Challenges for Diagnostic Clarity for Post-stroke Cognitive Impairment and Behavioural Issues in Middle-Income Countries: Case Studies From Malaysia

Following stroke, individuals require ongoing screening, diagnosis and monitoring for cognitive impairment. Services and policies around these vary widely between settings, and reports from many countries highlight persistent under-diagnosis of cognitive impairment in the months and years after stroke. Missed and delayed diagnosis of post-stroke cognitive impairment, including dementia, are important factors in shaping the experiences of people so affected and their family members, especially in low- and middle-income countries. Drawing upon ethnographic research conducted in Malaysia, this article draws upon three case studies to examine the continued health-seeking behaviour after the appearance of salient cognitive and behavioural symptoms that occurred after stroke. Findings highlight the challenges in getting formal diagnostic clarity for cognitive and behavioural symptoms in a rural setting within a middle-income country. No study participants sought help for memory or cognitive problems, partly due to limited lay awareness of cognitive impairment but more significantly due to health service factors. Despite their elevated risk for dementia, participants were not monitored for cognitive impairment during any follow-up care in various health facilities. Furthermore, caregivers' attempts to seek help when behavioural issues became untenable were met with multiple health system barriers. The journey was complicated by the meanings attached to the reactions towards cognitive symptoms at the community level. We suggest that strategies seek to increase the awareness of post-stroke cognitive and behavioural symptoms, and incorporate clear treatment pathways into the long-term care plans of community-dwelling stroke survivors.

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Protecting older adults of Sri Lanka amid COVID-19

10.31124/advance.11992911 ◽

2020 ◽

Author(s):

Keshini Madara Marasinghe

Keyword(s):

Public Health ◽

Older Adults ◽

Sri Lanka ◽

Community Dwelling ◽

Term Care ◽

Middle Income ◽

Middle Income Countries ◽

Aging Populations ◽

Clinical Responses ◽

Low And Middle Income

<p>Older adults over 60 are at a higher risk of getting severely sick and dying from COVID–19. Sri Lanka has one of the fastest aging populations in South and South–East Asia. In addition to having a rapidly aging population, Sri Lanka is a developing country with limited resources to accommodate the older population that can be significantly affected by COVID–19. Statistics up to date shows that older adults are at a much higher risk of dying from COVID–19. Older adults being at a much higher risk of contracting and dying from COVID–19 has important implications for the way in which public health and clinical responses should be developed. These implications have been largely overlooked in both high and low and middle–income countries when providing guidance and implementing regulations, which can have a greater impact in low and middle–income countries. Preparedness of the healthcare systems to respond to the pandemic with a lack of facilities, resources (i.e., ventilators) and staff in the healthcare system, specifically in hospitals, intensive care units and long–term care homes is a concern that should be taken into consideration when clinical responses are developed. Challenges around protecting community–dwelling older adults who are caregivers to grandchildren, receiving informal care from children in the same household, living in living in remote areas, or living alone or dependent on others need to be taken into consideration when developing public health responses.</p>

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Correlates of physical activity among community-dwelling individuals aged 65 years or older with anxiety in six low- and middle-income countries

International Psychogeriatrics ◽

10.1017/s1041610217002216 ◽

2017 ◽

Vol 30 (5) ◽

pp. 705-714 ◽

Cited By ~ 4

Author(s):

Davy Vancampfort ◽

Brendon Stubbs ◽

Mats Hallgren ◽

Nicola Veronese ◽

James Mugisha ◽

...

Keyword(s):

