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Une etude transversale, de type porte-a-porte dans le troisieme arrondissement de Bangui, menee en population generale, a ete realisee, entre octobre 2008 et mars 2009, afin d’aider a une meilleure connaissance des demences chez les personnes âgees de plus de 65 ans vivant dans la capitale centrafricaine. Sur 496 personnes âgees interrogees, 188 sujets presentaient des troubles cognitifs. Apres examen neuropsychologique, 40 de ces sujets ont ete diagnostiques dements. La prevalence des demences dans cette population etait de 8,1 % (IC 95 % = [5,7–10,5]). L’âge moyen des sujets dements, allant de 65 a 90 ans, etait de 76,0 ± 7,1 ans. Il existait un risque important de developper la demence pour une augmentation d’âge de dix ans (OR = 2,6; IC 95 %: [1,5–4,5]). Le rapport de masculinite etait de 6/34. Nous avons constate que 82,5 % des dements n’avaient jamais ete scolarises. Soixante-dix pour cent presentaient un etat de denutrition (indice de masse corporelle [IMC] ≤ 18,5 kg/m2), significativement associe aux demences (OR = 3,3; IC 95%: [1,5–7,3]). Pour 67,5 % des dements, leur tension arterielle etait elevee et significativement associee aux demences (OR = 2,4; IC 95 %: [1,1–5,4]). Un changement recent du statut financier etait un facteur significativement associe aux demences (OR = 6,4; IC 95 %: [1,8–22,5]). Ces resultats confortent l’existence des demences en milieu urbain africain. La prevalence observee est proche de celles retrouvees dans les pays a revenu eleve. Il convient de mener d’autres etudes plus elargies, aussi bien en zone rurale qu’en zone urbaine, afin de mieux cerner le probleme et d’envisager des solutions de prise en charge globale et des axes de prevention adaptes a notre contexte.

Resume Developper la prevention pour la maladie d'Alzheimer est necessaire au vu de l'augmentation du nombre de cas et de la non disponibilite d'un traitement curatif. A partir des donnees de la cohorte prospective PAQUID, nous avons etudie le risque de demence en fonction des activites de loisirs et de l'âge de cessation de l'activite professionnelle. La pratique d'un sport et la lecture diminuent de 25% le risque de demence a 15 ans. Par contre, l'âge de cessation d'activite n'est pas lie au risque de demence. Une vie active semble etre une voie possible dans la prevention de la demence. Pour citer cet article : M. Le Goff et al., C. R. Biologies 332 (2009).

Resume La tuberculose vertebrale realise classiquement une spondylodiscite appelee Mal de Pott. Rarement, elle se presente sous des formes atypiques rendant le diagnostic difficile. Les auteurs rapportent une serie retrospective de 7 patients immunocompetents traites pour une tuberculose vertebrale etendue. La mediane d’âge des patients etait de 24 ans avec des extremes allant de 5 a 39 ans et un sex-ratio de 5 hommes pour 2 femmes. Ils avaient presente une tetraplegie incomplete (4 cas), une paraplegie complete (1 cas), une paraplegie incomplete (1 cas) et une lombocruralgie (1 cas). La radiographie standard du rachis demandee en premiere intention permit de mettre en evidence la spondylodiscite mais le scanner X et l’IRM etaient indispensables pour definir au mieux l’etendue des lesions. Les diagnostics bacteriologique et histologique peuvent parfois etre deficients et les auteurs insistent sur le role diagnostique de l’epreuve therapeutique qui peut elle meme etre limitee par l’apparition de souche de Mycobacterium tuberculosis multiresistante.

