Hindawi
Parkinson’s Disease
Volume 2021, Article ID 7479423, 16 pages
https://doi.org/10.1155/2021/7479423
Review Article
The Current State of Parkinsonism in West Africa: A
Systematic Review
Jude T. Quarshie ,1 Esther N. Mensah ,2 Osbourne Quaye ,1,2
and Anastasia R. Aikins 1,2
1Department of Biochemistry Cell and Molecular Biology, College of Basic and Applied Sciences, University of Ghana,
Accra, Ghana
2West African Centre for Cell Biology of Infectious Pathogens (WACCBIP), Accra, Ghana
Correspondence should be addressed to Anastasia R. Aikins; araikins@ug.edu.gh
Received 13 May 2021; Revised 6 September 2021; Accepted 7 September 2021; Published 30 September 2021
Academic Editor: Jan Aasly
Copyright © 2021 Jude T. Quarshie et al. )is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Parkinsonism is one of the most common neurodegenerative diseases among the elderly. Africa is experiencing an increasing
burden of age-related conditions including parkinsonism. However, there is not enough data on the prevalence, symptoms, and
management of the disorder in West African patients. )is systematic review examines the current state of parkinsonism in West
Africa by discussing its epidemiology, symptomatology, and treatment. We searched PubMed, BioMed Central, and AJOL
databases from January 2000 to December 2020 for studies on parkinsonism conducted inWest African countries.We included 32
studies in this review: 23 from Nigeria, 5 from Ghana, and 1 each from Benin, Mali, Niger, and Senegal. Out of the 32 reviewed
studies, 11 focused on the prevalence of parkinsonism, 4 examined the genetics of Parkinson’s disease (PD), and 17 described the
symptomatology and therapy of parkinsonism. )e prevalence of parkinsonism in West Africa ranges from 6.0% to 8.3% of
neurologic admissions/consultations. )e estimated crude prevalence of PD in West Africa varies from 15 to 572 per 100,000
people. )us far, no pathogenic genetic variants have been associated with PD in the region. Levodopa is frequently used singly or
in combination with other medications to manage parkinsonian symptoms, which is consistent with reports from other African
regions. Most of the reviewed studies focused only on PD, limiting assessment of other forms of parkinsonism. Almost all the
prevalence studies were hospital-based and monocentric, making it impossible to accurately estimate the true prevalence of
parkinsonism in West Africa. Larger community-based prevalence studies are recommended to enable accurate quantification of
disease burden. Future genetic investigations should consider a wider array of gene mutations associated with parkinsonism.
Moreover, public health surveillance strategies should be established to monitor the epidemiology of the disorder.
1. Introduction in findings from genetic investigations suggest that the
genetics of PD is markedly different among different pop-
Parkinsonism is one of the most prevalent chronic neuro- ulations of the world [6]. For example, different variants of
logic syndromes in the elderly and the second most frequent the LRRK2 gene—a gene associated with PD risk—have been
type of movement disorder after essential tremor [1]. It may demonstrated to have distinct distributions in diverse
be idiopathic (Parkinson’s disease: PD) or may stem from populations [5]. SP may be caused by drugs, cerebrovascular
underlying health conditions—collectively termed second- accidents, manganese toxicity, and brain tumours [7–9].
ary parkinsonism (SP). PD, the idiopathic form of parkin- Currently, Africa is experiencing rapid transitions with
sonism, is the fastest-growing neurologic disorder increased life expectancy. )ere is an increasing number of
worldwide [2] and affects ∼2% of persons above age 60 [3–5]. people aged 60 or older, and this trend is foreseen to
)ere is compelling evidence that mutations at several ge- continue [10]. Consequently, the burden of age-related
netic loci maymediate its development. However, disparities conditions such as parkinsonism may be increasing [11].
2 Parkinson’s Disease
Nonetheless, there is a paucity of data on the prevalence, parkinsonian patients. We extracted information relating to
symptoms, and management of parkinsonism disorder in the characteristics of included studies and the results are as
African patients. Given that the disorder may result from follows:
several factors, its development may differ within African
regions. )is poses an important question: “what is the West (i) )e report: author(s), year of publication, study
African situation?” )is systematic review summarizes re- setting, and study period.
cent studies on parkinsonism in West African countries, in (ii) Characteristics of participants: sample size, sex, age
order to appreciate the progress made in understanding the at study, and age at disease onset.
condition as well as emphasize the need for further research (iii) Study site: single- or multicentre studies and hos-
on the subject. pital- or community-based studies.
(iv) Study design: cross-sectional, descriptive, case-
2. Methods control, case study, or case series.
Online databases were systematically searched for articles on (v) Eligibility criteria: criteria used to diagnose
parkinsonism in West Africa published from the year 2000 parkinsonism.
to the year 2020. )e databases searched were PubMed, (vi) Summary findings: prevalence and symptoms of
BioMed Central, Embase, Web of Science, ScienceDirect, parkinsonism, treatment regimens used.
Scopus, and African Journals Online (AJOL). French da- For genetic studies, we extracted data on the genes
tabases “La Banque des Données en Santé Publique” (BDSP) studied, genetic mutations found, and the analytical
and “Institut d’Epidémiologie Neurologique et de Neuro- methods used to detect mutations. Risk of bias was assessed
logie Tropicale” (IENT) were also searched. Search termi- regarding sample size, single- and multicentre studies, and
nologies used were [Parkinsonism OR “Parkinson’s disease” referral bias.
