Evaluation de la charge de l’aidant apres un accident vasculaire cerebral au Centre Hospitalier Universitaire de Brazzaville

Introduction: L’accident vasculaire cérébral (AVC) est la première cause du handicap acquis de l’adulte et la deuxième cause de démence. Le retour au domicile du patient est étroitement lié à la charge de l’aidant. Le but de notre étude était d’évaluer la charge de l’aidant principal des patients victimes d’AVC après le retour au domicile.Méthode: Il s’est agi d’une étude longitudinale analytique réalisée du 1er octobre 2014 au 30 septembre 2015, au CHU de Brazzaville. Tous les patients hospitalisés pour un premier AVC confirmé par une imagerie cérébrale et retournés à leur domicile ont été inclus. Tous les patients ayant un score de Rankin modifié ≥ 2 avant l’hospitalisation n’ont pas été inclus. L’échelle de Zarit a été utilisée pour évaluer la charge de l’aidant principal. Les autres variables étudiées regroupaient les données sociodémographiques des patients et des aidants. L’impact psychologique et fonctionnel de l’hémiplégie vasculaire des patients, a été évalué respectivement par le questionnaire abrégé de Beck et l’index de Barthel. Le logiciel SPSS 21 a été utilisé pour l’analyse statistique. Le seuil de significativité a été fixé à 0,05.Résultats: L’étude a porté sur 70 patients d’âge moyen de 55,4±11,49 ans, avec un sex ratio de 1,12. L’aidant principalétait représenté par un descendant dans 44,5%. L’âge moyen des aidants était de 41,4 ± 11,9 ans, significativement inférieur à celui des patients (p < 0,001). Le score de Zarit moyen était de 44,8 ±10,6 ; 36,4 ±12,1 et 27,2 ±13,8 respectivement à un, trois et six mois de suivi. La charge de l’aidant s’est améliorée avec le temps, avec une variation moyenne du score de Zarit entre le premier et sixième mois de suivi statistiquement significative de -17,6±8,16 (p<0,001). L’âge du patient « supérieur à 65 ans », le mode de vie « avec conjoint » et le type d’AVC « hémorragique » étaient identifiés comme facteurs associés à la charge de l’aidant.Conclusion: La charge de l’aidant principal s’améliore au cours de l’évolution, avec l’amélioration de l’autonomie fonctionnelle et de l’humeur des patients. Il est nécessaire d’inclure cette donnée lors de l’éducation thérapeutique des aidants dans le cadre d’une prise en charge globale des AVC.Mots clés: Accident vasculaire cérébral, Congo, Charge aidant, invalidité, réadaptationEnglish Title: Assessment of caregiver’s burden after stroke at the Brazzaville University HospitalEnglish AbstractIntroduction: Stroke is the leading cause of acquired disability in adults and the second leading cause of dementia. After the hospitalization phase, the return to the patient’s home is closely linked to the caregiver’s burden. The aim of our study was to assess the burden of the primary caregiver of stroke patients after returning home.Method: This was a longitudinal study carried out from 1st October 2014 to 30th September 2015 at the university hospital of Brazzaville. All patients hospitalized for a first stroke confirmed by brain imaging and returned to their homes were included. All patients with a modified Rankin Scale ≥ 2 prior to hospitalization were not included. The Zarit scale was used to assess the caregiver’s burden. The other variables studied included socio-demographic data from patients and caregivers, the psychological and physical impact of patients’ vascular hemiplegia, assessed respectively by abbreviated Beck’s questionnaire and the Barthel index. The SPSS 21 software was used for statistical analysis. The significance threshold was set at 0.05.Results: The study included 70 patients with a mean age of 55.4 ± 11.49 years, with a sex ratio of 1.12. The primary caregiver was represented by a descendant in 44.5%. The mean age of caregivers was 41.4 ± 11.9 years, significantly lower than that of the patients (p <0.001). The average Zarit score was 44.8 ± 10.6; 36.4 ± 12.1 and 27.2 ± 13.8 respectively at one, three and six months of follow-up. The caregiver burden improved over time, with an average change in the Zarit score between the first and the sixth month of statistically significant follow-up of -17.6 ± 8.16 (p <0.001). Patient age “over 65 years”, “spousal” lifestyle, and “haemorrhagic” stroke were identified as factors associated with the caregiver’s burden.Conclusion: The burden of neurological disability after a stroke on the primary caregiver improves as the course progresses, with improved functional autonomy and improved patient mood. It is necessary to include this data in the therapeutic education of caregivers in the context of comprehensive care for stroke patients.Keywords: Caregiver burden, Congo, disability, strok