Introduction: Since 2002, with the creation of Centers of Memory Resources and Research (CMRR), considerable progress has been made in France regarding the administrative and institutional framework within which Alzheimer's disease (AD) is managed. In this study, we explore three approaches that can help optimize the inclusion of patients in clinical trials related to AD. They are as follows: to assess communication concerning clinical trials on AD in French CMRR, to analyze the internal organization of these centers concerning the dynamics of inclusion, and to evaluate screening tools used. Methods: A national, descriptive, cross-sectional survey was conducted in all CMRR in France between May 1 and July 31, 2011, using a self-administered questionnaire. All investigators, subinvestigators and the relevant CMRR personnel were involved. Results: A total of 75% of the CMRR participated, and about 30% of the physicians contacted responded positively to the survey. Only 50% reported having communicated with health care professionals at least once in the previous 3 months, and less than 50% had communicated occasionally with the general public. A total of 75% of those surveyed had a research group but only half of the groups were active, 50% of the physicians did not have a consultation time dedicated to study recruitment, and 75% of the respondents had a screening tool in their CMRR but over half of them were not satisfied with it. Conclusion: This investigation provides a basis for improving the screening of patients by both internal organizational development and adaptation of tools already available. Improvement requires promoting regular communication that is appropriate and targeted to health care professionals, smaller memory centers, associations and the public, and therefore, familiarizing the whole population with clinical research on AD.

International audience; Risk factors for dementia in American and European countries have been well investigated. However, little research has been carried out in sub-Saharan Africa, where life events as well as environmental, socio-economic, and modifiable risk factors (i.e., cardiovascular risk factors) may differ. Two cross-sectional surveys were conducted in representative samples of the older general population living in Bangui (Central African Republic) and Brazzaville (Congo). Dementia was defined according to the DSM-IV criteria. Multivariate regression analyses were performed in order to identify independent factors associated with dementia. Among the 977 elderly Africans included in this analysis, 75 (7.6%) were diagnosed as having dementia. Increasing age, female gender, hypertension, a body mass index

Background: Data on dementia from low- and middle-income countries are still necessary to quantify the burden of this condition. This multicenter cross-sectional study aimed at estimating the prevalence of dementia in 2 large cities of Central Africa. Methods: General population door-to-door surveys were conducted in the districts of Bangui (Republic of Central Africa) and Brazzaville (Congo) in elderly aged ≧65 years. The subjects were screened with the Community Screening Interview for Dementia and the Five-Words Test. Diagnosis of dementia was made according to the DSM-IV criteria and to the clinical criteria proposed by the NINCDS-ADRDA for Alzheimer’s disease. Results: We enrolled 496 subjects in Bangui and 520 in Brazzaville. The prevalence of dementia was estimated at 8.1% (95% CI = 5.8–10.8) in Bangui and 6.7% (95% CI = 4.7–9.2) in Brazzaville. Conclusion: The prevalence of dementia in urban areas of Central Africa is close to those observed in high-income countries.

It is necessary to develop the prevention of Alzheimer's disease, because of the increase in the number of cases and unavailability of a curative treatment. From the data of the cohort PAQUID, we studied the risk of dementia according to leisure activities and the age of cessation of professional activity. The practice of a sport and reading decreases by 25% the risk of dementia during 15 years. The age of cessation of professional activity is not associated with the risk of dementia. An active life seems to be a possible way to prevent dementia.

