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Spinal cord schistosomiasis is a rare, underdiagnosed manifestation of schistosomiasis. We present the case of a 36-year-old male who presented to our institution with a one-week history of low back pain with rapidly progressive lower limb weakness, loss of sensation, and flaccid paraparesis. An MRI of the spine showed a longitudinally extensive transverse myelitis from T6 to L1, with enhancement at the cauda equina region. Further review of the images and serological tests eventually led to diagnosis of spinal schistosomiasis. He was treated with praziquantel and high-dose steroids, with minimal improvement in his symptoms.

Background Alzheimer’s disease is a neurodegenerative disease that affects patients’ ability to perform activities of daily living thus requiring assistance from their loved ones. The progressive nature of the disease unravels new and continuous challenges for the caregivers posing a huge burden on caregiving. However, there is little research in Sub‐ Saharan African countries including Kenya, on caregiver’s experiences managing patients with Alzheimer’s disease. We conducted an ethnographic study at the Aga Khan University Hospital (AKUH) to understand caregivers’ experiences and practices caring for patients with Alzheimer’s disease. Methods We purposively recruited 30 caregivers who have been managing patients with Alzheimer’s disease from the Neurology clinic at AKUH. We conducted semi‐structured in‐ depth interviews in English or Swahili, which lasted for about 60 minutes to completion. Interviews were audio‐recorded, transcribed, and analyzed thematically with the aid of Nvivo‐12 software. Results Key themes identified from data included: (a) Caregiver knowledge and skills in managing patients (b) Caregiving burden (emotional, psychological, physical, financial) (c) dealing with patient’s changing personality, moods, and loss of self‐identity (d) fulfilment and privilege taking care of loved ones (e) navigating through self‐chores and caregiving roles. Overall, most caregivers lacked knowledge and skills for managing patients with Alzheimer’s. Given the limited resources, awareness and support of Alzheimer’s in Kenya, we found that caregivers carried the burden of taking care of their loved ones with some reporting mental health issues related to caregiving burden. In addition, lack of skills and training on how to manage patients’ changing personalities and patients’ loss of identity left many caregivers frustrated and worn out. Despite the challenges, caregivers had a sense of fulfilment taking care of their loved ones. Conclusion Caregivers of Alzheimer’s disease in Kenya require support from healthcare providers and other stakeholders in terms of trainings and capacity building skills to enable them to provide optimal care for the patients. They also require psychosocial support to maintain a healthy balance between their daily life activities and those of caregiving.

The Frontal Assessment Battery (FAB) was developed as a short (6-item) bedside assessment of executive dysfunction in older adults with suspected neurodegeneration. This study describes psychometric features of the FAB in multilingual Kenyan adults with and without clinical diagnosis of dementia. The FAB consists of six items assessing verbal abstract reasoning, lexical fluency, motor learning, and inhibitory control. The score on each item ranges from 0-3, with higher scores indicating better performance. Bilingual English-Swahili study personnel translated, blind back-translated, and applied consensus-driven cultural adaptations. FAB was then administered to 95 participants [71 cognitively unimpaired (CU) controls; 24 people with dementia (PWD)] that ranged in age from 45 to 81 years (mean age = 59 years) and included 54 females and 41 males, with broad educational attainment (primary school to doctoral level). Psychometric evaluation included Cronbach's alpha to assess internal consistency and correlational analyses to assess age, sex, education, and language effects in the CU group. Group effects on FAB scores were assessed with multiple regression, after accounting for age, education, and language effects. The 6-item FAB shows good internal consistency (α = 0.85). Preferred language of assessment was the first language in 12%, second language in 55% and third language in 31%. There was no difference between first- and second-language testing but a disadvantage was apparent in third-language testing (mean diff = -1.3). No sex effects were apparent (t = -0.46; p = 0.65). FAB total scores were inversely associated with age (rho = -0.32; p < 0.01) and positively associated with education (rho = 0.4; p < 0.001). Group status predicted FAB scores (Beta = -0.72; t = 7.78; p <0.001), after accounting for age, education, and language effects. Average FAB scores for PWD were 9.3 (SD = 4.07) compared to 16.11 (SD = 2.1) in CU controls. Findings suggest sound psychometric features, with good internal consistency and expected age, education, and language effects. There were clear performance deficits in people with clinically diagnosed dementia, after accounting for important confounds, which suggest that the FAB may be a useful clinical tool for dementia detection in Kenyan adults.

