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Current Alzheimer Research

Editor-in-Chief

ISSN (Print): 1567-2050
ISSN (Online): 1875-5828

Review Article

Diabetes/Dementia in Sub-Saharian Africa and Nigerian Women in the Eye of Storm

Author(s): Efosa K. Oghagbon*, José Prieto-Pino, Faeren Dogoh, Monday Ogiator and Lydia Giménez-Llort*

Volume 19, Issue 2, 2022

Page: [161 - 170] Pages: 10

DOI: 10.2174/1567205018666211116093747

Price: $65

Abstract

In the next few years, the prevalence of diabetes mellitus (DM) is projected to dramatically increase globally, but most of the cases will occur in low-to-middle-income countries. Some of the major risk factors for diabetes accelerate the development of dementia in African-Americans, thus leading to a higher prevalence of dementia than Caucasians. Sub-Saharian Africa women have a disproportionately two-to-eight fold increased prevalence of dementia. In the eye of this storm, Nigeria holds the highest number of diabetics on the African continent, and its prevalence is rising in parallel to obesity, hypertension, and the population’s aging. The socio-economic impact of the rising prevalence of DM and dementia will be huge and unsustainable for the healthcare system in Nigeria, as has been recognized in developed economies. Here, we analyze the current situation of women's health in Nigeria and explore future perspectives and directions. The complex interplay of factors involved in diabetes and dementia in Nigerian women include key biological agents (metabolic syndrome, vascular damage, inflammation, oxidative stress, insulin resistance), nutritional habits, lifestyle, and anemia, that worsen with comorbidities. In addition, restricted resources, lack of visibility, and poor management result in a painful chain that increases the risk and burden of disease in Nigerian women from youth to old ages. Heath policies to increase the ratio of mental health professionals per number of patients, mostly in rural areas, foment of proactive primary care centers, and interventions targeting adolescents and adult women and other specific mothers-children pairs are strongly required for a sustainable development goal.

Keywords: diabetes mellitus, dementia, risk factors, LMIC, Sub-Saharan Africa, women, health policies.