Objectif Evaluer la frequence des complications de l\'epaule de l\'hemiplegique vasculaire et identifier les facteurs associes a ces complications Methodes C\'est une etude prospective realisee entre Juin et Octobre 2005 au Centre hospitalo-universitaire de Cocody (Abidjan, Cote d\'Ivoire). Elle concerne des patients admis en consultation de reeducation fonctionnelle (RF) ou en hospitalisation de neurologie. Resultats Cinquante patients âges en moyenne de 56,6 ± 13,4 ans (extremes de 29 et 85 ans) avec un sexe ratio de 1,17 en faveur des femmes, recrutes le plus souvent en RF (60%) ont ete inclus dans cette etude. Ils avaient un accident vasculaire cerebral (AVC) principalement ischemique (72%), qui evoluait en moyenne depuis 11,3 ± 12,9 semaines. Parmi eux 28 (56%) avaient une complication de l\'epaule qui etait : une douleur (DL, n=25), un syndrome epaule-main (SEM, n=10) ou une subluxation (SUB, n=18). Ces complications etaient associees dans 46,4% des cas. Ces patients etaient plus âges, avaient un AVC plus ancien, un index moteur du membre superieur plus faible mais un niveau d\'autonomie globale semblable a celui des patients sans complications. Ni l\'âge, ni la duree d\'evolution de l\'AVC n\'etait different selon le type de complication diagnostique. La fonctionnalite etait associe a la SUB (dans 72,2% des SUB le Frenchay arm test etait egal a 0 vs 37,5% chez les patients sans SUB p=0,02) tandis que le tonus des adducteurs du bras etait associe a la DL (dans 40% des DL le tonus des adducteurs etait egal a 1 vs 84% chez les patients ne presentant pas de DL p=0,006). Conclusion L\'epaule douloureuse de l\'hemiplegique est donc une complication frequemment retrouvee dans notre etude. Des etudes ulterieures seront utiles pour conforter la frequence de ces complications, l\'impact des differents facteurs qui semblent s\'y associer et analyser les possibilites de prise en charge tant curative que preventive dans notre milieu Objective To assess the frequency of shoulder complications among subjects with vascular hemiplegia and to identify factors associated with these complications. Methods Conducted between June and October 2005 at the teaching hospital of Cocody (Abidjan, Cote d\'Ivoire), this prospective survey concerned outpatients of rehabilitation unit (FS) and inpatients of neurology unit. Results Fifty patients with an average age of 56.6 ± 13, 4 years (ranged from 29 to 85), a sex ratio of 1.17 in favour of females, mainly recruited in the rehabilitation unit (60%) were included in this study. They had a stroke, mainly ischemic (72%), which progressed in average for 11, 3 ± 12.9 weeks. Among them 28 (56%) had a shoulder complication which was: a shoulder pain (SP, n=25), a shoulder-hand syndrome (n=10), or a glenohumeral joint subluxation (SUB, n=18). These complications were associated in 46.4% of cases. These patients were older, had a stroke progressing for a more long time, a lower pectoral limb motor index but a global self-sufficiency not different from the one of patients without shoulder complications. Neither age nor stroke progress duration was different according to the type of complication diagnosed. The functionality was associated with SUB (in 72,2% of SUB cases the Frenchay arm test was null vs 37,5% among patients without SUB p=0.02) while tonus was associated with pain (in 40% of SP cases the spasticity was scored 1 at the Aswhorth scale vs 84% among patients without SP p=0.006). Conclusion In our study hemiplegic shoulder pain were predominant. Further studies will be necessary in order to precise the prevalence of these complications, the relations with variable factors and to discuss the treatment best adapted to our social and professional environment. Keywords : Stroke ; Shoulder pain ; Shoulder-hand syndrome, Glenohumeral joint subluxation; Africa African Journal of Neurological Sciences Vol. 27 (1) 2008: pp. 11-15

The authors used computed tomography (CT) to assess and categorize the topography of ischemic strokes (IS) among blacks living in Abidjan, the commercial and administrative center of Côte d'Ivoire, in West Africa.This retrospective study analyzed CT data of patients admitted to the Sainte Anne Marie Polyclinic (the principal private hospital in the country) and to the neurology department of the university hospital center in Cocody, from January 1, 2000, to December 31, 2001. The study included patients who met World Health Organisation criteria for stroke and had CT performed during the hospitalization for this stroke. We examined CT data to find early and late signs of IS, analyze lesion diameter (15 mm cutoff used to distinguish infarcts from lacuna), and determine their topography (cerebral arterial territory and localization, that is, brain lobes, basal ganglia and posterior cerebral fossa).We included 260 subjects (58% males) with a median age of 45 years (range: 20-80 years). CT findings were abnormal for 224 patients with infarcts (72.7%), lacuna (27.3%), or both (8%). As reported elsewhere, the anterior arterial territory was most often affected (83.9%) with a middle cerebral artery lesion in 79.4% of patients. Posterior territory (16.1%) lesions and lacuna were probably underestimated because CT exploration is reported to be less useful for this area than for the carotid area. On the other hand, CT diagnoses infarcts more easily than it does lacuna. CT was normal for 36 patients although performed no more than 3 days after IS. These patients did not undergo CT angiography, which might have shown cerebral artery occlusion.Our study included IS of all types and typography. Stroke registries in Africa would provide useful data for better assessment of prevalence for specific topographic and etiologic types of stroke.