OR “Parkinson disease” OR “Parkinsonian disorder”] AND
“West Africa”. We also matched the term [Parkinsonism OR
“Parkinson’s disease” OR “Parkinson disease” OR “Par- 3. Results
kinsonian disorder”] with all 16 West African countries to From the nine databases searched, 29 studies were con-
ensure all relevant studies were obtained. sidered relevant to this review after screening of abstracts
Papers were initially selected based on title and abstracts, and removal of replicates. Of these, 3 articles were excluded
taking into account the inclusion and exclusion criteria due to unavailability of full texts, 1 paper was excluded due
presented below. )ey were then narrowed down after a to lack of quantitative data, and 7 additional articles were
critical evaluation of their full text. Publications were con- retrieved through reference screening of selected papers,
sidered relevant if they presented data on parkinsonism in making a total of 32 articles (Figure 1).
anyWest African country, irrespective of the study objective. Based on the inclusion and exclusion criteria, we ob-
References of relevant papers were manually scrutinized for tained papers from Benin, Ghana, Mali, Niger, Nigeria, and
publications that may have been missed in the initial search. Senegal—6 of the 16 West African countries (Figure 2).
Table 1 presents an overview of the analyzed papers.
2.1. Inclusion Criteria. Original research articles, case re- Categorized by year of publication, 8 and 24 articles were
ports, and case series onWest African parkinsonian patients published from 2000 to 2010 and from 2011 to 2020, re-
which were published from 2000 to 2020 formed the in- spectively. )e majority (23) of the studies were conducted
clusion criteria. in Nigeria, 5 in Ghana, and 1 each in Benin, Mali, Niger, and
Senegal. All of them were conducted in a single country and
almost all were monocentric studies (Table 1).
2.2. Exclusion Criteria. Conference abstracts, editorials,
short communications, systematic reviews, and meta-ana-
lyses were excluded. We also excluded publications that 3.1. Prevalence of Parkinsonism in West Africa. Eleven
provided a general discussion of parkinsonism without publications described the prevalence of parkinsonism; 7
presenting empirical data. Articles on neurologic diseases from Nigeria, 2 from Ghana, and 1 from Benin, and 1 from
that did not present any data on parkinsonism were ex- Niger. )e majority were retrospectively conducted with all
cluded. We excluded studies that did not undergo a formal but one presenting data on the hospital prevalence of par-
peer-review process. kinsonism and/or PD. )e prevalence of parkinsonism and
PD varied from 6.0 to 8.3% and 0.4 to 6.9% of neurologic
admissions in hospital-based studies, respectively. )e only
2.3. Data Extraction. Two reviewers (JTQ and ENM) in- community-based survey reported a 0.09% prevalence of
dependently conducted the data extraction from the in- parkinsonism (Table 2).
cluded studies. Given the rationale of this review, we did not For this analysis, the crude prevalence of parkinsonism
assess any specific outcomes. Notwithstanding, regarding or PD was calculated as the number of cases per 100,000
the symptomatology of parkinsonism, we sought for data on persons in the total population. )e crude prevalence of
primary motor symptoms, secondary motor symptoms, and parkinsonism, as presented in the community-based study
nonmotor symptoms experiences by West African was 91 per 100,000 people. )e crude prevalence of PD
Parkinson’s Disease 3
Identification of studies via databases Identification of studies
via other methods
Records identified from Duplicate records
databases removed Records identified from
(n = 4,719) (n = 194) citation searching (n = 7)
Records screened Records excluded
(n = 4,525) (n = 4,496)
Reports sought for retrieval Reports not retrieval Reports sought for retrieval
(n = 29) (n = 3) (n = 7)
Reports assessed for Reports excuded due Reports assessed foreligibility (n = 26) to lack of empirical eligibility (n = 7)
data
(n = 1)
Studies included in review
(n = 32)
Figure 1: Flow diagram of literature search strategy and results.
Benin
Burkina Faso
Cape Verde
Gambia
Ghana
Guinea
Guinea-Bissau
La Côte d’lvoire
Liberia
Mail
Mauritania
Niger
Nigeria
Senegal
Sierra Leone
Togo
Figure 2: West African countries are shown in shades of green. Yellow spots represent countries from which papers were obtained. (Image
from www.conceptdraw.com).
Included Screening Identification
4 Parkinson’s Disease
Table 1: Overview of reviewed publications.
Categories Subcategories Number of publications References
2016 to 2020 10 [12–21]
Year of publication 2011 to 2015 14 [22–35]2006 to 2010 6 [7], [36–40]
2000 to 2005 2 [41,42]
Benin 1 [19]
Ghana 5 [13, 15, 25, 27, 32]
Country Mali 1 [21]Niger 1 [17]
Nigeria 23 [7, 12, 14, 18, 20, 22–24, 26, 28–31, 33–42]
Senegal 1 [16]
Table 2: Summary of prevalence studies.