Depression chez l’hemiplegique vasculaire a Brazzaville

Cette étude avait pour objectif d’améliorer la prise en charge globale des patients atteints d’accident vasculaire cérébral (AVC) en décrivant les aspects épidémiologiques, cliniques et thérapeutiques de la dépression post-AVC qui est une complication sous-estimée malgré ses conséquences sur l’état fonctionnel et la qualité de vie des patients. Une cohorte de 70 patients atteints d’hémiplégie vasculaire a été constituée et suivie pendant six mois. La dépression a été évaluée par le questionnaire de Beck ; l’autonomie fonctionnelle et la qualité de vie, respectivement par l’index de Barthel et le Stroke Impact Scale. Un cahier d’observation a été utilisé pour obtenir des données socio-démographiques, cliniques et thérapeutiques.Tous les patients étaient déprimés. L’âge moyen des patients était de 55,5 ± 11,1 ans, le sex-ratio de 1,1. L’hémisphère gauche était le plus souvent atteint (57,5 %). Aucun patient n’a bénéficié d’une prise en charge médicamenteuse, psychologique ou sociale pendant la phase de récupération. L’évolution à 6 mois n’a pas été favorable chez 65,7 % des patients. L’âge élevé était associé à la persistance de la dépression (OR : 12,4 [1,2 - 127,9] p= 0,0]. Plus les patients était autonomes moins ils étaient déprimés (r= -0,59 ; p< 0,001) et avaient une meilleure qualité de vie (r= -0,57 ; p<0,001).Précoce et constante après une hémiplégie vasculaire, la dépression post-AVC est associé à un âge élevé. Sa prise en charge permettrait assurément d’améliorer la qualité de vie des patients, elle-même dépendante d’une gestion précoce et efficiente des AVC limitant le handicap.Mots clés: Dépression, Hémiplégie, AVCEnglish AbstractThe objective of this study was to improve the overall management of patients with stroke by describing the epidemiological, clinical and therapeutic aspects of post-stroke depression. A complication that is still unrecognized and / or underestimated despite its impact on the functional status and quality of life of patients. A cohort of 70 patients with vascular hemiplegia was established and followed for six months. Depression was assessed by Beck’s depression Inventory, Functional autonomy and quality of life, respectively by the Barthel index and the Stroke Impact Scale. An observation booklet was used to obtain socio-demographic, clinical and therapeutic data.All patients were depressed. The mean age was 55.5 ± 11.1 years, with a sex ratio of 1.1. The left hemisphere was the most affected (57.5%). No patients received medication, psychological or social support during the recovery phase. The change at 6 months was not favorable in 65.7% of the patients. The high age was associated with the persistence of depression (OR: 12.4 [1.2 - 127.9] p = 0.04). However depression was less frequent in patient with better autonomy (R = -0.59, p <0.001). These patients had a better quality of life (r = -0.57, p <0.001).Early and consistent after vascular hemiplegia, the persistence of post-stroke depression is associated with high  age. The management of post-stroke depression certainly improves the quality of life of patients, which is itself dependent on the early and efficient management of stroke, which makes it possible to limit the handicap.Keywords: Depression, Hemiplegia, Strok

Prevalence of peripheral artery disease in the elderly population in urban and rural areas of Central Africa:the EPIDEMCA study

