| 1. |
- Kalaria, Raj, et al.
(author)
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The 2022 symposium on dementia and brain aging in low- and middle-income countries: Highlights on research, diagnosis, care, and impact.
- 2024
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In: Alzheimer's & dementia : the journal of the Alzheimer's Association. - 1552-5279.
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Journal article (peer-reviewed)abstract
- Two of every three persons living with dementia reside in low- and middle-income countries (LMICs). The projected increase in global dementia rates is expected to affect LMICs disproportionately. However, the majority of global dementia care costs occur in high-income countries (HICs), with dementia research predominantly focusing on HICs. This imbalance necessitates LMIC-focused research to ensure that characterization of dementia accurately reflects the involvement and specificities of diverse populations. Development of effective preventive, diagnostic, and therapeutic approaches for dementia in LMICs requires targeted, personalized, and harmonized efforts. Our article represents timely discussions at the 2022 Symposium on Dementia and Brain Aging in LMICs that identified the foremost opportunities to advance dementia research, differential diagnosis, use of neuropsychometric tools, awareness, and treatment options. We highlight key topics discussed at the meeting and provide future recommendations to foster a more equitable landscape for dementia prevention, diagnosis, care, policy, and management in LMICs. HIGHLIGHTS: Two-thirds of persons with dementia live in LMICs, yet research and costs are skewed toward HICs. LMICs expect dementia prevalence to more than double, accompanied by socioeconomic disparities. The 2022 Symposium on Dementia in LMICs addressed advances in research, diagnosis, prevention, and policy. The Nairobi Declaration urges global action to enhance dementia outcomes in LMICs.
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| 2. |
- Lundberg, Patric, et al.
(author)
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HIV prevalence in persons with severe mental illness in Uganda: a cross-sectional hospital-based study
- 2013
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In: International Journal of Mental Health Systems. - : Springer Science and Business Media LLC. - 1752-4458. ; 7
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Journal article (peer-reviewed)abstract
- Background: In Uganda, a previous study reported high HIV prevalence in persons with severe mental illness (SMI) compared to the general population, suggesting that persons with SMI might constitute a high-risk group for HIV. However, the study included first-time psychiatric admissions only, a group whose HIV prevalence may not reflect the prevalence in persons with SMI in general. We determined prevalence and correlates of HIV in both first-time and previous psychiatric admissions, in a psychiatric hospital in Uganda. Methods: Cross-sectional study of HIV status in persons consecutively discharged from psychiatric admission wards in Butabika hospital, Uganda. Inclusion criteria: age 18-49 years; schizophrenia, bipolar disorder, depression, or other non-substance-use-related psychosis; Luganda or English proficiency. Exclusion criterion: Mental incapacity to give informed consent. Participants were HIV-tested, and interviewed using a structured questionnaire. Data were analysed using logistic regression. Results: HIV prevalence was 11.3% (CI 8.8-13.8) overall, 7.3% (CI 4.1-10.5) in men and 14.3% (CI 10.6-18.0) in women. Females had higher risk of HIV infection than males (OR 2.10; CI 1.20-3.67), after adjustment for age. Older patients had higher risk of HIV infection than younger patients (40-49 vs. 18-29 years: OR 2.34; CI 1.27-4.32), after adjustment for sex. Place of residence, marital status, income, education, occupation, psychiatric diagnosis and history of previous admission were not associated with HIV infection, after adjustment for sex and age. The above associations did not significantly differ between men and women. Conclusions: Persons admitted for SMI in Uganda have higher HIV prevalence than persons in the general population, irrespective of previous admissions. The excess HIV prevalence is mainly confined to women. The findings call for the integration of HIV prevention, testing and care with mental health services in settings with generalized HIV epidemics. Moreover, further research is needed to clarify the mechanisms underlying the increased HIV prevalence in women with SMI in Uganda, and to identify effective community-based interventions for this vulnerable group.