Author(s), Country, Setting,
Crude
geographic study design, Population, Diagnostic prevalence Studyreference region study period characteristics criteria used of PKS and
Summary findings limitations
PD
1. Single-centre
study
2. Diagnostic
criteria
undefined
Population: 3. Prevalence
Nigeria, Hospital, 26,355 data reflects
Talabi [41] South- cross- Neurologic PD is a rare cause of hospital
Western sectional, cases: 781
NA PD: 15 admission prevalence but
1998–2000 PD cases: 4 not true
(0.5%) prevalence of
population.
4. Risk of
referral bias as
study site is a
tertiary facility.
1. Single-centre
Population: study
8440 2. Diagnostic
Neurologic criteria
cases: 1249 undefined
PD cases: 14 3. Prevalence
Hospital, (1.1%) data reflects
Ekenze et al. Nigeria,South- cross- Males: 10 hospital[40] NA PD: 166 NAEastern sectional, (71.4%) prevalence but2003–2007 Females: 4 not true
(28.6%) prevalence of
Male-female population.
ratio� 2.5 :1 4. Risk of
Peak age referral bias as
incidence >70 y study site is a
tertiary facility.
Parkinson’s Disease 5
Table 2: Continued.
Author(s), Country, Setting,
Crude
geographic study design, Population, Diagnostic prevalence Studyreference region study period characteristics criteria used of PKS and
Summary findings limitations
PD
PKS cases: 124
PD cases: 98
Males: 75
(76.5%) One (1) PD patient had
Females: 23 a family history of PD
(23.5%) in a first-degree
Male-female relative.°
ratio 3.3 :1 Causes of 2 PKS:� ∗
Age at PD onset Vascular
[mean± SD parkinsonism
(range)]: Presence of at
∗Drug-induced
Hospital, 61.5± 10.0 least three of the parkinsonism
1. Single-centre
Okubadejo Nigeria, cross- (37–77) y following:
∗Multiple system study
et al. [7] South- sectional, 2°PKS cases: 26 tremors, rigidity, NA atrophy
2. Risk of
Western bradykinesia, and ∗Lewy body dementia referral bias as1996–2006 Males: 19
(73.1%) postural or gait
∗Carbon-monoxide study site is a
Females: 7 abnormality poisoning
tertiary facility.
∗
(26.9%) Progressive
Male-female supranuclear palsy∗
ratio 2.7 :1 Hemiparkinsonism-�
Age at 2°PKS hemiatrophy∗
onset Juvenile parkinsonism
[mean± SD with dystonia and
(range)]: hemiatrophy
57.5± 14.0
(22–78) y
Population: 1. Single-centre
6282 study
Neurologic Presence of at 2. Prevalence
cases: 980 least three of the data reflects
Nigeria, Hospital, PD cases: 4 following:
hospital
Owolabi cross- (0.4%) tremors, rigidity, prevalence but
et al. [39] North-Western sectional, Males: 4 akinesia or
PD: 63 NA not true
2005–2007 (100.0%) bradykinesia, and prevalence of
Females: 0 postural population.
(0.0%) instability 3. Risk of
Age range at referral bias as
study: 50–68 y study site is atertiary facility.
6 Parkinson’s Disease
Table 2: Continued.
Author(s), Country, Setting,
Crude
reference geographic study design,
Population, Diagnostic prevalence Study
region study period characteristics criteria used of PKS and
Summary findings limitations
PD
Neurologic
cases: 1153
PD cases: 80
(6.9%)
Males: 61
(76.3%)
Females: 19
(23.7%)
Male-female
ratio� 3.2 :1 )ree (3) PD patients
Age at PD onset had a family history of
[mean± SD Presence of at PD in a first-degree
Hospital, (range)]: least three of the relative.
Femi et al. Nigeria, cross- 58.2± 6.72 following: Causes of 2
°PKS: 1. Risk of
North- (39–76) y tremors, rigidity, NA ∗Vascular referral bias as[24] Western sectional, °2007–2011 2 PKS cases: 16 bradykinesia, and parkinsonism
study site is a
(1.4%) postural or gait ∗Drug-induced tertiary facility.
Males: 13 abnormality parkinsonism
(81.3%) ∗Head trauma-related
Females: 3 parkinsonism
(18.7%)
Male-female
ratio� 4.3 :1
Age at 2°PKS
onset
[mean± SD
(range)]:
51.4± 10.04
(30–67) y
1. Single-centre
study
2. Diagnostic
Population: 699 criteria
Neurologic undefined
cases: 152 3. Prevalence
Philip- Nigeria, Hospital, PD cases: 4 data reflects
Ephraim South- cross- (2.6%) NA PD: 572 NA hospital
et al. [29] Eastern sectional, prevalence but2009–2010 Males: 4(100.0%) not true
Females: 0 prevalence of
(0.0%) population.4. Risk of
referral bias as
study site is a
tertiary facility.
Parkinson’s Disease 7
Table 2: Continued.
Author(s), Country, Setting,
Crude
geographic study design, Population, Diagnostic prevalencereference characteristics criteria used of PKS and Summary findings
Study
region study period limitationsPD
1. Single-centre
study
2. Diagnostic
Population: criteria
1247 undefined
Neurologic 3. Prevalence
Hospital, cases: 267 data reflects
Eze and Kalu Nigeria,South- cross- PD cases: 1 hospital[31] Eastern sectional, (0.4%)
NA PD: 80 NA prevalence but
2012-2013 Males: 1 not true
(100.0%) prevalence of
Females: 0 population.