Background The Frontal Assessment Battery (FAB) was developed as a short (6‐item) bedside assessment of executive dysfunction in older adults with suspected neurodegeneration. This study describes psychometric features of the FAB in multilingual Kenyan adults with and without clinical diagnosis of dementia. Method The FAB consists of six items assessing verbal reasoning, lexical fluency, motor learning, and inhibitory control. The score on each item ranges from 0‐3, with higher scores indicating better performance. Bilingual English‐Swahili study personnel translated, blind back‐translated, and applied consensus‐driven cultural adaptations. FAB was then administered to 95 participants [71 cognitively unimpaired (CU) controls; 24 people with dementia (PWD)] that ranged in age from 45 to 81 years (mean age = 59 years) and included 54 females and 41 males, with broad educational attainment (primary school to doctoral level). Psychometric evaluation included Cronbach's alpha to assess internal consistency and correlational analyses to assess age, sex, education, and language effects in the CU group. Group effects on FAB scores were assessed with multiple regression, after accounting for age, education, and language effects. Result The 6‐item FAB shows good internal consistency (α = 0.85). Preferred language of assessment was the first language in 12%, second language in 55% and third language in 31%. There was no difference between first‐ and second‐language testing but a disadvantage was apparent in third‐language testing (mean diff = ‐1.3). No sex effects were apparent (t = ‐0.46; p = 0.65). FAB total scores were inversely associated with age (rho = ‐0.32; p < 0.01) and positively associated with education (rho = 0.4; p < 0.001). Group status predicted FAB scores (Beta = ‐0.72; t = 7.78; p <0.001), after accounting for age, education, and language effects. Average FAB scores for PWD were 9.3 (SD = 4.07) compared to 16.11 (SD = 2.1) in CU controls. Conclusion Findings suggest sound psychometric features, with good internal consistency and expected age, education, and language effects. There were clear performance deficits in people with clinically diagnosed dementia, after accounting for important confounds, which suggest that the FAB may be a useful clinical tool for dementia detection in Kenyan adults.

Background Over 55 million people worldwide live with dementia, with more than 60% residing in low‐ and middle‐income countries. Alzheimer's disease, the most common form of dementia, accounts for 60–70% of cases. Early and accurate diagnosis remains a global challenge, necessitating novel approaches to mitigate the disease burden. Biomarkers hold significant promise in improving diagnostic accuracy and predicting disease progression. Validated biomarkers for the preclinical stages of dementia are crucial for advancing diagnosis and therapeutic strategies. We aimed to identify potential clinical markers for early dementia detection and assess their predictive accuracy in identifying high‐risk individuals. Method We analyzed blood samples from dementia cases (n = 30) and controls (n = 75) for clinical parameters, including renal and liver function tests, lipid profiles, thyroid function tests, glomerular filtration rate (GFR), vitamin B12, and fasting glucose. Result Dementia cases showed significantly elevated high‐density lipoprotein (HDL), free thyroxine (FT4), and vitamin B‐12 (P = 0.0002, P = 0.015, and P = 0.004, respectively) compared to controls. We also observed significant reductions in GFR, free triiodothyronine (FT3), and the cholesterol‐to‐HDL ratio (P = 0.003, P = 0.0002, and P = 0.05, respectively). Logistic regression confirmed associations between HDL (Odds: 10.8, 95% CI: 0.34–5.01, P = 0.04) and FT4 (Odds: 33.78, 95% CI: 0.64–7.20, P = 0.028) with dementia after adjusting for age and sex. Vitamin B‐12, FT3, GFR, and the cholesterol‐to‐HDL ratio were not significantly associated with dementia (P > 0.05). Predictive models demonstrated strong performance (R2 = 0.47–0.52). Conclusion Our findings demonstrated the potential of HDL and FT4 as blood‐based clinical markers for early detection of cognitive impairment and dementia.

Over 55 million people worldwide live with dementia, with more than 60% residing in low- and middle-income countries. Alzheimer's disease, the most common form of dementia, accounts for 60-70% of cases. Early and accurate diagnosis remains a global challenge, necessitating novel approaches to mitigate the disease burden. Biomarkers hold significant promise in improving diagnostic accuracy and predicting disease progression. Validated biomarkers for the preclinical stages of dementia are crucial for advancing diagnosis and therapeutic strategies. We aimed to identify potential clinical markers for early dementia detection and assess their predictive accuracy in identifying high-risk individuals. We analyzed blood samples from dementia cases (n = 30) and controls (n = 75) for clinical parameters, including renal and liver function tests, lipid profiles, thyroid function tests, glomerular filtration rate (GFR), vitamin B12, and fasting glucose. Dementia cases showed significantly elevated high-density lipoprotein (HDL), free thyroxine (FT4), and vitamin B-12 (P = 0.0002, P = 0.015, and P = 0.004, respectively) compared to controls. We also observed significant reductions in GFR, free triiodothyronine (FT3), and the cholesterol-to-HDL ratio (P = 0.003, P = 0.0002, and P = 0.05, respectively). Logistic regression confirmed associations between HDL (Odds: 10.8, 95% CI: 0.34-5.01, P = 0.04) and FT4 (Odds: 33.78, 95% CI: 0.64-7.20, P = 0.028) with dementia after adjusting for age and sex. Vitamin B-12, FT3, GFR, and the cholesterol-to-HDL ratio were not significantly associated with dementia (P > 0.05). Predictive models demonstrated strong performance (R  = 0.47-0.52). Our findings demonstrated the potential of HDL and FT4 as blood-based clinical markers for early detection of cognitive impairment and dementia.

Background The Global Dementia Action Plan 2017‐2025 specifies key targets, with an emphasis on building research infrastructure and capability across the Global South. However, to date, only 0.1% of total research in Africa constitutes dementia research, the lowest volume of all LMIC regions. Several biomarker and risk models of the preclinical and prodromal stages of Alzheimer’s disease (AD) are proposed as optimal junctures for disease prevention, yet they ignore the influence of biological sex/gender on cognitive and disease processes, despite female sex/gender constituting a major AD modifier. Similarly, the application of these models in ethno‐racial and culturally diverse cohorts is limited, further compromising their generalizability. Consequently, there exists little understanding of the intersections of sex/gender, ethno‐racial, culture, and other risk factors in AD and related dementias (ADRD) onset. Method This partnership is led by The Brain and Mind Institute, Aga Khan University Nairobi, Kenya. We aim to i) establish a highly‐phenotyped co‐designed readiness cohort in a socio‐economically diverse community in Kenya (n = 250, ≥35 y/o) of individuals across the AD clinical continuum; with a focus on characterizing sex differences in psychobiological determinants of AD and ii) compare harmonized data from our cohort with western cohorts enriched with diasporic African populations to determine culturally‐specific, ethno‐racial, lifestyle, health and biological determinants between indigenous and diasporic Africans and other ethnicities. Result We extend Nigerian‐based Ibadan study pilot data, that identified female sex as a significant factor associated with higher AD risk (HR:1.51, 95% CI: 1.67‐ 1.36), with sex‐specific differences in AD risk profiles noted. Population characteristics will be defined for the initial recruitment phase for FemBER‐Africa (target n = 50 by July 2024), purposively sampled from the Nairobi locality to ensure balanced groups by sex/gender, ethno‐racial characteristics, age, socio‐economic status. Learnings from the cultural adaption of tools and measures will also be presented. Conclusion FemBER‐Africa addresses knowledge gaps surrounding the intersectionality of sex/gender, ethno‐racial, culture and psychobiological determinants of brain health in indigenous and diasporic African populations. This readiness cohort represents a world‐first culturally informed African ADRD program and an optimal platform for future culturally specific risk‐reduction and prevention trials, adaptable for other African contexts.

Dementia prevention in Africa is critically underexplored, despite the continent's high prevalence of modifiable risk factors. With a predominantly young and middle‐aged population, Africa presents a prime opportunity to implement evidence‐based strategies that could significantly reduce future dementia cases and mitigate its economic impact. The multinational Africa‐FINGERS program offers an innovative solution, pioneering culturally sensitive, multidomain interventions tailored to the unique challenges of the region.  Leveraging insights from landmark global studies such as Worldwide‐FINGERS and Alzheimer's Disease Neuroimaging Initiative, the program employs a multideterminant precision prevention framework, grounded in community based systems dynamics. Africa‐FINGERS further integrates cutting‐edge state‐of‐the‐art multimodal biomarker evaluations tailored to regional contexts, with the goal of advancing brain health and establishing a global standard for dementia prevention. This groundbreaking initiative highlights the potential for scalableand sustainable interventions, thus is poised to transform dementia risk reduction efforts across the continent. Highlights Dementia rates are escalating in Africa, largely due to longer life spans and increased prevalence of modifiable risk factors. Yet, few regional interventions have directly targeted lifestyle factors to reduce dementia risk. The multinational Africa‐FINGERS study will address this gap by adapting the successful FINGERS lifestyle intervention to African populations. Africa‐FINGERS will pioneer a culturally informed, multidomain dementia risk reduction intervention in the African region through feasibility dementia prevention trials in rural and urban sites across Kenya and Nigeria in the first instance, enrolling 600 at‐risk adults (≥ 50 years). The program adopts participatory research methods to develop culturally appropriate interventions and build infrastructure to evaluate dementia biomarkers from ante and post mortem samples. A cost‐effectiveness analysis will be conducted to guide the strategic implementation of Africa‐FINGERS into regional health systems. The Africa‐FINGERS strategy aligns with the Worldwide‐FINGERS framework and integrates the global Alzheimer's Disease Neuroimaging Initiative approach, emphasizing multimodal analysis.

Dementia rates are rising globally, with the burden increasing most rapidly in low‐ to middle‐income countries. Despite this, research into Alzheimer's disease and related dementias (ADRD) among African populations remains limited, with existing models based on Western cohorts that overlook sex‐, gender‐, and ancestry‐specific factors. The Female Brain Health and Endocrine Research in Africa (FemBER‐Africa) project, hosted at the Brain and Mind Institute, Aga Khan University, Kenya, will establish a deeply phenotyped cohort of 250 African individuals across the ADRD spectrum. It will assess sex‐specific risk factors linked to ethnicity, lifestyle, and endocrinological variables using fluid‐based biomarkers (blood and saliva), neuroimaging (magnetic resonance imaging and positron emission tomography), and culturally adapted cognitive tests. By comparing data with Western and diasporic cohorts, the study aims to identify ancestry‐specific and shared mechanisms driving ADRD risk and progression. The findings will support targeted, culturally relevant prevention and intervention strategies, addressing the underrepresentation of African populations in global dementia research. Highlights By 2030, > 78 million individuals are expected to have dementia, with the highest burden among women in low‐ to middle‐income countries. Despite this, African populations remain underrepresented in Alzheimer's disease and related dementias (ADRD) research. Existing ADRD risk models fail to account for the unique influence of sex, gender, and ancestry on dementia risk. Female‐specific reproductive and hormonal factors, including menopause transition and hormone therapy use, are poorly integrated into current models. The Female Brain Health and Endocrine Research in Africa (FemBER‐Africa) project is the first large‐scale study to examine sex‐ or gender‐specific and endocrine contributors to ADRD in an African population, using advanced diagnostic, biomarker, and culturally adapted cognitive assessments. The study will assess how biological (hormonal, metabolic), lifestyle (physical activity, diet), and socio‐cultural (education, health‐care access) factors interact to influence ADRD risk in African women. Insights from FemBER‐Africa will inform the development of sex‐ and gender‐specific, culturally adapted ADRD prevention strategies, enhancing the precision and equity of dementia mitigation efforts globally.

Cerebral fat embolism (CFE) is a potentially fatal condition associated with displaced long bone fracture of the lower extremities. CFE, usually seen in young men, has an incidence ranging between 0.9% and 11% in patients with long bone fractures. CFE can present with various neurological symptoms, and a diffusion-weighted magnetic resonance imaging (MRI) (DWI) remains the definitive diagnostic study. Early treatment of the fracture is crucial in the management of CFE. To the best of our knowledge, we are the first to report a case of CFE in East Africa.