Physical Activity ◽

Cognitive Impairment ◽

Social Cohesion ◽

Community Dwelling ◽

World Health ◽

Older Individuals ◽

Middle Income ◽

Middle Income Countries ◽

Wide Range ◽

Low And Middle Income

ABSTRACTBackground:Given the important health benefits of physical activity (PA) and the higher risk for physical inactivity in people with anxiety, and the high prevalence of anxiety and low PA among the elderly, there is a need for research to investigate what factors influence PA participation among anxious older individuals. We investigated PA correlates among community-dwelling adults aged ≥ 65 years with anxiety symptoms in six low- and middle-income countries.Methods:Cross-sectional data from the World Health Organization's Study on Global Ageing and Adult Health were analyzed. PA level was assessed by the Global Physical Activity Questionnaire. 980 participants with anxiety (mean age 73.3 years; 62.4% females) were grouped into those who do and do not (low PA) meet the 150 minutes of moderate-to-vigorous PA per week recommendation. Associations between PA and the correlates were examined using multivariable logistic regressions.Results:The prevalence of low PA was 44.9% (95% CI = 39.2–50.7%). Older age, male gender, less consumption of alcohol, mild cognitive impairment, pain, a wide range of somatic co-morbidities, slow gait, weak grip strength, poor self-rated health, and lower levels of social cohesion were identified as significant positive correlates of low PA.Conclusions:Our data illustrate that a number of sociodemographic and health factors are associated with PA levels among older people with symptoms of anxiety. The promotion of social cohesion may increase the efficacy of public health initiatives, while from a clinical perspective, somatic co-morbidities, cognitive impairment, pain, muscle strength, and slow gait need to be considered.

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Protecting older adults of Sri Lanka amid COVID-19

10.31124/advance.11992911.v2 ◽

2020 ◽

Author(s):

Keshini Madara Marasinghe

Keyword(s):

Public Health ◽

Older Adults ◽

Sri Lanka ◽

Community Dwelling ◽

Term Care ◽

Middle Income ◽

Middle Income Countries ◽

Aging Populations ◽

Clinical Responses ◽

Low And Middle Income

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Sarcopenia and Mild Cognitive Impairment in Older Adults from Six Low- and Middle-Income Countries

Journal of Alzheimer s Disease ◽

10.3233/jad-210321 ◽

2021 ◽

pp. 1-10

Author(s):

Louis Jacob ◽

Karel Kostev ◽

Lee Smith ◽

Hans Oh ◽

Guillermo F. López-Sánchez ◽

...

Keyword(s):

South Africa ◽

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Positive Association ◽

Community Dwelling ◽

Middle Income ◽

Middle Income Countries ◽

Skeletal Mass ◽

Low And Middle Income

Background: Little is known about the relationship between sarcopenia and mild cognitive impairment (MCI) in low- and middle-income countries (LMICs). Objective: This study aimed to investigate this association among community-dwelling adults aged≥65 years from six LMICs. Methods: Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health (SAGE) were analyzed. These data were obtained in China, Ghana, India, Mexico, Russia, and South Africa in 2007–2010. Participants were considered to have sarcopenia if they had low skeletal muscle mass (i.e., lower skeletal mass index) and a weak handgrip strength. MCI was defined using the National Institute on Aging-Alzheimer’s Association criteria. Multivariable logistic regression analysis was conducted to assess associations. Results: The final analytical sample consisted of 12,912 individuals aged≥65 years with preservation in functional abilities without stroke (mean [standard deviation] age 72.2 [10.8] years; 45.2% males). The overall prevalence of sarcopenia and MCI were 11.3% and 18.1%, respectively. After adjusting for potential confounders, there was a positive association between sarcopenia and MCI in all countries (i.e., odds ratio [OR] > 1) with the exception of South Africa, and the overall estimate was OR = 1.60 (95% confidence interval [CI] = 1.32–1.93) with a low level of between-country heterogeneity (I2 = 0.0%). Conclusion: There was a positive association between sarcopenia and MCI in this sample of older adults living in LMICs. Causality should be assessed in future longitudinal research, while the utility of sarcopenia as a marker of MCI should also be investigated.

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Anxiety symptoms and mild cognitive impairment among community-dwelling older adults from low- and middle-income countries

Journal of Affective Disorders ◽

10.1016/j.jad.2021.04.076 ◽

2021 ◽

Author(s):

Lee Smith ◽

Louis Jacob ◽

Guillermo F. López-Sánchez ◽

Laurie Butler ◽

Yvonne Barnett ◽

...