(0.0%) 4. Risk of
referral bias as
study site is a
tertiary facility.
Neurologic
cases: 1836
PKS cases: 120 1. Single-centre
(6.5%) Causes of 2°PKS: study
Hospital, Male-female ∗Vascular 2. Diagnostic
Sarfo et al. Ghana, cross- ratio� 2.1 :1 parkinsonism criteria
[15] Southern sectional, Age at study NA NA ∗Parkinson plus undefined
2011–2013 [median syndromes (multiple 3. Risk of
(IQR)]: 65 system atrophy) referral bias as
(58–74) y study site is a
PD cases: 102 tertiary facility.
(5.6%)
Neurologic 1. Single-centre
cases: 6494 study
Hospital, PD cases: 33 2. Diagnostic
Sarfo et al. Ghana, cross- (0.5%) criteria
[13] Southern sectional, Male-female NA NA NA undefined
2008–2013 ratio� 4.5 :1 3. Risk ofAge at study referral bias as
[mean± SD]: study site is a
70.6± 11.5 y tertiary facility.
Neurologic
cases: 1695
2°PKS cases: 76
(4.5%) 1. Single-centre
PD cases: 25 study
Hospital, (1.5%) 2. Diagnostic
Assadeck cross- Males: 15 (60%) Low (1.47%) frequency criteria
et al. [17] Niger sectional, Females: 10 NA NA of PD undefined
2009–2013 (40%) 3. Risk of
Male-female referral bias as
ratio� 1.5 :1 study site is a
Age at onset tertiary facility
[mean (range)]:
58 (42–74) y
8 Parkinson’s Disease
Table 2: Continued.
Author(s), Country, Setting,
Crude
reference geographic study design,
Population, Diagnostic prevalence Study
region study period characteristics criteria used of PKS and
Summary findings limitations
PD
1. Risk of
information
bias as age was
Presence of self-reported in
Community akineto- a populationPopulation: hypertonic with high
Adoukonou Benin, cross-sectional 1094 syndrome and/or PKS: 91 Cause of PKS: illiteracy rateet al. [19] Northern Jun.–Aug. PKS cases: 1 resting tremor drug-induced 2. Subjective
2014 (0.09%) and nasal- signs such aspalpebral reflex pain and
inexhaustible paresthesia may
have been
exaggerated or
minimized.
NA: not available; crude prevalence: is given as (cases/100,000)× population; PD: Parkinson’s disease; PKS: parkinsonism; 2°PKS: secondary parkinsonism; y:
years; SD: standard deviation; IQR: interquartile range.
varied from 15 to 572 per 100,000 people. PD was the most Mali, and 1in Senegal. All papers were hospital-based in-
frequent cause of parkinsonism. Furthermore, there was a vestigations, 11 were case-control studies, 3 were descriptive
male preponderance of PD patients, with the ratio of males studies, 2 were case reports, and 1 was a comparative analysis
to females ranging from 1.5 :1 to 4.5 :1. )e age at clinical between two groups of PD patients. )ere was a prepon-
onset of disease ranged from 22 to >67 years while the age of derance of male patients in the reviewed studies. )e mean
patients at study ranged from 50 to >68 years (Table 2). age at disease onset was >60 years, whereas the mean age at
)e diagnostic criteria used for the prevalence studies study was >62 years. )e diagnostic criteria used were the
were the presence of at least three of the following: tremor, UK Parkinson’s Disease Society Brain Bank Clinical Diag-
rigidity, bradykinesia, and postural instability. In general, no nostic Criteria. None of the surveys described any predis-
publication directly measured predisposing factors to par- posing factors, although, in one survey, 19 of 91 PD patients
kinsonism, although 2 studies reported a positive family had a positive family history of the disease (Table 4).
history in some patients. )e most common types of SP )e key motor symptoms of PD—tremor, rigidity,
described were vascular parkinsonism and drug-induced bradykinesia, and postural or gait abnormalities—were re-
parkinsonism (Table 2). ported extensively in most of the reviewed literature. )e
secondary motor symptoms frequently experienced include
freezing of gait, speech disorders, and dysphagia. )e
3.2. Genetics of PD in West Africa. Out of the 32 studies common nonmotor symptoms were cognitive and sleep
reviewed, only 4 focused on the genetics of PD, of which 3 disorders (Table 5). Several treatment regimens were pre-
were carried out in Nigeria and 1 in Ghana. All 4 studies sented in the reviewed studies. Levodopa was commonly
examined hospital-based cohorts. One of them focused on used singly or in combination with other drugs. )e do-
sporadic PD cases, 2 focused on both familial and sporadic pamine agonists used were bromocriptine, pramipexole, and
PD cases, and 1 did not specify (Table 3). A single study ropinirole whereas the anticholinergics used were trihex-
screened for pathogenic variants of the ATXN3 and PRKN yphenidyl and benztropine. Only one group reported the use
genes in Nigerian cohorts. Two groups sequenced exons 31 of an MAO inhibitor, selegiline (Table 6).
and 41 of the LRRK2 gene for possible mutations, another
screened for the p.G2019S mutation in the LRRK2 gene,
while the other screened for 12 mutations in the LRRK2 gene 4. Discussion
including genetic variants classified as pathogenic in Eu- )is review represents a comprehensive summary of re-
ropeans and Asians. No pathogenic variants of the studied search data on parkinsonism inWest Africa. )e majority of
genes were identified in any of the studies (Table 3). the reviewed publications investigated only PD, and those
that provided data on SP did not describe any risk factors.