International audienceData on peripheral artery disease in Africa are sparse and limited to urban areas. Given the urban/rural socio-economical gradient in these countries, we sought to determine the prevalence and risk factors of peripheral artery disease in urban and rural areas of two countries in Central Africa. Individuals ≥65 years old living in two urban and rural areas of the Republic of Central Africa (ROC) and the Central African Republic (CAR) were invited. Demographic, clinical and biological data were collected. Ankle-brachial index ≤0.90 defined peripheral artery disease. Among the 1871 participants (age 73 years, 62% female) the prevalence of peripheral artery disease was 14.8%, higher in ROC than in CAR (17.4% vs. 12.2%, p = 0.007) and higher in females than males (16.6% vs. 11.9%, p = 0.012). The prevalence of peripheral artery disease increased with age, respectively at 10.9%, 14.9%, 15.1% and 22.2% for age bands of 65-69, 70-74, 75-79 and 80+years (p < 0.001). Higher rates of peripheral artery disease were found in urban areas in ROC (20.7% vs. 14.4% in rural areas, p = 0.011), but not in CAR (11.5% vs. 12.9%, p = NS). In multivariate analysis, peripheral artery disease was significantly associated with age (odds ratio (OR): 1.03; p = 0.004), dyslipidaemia (OR: 1.88; p = 0.003), smoking (OR: 1.78; p = 0.003), obesity (OR: 1.98; p = 0.034) and underweight (OR: 1.49; p = 0.023). Regular alcohol drinking was associated with decreased risk of peripheral artery disease (OR: 0.73; p = 0.044). The prevalence of peripheral artery disease in the elderly is high in Africa, especially in females. In ROC, with a higher urban-rural socio-economic gradient, peripheral artery disease is more frequent in the urban areas

Angiology

Epidemiological research on the implication of atherosclerosis in the development of cognitive impairment is lacking in low- and middle-income countries, where two-thirds of the individuals affected by dementia live. Individuals aged >/=65 years living in urban and rural areas of 2 countries in Central Africa were invited. Demographic, clinical, and biological data were collected, and the ankle-brachial index (ABI) was measured. Cognitive impairment was defined according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Among 1662 participants (age 72.9 years, 59.3% females), the prevalence of cognitive impairment was 13.6%, which is higher in individuals with ABI /= 1.40 than those with 0.90 < ABI < 1.40 (20.1% and 17% vs 12%, P = .0024). Cognitive impairment was significantly associated with the factors such as age (odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.07-1.12, P < .0001), female gender (OR: 2.36, 95% CI: 1.59-3.49, P < .0001), smoking (OR: 1.54, 95% CI: 1.06-2.23, P = .0026), and low ABI (</=0.90; OR: 1.52, 95% CI: 1.03-2.25, P = .0359). The ABI, a ubiquitous marker of atherosclerosis, provides independent and incremental information on susceptibility to present with cognitive disorders

Apolipoprotein E ϵ4 allele and neuropsychiatric symptoms among older adults in Central Africa (EPIDEMCA study)

OBJECTIVES: To evaluate the association between neuropsychiatric symptoms and apolipoprotein E (APOE) ϵ4 allele among older people in Central African Republic (CAR) and the Republic of Congo (ROC). DESIGN: Multicenter population-based study following a two-phase design. SETTING: From 2011 to 2012, rural and urban areas of CAR and ROC. PARTICIPANTS: People aged 65 and over. MEASUREMENTS: Following screening using the Community Screening Interview for Dementia, participants with low cognitive scores (CSI-D ≤ 24.5) underwent clinical assessment. Dementia diagnosis followed the DSM-IV criteria and Peterson's criteria were considered for Mild Cognitive Impairment (MCI). Neuropsychiatric symptoms were evaluated through the brief version of the Neuropsychiatric Inventory (NPI-Q). Blood samples were taken from all consenting participants before APOE genotyping was performed by polymerase chain reaction (PCR). Logistic regression models were used to evaluate the association between the APOE ϵ4 allele and neuropsychiatric symptoms. RESULTS: Overall, 322 participants had complete information on both neuropsychiatric symptoms and APOE status. Median age was 75.0 years and 81.1% were female. Neuropsychiatric symptoms were reported by 192 participants (59.8%) and at least 1 APOE ϵ4 allele was present in 135 (41.9%). APOE ϵ4 allele was not significantly associated with neuropsychiatric symptoms but showed a trend toward a protective effect in some models. CONCLUSION: This study is the first one investigating the association between APOE ϵ4 and neuropsychiatric symptoms among older people in sub-Saharan Africa (SSA). Preliminary findings indicate that the APOE ϵ4 allele was not associated with neuropsychiatric symptoms. Further research seems, however, needed to investigate the protective trend found in this study