[1]
Mietlicki-Baase EG. Amylin in Alzheimer’s disease: Pathological peptide or potential treatment? Neuropharmacology 2018; 136(Pt B): 287-97.
[http://dx.doi.org/10.1016/j.neuropharm.2017.12.016] [PMID: 29233636]
[2]
Palacios-Mendoza M, Jurado MB, Gamboa X, et al. Diabetes Is Associated with Cognitive Decline in Middle-Aged Patients. Metab Syndr Relat Disord 2018; 16(10): 514-20.
[http://dx.doi.org/10.1089/met.2018.0014]
[3]
Simó R, Ciudin A, Simó-Servat O, Hernández C. Cognitive impairment and dementia: A new emerging complication of type 2 diabetes-The diabetologist’s perspective. Acta Diabetol 2017; 54(5): 417-24.
[http://dx.doi.org/10.1007/s00592-017-0970-5] [PMID: 28210868]
[4]
Matioli MNPDS, Suemoto CK, Rodriguez RD, et al. Association between diabetes and causes of dementia: Evidence from a clinicopathological study. Dement Neuropsychol 2017; 11(4): 406-12.
[http://dx.doi.org/10.1590/1980-57642016dn11-040010] [PMID: 29354221]
[5]
Research and Markets. Dementia with Diabetes - Epidemiology Forecast-2030. Ed. Research and Markets, Dublin, Ireland. Available from: https://www.researchandmarkets.com/ reports/5129086/dementia-with-diabetes-epidemiology-forecast-to (Accessed September 11, 2020)
[7]
Corfield, S. Women & dementia: A global challenge. London; Global Alzheimer’s and Dementia Action Alliance. Available from: https://www.gadalliance.org/report-women-dementia-a- global-challenge/ (Accessed September 11, 2020)
[8]
Chen C, Zissimopoulos JM. Racial and ethnic differences in trends in dementia prevalence and risk factors in the United States. Alzheimers Dement (N Y) 2018; 4(1): 510-20.
[http://dx.doi.org/10.1016/j.trci.2018.08.009] [PMID: 30364652]
[9]
Adeloye D, Ige JO, Aderemi AV, et al. Estimating the prevalence, hospitalisation and mortality from type 2 diabetes mellitus in Nigeria: A systematic review and meta-analysis. BMJ Open 2017; 7(5): e015424.
[http://dx.doi.org/10.1136/bmjopen-2016-015424] [PMID: 28495817]
[10]
George-Carey R, Adeloye D, Chan KY, et al. An estimate of the prevalence of dementia in Africa: A systematic analysis. J Glob Health 2012; 2(2): 020401.
[http://dx.doi.org/10.7189/jogh.02.020401] [PMID: 23289076]
[11]
McFerson H. Poverty Among Women in Sub-Saharan Africa: A Review of Selected Issues. J Int Womens Stud 2010; 11(4): 50-72.
[12]
Anyanwu JC. Poverty in Nigeria: A Gendered Analysis. Afr Stat J 2010; 11: 38-61.
[13]
Bailey SL, Ayles H, Beyers N, et al. Diabetes mellitus in Zambia and the Western Cape province of South Africa: Prevalence, risk factors, diagnosis and management. Diabetes Res Clin Pract 2016; 118: 1-11.
[http://dx.doi.org/10.1016/j.diabres.2016.05.001] [PMID: 27485851]
[14]
Oghagbon EK, Giménez-Llort L. Short height and poor education increase the risk of dementia in Nigerian type 2 diabetic women. Alzheimers Dement (Amst) 2019; 11(1): 493-9.
[http://dx.doi.org/10.1016/j.dadm.2019.05.006] [PMID: 31334329]
[15]
Preux PM, Guerchet M, Epidemca . Epidemiolocy of dementia in sub-Saharan Africa. Bull Acad Natl Med 2015; 199(7): 1187-97.
[http://dx.doi.org/10.1016/S0001-4079(19)30858-1] [PMID: 29879338]
[16]
Adeloye D, Auta A, Ezejimofor M, et al. Prevalence of dementia in Nigeria: A systematic review of the evidence. J Glob Health Rep 2019; 3: e2019014.
[http://dx.doi.org/10.29392/joghr.3.e2019014] [PMID: 31528708]
[17]
Guerchet M, M’belesso P, Mouanga AM, et al. Prevalence of dementia in elderly living in two cities of Central Africa: The EDAC survey. Dement Geriatr Cogn Disord 2010; 30(3): 261-8.
[http://dx.doi.org/10.1159/000320247] [PMID: 20847557]
[18]
