1. 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

2. 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

3. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
background1
Controversies about screening for dementia in non patient community dwelling older adults.
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4. 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.
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5. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
background3
Other findings and reports:
Potential to delay progression when detected early
Leads to evaluation
Determines further clinical approach
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NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

6. 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.
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NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

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

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

9. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
setting1
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10. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
setting2
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11. 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

12. 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.
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13. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
methods4
Scoring of Blessed:
Weighted
Total score range=0-29
No error=0
Cut score consistent with dementia=≥ 10
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14. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results1
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15. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results2
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16. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results3
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17. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results4
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18. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results5
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19. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results
Score on Blessed
Range=12-21
Mean=17 ± 3.6
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20. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results
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21. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results6
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22. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results7
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23. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results8
Time now
Wrong=100%
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24. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results9
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25. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results10
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26. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
results11
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27. 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.
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NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

28. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
comments2
To be considered:
Sensitivity
Specificity
Validity
Testing cost
Ceiling/flooring
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NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

29. 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 .
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NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

30. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
comments4
With a score range of , 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 !
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NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

31. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
comments5
Great confounds of cognitive tests
Age
Gender
Education
Race
Ethnicity
Culture
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NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

32. 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.
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NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

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

34. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
comments8
Surprisingly only 8% correctly recalled a local name and exact address five minutes after its first presentation.
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35. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
comments9
? Villages / rural communities have no street numbers
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36. 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.
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NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

37. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
comments11
The currently available tests appear too long for screening in the rural Nigerian setting.
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38. 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).
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NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA

39. NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA
limitations
GMS result- not presented
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NNAMDI AZIKIWE UNIVERISTY AWKA NIGERIA