Nonetheless, this analysis provides data on the prevalence,
3.3. Symptomatology and Treatment of Parkinsonism inWest symptoms, and treatment of parkinsonism in West Africa.
Africa. Seventeen publications studied the symptoms and As expected, PD was the most diagnosed form of par-
complications of PD, the effectiveness of treatment regimens kinsonism, as observed in other analyses [1]. We only
used, and the effect of dietary intake on PD treatment. present data on the estimated crude prevalence of PD in
)irteen of these were conducted in Nigeria, 2 in Ghana, 1 in Nigeria as it was the only country with adequate data on the
Parkinson’s Disease 9
Table 3: Summary of genetic studies.
Author(s), Country Population Genesreference characteristics studied Method of analysis Summary findings Study limitations
PD cases: 57 Screen for pathogenic
Males: 43 (75.4%) repeat expansions No pathogenicATXN3 Sanger sequencing of expansions Small sample size; thus,Okubadejo Females: 14 (24.6%) definite conclusions about
et al. [38] Nigeria Age at study LRRK2 exons 31 and 41 No variants the prevalence of gene
[mean± SD (range)]: PRKN Sanger sequencing of all Several variants but noneexons and exon/intron pathogenic mutations are unachievable.62.3± 9.1 (43–80) y boundaries
PD cases: 54
Males: 33 (61.1%)
Females: 21 (75.4%) Small sample size; thus,
Cilia et al. Age at study Sequencing of exon 31
[25] Ghana [mean± SD (range)]: LRRK2 and exon 41 with their
One nonpathogenic definite conclusions about
65± 12 (34–89) y intron-exon boundaries variant the prevalence of gene
Age at onset mutations are unachievable.
[mean± SD (range)]:
59.5± 12 (30–83) y
PD cases: 123
Males: 93 (73.8%)
Females: 3 (26.2%) 1. Other known mutations of
Age at study Kompetitive Allele LRRK2 p.G2019S the LRRK2 gene were notOkubadejo Nigeria [mean± SD (range)]: LRRK2 Specific PCR (KASP) mutation is not screened.et al. [18] 61.9± 9.9 (36–81) y assay to screen for implicated in PD in 2. Screening method did not
Age at onset p.G2019S mutation Nigerian patients allow for the identification of
[mean± SD]: novel pathologic variants.
59.0± 13 y
PD cases: 92
Males: 70 (76.1%)
Females: 22 (23.9%) 1. Other known mutations of
Rizig et al. Age at study Kompetitive Allele LRRK2 pathogenic alleles
the LRRK2 gene were not
[12] Nigeria [mean± SD (range)]: LRRK2 Specific PCR (KASP) were absent for all 12
screened.
62.1± 9.2 (39–90) y assay of 12 variants SNPs 2. Screening method did not
Age at onset allow for the identification of
[mean± SD (range)]: novel pathologic variants.
58.8± 9.4 (36–78) y
PD: Parkinson’s disease; ATXN3: ataxin 3; LRRK2: leucine-rich repeat kinase 2; PRKN: Parkin RBR E3 Ubiquitin Protein Ligase; SNPs: single nucleotide
polymorphisms; PCR: polymerase chain reaction; y: years; SD: standard deviation.
subject.)e crude prevalence of PD varied among regions in head trauma. )e most frequent types of SP were drug-
Nigeria, as well as between different time points in the same induced and vascular parkinsonism, which is similar to the
region in the country. For example, in 2003, Talabi recorded findings of other surveys [44, 45]. Drug-induced parkin-
a PD prevalence of 15 per 100,000 people in South-Western sonism is the most common cause of SP in older people [1, 8]
Nigeria in a 3-year retrospective study [41]. Ekenze et al., in and is associated with the use of drugs that block dopa-
2010, reported a crude PD prevalence of 166 per 100,000 minergic receptors or deplete dopamine stores such as
people in South-Eastern Nigeria in a 5-year retrospective antipsychotics, antiemetics, and calcium channel blockers
study [40]. In 2013, Philip-Ephraim et al. recorded a crude [46]. Vascular parkinsonism accounts for 4.4–12% of all
PD prevalence of 572 per 100,000 people in South-Eastern parkinsonism cases and is associated with hypertension,
Nigeria in a 2-year retrospective study [29]. Furthermore, stroke, and diabetes mellitus [45].
Eze and Kalu in 2014 reported a crude PD prevalence of 80 Although none of the studies assessed predisposing
per 100,000 people in South-Eastern Nigeria in a 2-year factors for PD, three articles recorded positive family history
retrospective study [31]. )us, the evidence suggests inter- of PD in a total of 23 patients. )e results of the genetic
regional variations in crude prevalence. Perhaps, estimates studies demonstrated the absence of mutations in the
will less likely vary if similar methodologies and diagnostic ATXN3, LRRK2, and PRKN genes amongst West Africans.
criteria are used [43]. Nonetheless, the data we present were Mutations in the LRRK2 gene—especially the LRRK2
retrospectively collected in monocentric, hospital-based G2019S mutation—are responsible for significant PD cases
surveys, making it is difficult to accurately quantify the among North-African, European, Asian, and Middle-East-
burden of PD within Nigeria. ern populations [5, 6, 47]. PD due to PRKN and ATXN3
)e causes of SP described in the reviewed literature mutations has also been described [48, 49]. )e different
include drugs, cerebrovascular accidents, dementia, and results from genetic studies suggest that the genetics of PD is
10 Parkinson’s Disease
Table 4: Summary of other studies.
Author(s), Country, Setting,
reference geographic study design,
Population Diagnostic
characteristics criteria used Summary findings Study limitationsregion study period
PD cases: 33
Males: 25
(75.8%) Presence of at
Females: 8 least three of the Parasympathetic
(24.2%) following: dysfunction occurs in PD, 1. Single-centre study
Okubadejo Nigeria, Hospital, Age at study tremors, majority of which is 2. Small sample size
et al. [42] South-Western case-control
[mean± SD rigidity, symptomatic. 3. Risk of referral bias as
(range)]: bradykinesia, Age >65 is associated with study site is a tertiary
63.2± 10.2 and postural or parasympathetic facility.
(39–80) y gait dysfunction in PD
Age at onset abnormality
[mean± SD]:
60.6± 10.3 y
PD case: 1
Alasia et al. Nigeria, Hospital, Males: 1 Toxic (septic) parkinsonism 1. Small sample size.
[36] Southern case report (100%) may be induced by gram 2. Causative bacteria notAge at study: negative septicaemia stated.
71 y
PD cases: 51
Males: 37
(72.6%) 1. Single-centre study
Females: 14 2. Small sample size
(27.4%) UK Parkinson’s Cognitive dysfunction is 3. Risk of referral bias as
Nigeria, Hospital,
Age at study disease society associated with old age, late study site is a tertiary facility
Akinyemi case-control, [mean± SD brain bank PD onset, and higher disease 4. All subjects had rest
et al. [37] South-Western Jul.–Dec.
(range)]: clinical severity tremors, which may
2005 65.1± 9.2 diagnostic Late PD onset is an constitute a selection bias as(42–85) y
Age at onset criteria.
independent predictor of akinetic-predominant PD
cognitive dysfunction. subjects may suffer from
[mean± SD worse cognitive impairment
(range)]: than tremor-predominant
60.9± 8.4
(41–80) y
1. Small sample size.
PD cases: 40 2. Long-term follow-up of
Males: 32 UK Parkinson’s the different variables was
Nigeria, Hospital, (80%) disease society
Hyperhomocysteinaemia is not done.
Ojo et al. South- case-control, Females: 8 brain bank
common in PD patients with 3. Risk of information bias
[22] prolonged use of LD but has as patient’s self-reportedWestern Mar.–Sept. (20%) clinical2006 Age at study diagnostic no relationship with disease compliance and dosages
[mean± SD]: criteria. severity or disability used.
65.8± 9.8 y 4. Other causes ofhyperhomocysteinaemia
were not evaluated
PD cases: 40
Males: 32 UK Parkinson’s
Ojo et al. Nigeria,
Hospital, (80%) disease society Cognitive impairment and 1. Small sample size.
South- case-control, Females: 8 brain bank depression in PD are related 2. Risk of referral bias as[23] Western Jan.–Sept. (20%) clinical to disability and worsening study site is a tertiary2006 Age at study diagnostic disease severity. facility.
[mean± SD]: criteria.
65.8± 9.8 y
Parkinson’s Disease 11
Table 4: Continued.
Author(s), Country, Setting,
reference geographic study design,
Population Diagnostic
region study period characteristics criteria used
Summary findings Study limitations
PD cases: 55
37 (67.3%) UK Parkinson’s
males disease society Daily intake of protein in
Barichella Ghana. Hospital, 18 (32.7%) brain bank Ghanaian patients with PD
et al. [27] multiregional case-control females clinical positively influences their 1. Small sample size
Age at study diagnostic response to LD treatment
[mean± SD]: criteria.
65.8± 10.5 y
PD cases: 50
Males: 28 1. Small sample size
(56%) 2. Single-centre study
Females: 22 UK Parkinson’s Hallucinations and 3. Possibility of
Nigeria, (44%) disease society agitations differentiate PD misclassification of SP asOjagbemi
[26] South-
Hospital, brain bank PD
Western comparative
Age at study
[mean± SD]: clinical
patients with cognitive 4. Risk of information bias
64.3± 9.7 y diagnostic
dysfunction from those with
criteria. normal cognition.
as caregivers who reported
Age at onset patients’ symptoms may
[mean± SD]: have exaggerated or
62.1± 10.2 y understated symptoms.
1. Risk of information bias
as caregivers who reported
PD cases: 50 patients’ symptoms may
Males: 28 have exaggerated or
(56%) UK Parkinson’s understated symptoms.
Hospital, Females: 22 disease society 2. Possibility of
Ojagbemi Nigeria, case-control, (44%) brain bank Neuropsychiatric symptoms misclassification of SP as
et al. [28] South- Age at studyWestern Jul.–Dec. [mean± SD]: clinical occur frequently in PD
PD
2009 3. Risk of referral bias as65.4± 9.4 y diagnosticcriteria. study site is a tertiaryAge at onset facility.
[mean± SD]: 4. Drug treatment may have
62.1± 10.2 y increased risk of
neuropsychiatric symptoms
in PD patients than controls
PD cases: 36
Males: 27 UK Parkinson’s
Okunoye Hospital, (75%) disease society
and Nigeria, case-control, Females: 9 brain bank Depression may be common 1. Small sample size
Asekomeh Southern Jun.–Nov. (25%) clinical among patients with PD 2. Single-centre study
[30] 2009 Age at study diagnostic
[mean± SD]: criteria.
64.3± 10.9 y
12 Parkinson’s Disease
Table 4: Continued.
Author(s), Country, Setting, Population Diagnostic
reference geographic study design, characteristics criteria used Summary findings Study limitationsregion study period
PKS cases: 101
Primary
atypical PKS
cases: 2
2°PKS cases: 8 Presence of at 1. Control group hadPD cases: 91 least three of the Nineteen (19) PD patients different genetic andMales: 58 following: had a positive family history. environmental background.(63.7%) Motor fluctuations and 2. Access to medications
Cilia et al. Ghana, Hospital, tremors,case-control, Females: 33 rigidity, dyskinesias are not between the study and[32] multiregional 2008–2012 (36.3%) bradykinesia, associated with the duration control groups complicatedMale-female and postural or of LD therapy, but rather the study design.ratio� 1.8 :1 gait with longer disease duration 3. Risk of inclusion bias asAge at PKS and higher LD daily dose the study was a hospital-
onset abnormality based trial.
[mean± SD
(range)]:
60.6± 11.3
(27–91) y
PD cases: 36 UK Parkinson’sHospital,
Okunoye Nigeria, descriptive, Males: 27
disease society
(75%) brain bank Nonmotor symptoms occur 1. Small sample size[33] Southern Jun.–Nov. Females: 9 clinical in PD 2. Single-centre study2009 (25%) diagnosticcriteria.
PD cases: 36
Males: 27
(75%)
Females: 9
(25%)
Age at study 1. Small sample size
[mean± SD]: UK Parkinson’s Patients with PD have much 2. Single-centre study64.3± 10.9 y disease society poorer generic and specific 3. Questionnaire lackedOkunoye Nigeria, Hospital, Age at onset brain bank items on self-image, night
et al. [35] Southern case-control [mean± SD clinical health related quality of lifein comparison to their time sleep problems, sexual(range)]: diagnostic
60.8± 10.5 criteria. healthy counterparts
activity, and finances which
were major concerns for
(39–80) y patients.
Age at onset
[mean± SD
(range)]:
60.8± 10.5
(39–80) y.
PD cases: 80 UK Parkinson’s Significant features of
Nigeria, Age at study disease society gastrointestinal dysfunctionOwolabi Hospital, brain bank in PD include constipation, 1. Risk of referral bias as
et al. [34] North-Western case-control
[mean± SD
(range)]: clinical sialorrhea, dysphagia,
study site is a tertiary
61.1± 8.5 y diagnostic difficult mastication, and
facility.
criteria. choking.
Parkinson’s Disease 13
Table 4: Continued.
Author(s), Country, Setting,geographic study design, Population Diagnosticreference characteristics criteria used Summary findings Study limitationsregion study period
PD cases: 35
Males: 21
(60%)
Females: 4
(40%)
Age at study UK Parkinson’s 1. Scales used were availableHospital, [mean± SD disease society in the local language; thus,Maiga et al. Senegal descriptive, (range)]: brain bank Major alteration of sleep they were probably not[16] Apr.–Jun. 65.7± 7.4 clinical quality occurs in PD. adapted to the sociocultural2014 (48–79) y diagnostic context of Senegalese
Age at onset criteria. populations.
[mean± SD
(range)]:
63± 7.89
(46–77) y
PD cases: 78
Males: 60 UK Parkinson’s
(76.9%) disease society 1. Pulmonary function
Owolabi Nigeria,North- Hospital, Females: 18 brain bank Pulmonary function is
parameters that are
et al. [14] Western case-control (23.1%) clinical reduced in PD
conventionally used to
Age at study diagnostic evaluate respiratory muscle
[mean± SD]: criteria. strength were not employed
62.32± 8.67 y
PD case: 1
Nigeria, Hospital, Males: 1 Severe vomiting andEkpe [20] South-
Eastern case report
(100%) diarrhoea could be 1. Small sample size
Age at study: symptoms of PD
72 y
PD cases: 60
Males: 41 UK Parkinson’s
Hospital, (68.3%) disease society Nonmotor symptoms of PD
Maı̈ga et al. descriptive, Females: 19 brain bank include sensitive disorders, 1. Lack of complete patient
[21] Mali Jan.–Nov. (31.7%)Age at study clinical
dysautonomia,
2013 diagnostic psychobehavioral disorders,
data.
[mean and sleep disorders
(range)]: 66.5 4 criteria.