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| 3. |
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| 4. |
- Nakasujja, Noeline
(author)
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Cognitive deficits and HIV-associated psychotic disorders in Uganda
- 2011
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Doctoral thesis (other academic/artistic)abstract
- Introduction: HIV infection is known to cause neuro-psychiatric disturbances whose prevalence ranges between 74-83%. The prevalence of HIV in patients with psychosis has been found at 18%. Cognitive dysfunction occurs in 37% of HIV individuals with advanced HIV/AIDS even after the initiation of antiretroviral therapy. This thesis presents the feasibility of a rapid screening test for HIV dementia in a resource limited setting; the nature of HIV related psychoses and the impact of HIV infection on the cognitive function of patients with and without psychosis. Methods: Four studies (1-IV) were conducted using multiple methods. We determined the validity of the International HIV Dementia Scale (IHDS) through administering standardized neurological and neuropsychological assessments to 66 HIV-positive individuals in the USA, 81 HIV positive individuals and 100 HIV negative individuals in Uganda (Study I). We recruited 102 HIV positive individuals from the Infectious Diseases Institute and 25 HIV negative individuals from the AIDS Information Centre. Depression and cognitive function were assessed at 0, 3 and 6 months (Study II). One hundred and fifty six HIV positive and 322 HIV negative patients with psychosis were consecutively recruited from two national referral hospitals. Psychiatric, physical, and laboratory assessments were conducted at 0, 3 and 6 months (Study III & Study IV). Data was analyzed using univariate, bivariate and multivariable methods including linear and logistic regression analysis to test for predictors of the different types of psychosis and the relationship to cognitive impairment. Results: The sensitivity and specificity for HIV dementia with the IHDS was 80% and 57% in the US part of the study, and 80% and 55% in the Uganda part of the study (I). We found higher scores (equal to or greater than 16) on the Centre for Epidemiologic Depression Scale in the HIV-positive group at all 3 clinic visits (54% vs 28%; 36% vs 13%; and 30% vs 24% respectively; all p < 0.05 (II). The HIV positive group had higher likelihood for cognitive impairment (OR 8.9; 95% CI 2.6-29.9). Mania, major depression and schizophrenia occurred more in the HIV negative group, 67%:62%:80% respectively, while psychotic disorder not otherwise specified occurred more in the HIV positive individuals 88% vs 12 %, (p < 0.001) (III). The HIV positive individuals were more likely to be impaired in the following domains, verbal memory (OR 1.8, 95% CI 1.0-2.9), verbal fluency (OR 3.4; 95% CI 2.2-5.2), Colour trails 1(OR 2.0; 95% CI 1.3-3.0 and Colour trail 2 (OR 3.5; 95% CI 2.0-6.1). Conclusion: We found it feasible to screen for HIV dementia using the IHDS and suggest this is implemented in routine clinical care. Depression symptomatology and the presentation of psychosis are distinct and common among HIV infected individuals compared to HIV negative individuals. The cognitive function of individuals with psychosis is worsened by HIV infection. Treatment algorithms for the different types of psychoses and the cognitive impairment that occur in HIV infection should be developed. There is need for policy changes that can improve guidelines for the care of HIV infected individuals with neuropsychiatric complications in resource limited settings.
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| 5. |
- Nawagi, Faith, et al.
(author)
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Sociodemographic Characteristics and Health Profile of the Elderly Seeking Health Care in Kampala, Uganda
- 2018
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In: Current Gerontology and Geriatrics Research. - : Hindawi Limited. - 1687-7063 .- 1687-7071. ; 2018
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Journal article (peer-reviewed)abstract
- Aging entails health challenges globally, but pertinent data from low-income countries like Uganda remains scarce. A cross-sectional study was carried out at Mulago National Referral Hospital in Kampala, among 134 patients (38% men and 62% women) aged ≥60 years. Data was collected on sociodemographic characteristics, medical disorders, cognitive function, hearing handicap, and functional status, that is, Basic Activities of Daily Living (BADL) and Instrumental Activities of Daily Living (IADL). The participants had high independency in BADL (89%) and IADL (75%). The most common medical conditions were bone/joint pain (35%), hypertension (24%), and visual problems (20%). More women (54%) than men (37%) reported bone and joint pain. The majority (80%) of the participants did not report any hearing handicap, and half (54%) did not have any cognitive impairment. Dependency in IADL was associated with advanced age, being female, and being financially dependent, and the risk of having a hearing handicap was higher among those above the median age (68 years). In adjusted models, the effects remained similar although statistical significance was only achieved for advanced age versus dependency in IADL (RR: 2.38, 95% CI: 1.12-5.08) and hearing handicap (RR: 2.67, 95% CI: 1.17-6.12). Thus, socioeconomic status and gender are relevant aspects when attempting to understand the health profile of the elderly in Kampala, Uganda.
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