A comparison of caregiver burden in older persons and persons with Parkinson's disease or dementia in sub-Saharan Africa.

BACKGROUND: Caregiver burden includes the many physical, mental and socio-economic problems arising from caring for individuals with chronic and disabling diseases. Being a carer in sub-Saharan Africa (SSA), where little is known about chronic neurological conditions, may be extremely demanding. Conversely, multigenerational living may allow sharing of care among many caregivers. We wished to determine the relative burden of caring for two chronic neurodegenerative conditions (Parkinson's disease (PD) and dementia) in rural Tanzania. METHODS: All surviving patients from a PD prevalence study, newly identified people with PD from a neurological disorders study and all people with dementia from a dementia prevalence study in Hai, rural Tanzania, were invited to participate. The Zarit Burden Interview (ZBI) was used to determine level of caregiver strain (higher score reflects more strain). RESULTS: Of 25 PD patients ZBI was recorded in 20 (14 male). Five had no identifiable carer as they were largely independent. Three had PD dementia (PDD). Of 75 people with dementia (excluding 3 PDD), 43 (32 female) completed the ZBI. For the other 32, the caregivers felt the care they provided was a normal intergenerational expectation. Median ages were 78.5 and 85 years for PD and dementia, respectively. Median ZBI was 30.5 for PD and 14 for dementia (U = 166.0, z = -3.913, p < 0.001). Disease duration and disease type (PD or dementia) were univariate predictor of ZBI score, although only disease type was predictive by multivariable linear regression. CONCLUSIONS: Caring for an individual with PD may be more burdensome than caring for an individual with dementia in SSA. People with more advanced PD had higher caregiver burden.

Non-motor symptoms in a prevalent population with Parkinson's disease in Tanzania.

INTRODUCTION: Most of the patients identified in a community-based prevalence study of Parkinson's disease (PD) in the Hai district, rural northern Tanzania, in 2005-2006, had not been previously diagnosed or treated. METHODS: Screening methods to identify patients have been previously described. Diagnosis was confirmed by the UK, PD Society Brain Bank Criteria. Patients were assessed in their own home with the assistance of a local translator and completed: Unified PD Rating Scale (UPDRS), Non-motor Symptoms Assessment Scale, PDQ-39, Hoehn and Yahr scale, and Hospital Anxiety and Depression Scale (HAD). RESULTS: Thirty-three (23 male, mean age 74, range 38-94 years) patients were identified. Only 5 had ever taken PD medication, and only 3 were currently treated. Hoehn and Yahr stage ranged from 2 to 5, disease duration from 3 months to 19 years, mean UPDRS was 50 (range 24-97), mean PDQ-39 386 (range 219-580) and mean non-motor symptom scale score 62 (range 11-209). Some patients who had never taken medication for PD, and who did not fulfil the Lewy Body Dementia diagnostic criteria, had experienced visual hallucinations. CONCLUSIONS: By studying patients at varying stages of PD who have not received treatment we can learn more about the symptoms of late stage PD and ascertain whether they are drug- or disease-related, or a combination of both. Hallucinations are likely to be a manifestation of the disease, but are often precipitated or exacerbated by medication. These patients have now commenced treatment, with close monitoring for complications, including motor or neuro-psychiatric symptoms.

The prevalence of essential tremor in rural northern Tanzania.

INTRODUCTION: Estimates of the prevalence of essential tremor (ET) vary widely but there are few existing data on the prevalence of ET in sub-Saharan Africa. PATIENTS AND METHODS: A door-to-door community based prevalence study of ET was carried out in the Hai district of northern Tanzania (n = 161,071). The screening questionnaire was followed by examination of positive responders and backed up with other case finding methods. RESULTS: 222 patients responded positively to the screening questions and 43 were referred by village elders. 65 (38 men, 27 women) were diagnosed with ET. Mean age was 72 years and mean duration of symptoms was 11.3 years. The crude prevalence rate was 41/100,000 and age standardised prevalence compared with the UK population (2001) was 82/100,000. DISCUSSION: This is the first community based prevalence study of ET in sub-Saharan Africa. Previous data from community based neurological surveys showed lower prevalence rates of 5/100,000 in Ethiopia and 10/100,000 in Nigeria. Non-selective beta blockers are available locally and are affordable, yet none of these patients had previously been on any treatment.

The challenge of Parkinson's disease management in Africa.

Parkinson's disease (PD) is said to be less common in Africa than elsewhere in the world, but previous studies have been based on small numbers. Also, the differences may be due to the diagnostic criteria used, case finding methods and different population age structures. Developing countries have few facilities for chronic disease management and non-communicable diseases, although on the increase, tend to play second fiddle to malaria and HIV/AIDS. Previous reports suggest that, at least from anecdotal information, under-diagnosis of PD is common and long-term availability of medication, follow-up, patient education and multidisciplinary input is lacking. Published literature is scarce and there is a lack of recent information. We are currently conducting a door-to-door prevalence study in northern Tanzania in a population of 161,162. We have reviewed previous literature on PD in Africa and illustrate our personal experience of PD and its management in Africa with three cases.