Limoges-Cedex 87025, France.
Email: [email protected]
Search for more papers by this authorfor the EPIDEMCA Group
Search for more papers by this authorAbstract
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.
CONFLICT OF INTEREST
None declared.
Supporting Information
| Filename | Description |
|---|---|
| gps5006-sup-0001-Supplementary Tables.docxWord 2007 document , 27.6 KB |
Table S1: Sociodemographic characteristics of participants selected for the second stage, included in the study and the ones excluded from the study, EPIDEMCA, 2011–2012 Table S2. Characteristics of included participants according to cognitive disorders, EPIDEMCA, 2011–2012 Table S3. Prevalence of each neuropsychiatric symptom according to their country, EPIDEMCA, 2011–2012 Table S4. Prevalence of each neuropsychiatric symptom in Alzheimer's Disease and in vascular dementia, EPIDEMCA, 2011–2012 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Kales HC, Gitlin LN, Lyketsos CG. Assessment and management of behavioral and psychological symptoms of dementia. BMJ. 2015; 350: h369. https://doi.org/10.1136/bmj.h369
- 2Lyketsos CG, Steinberg M, Tschanz JT, Norton MC, Steffens DC, Breitner JCS. Mental and behavioral disturbances in dementia: findings from the Cache County Study on Memory in Aging. Am J Psychiatry. 2000; 157(5): 708-714. https://doi.org/10.1176/appi.ajp.157.5.708
- 3Van der Linde RM, Dening T, Matthews FE, Brayne C. Grouping of behavioural and psychological symptoms of dementia. Int J Geriatr Psychiatry. 2014; 29(6): 562-568. https://doi.org/10.1002/gps.4037
- 4Ferri CP, Ames D, Prince M. 10/66 dementia research group. Behavioral and psychological symptoms of dementia in developing countries. Int Psychogeriatr IPA. 2004; 16(4): 441-459. https://doi.org/10.1017/S1041610204000833
- 5Baiyewu O, Unverzagt F, Ogunniyi A, et al. Behavioral symptoms in community-dwelling elderly Nigerians with dementia, mild cognitive impairment, and normal cognition. Int J Geriatr Psychiatry. 2012; 27(9): 931-939. https://doi.org/10.1002/gps.2804
- 6Paddick S-M, Kisoli A, Longdon A, et al. The prevalence and burden of behavioural and psychological symptoms of dementia in rural Tanzania. Int J Geriatr Psychiatry. 2015; 30(8): 815-823. https://doi.org/10.1002/gps.4218
- 7 WHO. WHO: Mental health and older adults. WHO. http://www.who.int/mediacentre/factsheets/fs381/en/. Published 2015. Accessed October 17, 2017.
- 8Teipel SJ, Thyrian JR, Hertel J, et al. Neuropsychiatric symptoms in people screened positive for dementia in primary care. Int Psychogeriatr. 2015; 27(1): 39-48. https://doi.org/10.1017/S1041610214001987
- 9Hazzan AA, Ploeg J, Shannon H, Raina P, Oremus M. Caregiver perceptions regarding the measurement of level and quality of care in Alzheimer's disease. BMC Nurs. 2015; 14(1): 54. https://doi.org/10.1186/s12912-015-0104-8
- 10Baiyewu O, Smith-Gamble V, Akinbiyi A, et al. Behavioral and caregiver reaction of dementia as measured by the neuropsychiatric inventory in Nigerian community residents. Int Psychogeriatr IPA. 2003; 15(4): 399-409. https://doi.org/10.1017/S1041610203009645
- 11Prince M, Comas-Herrera A, Knapp M, Guerchet M, Karagiannidou M. World Alzheimer Report 2016 Improving healthcare for people living with dementia coverage, quality and costs now and in the future. 2016.
- 12Guerchet M, Mbelesso P, Ndamba-Bandzouzi B, et al. 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. SpringerPlus. 2014; 3(1): 338. https://doi.org/10.1186/2193-1801-3-338
- 13Hall K, Hendrie H, Brittain H, Norton J. The development of a dementia screening interview in two distinct languages. Int J Methods Psychiatr Res. 1993; 3: 1-28.
- 14Copeland JRM, Dewey ME, Griffiths-Jones HM. A computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT. Psychol Med. 1986; 16(1): 89-99. https://doi.org/10.1017/S0033291700057779
- 15Grober E, Buschke H, Crystal H, Bang S, Dresner R. Screening for dementia by memory testing. Neurol. 1988; 38(6): 900-903. https://doi.org/10.1212/WNL.38.6.900
- 16Zazzo R. Test des deux barrages. Actualités Pédagogiques et Psychologiques. Neuchâtel, Delachaux & Niestlé. In: Vol 7. ; 1974.
