title: Dementia-associated mortality and its predictors among older adults in sub-Saharan Africa: results from a 2-year follow-up in Congo (the EPIDEMCA-FU study).
abstract: between 2011 and 2012, we carried out a study of dementia prevalence in central Africa throughout the EPIDEMCA (Epidemiology of Dementia in Central Africa) programme.
  
  
  
  to assess dementia-related mortality among Congolese older people from the EPIDEMCA study after 2 years of follow-up.
  
  
  
  longitudinal population-based cohort study.
  
  
  
  Gamboma and Brazzaville, Republic of Congo.
  
  
  
  older participants were traced and interviewed in rural and urban Congo annually between 2012 and 2014. DSM-IV and NINCDS-ADRDA criteria were required for dementia diagnosis. Data on vital status were collected throughout the follow-up. Cox proportional hazards model was used to assess the link between baseline dementia diagnosis and mortality risk.
  
  
  
  of 1,029 participants at baseline, 910 (88.4%) have a complete cognitive diagnosis. There were 791 participants (76.87%) with normal cognition, 56 (5.44%) with MCI and 63 (6.12%) with dementia. After 2 years of follow-up, 101 (9.8%) participants had died. Compared with participants with normal cognition, patients with dementia had 2.5 times higher mortality risk (HR = 2.53, 95% CI 1.42-4.49, P = 0.001). Among those with dementia, only clinical severity of dementia was associated with an additional increased mortality risk (HR = 1.91; CI 95%, 1.23-2.96; P = 0.004). Age (per 5-year increase), male sex and living in an urban area were independently associated with increased mortality risk across the full cohort.
  
  
  
  among Congolese older adults, dementia is associated with increased mortality risk. Our results highlight the need for targeted health policies and strategies for dementia care in sub-Saharan Africa (SSA).
authors.affiliation: UMR1094 Tropical Neuroepidemiology, University of Limoges, Limoges, France.
authors.forename: Harielle
authors.initials: H
authors.lastname: Samba
authors.affiliation: UMR1094 Tropical Neuroepidemiology, University of Limoges, Limoges, France King's College London, IoPPN, HSPR, London, UK.
authors.forename: Maelenn
authors.initials: M
authors.lastname: Guerchet
authors.affiliation: UMR1094 Tropical Neuroepidemiology, University of Limoges, Limoges, France Department of Neurology, Brazzaville University Hospital, Brazzaville, Congo.
authors.forename: Bebene
authors.initials: B
authors.lastname: Ndamba-Bandzouzi
authors.affiliation: UMR1094 Tropical Neuroepidemiology, University of Limoges, Limoges, France Department of Neurology, Amitié Hospital, Bangui, Central African Republic.
authors.forename: Pascal
authors.initials: P
authors.lastname: Mbelesso
authors.affiliation: UMR1094 Tropical Neuroepidemiology, University of Limoges, Limoges, France Department of vascular medicine, Limoges University Hospital, Limoges, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Lacroix
authors.affiliation: INSERM U897, University Victor Segalen Bordeaux 2, Bordeaux, France.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Dartigues
authors.affiliation: CEBIMER, CHU, Limoges, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Preux
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003223:Congo / Q000453:epidemiology; D003704:Dementia / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012737:Sex Factors; D014505:Urban Population / Q000706:statistics & numerical data
keywords: Republic of Congo; dementia; mortality; older people; sub-Saharan Africa