(25–94) y
PD: Parkinson’s disease; PKS: parkinsonism; 2°PKS: secondary parkinsonism; LD: levodopa; y: years; SD: standard deviation.
markedly different in different populations of the world and association between PD and age suggests that its develop-
that the common LRRK2 G2019S mutation is not a frequent ment depends on cumulative exposure to environmental
cause of PD in West Africa. factors, and/or age-dependent biological factors [58]. Ac-
In all the reviewed studies, there was a preponderance of cordingly, the factors for PD etiology may be similar irre-
male PD patients. )is observation is confirmed by previous spective of geographical area or ethnicity.
findings which have shown that PD is more incident in )e primary motor symptoms of PD—tremor, rigidity,
males than in females, with men being at least twofold at bradykinesia, and postural or gait abnormalities—were
greater risk of PD than women [50–54]. )is may be at- identified in much of the reviewed literature. Some of the
tributed to the neuroprotective effect of estrogen demon- studies reported secondary motor symptoms such as
strated in females compared to males [54–56], or to the micrographia, hypomimia, speech problems, and dysphagia.
higher expression of pathogenic genes in the dopaminergic Additionally, nonmotor symptoms like cognitive disorders,
neurons of the substantia nigra pars compacta of males [50]. sleep disorders, and gastrointestinal disorders were observed
Other hypotheses attribute it to nonhormonal gender fac- in some studies. Consistent with other studies, levodopa was
tors, due to the strong linkage to the X-chromosome ob- used in combination with other drugs such as dopamine
served in several genome-wide studies of PD susceptibility agonists to manage parkinsonian symptoms. Other drugs
[49, 57]. Age is the most important risk factor for parkin- mentioned were anticholinergics and monoamine oxidase
sonism [52]. )is fact is observed in this analysis where the inhibitors, both of which have been shown to alleviate the
mean age of disease onset in most studies was ≥60 years. )e symptoms of PD [52]. A recent study by Hamid et al.
14 Parkinson’s Disease
Table 5: Symptoms and signs of PD described.
Category Symptom or sign Brief description References
Resting tremor Slight tremor in the hand or foot on one side of the body [7, 16, 17, 20, 24, 26, 32, 37]
Primary motor Bradykinesia Difficulty with repetitive movements [17, 20, 24, 26, 32, 37]
symptoms Rigidity Stiffness and inflexibility of the limbs, neck, and trunk [7, 16, 17, 20, 24, 26, 37]
Postural instability Tendency to be unstable when standing upright [17, 24, 37]
Freezing of gait Hesitating before stepping and exaggerated first step [17, 24, 32]
Micrographia Shrinkage in handwriting [24]
Secondary motor Hypomimia Decreased expressiveness of the face [24]
symptoms Falls Falling due to instability [24, 32]
Speech problem Dysarthria, drooling, and excess saliva [17, 24, 30, 33, 37]
Dysphagia Difficulty in swallowing [22, 25, 29, 30, 34]
Cognitive disorders Delusion, hallucination, depression, agitation, anxiety,apathy, anxiety, irritability, forgetfulness [17, 21, 23, 24, 26, 28, 30, 32, 33]
Pain Generalised body pains [16, 17, 21, 24, 33]
Sleep disorder Insomnia, interrupted sleep, excessive daytime sleepiness [16, 17, 21, 24, 33, 37]
Autonomic
dysfunction Cardiovascular disorders [42]
Nonmotor Pulmonary problems Reduced vital capacity [14]
symptoms Sialorrhea Excessive salivation [21, 34]
Mood disorder Persistent low mood [33, 37]
Sweating Excessive sweating [17, 33]
Genitourinary
disorders Urinary incontinence, urinary urgency [21]
Gastrointestinal
disorders Constipation, indigestion, and abdominal pain [17, 20–22, 25, 34]
Table 6: Medications recorded in publications. 5. Conclusion
Drugs used References Although research on parkinsonism in West Africa has
Levodopa [16, 22, 26, 32] increased over the years, there is still inadequate data on its
Dopamine agonist [7, 16, 24] epidemiology. PD in West Africa occurs more in males and
Anticholinergic [17, 24] usually begins after age 60. Moreover, a substantial number
Monoamine oxidase inhibitor [24] of patients experience cognitive dysfunction, motor fluc-
Levodopa + carbidopa [7, 14, 15, 17, 23, 24] tuations, sleep disorders, and reduced pulmonary function.
Levodopa + dopamine agonist [16, 22, 26] More community-based epidemiological surveys should
Levodopa + anticholinergic [22, 26]
Levodopa + carbidopa + anticholinergic [7, 23] assess the risk factors of the disease. Moreover, public health
Levodopa + dopamine surveillance strategies should be established to monitor the
agonist + anticholinergic [7, 22, 26] epidemiology of the disorder.
demonstrated that PD-specific therapies are largely un- Data Availability
available and unaffordable in most African countries [59].
)ere is a need to initiate and drive policies aimed at im- )e data for the study were obtained from the public da-
proving accessibility to treatment. tabases: PubMed, BioMed Central, Embase, Web of Science,ScienceDirect, Scopus, African Journals Online (AJOL), “La
Banque des Données en Santé Publique” (BDSP), and
4.1. Strengths and Limitations. )is review, to the best of our “Institut d’Epidémiologie Neurologique et de Neurologie
knowledge, is the first of its kind on parkinsonism in West Tropicale” (IENT).
Africa. )e information presented in this analysis will in-
form decisions regarding the development of future par- Conflicts of Interest
kinsonism screening strategies. Although the data we
provide is robust due to the systematic method of article )e authors have no conflicts of interest to disclose.
evaluation, there are limitations to this study. Firstly, due to
a lack of sufficient data, the epidemiology of parkinsonism in References
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