Etiology of Alzheimer's disease (AD) is still undefined in its most frequent sporadic type, but a role of vascular risk factor is more and more evocated in its pathophysiology. This role enables to hope that preventive or curative care of vascular risk factors could decrease AD incidence. Among these factors, high blood pressure, diabetes, hypercholesterolemia and tobacco consumption were the most studied. We review the risk for AD, which had been associated with each of these factors in epidemiological studies. High blood pressure is associated with an increased risk of AD in most studies while the results are more controversial for the others factors. All these four vascular risk factors have variable interaction with the presence of cerebrovascular diseases and of the epsilon 4 allele of the apolipoprotein E gene which is a predisposition factor for sporadic AD.

Tuberculosis remains a public health problem in Côte-d'Ivoire, a sub-saharan region country, where infection with a prevalence of 2-10% increase tuberculosis incidence assesed to 290 per 100,000 habitants. Authors report a case of a ischemic stroke (IS) and unknown HIV and tuberculosis infection; discuss these infections responsibility in the occurrence of this IS and past neurological signs. The patient presented with a left hemiparesis without infectious sign nor drowsiness. Medical history noticed a weight loss and two months ago a completely regressive tetraparesia. CT cerebral scan didn't found other sign than a IS located in the right middle cerebral artery territory as describe in the literature. The cerebrospinal fluid (CS) blood cell count was high and Mycobacterium tuberculosis (MT) was found at direct exam. Positive HIV blood serology and MT where noticed at direct spit smears without chest radiograph lesion. After MT six month treatment progresses was good with no MT in CS and spit smears. Because of financial problems HIV treatment was unitialized at this time and MT was prolonged to 12 months. Literature point out different forms sometimes associated of intracranial tuberculosis (meningitis, hydrocephalus, tuberculoma, milliary, abscess, empyema). MT at direct exam was scarce, in spite of news biological methods MT diagnosis can be difficult and need a biopsy or a test treatment. Arachnoid's enhancement is frequent but MT can be misdiagnosed by CT scan which is sometimes less efficient than IRM.This case argue that tuberculosis may be evocated as a stroke aetiology especially in presence of HIV infection even if some cardiovascular risk factors are present.