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Anxiety Symptoms ◽

Community Dwelling ◽

Middle Income ◽

Middle Income Countries ◽

Community Dwelling Older Adults ◽

Low And Middle Income

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Perceived Stress and Mild Cognitive Impairment among 32,715 Community-Dwelling Older Adults across Six Low- and Middle-Income Countries

Gerontology ◽

10.1159/000492177 ◽

2018 ◽

Vol 65 (2) ◽

pp. 155-163 ◽

Cited By ~ 6

Author(s):

Ai Koyanagi ◽

Hans Oh ◽

Davy Vancampfort ◽

Andre F. Carvalho ◽

Nicola Veronese ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Perceived Stress ◽

Community Dwelling ◽

World Health ◽

Middle Income ◽

Middle Income Countries ◽

Study Results ◽

Stress Score ◽

Low And Middle Income

Background: Perceived stress may be a modifiable risk factor for mild cognitive impairment (MCI) and ultimately dementia, but studies on this topic from low- and middle-income countries (LMICs) are lacking. Objective: We assessed the association between perceived stress and MCI in six LMICs (China, Ghana, India, Mexico, Russia, and South Africa) using nationally representative data. Methods: Cross-sectional, community-based data on individuals aged ≥50 years from the World Health Organization’s Study on Global Ageing and Adult Health were analyzed. The definition of MCI was based on the National Institute on Ageing-Alzheimer’s Association criteria. A perceived stress score (range 0 [lowest stress] to 10 [highest stress]) was computed based on two questions from the Perceived Stress Scale. Multivariable logistic regression analysis was conducted to assess the association between perceived stress and MCI. Results: The mean (SD) age of the 32,715 participants was 62.1 (15.6) years and 51.7% were females. After adjustment for potential confounders including depression, in the overall sample, a one-unit increase in the perceived stress score was associated with a 1.14 (95% CI = 1.11–1.18) times higher odds for MCI. The association was similar among those aged 50–64 and ≥65 years. Countrywise analysis showed that there was a moderate level of between-country heterogeneity in this association (I2 = 59.4%), with the strongest association observed in Russia (OR = 1.33, 95% CI = 1.15–1.55). Conclusion: If our study results are confirmed in prospective studies, addressing perceived stress may have an impact in reducing the risk for MCI and subsequent dementia in LMICs.

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Is loneliness associated with mild cognitive impairment in low‐ and middle‐income countries?

International Journal of Geriatric Psychiatry ◽

10.1002/gps.5524 ◽

2021 ◽

Author(s):

Lee Smith ◽

Jodie Bloska ◽

Louis Jacob ◽

Yvonne Barnett ◽

Laurie Butler ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

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Prevalence and Risk of Mild Cognitive Impairment in Low and Middle-Income Countries: A Systematic Review

Journal of Alzheimer s Disease ◽

10.3233/jad-201043 ◽

2020 ◽

pp. 1-20

Author(s):

Andrea M. McGrattan ◽

Yueping Zhu ◽

Connor D. Richardson ◽

Devi Mohan ◽

Yee Chang Soh ◽

...

Keyword(s):

Systematic Review ◽

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Resource Planning ◽

Cognitive State ◽

Middle Income ◽

Total N ◽

Middle Income Countries ◽

Increased Risk ◽

Low And Middle Income

Background: Mild cognitive impairment (MCI) is a cognitive state associated with increased risk of dementia. Little research on MCI exists from low-and middle-income countries (LMICs), despite high prevalence of dementia in these settings. Objective: This systematic review aimed to review epidemiological reports to determine the prevalence of MCI and its associated risk factors in LMICs. Methods: Medline, Embase, and PsycINFO were searched from inception until November 2019. Eligible articles reported on MCI in population or community-based studies from LMICs. No restrictions on the definition of MCI used as long as it was clearly defined. Results: 4,621 articles were screened, and 78 retained. In total, n = 23 different LMICs were represented; mostly from China (n = 55 studies). Few studies from countries defined as lower-middle income (n = 14), low income (n = 4), or from population representative samples (n = 4). There was large heterogeneity in how MCI was diagnosed; with Petersen criteria the most commonly applied (n = 26). Prevalence of aMCI (Petersen criteria) ranged from 0.6%to 22.3%. Similar variability existed across studies using the International Working Group Criteria for aMCI (range 4.5%to 18.3%) and all-MCI (range 6.1%to 30.4%). Risk of MCI was associated with demographic (e.g., age), health (e.g., cardio-metabolic disease), and lifestyle (e.g., social isolation, smoking, diet and physical activity) factors. Conclusion: Outside of China, few MCI studies have been conducted in LMIC settings. There is an urgent need for population representative epidemiological studies to determine MCI prevalence in LMICs. MCI diagnostic methodology also needs to be standardized. This will allow for cross-study comparison and future resource planning.

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