Mavrodaris A, Powell J, Thorogood M. Prevalences of dementia and cognitive impairment among older people in sub-Saharan Africa: A systematic review. Bull World Health Organ 2013; 91(10): 773-83.
[http://dx.doi.org/10.2471/BLT.13.118422] [PMID: 24115801]
[19]
Rocca WA. Time, sex, gender, history, and dementia. Alzheimer Dis Assoc Disord 2017; 31(1): 76-9.
[http://dx.doi.org/10.1097/WAD.0000000000000187] [PMID: 28169841]
[20]
Kunkle BW, Schmidt M, Klein H-U, et al. Novel Alzheimer Disease Risk Loci and Pathways in African American Individuals Using the African Genome Resources Panel: A Meta-analysis. JAMA Neurol 2021; 78(1): 102-13.
[http://dx.doi.org/10.1001/jamaneurol.2020.3536] [PMID: 33074286]
[21]
Almeida OP, Hankey GJ, Yeap BB, Golledge J, Flicker L. Depression as a modifiable factor to decrease the risk of dementia. Transl Psychiatry 2017; 7(5): e1117.
[http://dx.doi.org/10.1038/tp.2017.90] [PMID: 28463236]
[22]
Cox SR, Ritchie SJ, Dickie DA, et al. Interaction of APOE e4 and poor glycemic control predicts white matter hyperintensity growth from 73 to 76. Neurobiol Aging 2017; 54: 54-8.
[http://dx.doi.org/10.1016/j.neurobiolaging.2017.02.014] [PMID: 28324763]
[23]
Ronquillo JG, Baer MR, Lester WT. Sex-specific patterns and differences in dementia and Alzheimer’s disease using informatics approaches. J Women Aging 2016; 28(5): 403-11.
[http://dx.doi.org/10.1080/08952841.2015.1018038] [PMID: 27105335]
[24]
Arum KC, Nnanyelu NJ, Ugah TE, Oranye HE. Statistical study of life expectancy of male and female children at birth in some selected African countries. African Journal of Mathematics and Statistics Studies 2019; 2(1): 1-9.
[25]
Husaini B, Gudlavalleti AS, Cain V, Levine R, Moonis M. Risk factors and hospitalization costs of Dementia patients: Examining race and gender variations. Indian journal of community medicine: Official publication of Indian Association of Preventive &. Soc Med (Soc Med Publ Group) 2015; 40(4): 258.
[26]
Bickett A, Tapp H. Anxiety and diabetes: Innovative approaches to management in primary care. Exp Biol Med (Maywood) 2016; 241(15): 1724-31.
[http://dx.doi.org/10.1177/1535370216657613] [PMID: 27390262]
[27]
Forsberg JM, Flores AM, Plec AA, Vincent SK, Hartos JL. Relations between diabetes status, comorbid conditions, and current mental health in older adult females. Ment Health (Lond) 2018; 13: 715-9.
[28]
Aregbeshola BS, Khan SM. Out-of-Pocket Payments, Catastrophic Health Expenditure and Poverty Among Households in Nigeria 2010. Int J Health Policy Manag 2018; 7(9): 798-806.
[http://dx.doi.org/10.15171/ijhpm.2018.19] [PMID: 30316228]
[29]
Makama GY. Patriarchy and gender inequality in Nigeria: The way forward. Eur Sci J 2013; 9(17): 115-44.
[30]
Ogunlela YI, Mukhtar AA. Gender issues in agriculture and rural development in Nigeria: The role of women. Humanity & Social Sciences Journal 2009; 4(1): 19-30.
[31]
Nelson EE. Democracy and the struggle for political empowerment of women in Nigeria. Int’ l J. Advanced Legal Stud. &. Governance (Oxford) 2012; 3: 85.
[32]
Sheen YJ, Sheu WH. Association between hypoglycemia and dementia in patients with type 2 diabetes. Diabetes Res Clin Pract 2016; 116(38): 279-87.
[http://dx.doi.org/10.1016/j.diabres.2016.04.004] [PMID: 27321346]
[33]
Redondo MT, Reales JM, Ballesteros S. Implicit and explicit memory in old people without dementia but metabolic disorders induced by DM2. Psicologica (Valencia) 2010; 31(1): 87-108. [Memoria implícita y explícita en mayores no dementes con trastornos metabólicos producidos por la diabetes mellitus tipo 2].
[34]
Waragai M, Adame A, Trinh I, et al. Possible involvement of adiponectin, the anti-diabetes molecule, in the pathogenesis of Alzheimer’s disease. J Alzheimers Dis 2016; 52(4): 1453-9.