L\'EXAMEN CLINIQUE POUR LA DETECTION DE LA POLYNEUROPATHIE ET DE L'ARTERIOPATHIE DES MEMBRES INFERIEURS EN CONSULTATION DE DIABETOLOGIE A ABIDJAN: QUELLE VALEUR DIAGNOSTIQUE? RESUME Introduction:La polyneuropathie (P) et l'arteriopathie (A) sont les principaux incrimines dans la survenue de lesions du pied diabetique qui mettent en jeu le pronostic fonctionnel de ces sujets. L'objectif: principal de cette etude etait d'apprecier la valeur diagnostique de l'examen clinique pour la detection de la P et de l'A des membres inferieurs, en consultation ambulatoire de diabetologie a Abidjan (Cote-d'Ivoire). Methodes : Cette etude transversale concerne 120 diabetiques randomises dans le principal centre antidiabetique ambulatoire d'Abidjan. Selon les resultats de l'electromyogramme et du doppler des membres inferieurs, les sujets ont ete repartis en 4 populations: P isolee, A isolee, P et A associes (PA), absence de P et de A. Les performances de l'examen clinique ont ete appreciees par la sensibilite (Se), la specificite (Sp), l'indice de Youden (Y) et les rapports de vraisemblance positif et negatif. Resultats: Il s'agissait de 84 hommes et 36 femmes âges en moyenne de 46 ( ± 8 ans avec des extremes de 27 et 65 ans), non insulinodependants dans 86% des cas. La Se est meilleure pour une P (82%) que pour une A (45%) et pour la PA (50%). La Sp est meilleure pour l'A (82%) que pour la PA (73%) et pour la P (62%). Les erreurs sont moins frequentes lorsqu'on diagnostique une P (Y a 45%), qu'une A (Y a 28%) ou qu'une PA (Y a 24%). L'apport diagnostique d'un resultat positif et d'un resultat negatif est moins important pour l'association PA que pour une A et une P. Chez les PA, la polyneuropathie est cliniquement surestimee aux detriments de l\'arteriopathie: 78% des patients qui ont des signes cliniques de P sont des PA et il n\'est pas retrouvee cliniquement d\'A isolee chez les patients PA. Conclusion : La P, l'A et leur association echappent souvent a l'examen clinique. Le medecin manque ainsi l'opportunite de traiter ces pathologies et de renforcer les mesures de prevention du pied diabetique. Pour la polyneuropathie des scores, exclusivement cliniques pourraient etre utilises. ABSTRACT Background : Lower limbs polyneuropathy (P) and arterial disease (A) are the main causes of diabetic foot lesions which threatens the functional prognosis of these subjects. Objective : The aim of this study was to assess medical examination diagnostic value for lower limbs P and A, in ambulatory diabetic care in Abidjan (Cote-d'Ivoire). Methods : One hundred and twenty diabetics patients randomly selected at the main antidiabetic ambulatory centre of Abidjan, were included in a cross-sectional survey. Our gold standards tests were lower limbs Electromyogramm and Doppler. After their results, subjects were divided up to 4 populations: P isolated, A isolated, P and A associated (PA), lack of P and A. Medical examination diagnostic value were assessed by different index: sensibility (Se), specificity (Sp), Youden indice (Y), positive and negative likelihood ratios. Results : Eigthy-four males and 36 females were included in this study. Eighty-six percents were non insulino-dependants. The average age for all subjects is 46 years (± 8, ranged from 27 to 65 years). Se is better for screening P (82%) than A (45%) and association PA (50%). Sp is better for screening A (82%) than PA (73%) and P (62%). Diagnosis mistakes are less frequent when medical examination detect P(Y= 45%), than A (Y= 28%) or PA (Y= 24%). Diagnostic contribution of one positive result and one negative result was less important for PA than for A and for P. Among PA subjects, polyneuropathy was overestimate to the detriment of arteriopathy: 78% of patients clinicaly diagnosed as P are PA and it was not founded isolated arteriopathy at the medical examination among PA subjects. Conclusion : P, A or their fearsome association are in many cases misdiagnosed by the medical examination. The consulting physician miss the opportunity to treat these diseases and to reinforce diabetic foot safety measures. Regarding P, scores considered as valid could be used for the medical examination; or as a help to conceive a clinical score adapted to our medical practice. Key Words: Arteriopathie, Diabete, Polyneuropathie, Examen clinique, Africa-Arteriopathy, Diabetes, Polyneuropathy, Medical examination African Journal of Neurological Sciences Vol.23(2) 2004

