Browsing by Author "Gouse, Hetta"

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    Assessing type 2 diabetes associated NeuroCognitive impairment using an e-screening tool in a South African population
    (2018) Bobrow, Kirsten; Levitt, Naomi; Gouse, Hetta; Zweginthal, Virgina
    Background: Type 2 diabetes has been found to be associated with cognitive impairments in planning, problem solving, organization, and working memory and also with an increased risk of dementia. Neurocognitive impairment may impact self-care and other health behaviours increasing the risk of poor health outcomes in this patient population. Detection of neurocognitive impairment in low and middle-income settings is challenging; there is a lack of validated screening tools suitable for local use in primary care and outpatient settings and access to formal neuropsychological testing services is limited. The inability to easily identify people with type 2 diabetes with neurocognitive impairments is constraining the development of context appropriate interventions to improve the care and outcomes in this sub-group of patients. Aim: The aim of the current analysis is to explore associations between neurocognitive function and measures of diabetes control (HbA1c, disease duration, type of blood glucose lowering treatment) at baseline in a population of people with type 2 diabetes participating in a clinical trial of treatment adherence support using SMS-text messages. Materials and Methods: Sms text Adherence suppoRt for type 2 Diabetes (StAR2D) is a randomised clinical trial testing if a system of SMS-text messages to support treatment adherence is more effective than usual care for controlling blood sugar among people with type 2 diabetes in sub-Sahara Africa (ISRCTN70768808). We have embedded neurocognitive assessment sub-studies into the Cape Town trial site. At baseline participants in the StAR2D trial complete a novel mobile-device based cognitive assessment, NeuroScreen, assisted by a field research assistant. The assessment contains 9 variants of tests found in the gold-standard neuropsychological test battery that have been adapted and normed for use in South Africa. It is available in English or isiXhosa. The assessment takes between 20 to 40 minutes depending on participant error rate. This cross-sectional analysis of baseline data uses linear and logistic regression models to explore associations between neurocognitive function and measures of diabetes control. Results: Six hundred participants eligible for enrolment in the StAR2D trial were recruited from the Cape Town trial site; 499 participants completed the baseline neurocognitive screening assessment (20 to 40 minutes to complete); 101 participants did not complete the assessment (commonly due to eyesight, hearing or motor difficulties e.g. hemiplegia due to previous stroke or technical difficulties.) We found differences in the scores in some but not all the neuropsychological tests. Using cut points suggested by an earlier validation study of NeuroScreen tool more than half of study participants would be scored as having at least mild neurocognitive impairment. HbA1c, duration of disease, type of blood glucose lowering treatment were not significantly associated with individual or overall neuropsychological test scores or odds of neurocognitive impairment. Conclusions: The prevalence of neurocognitive impairment may be substantial in this patient population. A novel tablet based neurocognitive screening tool was broadly feasible and acceptable to lay researchers and trial participants. There was no evidence that HbA1c, duration of disease, or type of blood glucose lowering treatment (oral agents alone or insulin containing regimens) was significantly associated with individual or overall neuropsychological test scores or odds of neurocognitive impairment. Validating this tool for this patient population and optimising its role in routine clinical care need further study.
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    Neurocognitive impairment in treatment-experienced adults living with HIV attending primary care clinics in Zimbabwe
    (2020-05-29) Nyamayaro, Primrose; Gouse, Hetta; Hakim, James; Robbins, Reuben N; Chibanda, Dixon
    Background HIV affects the central nervous system resulting in HIV associated neurocognitive impairment (NCI) in approximately 50% of people living with HIV. It typically affects memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning cognitive domains. NCI can affect adherence to antiretroviral therapy (ART), employability, driving ability and activities of daily living. NCI is not routinely screened for in Zimbabwe, and the burden is not known in this setting. The objectives of this study were: 1) To determine NCI prevalence using a comprehensive neuropsychological battery at two primary health care clinics in Harare; 2) To assess the pattern of cognitive impairment across cognitive domains using a gold standard neuropsychological (NP) battery in HIV-positive patients compared to HIV-negative controls. Methods Inclusion criteria: 18 years or older; minimum 7 years education; no neurological or psychiatric disorders. HIV-positive participants were on ART for ≥3 months; HIV-negative participants had a confirmed HIV negative status in the past month. A comprehensive NP battery, functional assessments, demographic and medical history questionnaires were administered. The NP battery consisted of tests assessing memory, learning, working memory, fine motor skills, speed of information processing, verbal fluency and executive functioning. Results Two-hundred-and-thirty-one participants were recruited. Of those, 155 were HIV-positive (Female = 70%, Age M = 37.8; SD 11.2) and 76 HIV-negative (Female = 63%, Age M = 31.2; SD 9.9). HIV-positive participants were on ART for an average of 6 years. NCI was present in 49.7% HIV positive participants. Compared to HIV-negative participants, the HIV-positive group had significantly poorer scores in 5 out of 7 cognitive domains. A good level of education is negatively correlated with NCI. Conclusions NCI prevalence in HIV-positive population Zimbabwe is consistent with global estimates. NCI persists in adults who are on ART. Routine assessment of NCI in adults attending primary care clinics using this adapted battery is therefore important so that they are identified early and are provided the necessary interventions.
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    Neuropsychological, functional and behavioural outcome and predictors of outcome in a sample of traumatic brain injury litigants
    (2008) Gouse, Hetta; Thomas, Kevin; Solms, Mark
    Generally, this study aimed to explore whether financial settlement in litigation influences outcome and recovery from closed head injury in a sample of traumatic brain injured (TBI) litigants who were tested and interviewed both during litigation (at time 1, or T1) and 1 year or more after case settlement (at time 2, or T2). More specifically, my major goals were to assess (a) changes between TI and T2 on outcome variables such as neuropsychological test scores and self- and other-reported cognitive function, behaviour, activities of daily living (ADL), and physical dependency (PD), and (b) the impact of demographic (e.g., years of education, employment status) and clinical (e.g., severity of injury, degree of post-traumatic amnesia, Glasgow Coma Scale score) variables on the aforementioned outcome variables.
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    Parkinson's disease and the influence of the forebrain dopaminergic system on dreaming
    (2004) Gouse, Hetta; Solms, Mark
    The purpose of the study was to investigate a hypothesis proposed by Solms (2000) to the effect that a forebrain dopaminergic mechanism is the final common path to dreaming. It was hypothesised that sufferers of Parkinson's disease (PO) would have decreased intensity and frequency of dreams - that is that PO disease may lead to cessation or reduced dreaming, reduced duration of dreams, reduced narrative complexity of dream and a change in dream emotion and that this will further decrease with the duration of the disease irrespective of the medication that the patient is taking. Self-report questionnaires (N=40) and the Most Recent Dream Report (Oomhoff, 1996) was used for assessment. PO patients were found to have shorter as well as more pleasant dreams. A correlation (p < .05) was found in the PO sample between duration of illness and emotional quality of dreams and dream duration. The specific hypothesis of the study was not fully supported. However, the findings do support the suggestion that dreaming is generated by the mesocortical-mesolimbic dopamine system.