[http://dx.doi.org/10.3233/JAD-151116] [PMID: 27079710]
[35]
Kimura N. Diabetes mellitus induces Alzheimer’s disease pathology: Histopathological evidence from animal models. Int J Mol Sci 2016; 17(4): 503.
[http://dx.doi.org/10.3390/ijms17040503] [PMID: 27058526]
[36]
Stanley M, Macauley SL, Holtzman DM. Changes in insulin and insulin signaling in Alzheimer’s disease: Cause or consequence? J Exp Med 2016; 213(8): 1375-85.
[http://dx.doi.org/10.1084/jem.20160493] [PMID: 27432942]
[37]
Crane PK, Walker R, Hubbard RA, et al. Glucose levels and risk of dementia. N Engl J Med 2013; 369(6): 540-8.
[http://dx.doi.org/10.1056/NEJMoa1215740] [PMID: 23924004]
[38]
Hendrie HC. Lessons learned from international comparative crosscultural studies on dementia. Am J Geriatr Psychiatry 2006; 14(6): 480-8.
[http://dx.doi.org/10.1016/S1064-7481(12)61668-6] [PMID: 16731716]
[39]
Payami H, Zareparsi S, Montee KR, et al. Gender difference in apolipoprotein E-associated risk for familial Alzheimer disease: A possible clue to the higher incidence of Alzheimer disease in women. Am J Hum Genet 1996; 58(4): 803-11.
[PMID: 8644745]
[40]
Rippon GA, Tang MX, Lee JH, Lantigua R, Medrano M, Mayeux R. Familial Alzheimer disease in Latinos: Interaction between APOE, stroke, and estrogen replacement. Neurology 2006; 66(1): 35-40.
[http://dx.doi.org/10.1212/01.wnl.0000191300.38571.3e] [PMID: 16401842]
[41]
Rajabli F, Feliciano BE, Celis K, et al. Ancestral origin of ApoE ε4 Alzheimer disease risk in Puerto Rican and African American populations. PLoS Genet 2018; 14(12): e1007791.
[http://dx.doi.org/10.1371/journal.pgen.1007791] [PMID: 30517106]
[42]
Razay G, Vreugdenhil A, Wilcock G. The metabolic syndrome and Alzheimer disease. Arch Neurol 2007; 64(1): 93-6.
[http://dx.doi.org/10.1001/archneur.64.1.93] [PMID: 17210814]
[43]
Muller M, Tang MX, Schupf N, Manly JJ, Mayeux R, Luchsinger JA. Metabolic syndrome and dementia risk in a multiethnic elderly cohort. Dement Geriatr Cogn Disord 2007; 24(3): 185-92.
[http://dx.doi.org/10.1159/000105927] [PMID: 17641531]
[44]
Solfrizzi V, Scafato E, Capurso C, et al. Metabolic syndrome, mild cognitive impairment, and progression to dementia. Neurobiol Aging 2011; 32(11): 1932-41.
[http://dx.doi.org/10.1016/j.neurobiolaging.2009.12.012] [PMID: 20045217]
[45]
Jervase E, Barnabas D, Emeka AG, Osondu N. Sex differences and relationship between blood pressure and age among the Ibos Of Nigeria. The Internet Journal of Biological Anthropology 2009; 3
[46]
Okubadejo NU, Ozoh OB, Ojo OO, et al. Prevalence of hypertension and blood pressure profile amongst urban-dwelling adults in Nigeria: A comparative analysis based on recent guideline recommendations. Clin Hypertens 2019; 25(1): 7.
[http://dx.doi.org/10.1186/s40885-019-0112-1] [PMID: 31016027]
[47]
Li J, Cesari M, Liu F, Dong B, Vellas B. Effects of diabetes mellitus on cognitive decline in patients with Alzheimer disease: A systematic review. Can J Diabetes 2017; 41(1): 114-9.
[http://dx.doi.org/10.1016/j.jcjd.2016.07.003] [PMID: 27614804]
[48]
Hoscheidt SM, Kellawan JM, Berman SE, et al. Insulin resistance is associated with lower arterial blood flow and reduced cortical perfusion in cognitively asymptomatic middle-aged adults. J Cereb Blood Flow Metab 2017; 37(6): 2249-61.
[http://dx.doi.org/10.1177/0271678X16663214] [PMID: 27488909]
[49]
Martínez-Lazcano JC, Boll-Woehrlen MC, Hernández-Melesio MA, Rubio-Osornio M. Sánchez- Mendoza MA, Ríos C. Free radicals and oxidative stres in neurodegenerative disorders [Radicales libres y estrés oxidativo en las enfermedades neurodegenerativas. Mensaje Bioquim 2010; 34: 43-59.
[50]
