2. THE PREVALENCE OF BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA IN RURAL TANZANIA
Dr. Stella-Maria Paddick

3. Why study dementia in sub-Saharan Africa?
Adapted from 10/66 Dementia Research Group, KCL

4. Background
The prevalence of dementia is predicted to increase rapidly in developing countries .
Behavioural and psychological symptoms of dementia (BPSD) are common in Western countries, and recognised as a major problem for people with dementia and their carers.
There are few data on the prevalence and manifestations of BPSD in sub-Saharan Africa.

5. Study Aims
To estimate the prevalence and pattern of BPSD symptoms and associated caregiver distress in rural Tanzania

6. Study population- dementia prevalence study
Six villages – total population 34,078.
1220 people aged over 70 on census.
Over 95% screened.
Age standardised prevalence of dementia by DSM-IV criteria 6.4%.
Insert comparison chart here.

7. Screening for dementia
Two stage door to door study using census data.
Community Screening Instrument for Dementia – CSI-D.
Carried out by village health workers following training.
Important for building relationship with elderly people and carers

8. Clinical Assessment Clinical assessment based on DSM-IV criteria
10/66 dementia research group protocol
GMS-AGECAT
Neuropsychiatric Inventory (NPI) –symptoms over previous month, severity and distress caused.
Carer demographic questionnaire.
Zarit Care Questionnaire.
All probable CSI-D cases.
Half of possible cases.
5% ’no dementia’ cases.
Geriatric Mental State
Neuropsychiatric Inventory
Dementia risk factors
WHO disability assessment schedule
Neurological examination
Household questionnaire
Barthel
Zarit Caregiver Burden Questionnaire

9. Results

10. Results Total numbers from prevalence study included in BPSD study
DSM-IV dementia MCI No dementia 163

11. Caregivers of people with dementia

12. Caregivers of people with dementia

13. Total Number of Symptoms
Results - NPI
88% of people with dementia had at least one NPI symptom.
Significant difference in both severity and distress scores between those with DSM-IV dementia and those without (P<0.0001)
Test Statisticsa
Total Severity
Total Distress
Total Number of Symptoms
Mann-Whitney U
Wilcoxon W Z
-4.576
-4.208
-4.519
Asymp. Sig. (2-tailed)
.000
a. Grouping Variable: DSM IV dementia by clinical diagnosis (ignoring MCI)

14. Results - NPI Inventory

15. Results – dementia only.
BPSD symptoms ranked by frequency
BPSD symptoms ranked by carer distress score

16. BPSD symptoms and care burden as measured by Zarit Care Burden Questionnaire
Carers of those with more severe or distressing BPSD were more likely to also report significant caregiver burden.
Test Statisticsa
NPISeverityTotal
NPIDistressTotal
Mann-Whitney U Z
-3.081
-3.176
Asymp. Sig. (2-tailed)
.002
.001
a. Grouping Variable: Total Zarit Caregiver Burden score

17. Conclusions
Dementia prevalence comparable to Western studies-no persons with dementia previously given diagnosis.
BPSD common, frequently problematic and distressing and not understood.
Important public health issue for carer support and education in resource poor settings.

18. Thank you to all Hai District study participants, carers, medical officers and village enumerators for helping with this study
Dr. Stella-Maria Paddick
Dr. Anna Longdon
Dr. Catherine Dotchin
Dr. W. Keith Gray
Mr. Aloyce Kisoli
Dr. Felicity Dewhurst
Dr. Matthew Dewhurst
Dr. Ahmed Iqbal
Dr. Andrew Teodorczuk
Professor Richard Walker

20. Prevalence of psychotic symptoms – combining GMS AGECAT and NPI data

21. Severity of NPI symptoms when present in dementia and non dementia cases.

22. Comparison with other developed and developing world studies
European AD consortium 2007 – 96% had at least one symptom.
In Western studies – apathy often most common followed by depression.
Ferri et al 10/66 study (developing world multi-site)-70.9% had at least one BPSD symptom.

23. Why study dementia in Hai, Tanzania?
Organised village health worker/clinical officer system.
Surveillance area.
Reliable census data.
Data collected on births, deaths and ‘verbal autopsy’.
Previous successful prevalence studies by our research group.

24. Why study dementia in sub-Saharan Africa?
Projected prevalence of dementia (millions)
Worldwide dementia costs compared to sovereign economies
Source –World Alzheimer’s Report 2009/ 2010