Conference abstract
Preventing stroke, ischemic heart disease, and dementia together in Cameroon (and Africa)
Pan African Medical Journal - Conference Proceedings. 2023:17(26).04
Jun 2023.
doi: 10.11604/pamj-cp.2023.17.26.1825
Archived on: 04 Jun 2023
Contact the corresponding author
Keywords: Dementia, heart disease, CCC-APP
Oral presentation
Preventing stroke, ischemic heart disease, and dementia together in Cameroon (and Africa)
Vladimir Hachinski1, Abdfazl Avan1, Alfred K. Njamnshi2,&
1Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada, 2Brain Research Africa Initiative, Yaoundé, Cameroon; Neuroscience Lab, Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
&Corresponding author
Introduction: the prevalence of dementia in Cameroon is increasing, and the incidence is high, particularly in 70 years + individuals. The same is true for ischemic heart disease and stroke, although the incidence decreased over the last 5 years. Although these data are encouraging, many challenges remain, yet to be addressed. Hypertension is a link between and the most common of the risk factors shared by stroke, ischemic heart disease, and dementia. It has a lifetime risk of developing of 80% and only 50% of people at risk are aware of it. Among those aware of it, only half get treated. And among the latter, only half have been treated successfully. This offers a great opportunity for joint prevention.
Methods: we present evidence supporting that the greatest potential payoff in healthcare is prevention, particularly for stroke, ischemic heart disease, and dementia, and that they should be prevented together.
Results: in Ontario (London), Canada, a province with a population of 14 million, although dementia remains untreatable except symptomatically, over a 12-year period, the incidence of stroke decreased by 72% and dementia by 7%. Thus, thousands of individuals were spared a tragedy because of the diverse strategies implemented to fight stroke and risk factors. The actual approach that accounts for such incidence decreases is not clear yet. Nonetheless, it appears that it is possible to decrease the incidence of these serious conditions through a comprehensive (considers all relevant factors), customized (to the most promising combination for a given population/individual), and cost-effective approach (CCC-APP). Most major dementias have a vascular component, ranging from 56% (frontotemporal dementias) to 83% (Alzheimer’s disease), raising the concept of vascular cognitive impairment (VCI) from population-based studies (cognitive impairment caused by/associated with vascular factors). A good way to diagnose VCI is to apply the ischemic score, the shortcoming being that it requires neurological examination, making it impractical for most physicians. We developed an ischemic score with 5 composite questions not requiring a neurological examination, that can be used by all health professionals to simplify the diagnosis of VCI. Furthermore, promising predictors of ischemic disease progression to dementia in older individuals, such as apolipoprotein E (APOE) were characterized.
Conclusion: we propose CCC-APP, including HBP testing and treatment as an efficient and effective approach to decrease incidences of stroke, ischemic heart disease and dementia in Cameroon and Africa, particularly in midlife (44-69-year-old) individuals who have worst executive functions.
Preventing stroke, ischemic heart disease, and dementia together in Cameroon (and Africa)
Vladimir Hachinski1, Abdfazl Avan1, Alfred K. Njamnshi2,&
1Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada, 2Brain Research Africa Initiative, Yaoundé, Cameroon; Neuroscience Lab, Faculty of Medicine & Biomedical Sciences, The University of Yaoundé I, Yaoundé, Cameroon
&Corresponding author
Introduction: the prevalence of dementia in Cameroon is increasing, and the incidence is high, particularly in 70 years + individuals. The same is true for ischemic heart disease and stroke, although the incidence decreased over the last 5 years. Although these data are encouraging, many challenges remain, yet to be addressed. Hypertension is a link between and the most common of the risk factors shared by stroke, ischemic heart disease, and dementia. It has a lifetime risk of developing of 80% and only 50% of people at risk are aware of it. Among those aware of it, only half get treated. And among the latter, only half have been treated successfully. This offers a great opportunity for joint prevention.
Methods: we present evidence supporting that the greatest potential payoff in healthcare is prevention, particularly for stroke, ischemic heart disease, and dementia, and that they should be prevented together.
Results: in Ontario (London), Canada, a province with a population of 14 million, although dementia remains untreatable except symptomatically, over a 12-year period, the incidence of stroke decreased by 72% and dementia by 7%. Thus, thousands of individuals were spared a tragedy because of the diverse strategies implemented to fight stroke and risk factors. The actual approach that accounts for such incidence decreases is not clear yet. Nonetheless, it appears that it is possible to decrease the incidence of these serious conditions through a comprehensive (considers all relevant factors), customized (to the most promising combination for a given population/individual), and cost-effective approach (CCC-APP). Most major dementias have a vascular component, ranging from 56% (frontotemporal dementias) to 83% (Alzheimer’s disease), raising the concept of vascular cognitive impairment (VCI) from population-based studies (cognitive impairment caused by/associated with vascular factors). A good way to diagnose VCI is to apply the ischemic score, the shortcoming being that it requires neurological examination, making it impractical for most physicians. We developed an ischemic score with 5 composite questions not requiring a neurological examination, that can be used by all health professionals to simplify the diagnosis of VCI. Furthermore, promising predictors of ischemic disease progression to dementia in older individuals, such as apolipoprotein E (APOE) were characterized.
Conclusion: we propose CCC-APP, including HBP testing and treatment as an efficient and effective approach to decrease incidences of stroke, ischemic heart disease and dementia in Cameroon and Africa, particularly in midlife (44-69-year-old) individuals who have worst executive functions.