Neergaard JS, Dragsbæk K, Christiansen C, et al. Metabolic syndrome, insulin resistance, and cognitive dysfunction: Does your metabolic profile affect your brain? Diabetes 2017; 66(7): 1957-63.
[http://dx.doi.org/10.2337/db16-1444] [PMID: 28389469]
[51]
Bello AB, Bello TO, Aremu AA, Adetiloye VA. Normal Cerebral Blood Flow Volume in Healthy Nigerian Adults. Br J Med Med Res 2016; 17(2): 1-11.
[http://dx.doi.org/10.9734/BJMMR/2016/25801]
[52]
Smith LA, Melbourne A, Owen D, et al. Cortical cerebral blood flow in ageing: Effects of haematocrit, sex, ethnicity and diabetes. Eur Radiol 2019; 29(10): 5549-58.
[http://dx.doi.org/10.1007/s00330-019-06096-w] [PMID: 30887200]
[53]
Adegoke O, Ozoh OB, Odeniyi IA, et al. Prevalence of obesity and an interrogation of the correlation between anthropometric indices and blood pressures in urban Lagos, Nigeria. Sci Rep 2021; 11(1): 3522.
[http://dx.doi.org/10.1038/s41598-021-83055-w] [PMID: 33568712]
[54]
Gabbouj S, Ryhänen S, Marttinen M, et al. Altered Insulin Signaling in Alzheimer’s Disease Brain - Special Emphasis on PI3K-Akt Pathway. Front Neurosci 2019; 13: 629.
[http://dx.doi.org/10.3389/fnins.2019.00629] [PMID: 31275108]
[55]
Guilbaud A, Niquet-Leridon C, Boulanger E, Tessier FJ. How Can Diet Affect the Accumulation of Advanced Glycation End-Products in the Human Body? Foods 2016; 5(4): 84.
[http://dx.doi.org/10.3390/foods5040084] [PMID: 28231179]
[56]
Aljada A, Mohanty P, Ghanim H, et al. Increase in intranuclear nuclear factor kappaB and decrease in inhibitor kappaB in mononuclear cells after a mixed meal: Evidence for a proinflammatory effect. Am J Clin Nutr 2004; 79(4): 682-90.
[http://dx.doi.org/10.1093/ajcn/79.4.682] [PMID: 15051615]
[57]
Byun K, Yoo Y, Son M, et al. Advanced glycation end-products produced systemically and by macrophages: A common contributor to inflammation and degenerative diseases. Pharmacol Ther 2017; 177: 44-55.
[http://dx.doi.org/10.1016/j.pharmthera.2017.02.030] [PMID: 28223234]
[58]
Baeta-Corral R, Castro-Fuentes R, Giménez-Llort L. Sexual Dimorphism in the Behavioral Responses and the Immunoendocrine Status in d-Galactose-Induced Aging. J Gerontol A Biol Sci Med Sci 2018; 73(9): 1147-57.
[http://dx.doi.org/10.1093/gerona/gly031] [PMID: 29471511]
[59]
Aragno M, Mastrocola R. Dietary sugars and endogenous formation of advanced glycation endproducts: Emerging mechanisms of disease. Nutrients 2017; 9(4): 385.
[http://dx.doi.org/10.3390/nu9040385] [PMID: 28420091]
[60]
Brings S, Fleming T, Freichel M, Muckenthaler MU, Herzig S, Nawroth PP. Dicarbonyls and advanced glycation end-products in the development of diabetic complications and targets for intervention. Int J Mol Sci 2017; 18(5): 984.
[http://dx.doi.org/10.3390/ijms18050984] [PMID: 28475116]
[61]
Pertynska-Marczewska M, Merhi Z. Relationship of Advanced Glycation End Products With Cardiovascular Disease in Menopausal Women. Reprod Sci 2015; 22(7): 774-82.
[http://dx.doi.org/10.1177/1933719114549845] [PMID: 25228634]
[62]
Giménez-Llort L, García Y, Buccieri K, et al. Gender-Specific Neuroimmunoendocrine Response to Treadmill Exercise in 3xTg-AD Mice. Int J Alzheimers Dis 2010; 2010: 128354.
[http://dx.doi.org/10.4061/2010/128354] [PMID: 20981262]
[63]
García-Mesa Y, López-Ramos JC, Giménez-Llort L, et al. Physical exercise protects against Alzheimer’s disease in 3xTg-AD mice. J Alzheimers Dis 2011; 24(3): 421-54.
[http://dx.doi.org/10.3233/JAD-2011-101635] [PMID: 21297257]
[64]
Ragy MM, Kamal NN. Linking senile dementia to type 2 diabetes: Role of oxidative stress markers, C-reactive protein and tumor necrosis factor-α. Neurol Res 2017; 39(7): 587-95.
[http://dx.doi.org/10.1080/01616412.2017.1312773] [PMID: 28393627]
