Objective: To describe the rate and severity of cognitive impairment within the coastal Kenyan cohort of TraPCAf.

Background: Cognitive impairment is a well-recognised non-motor symptom of PD, however there is very limited evidence on the burden of cognitive impairment in African people with Parkinson’s (PwP) and no data on the prevalence of cognitive impairment among Kenyans with PD.

Method: Participants were recruited through an affiliated prevalence study in Kilifi and neurology outpatients in Mombasa within TraPCAf. Each patient had two age and sex matched controls recruited. Cognition was assessed using MDS-UPDRS 1.1, CISI-PD and Identifying Dementia in Elderly Africans (IDEA) screen. Age and sex matched controls also completed the IDEA cognitive screen.

Results: 52 PwP and 104 controls were recruited, with mean age of 64.5 years (range 25-87) and 58 were female (37%). 12 PwP (23.1%) were found to have an IDEA score ≤8 (suggestive of poor cognitive performance) compared to 26.9% (n=14) PwP who had a CISI PD Cognition score of ≥3. However, only 7.7% (n=4) self-reported cognitive impairment scores of ≥3 on the MDS UPDRS 1.1.  After adjusting for age and sex, controls had higher IDEA scores than PwP (β = 1.27, p = 0.001). IDEA score correlated more strongly with age (r=-0.53, p<0.001) than disease duration (r=0.038, p=0.792).  After adjusting for age and sex, IDEA scores were significantly higher among neurology outpatients in Mombasa than prevalent patients in Kilifi (β = 2.12, p = 0.012).  In contrast, after adjusting for age and sex, differences in IDEA scores between the corresponding control groups were smaller and not statistically significant (p=0.107).

Conclusion: The three methods of assessing cognition represent differing approaches: self-report, clinical assessment based on history, and objective assessment using a validated scale. Self-reporting of cognitive impairment was low despite there being indicators in the history picked up by CISI-PD. All self-reports of cognitive impairment were identified by CISI-PD or IDEA screen. There were some PwP with IDEA ≤8 who scored ≤3 on CISI-PD and vice-versa. This highlights the importance of multiple points of reference in analysing cognition and the potential lack of utility of self-reported cognition in this cohort.

References: Paddick SM, Gray WK, Ogunjimi L, Lwezuala B, Olakehinde O, Kisoli A, Kissima J, Mbowe G, Mkenda S, Dotchin CL, Walker RW, Mushi D, Collingwood C, Ogunniyi A. Validation of the Identification and Intervention for Dementia in Elderly Africans (IDEA) cognitive screen in Nigeria and Tanzania. BMC Geriatr. 2015 Apr 25;15:53. doi: 10.1186/s12877-015-0040-1. PMID: 25908439; PMCID: PMC4455989.

Walker R, Fothergill-Misbah N, Kariuki S, Ojo O, Cilia R, Dekker MCJ, Agabi O, Akpalu A, Amod F, Breckons M, Cham M, Del Din S, Dotchin C, Guggsa S, Kwasa J, Mushi D, Nwaokorie FO, Park T, Rochester L, Rogathi J, Sarfo FS, Shalash A, Ternent L, Urasa S, Okubadejo N. Transforming Parkinson’s Care in Africa (TraPCAf): protocol for a multimethodology National Institute for Health and Care Research Global Health Research Group project. BMC Neurol. 2023 Oct 19;23(1):373. doi: 10.1186/s12883-023-03414-0. PMID: 37858118; PMCID: PMC10585779.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/the-burden-of-cognitive-impairment-in-people-with-parkinsons-across-outpatients-and-prevalent-patients-in-coastal-kenya-a-transforming-parkinsons-care-in-africa-trapcaf-study/