APOE E4 is associated with impaired self-declared cognition but not disease risk or age of onset in Nigerians with Parkinson's disease

The relationship between APOE polymorphisms and Parkinson's disease (PD) in black Africans has not been previously investigated. We evaluated the association between APOE polymorphic variability and self-declared cognition in 1100 Nigerians with PD and 1097 age-matched healthy controls. Cognition in PD was assessed using the single item cognition question (item 1.1) of the MDS-UPDRS. APOE genotype and allele frequencies did not differ between PD and controls (p > 0.05). No allelic or genotypic association was observed between APOE and age at onset of PD. In PD, APOE ε4/ε4 conferred a two-fold risk of cognitive impairment compared to one or no ε4 (HR: 2.09 (95% CI: 1.13-3.89; p = 0.02)), while APOE ε2 was associated with modest protection against cognitive impairment (HR: 0.41 (95% CI 0.19-0.99, p = 0.02)). Of 773 PD with motor phenotype and APOE characterized, tremor-dominant (TD) phenotype predominated significantly in ε2 carriers (87/135, 64.4%) compared to 22.2% in persons with postural instability/gait difficulty (PIGD) (30/135) and 13.3% in indeterminate (ID) (18/135, 13.3%) (p = 0.037). Although the frequency of the TD phenotype was highest in homozygous ε2 carriers (85.7%), the distribution of motor phenotypes across the six genotypes did not differ significantly (p = 0.18). Altogether, our findings support previous studies in other ethnicities, implying a role for APOE ε4 and ε2 as risk and protective factors, respectively, for cognitive impairment in PD

Poor compliance with lifestyle modifications and related factors in hypertension

Background: Lifestyle modification (LSM) is the first step in the management of hypertension, and it has good outcomes. These outcomes can only be achieved with good compliance. However, the level of compliance with LSM is not established in our setting. Hence, we sought to determine the level of compliance with LSM, and the related factors in hypertensive patients.Methods: This was a cross - sectional study of hypertensive patients in a tertiary health centre. An intervieweradministered questionnaire was used to obtain data on socio - demographic variables, and assess the practice of seven aspects of LSM. Compliance with each LSM, and the different LSM assessed were determined. Chi square test was used to determine associations, and p values = 0.05 were significant.Results: There were 254 respondents with a median age of 63 years, and 104(40.9%) were males. Compliance with each LSM was regular exercises 12.1%; salt restriction 26.4%; increased intake of fruits 21.3% and vegetables 13.4%; low fat diet 31.1%; cessation of smoking  96.6%; and alcohol moderation 87.4%. Generally, sixty – eight (26.8%) had good compliance, while 186 (73.2%) had poor compliance. The association of gender, educational status, and duration of hypertension gave p values of 0.009, 0.006, and 0.00 respectively.Conclusion: Compliance with LSM is poor among hypertensive patients. Regular physical exercise, increased intake of vegetables and fruits were the least practiced. Low educational status, long history of hypertension, and male gender are the related factors. Measures to address these factors should be initiated

Limitations in education, employment and relationship amongst persons with epilepsy: the experiences from Benin City, Nigeria

Background: The persons with epilepsy have higher rates of educational underachievement, unemployment and being unmarried. These socioeconomic consequences of epilepsy can be more difficult to overcome than the seizures. In Nigeria there is a paucity of information on the socioeconomic limitations experienced by persons with epilepsy (PWE). We therefore sought to determine the predictors of these socioeconomic variables amongst PWE in Benin City, Nigeria. Methods: This was a cross-sectional study, done at the neurology clinics of the University of Benin Teaching Hospital and the Central Hospital, Benin City. Persons on treatment for epilepsy were consecutively recruited. Using a structured questionnaire the demographics, clinical characteristics and socioeconomic experiences with regards to education, employment and relationships were obtained. Results: One hundred and thirty PWE were recruited. The mean age was 37±10.3 years, range 25 to 55yrs, with 54% being males, while 53.1% have had epilepsy for over 10yrs. About 45% have comorbid conditions, 51% are not adherent to antiepilepsy drugs, while 49.2% have had stigma experience. Approximately 47% have had more than 10 years of schooling, about 56.2% are employed while 55.4% are in an intimate relationship. Educational underachievement was predicted by stigmatization, while unemployment and not being in a relationship was predicted by stigmatization and longer duration of epilepsy. Conclusion: The high proportion of the participants with socioeconomic challenges is worrisome. It is hoped that meeting the educational and vocational needs of PWE, in addition to public campaign on epilepsy could reverse the situation