Cardiovascular risk factors and near visual impairment among Congolese older people: EPIDEMCA-FU population-based cohort

Objective:It is recognized that some cardiovascular risk factors (CVRF) are involved in poor ocular health. The deleterious effects are potentially more pronounced among older adults. However, it is unknown whether CVRF areassociated independently or not to Visual Impairment (VI) among African older people while both (CVRF and VI) are verycommon in sub-Saharan Africa. Therefore, we investigated the association between CVRF and near VI amongCongolese older people.Methods: Participants were Congolese older people aged ≥ 65 years included in EPIDEMCA-FU (Epidemiology ofDementia in Central Africa - Follow-up) population-based cohort carried out from 2011 to 2015. Visual acuity wasassessed at 30 cm using a Parinaud chart. Near VI was defined as having a visual acuity < 20/40. A cohort design wasused taking all CVRF and covariates at baseline and visual acuity at 1st follow-up. Associations were investigated usingmultivariate logistic regression.Results: 549 participants were included in our analyses. Participants median age was 72 years [interquartile range: 68-78 years] and 331 (60.3%) were females. In total, 378 had near VI (328 had mild/moderate near VI, 38 had severe VI and12 were blind). Prevalence of near VI was 68.8% [95% Confidence Interval: 64.9% - 72.7%] and higher in males (71.1%;95%CI: 65.1% - 77.1%) than females (67.4%; 95% CI: 62.3% - 72.4%). Of the CVRF explored, we found that having highBMI ≥ 25 kg/m2 (adjusted Odds Ratio = 2.31 [95%CI: 1.25 – 4.28]), diabetes (aOR=2.14 [95%CI: 1.07 – 4.29]) andhypertension (aOR=1.65 [95%CI: 1.03 – 2.66]) were independently associated with near VI. However, after adjustmenton cognitive status, hypertension (full-adjusted OR=1.58 [95%CI: 0.97 – 2.58]) was no longer significantly associated withVI. There was no interaction between these CVRF. We found no significant association for alcohol consumption(p=0.541), smoking status (p=0.88), and indirect marker of poor diet (0.33) in our sample.Conclusion: Prevalence of near VI was high among Congolese older people. High BMI, diabetes, and hypertension wereindependently associated to near VI in this population. Our study suggests that these CVRF could represent targets for VIprevention. However, further studies are required to clarify underling mechanisms because these associations may bemediated by the presence of ocular conditions/eye diseases

Mutation in the 3’untranslated region of APP as a genetic determinant of cerebral amyloid angiopathy

International audienceAβ-related cerebral amyloid angiopathy (CAA) is a major cause of primary non-traumatic brain hemorrhage. In families with an early onset of the disease, CAA can be due to amyloid precursor protein (APP) pathogenic variants or duplications. APP duplications lead to a ~1.5-fold increased APP expression, resulting in Aβ overproduction and deposition in the walls of leptomeningeal vessels. We hypothesized that rare variants in the 3’untranslated region (UTR) of APP might lead to APP overexpression in patients with CAA and no APP pathogenic variant or duplication. We performed direct sequencing of the whole APP 3’UTR in 90 patients with CAA and explored the functional consequences of one previously unreported variant. We identified three sequence variants in four patients, of which a two-base pair deletion (c.*331_*332del) was previously unannotated and absent from 175 controls of same ethnicity. This latter variant was associated with increased APP expression in vivo and in vitro. Bioinformatics and functional assays showed that the APP c.*331_*332del variant affected APP messenger RNA (mRNA) structure and binding of two microRNAs (miR-582-3p and miR-892b), providing a mechanism for the observed effects on APP expression. These results identify APP 3’UTR sequence variants as genetic determinants of Aβ-CAA