[65]
Oghagbon E, Harbige LS, Valdes-Ramos R, Guadarrama-Lopez AL. Circulating cytokines and phospholipid fatty acids in African Nigerian type 2 diabetes mellitus. Ann Nutr Metab 2017; 71: 31-79.
[66]
Norambuena A, Wallrabe H, McMahon L, et al. mTOR and neuronal cell cycle reentry: How impaired brain insulin signaling promotes Alzheimer’s disease. Alzheimers Dement 2017; 13(2): 152-67.
[http://dx.doi.org/10.1016/j.jalz.2016.08.015] [PMID: 27693185]
[67]
Jeong SM, Shin DW, Lee JE, Hyeon JH, Lee J, Kim S. Anemia is associated with incidence of dementia: A national health screening study in Korea involving 37,900 persons. Alzheimers Res Ther 2017; 9(1): 94.
[http://dx.doi.org/10.1186/s13195-017-0322-2] [PMID: 29212527]
[68]
Wedlund L, Kvedar J, Layman W. Anticipating and treating dementia: Lessons hidden in plain sight. NPJ Digit Med 2020; 3(1): 153.
[http://dx.doi.org/10.1038/s41746-020-00359-3] [PMID: 33299106]
[69]
Wolters FJ, Zonneveld HI, Licher S, et al. Hemoglobin and anemia in relation to dementia risk and accompanying changes on brain MRI. Neurology 2019; 93(9): e917-26.
[http://dx.doi.org/10.1212/WNL.0000000000008003] [PMID: 31366722]
[70]
Andro M, Le Squere P, Estivin S, Gentric A. Anaemia and cognitive performances in the elderly: A systematic review. Eur J Neurol 2013; 20(9): 1234-40.
[http://dx.doi.org/10.1111/ene.12175] [PMID: 23647493]
[71]
AlDallal SM, Jena N. Prevalence of Anemia in Type 2 Diabetic Patients. J Hematol (Brossard) 2018; 7(2): 57-61.
[http://dx.doi.org/10.14740/jh411w] [PMID: 32300413]
[72]
Tussing-Humphreys L, Braunschweig C. Anemia in postmenopausal women: Dietary inadequacy or nondietary factors? J Am Diet Assoc 2011; 111(4): 528-31.
[http://dx.doi.org/10.1016/j.jada.2011.01.006] [PMID: 21443984]
[73]
Ogunsakin RE, Akinyemi O, Babalola BT, Adetoro G. Spatial pattern and determinants of anemia among women of childbearing age in Nigeria. Spat Spatio-Temporal Epidemiol 2021; 36: 100396.
[http://dx.doi.org/10.1016/j.sste.2020.100396] [PMID: 33509424]
[74]
Egbewale BE, Akindele AA, Adedokun SA, Oyekale OA. Prevalence of asymptomaticmalaria and anaemia among elderly population in Osun state Southwestern, Nigeria. Int J Community Med Public Health 2018; 5(7): 2650-6.
[http://dx.doi.org/10.18203/2394-6040.ijcmph20182449]
[75]
Kagu MB, Mshelia DS. Anaemia in patients with diabetes mellitus attending regular diabetic outpatient clinic in Maiduguri, Nigeria. Niger J Health Biomed Sci 2005; 4(1): 1-4.
[http://dx.doi.org/10.4314/njhbs.v4i1.11527]
[76]
Awofisoye OI, Adeleye JO, Olaniyi JA, Esan A. Prevalence and correlates of anemia in type 2 diabetes mellitus: A study of a Nigerian outpatient diabetic population. Sahel Med J 2019; 22: 55-63.
[http://dx.doi.org/10.4103/smj.smj_65_18]
[77]
Feteh VF, Choukem SP, Kengne AP, Nebongo DN, Ngowe-Ngowe M. Anemia in type 2 diabetic patients and correlation with kidney function in a tertiary care sub-Saharan African hospital: A cross-sectional study. BMC Nephrol 2016; 17(1): 29.
[http://dx.doi.org/10.1186/s12882-016-0247-1] [PMID: 26994993]
[78]
Jenkins R. Supporting governments to adopt mental health policies. World Psychiatry 2003; 2(1): 14-9.
[PMID: 16946880]
[79]
Stenberg K, Axelson H, Sheehan P, et al. Advancing social and economic development by investing in women’s and children’s health: A new Global Investment Framework. Lancet 2014; 383(9925): 1333-54.
[http://dx.doi.org/10.1016/S0140-6736(13)62231-X] [PMID: 24263249]
[80]
UN Women. Women and the sustainable development goals (SDGs), 2020 Available from: https://www.unwomen.org/en/news/in-focus/women-and-

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