NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA ACOS Richard Uwakwe* Ifeoma Modebe Ifeoma Njelita Nkiru Ezeama Toochukwu Mbachi *Faculty of Medicine College of Health Sciences Nnamdi Azikiwe University Awka NIGERIA. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA ACOS Screening for memory impairment in community dwelling older adults in rural Nigeria: use of the Short Blessed memory test. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA background1 Controversies about screening for dementia in non patient community dwelling older adults. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA background2 Some research and consensus reports: Risk dates much earlier May no longer be modifiable once disease has begun Not clearly recommended. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA background3 Other findings and reports: Potential to delay progression when detected early Leads to evaluation Determines further clinical approach 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA background4 Aim: What is the utility of the Short Blessed memory test in community dwelling older adults in rural Nigeria. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA background5 First phase in a planned whole Local Government Area cognitive study in Anambra State, South East, Nigeria. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA methods1 The six item short Blessed Memory test administered to 50 participants. Site: Dunukofia Social Centre, near Abagana, Njikoka 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA setting1 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA setting2 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA methods2 BOCM tests: Year month time counting 20 to 1 backwards months of the year in reverse order memory phrase to recall. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA methods3 Within less than 5 minutes In this study, the memory phrase was changed to a local language name and address. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA methods4 Scoring of Blessed: Weighted Total score range=0-29 No error=0 Cut score consistent with dementia=≥ 10 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results1 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results2 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results3 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results4 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results5 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results Score on Blessed Range=12-21 Mean=17 ± 3.6 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results6 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results7 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results8 Time now Wrong=100% 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results9 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results10 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA results11 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA comments1 Main considerations in choosing a screening test : Practicality Applicability in settings in which the older adults receive their care. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA comments2 To be considered: Sensitivity Specificity Validity Testing cost Ceiling/flooring 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA comments3 The financial effects of the test i.e.: Benefits of a true-positive finding Costs of a false-positive finding Epidemiology of dementia . 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA comments4 With a score range of 12- 21 , mean of 17±3.6, on the Blessed test and a recommended cut score of ≥ 10, 100% of the participants would be +ve for dementia. Spurious ! 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA comments5 Great confounds of cognitive tests Age Gender Education Race Ethnicity Culture 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA comments6 The sense of time in rural Nigeria seems to be entirely different from what it is in developed countries : Morning, afternoon, evening . No participant was able to state the exact time within one hour error margin. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA comments7 Worst performances : Months of the year backwards ( 1 person=2%) correct Present year ( 3 persons=6% ) correct 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA comments8 Surprisingly only 8% correctly recalled a local name and exact address five minutes after its first presentation. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA comments9 ? Villages / rural communities have no street numbers 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA Comments 10 The best performance was in counting 20 backwards. The unmodified six item Blessed short memory tests can not be used to screen for cognitive impairment in community older adults in Nigeria. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA comments11 The currently available tests appear too long for screening in the rural Nigerian setting. 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA comments12 Enormous cultural adaptation needed for a very short and quick screener ? A one stage assessment / diagnosis may be a trade off (depending on use). 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA limitations GMS result- not presented 30/11/2018 NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA