Delaying the initiation of levodopa has been proposed to reduce the risk of motor complications in Parkinson’s disease. In a 4-year multicentre study in Ghana, Cilia et al. find that motor fluctuations and dyskinesias are predicted by disease duration and levodopa dose, but not by the duration of levodopa therapy.

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Background There are limited data on vascular cognitive impairment (VCI) from low- and middle income countries where the stroke burden is burgeoning. Objective To characterize the burden, determinants, and effects on health-related quality of life, of VCI in sub-Saharan Africa (SSA). Methods From January 2015 to February 2016, we collected information on 147 consecutive stroke survivors (>45 years) seen at a tertiary hospital in Ghana and 49 demographically matched stroke-free controls. Data collected included demographics, clinical factors, health-related quality of life and presence of depression. Cognitive status was evaluated using a standard vascular neuropsychological battery which assessed memory, executive function/mental speed, language, and visuospatial/ visuoconstructive functioning. Expert VCI guideline and DSM IV criteria were used to classify stroke patients into no VCI, VCI but no dementia, and vascular dementia (VD). Results Mean ± SD age of stroke survivors was 59.9 ± 13.7 years of which 47.6% were women. Among the cohort, 77/147 (52.3%) had no VCI, 50/147 (34.0%) had VCI no dementia and 20/147 (13.6%) had VD. Three factors remained significantly associated with VCI: increasing age for each successive 10 year rise (OR 1.44, 95% CI: 1.03–2.02); lack of formal education (OR 5.26, 95% CI: 1.01–27.52); and worse functional disability on the modified Rankin scale (OR 2.46, 1.61–3.75). Patients with VD had the poorest health related quality of life. Conclusion Half of the Ghanaian stroke survivors encountered in this cross-sectional study had evidence of cognitive dysfunction. Future studies in SSA will need to identify strategies to address this immense burden.

BackgroundAlthough the burden of neurological disorders is highest among populations in developing countries there is a dearth of data on the clinical spectrum of these disorders.ObjectiveTo profile the frequency of neurologic disorders and basic demographic data in an adult neurology out-patient service commissioned in 2011 in Kumasi, Ghana.MethodsThe study was conducted at the neurology clinic of the Komfo Anokye Teaching Hospital in Kumasi, Ghana. Over a three year period, all medical records of patients enrolled at the out-patient neurology clinic was reviewed by a neurologist and neurological diagnoses classified according to ICD-10.Results1812 adults enrolled for care in the neurology out-patient service between 2011 and 2013. This comprised of 882 males and 930 females (male: female ratio of 1.0: 1.1) with an overall median age of 54 (IQR, 39–69) years. The commonest primary neurological disorders seen were strokes, epilepsy and seizure disorders, and movement disorders at frequencies of 57.1%, 19.8%, and 8.2% respectively.ConclusionsCerebrovascular diseases, epilepsy and movement disorders were among the commonest neurological disorders and the major contributors to neurologic morbidity among Ghanaians in an urban neurology clinic.