EPIDEMIOLOGIE DES PATIENTS HOSPITALISES EN NEUROLOGIE: EXPERIENCE DU CENTRE HOSPITALIER UNIVERSITAIRE DE COCODY A ABIDJAN (COTE-D'IVOIRE) RESUME Objectif: Identifier les principales etiologies et diagnostics des affections neurologiques et decrire leur evolution, en hospitalisation de neurologie. Methodes: Analyse retrospective des dossiers medicaux des patients admis dans le service de Neurologie du CHU de Cocody (Abidjan) entre le 1er decembre 1998 au 31 Decembre 2000. Resultats: Mille dix huit sujets âges en moyenne de 45 ± 17,7 ans (extremes de 1 et 93 ans) avec un sexe ratio de 1,7 en faveur des hommes. Ces patients provenant en majorite du service des urgences (65,2%) ont ete hospitalises en moyenne pendant 12,5± 9,6 jours. Les principaux diagnostics etaient: un Accident vasculaire cerebral (42,1%), un abces cerebral (17,9%) et une meningo-encephalite (ME) dans 11,9%. La letalite globale en cours d'hospitalisation etait de 23,5% avec un deces plus frequent lors des infections neurologiques (30,5%) que des affections vasculaires (20,6%). Le risque de deces etait d'une part plus eleve en cas d'infection neurologique qu'en cas d'accident vasculaire cerebral et d'autre part plus eleve en cas d'infection par rapport a toutes les autres affections. Les letalites les plus elevees etaient observees pour les ME (52,1%), les polyradiculoneuropathies (50%) et les encephalites (34,2%). Conclusion: Dans notre etude les affections infectieuses et vasculaires sont predominantes. Des etudes ulterieures seront utiles pour conforter la frequence de ces affections et analyser la prise en charge de celles qui sont les plus letales. ABSTRACT Objective: To identify aetiologies and diagnosis of neurological diseases and describe their progress at neurology hospitalization. Methods: A retrospective analysis of medical back-rest of subjects admitted at the inpatients unit of Cocody neurological service between the 1st December 1998 and the 31th December 2000. Results: One thousand and eighteen patients with an average age of 45 ±17,7 years (ranged from 1 to 93 years) and a sex ratio of 1,7 were included in this study. These patients mostly transfered from the casualty department (65,2%) had a mean length hospital stay 12,5± 9,6 days (ranged from 1 to 68). The main diagnosis where: a stroke (42,1%), a cerebral abscess (17,9%) and a meningoencephalitis (ME) for 11,9%. Global letality during hospital stay was about 23,5% with a death more frequent for infectious (30,5%) than for vascular diseases (20,6%). Death risk was in the one hand higher for neurological infectious than for stroke and in the second hand higher for neurological infectious than for all other diseases. Highest letality were observed for ME (52,1%), polyradiculoneuropathies (50%) and encephalitis (34,2%). Conclusion: In our study infectious and vascular diseases were predominant. Studies are necessary to strengthen the frequency of these diseases and to analyse the management of the most lethal of them. Key Words: Afrique, Epidmiologie, Neurologie, Africa, Epidemiology, Neurology African Journal of Neurological Sciences Vol.23(2) 2005

Assess the etiology and course of cases of encephalopathy seen in the neurology department of the Cocody University Hospital in Abidjan (Côte-d'Ivoire), a city of more than three million inhabitants.Retrospective analysis of patients admitted to the hospital neurology unit from 1 December, 1998, through 31 December, 2000; with a lesion of the brain, brainstem, cerebellum or meninges. Lesions were either confirmed by computed tomography or clinically obvious; MRI was unavailable.Overall, 1011 subjects met the inclusion criteria: 58% were male; their median age was 45 years (range: 1 to 93 years); more than 40% were not working, and 92% had a medical history. The etiology was vascular (445), infectious (380) or undetermined (125); rare cases were degenerative (5) or traumatic (4). Of 35 cases of metabolic encephalopathy, half were associated with another etiology. Pathological confirmation of cerebral tumors (22) was unavailable. All cases of toxic encephalopathy (11) involved adults and alcohol. Global lethality was 26% and did not differ significantly according to whether or not the etiology was identified (26% vs 28.8%). Another 13% were lost to follow-up (left without discharge), and 61% patients recovered and were discharged after a median hospitalization of 12.5 days.The proportion of cases with an undetermined etiology is worrisome. Better knowledge would be useful to develop indicators to evaluate improvements in the medical management of these diseases.

Background It is crucial to define health policies that target patients with the highest needs. In France, public financial support is provided to dependent patients: it can be used to finance informal care time and nonmedical care use. Eligibility for public subsidies and reimbursement of costs is associated with a specific tool: the autonomie gerontologie groupes iso-ressources (AGGIR) scale score. Objective Our objective was to explore whether patients with Alzheimer's disease who are eligible for public financial support have greater needs than do noneligible patients. Methods Using data from the Dependance des patients atteints de la maladie d'Alzheimer en France study, we calculated nonmedical care expenditures (in €) using microcosting methods and informal care time demand (hours/month) using the Resource Use in Dementia questionnaire. We measured the burden associated with informal care provision with Zarit Burden Interview. We used a modified two-part model to explore the correlation between public financial support eligibility and these three variables. Results We find evidence of higher informal care use, higher informal caregivers' burden, and higher care expenditures when patients have an AGGIR scale score corresponding to public financial support eligibility. Conclusions The AGGIR scale is useful to target patients with the highest costs and needs. Given our results, public subsidies could be used to further sustain informal caregivers networks by financing programs dedicated to lowering informal caregivers' burden.