- 17Isaacs B, Kennie AT. The set test as an aid to the detection of dementia in old people. Br J Psychiatry. 1973; 123(575): 467-470. https://doi.org/10.1192/bjp.123.4.467
- 18Edjolo A, Ndamba Bandzouzi B, Mbelesso P, et al. Development and evaluation of the Central Africa Dependency Scale (CA-D) for dementia diagnosis in older with item response theory: the EPIDEMCA study. Alzheimers Dement. 2017; 13(7): P735-P736. https://doi.org/10.1016/j.jalz.2017.06.960
10.1016/j.jalz.2017.06.960 Google Scholar
- 19Robert P, Michel E, Benoit M, et al. Validation du NPI-R, version réduite de l'Inventaire Neuropsychiatrique français. Revue Neurologique - REV NEUROL. 2005; 161: 126-126. https://doi.org/10.1016/S0035-3787(05)85398-6
- 20Van der Linde RM, Stephan BC, Dening T, Brayne C. Instruments to measure behavioural and psychological symptoms of dementia: changing use over time. Int J Geriatr Psychiatry. 2013; 28(4): 433-435. https://doi.org/10.1002/gps.3856
- 21Cummings JL, Mega M, Gray K, Rosenberg-Thompson S, Carusi DA, Gornbein J. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurol. 1994; 44(12): 2308-2314. https://doi.org/10.1212/WNL.44.12.2308
- 22Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurol. 1997; 48(5 Suppl 6): S10-S16. https://doi.org/10.1212/WNL.48.5_Suppl_6.10S
- 23Kaufer DI, Cummings JL, Christine D, et al. Assessing the impact of neuropsychiatric symptoms in Alzheimer's disease: the Neuropsychiatric Inventory Caregiver Distress Scale. J Am Geriatr Soc. 1998; 46(2): 210-215. https://doi.org/10.1111/j.1532-5415.1998.tb02542.x
- 24Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med. 2004; 256(3): 183-194. https://doi.org/10.1111/j.1365-2796.2004.01388.x
- 25 American Psychiatric Association. Diagnostic and statistical manual of mental disorders, fourth edition, text revision. http://behavenet.com/diagnostic-and-statistical-manual-mental-disorders-fourth-edition-text-revision. Published 2000. Accessed March 10, 2016.
- 26McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's disease. Neurol. 1984; 34(7): 939-944.
- 27Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurol. 1993; 43(11): 2412-2414.
- 28Paraïso MN, Houinato D, Guerchet M, et al. Validation of the use of historical events to estimate the age of subjects aged 65 years and over in Cotonou (Benin). Neuroepidemiology. 2010; 35(1): 12-16. https://doi.org/10.1159/000301715
- 29Hyler S. Personality Questionnaire (PDQ-4 +). New York: New York State Psychiatric Institute; 1994.
- 30Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Measur. 1977; 1(3): 385-401. https://doi.org/10.1177/014662167700100306
10.1177/014662167700100306 Google Scholar
- 31Persson G, Skoog I. A prospective population study of psychological risk factors for late onset dementia. Int J Geriatr Psychiatry. 1996; 11: 15-22.
- 32Saito T, Murata C, Saito M, Takeda T, Kondo K. Influence of social relationship domains and their combinations on incident dementia: a prospective cohort study. J Epidemiol Community Health. 2018; 72(1): 7-12. https://doi.org/10.1136/jech-2017-209811
- 33Batsch N, Mittelman M. World Alzheimer Report 2012: overcoming the stigma of dementia. 2012.
- 34Kiely K, Mortby M, Anstey K. Differential associations between sensory loss and neuropsychiatric symptoms in adults with and without a neurocognitive disorder. Int Psychogeriatr. 2017; 30(02): 1-12. https://doi.org/10.1017/S1041610217001120
- 35Erber NP, Scherer SC. Sensory loss and communication difficulties in the elderly. Australas J Ageing. 1999; 18(1): 4-9. https://doi.org/10.1111/j.1741-6612.1999.tb00079.x
- 36Schneider JM, Gopinath B, McMahon CM, Leeder SR, Mitchell P, Wang JJ. Dual sensory impairment in older age. J Aging Health. 2011; 23(8): 1309-1324. https://doi.org/10.1177/0898264311408418
- 37Viljanen A, Törmäkangas T, Vestergaard S, Andersen-Ranberg K. Dual sensory loss and social participation in older Europeans. Eur J Ageing. 2014; 11(2): 155-167. https://doi.org/10.1007/s10433-013-0291-7
- 38Linszen MMJ, Brouwer RM, Heringa SM, Sommer IE. Increased risk of psychosis in patients with hearing impairment: review and meta-analyses. Neurosci Biobehav Rev. 2016; 62: 1-20. https://doi.org/10.1016/j.neubiorev.2015.12.012
- 39Vance DE, Burgio LD, Roth DL, Stevens AB, Fairchild JK, Yurick A. Predictors of agitation in nursing home residents. J Gerontol B Psychol Sci Soc Sci. 2003; 58(2): P129-P137. https://doi.org/10.1093/geronb/58.2.P129
- 40Adewuya AO, Atilola O, Ola BA, et al. Current prevalence, comorbidity and associated factors for symptoms of depression and generalised anxiety in the Lagos State Mental Health Survey (LSMHS), Nigeria. Compr Psychiatry. 2018; 81: 60-65. https://doi.org/10.1016/j.comppsych.2017.11.010
- 41Hinton L, Farias ST, Wegelin J. Neuropsychiatric symptoms are associated with disability in cognitively impaired Latino elderly with and without dementia: results from the Sacramento Area Latino Study on Aging. Int J Geriatr Psychiatry. 2008; 23(1): 102-108. https://doi.org/10.1002/gps.1952
- 42Steinberg M, Shao H, Zandi P, et al. Point and 5-year period prevalence of neuropsychiatric symptoms in dementia: the Cache County Study. Int J Geriatr Psychiatry. 2008; 23(2): 170-177. https://doi.org/10.1002/gps.1858
