Abstract
Cognitive impairment is thought to be a major cause of disability worldwide, though data from sub-Saharan Africa (SSA) are sparse. This study aimed to investigate the association between cognitive impairment and disability in a cohort of community-dwelling older adults living in Tanzania. The study cohort of 296 people aged 70 years and over was recruited as part of a dementia prevalence study. Subjects were diagnosed as having dementia or mild cognitive impairment according to the DSM-IV criteria. Disability level was assessed according to the WHO Disability Assessment Schedule, version 2.0 (WHODAS). A higher WHODAS score indicates greater disability. The median WHODAS in the background population was 25.0; in those with dementia and in those with mild cognitive impairment, 72 of 78 (92.3%) and 41 of 46 (89.1%), respectively, had a WHODAS score above this level. The presence of dementia, mild cognitive impairment, hearing impairment, being unable to walk without an aid and not having attended school were independent predictors of having a WHODAS score above 25.0, though age and gender were not. In summary, cognitive impairment is a significant predictor of disability in elderly Tanzanians. Screening for early signs of cognitive decline would allow management strategies to be put in place that may reduce the associated disability burden.
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References
United Nations Department of Economic and Social Affairs; Population Division. World population prospects: the 2008 revision. New York: United Nations; 2009.
Prince M, Bryce R, Albanese E, Wimo A, Ribeiro W, Ferri CP. The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement 2013;9, 63–75 e2.
Sousa RM, Ferri CP, Acosta D, Albanese E, Guerra M, Huang Y, et al. Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey. Lancet 2009;374:1821–30.
Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2163–96.
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012;380:2197–223.
World Health Organization. International Classification of Functioning, Disability and Health (ICF). Geneva: World Health Organization; 2001.
Ustun TB, Chatterji S, Kostanjsek N, Rehm J, Kennedy C, Epping-Jordan J, et al. Developing the World Health Organization Disability Assessment Schedule 2.0. Bull World Health Organ 2010;88:815–23.
Schlote A, Richter M, Wunderlich MT, Poppendick U, Moller C, Schwelm K, et al. WHODAS II with people after stroke and their relatives. Disabil Rehabil 2009;31:855–64.
Garin O, Ayuso-Mateos JL, Almansa J, Nieto M, Chatterji S, Vilagut G, et al. Validation of the ‘‘World Health Organization Disability Assessment Schedule, WHODAS-2’’ in patients with chronic diseases. Health Qual Life Outcomes 2010;8:51.
Sousa RM, Dewey ME, Acosta D, Jotheeswaran AT, Castro-Costa E, Ferri CP, et al. Measuring disability across cultures–the psychometric properties of the WHODAS II in older people from seven low- and middle-income countries. The 10/66 Dementia Research Group population-based survey. Int J Methods Psychiatr Res 2010;19:1–17.
Kutlay S, Kucukdeveci AA, Elhan AH, Oztuna D, Koc N, Tennant A. Validation of the World Health Organization disability assessment schedule II (WHODAS-II) in patients with osteoarthritis. Rheumatol Int 2011;31:339–46.
Longdon AR, Paddick SM, Kisoli A, Dotchin C, Gray WK, Dewhurst F, et al. The prevalence of dementia in rural Tanzania: a cross-sectional community-based study. Int J Geriatr Psychiatry 2013;28:728–37.
Adult Morbidity and Mortality Project (AMMP). Policy implications of adult morbidity and mortality; final report. Dar-es-Salaam: Tanzanian Ministry of Health; 2004.
Hall KS, Hendrie HC, Brittain HM, Norton JA, Rodgers DD, Prince CS, et al. The development of a dementia screening interview in 2 distinct languages. Int J Methods Psychiatr Res 1993;3:1–28.
Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179–86.
He W, Muenchrath MN, Kowal P. Shades of gray: a crosscountry study of health and well-being of the older populations in SAGE countries, 2007–2010. Washington, DC, USA: U.S. Government Printing Office; 2012.
Xavier Gomez-Olive F, Thorogood M, Clark BD, Kahn K, Tollman SM. Assessing health and well-being among older people in rural South Africa. Glob Health Action 2010;3.
Mwanyangala MA, Mayombana C, Urassa H, Charles J, Mahutanga C, Abdullah S, et al. Health status and quality of life among older adults in rural Tanzania. Glob Health Action 2010;3.
Kyobutungi C, Egondi T, Ezeh A. The health and well-being of older people in Nairobi’s slums. Glob Health Action 2010;3.
Debpuur C, Welaga P, Wak G, Hodgson A. Self-reported health and functional limitations among older people in the Kassena-Nankana district, Ghana. Glob Health Action 2010;3.
Heslin JM, Soveri PJ, Winoy JB, Lyons RA, Buttanshaw AC, Kovacic L, et al. Health status and service utilisation of older people in different European countries. Scand J Prim Health Care 2001;19:218–22.
Mushi D, Rongai A, Paddick SM, Dotchin C, Mtuya C, Walker R. Social representation and practices related to dementia in Hai district of Tanzania. BMC Public Health 2014;14:260.
Shaji KS, Arun Kishore NR, Lal KP, Prince M. Revealing a hidden problem. An evaluation of a community dementia case-finding program from the Indian 10/66 dementia research network. Int J Geriatr Psychiatry 2002;17:222–5.
Baiyewu O, Unverzagt FW, Ogunniyi A, Hall KS, Gureje O, Gao S, et al. Cognitive impairment in community-dwelling older Nigerians: clinical correlates and stability of diagnosis. Eur J Neurol 2002;9:573–80.
Dewhurst MJ, Dewhurst F, Gray WK, Chaote P, Orega GP, Walker RW. The high prevalence of hypertension in rural-dwelling Tanzanian older adults and the disparity between detection, treatment and control: a rule of sixths? J Hum Hypertens 2013;27:374–80.
Walker R, Whiting D, Unwin N, Mugusi F, Swai M, Aris E, et al. Stroke incidence in rural and urban Tanzania: a prospective, community-based study. Lancet Neurol 2010;9:786–92.
Woods B, Aguirre E, Spector AE, Orrell M. Cognitive stimulation to improve cognitive functioning in people with dementia. Cochrane Database Syst Rev 2012;2:CD005562.
Prince M, Bryce R, Ferri CP. World alzheimer report 2011: the benefits of early diagnosis and intervention. London, UK: Alzheimer Disease International; 2011.
Gureje O, Ogunniyi A, Kola L, Afolabi E. Functional disability in elderly Nigerians: results from the Ibadan study of aging. J Am Geriatr Soc 2006;54:1784–9.
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Dotchin, C.L., Paddick, SM., Gray, W.K. et al. The association between disability and cognitive impairment in an elderly Tanzanian population. J Epidemiol Glob Health 5, 57–64 (2015). https://doi.org/10.1016/j.jegh.2014.09.004
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DOI: https://doi.org/10.1016/j.jegh.2014.09.004