A trio of Penn Medicine researchers recently traveled to Uganda for a conference on brain diseases, bringing together local and international experts to talk about the latest research impacting brain health in Sub-Saharan Africa.
I talked with John Trojanowski, MD, PhD, director of Penn’s Institute on Aging and co-director of the Center for Neurodegenerative Disease Research, about the trip and discussed the impact this journey had on the continuing quest to find diagnostic tools and treatments for neurodegenerative diseases such as Alzheimer’s disease.
Science of Aging: What were the main takeaways from the conference?
John Trojanowski:Makerere University has a very sophisticated medical school, and not unlike the academic medical centers in the United States, it’s clinical partner, Mulago Hospital was also very dedicated to providing outstanding patient care. Similar to the Hospital of the University of Pennsylvania, Mulago is a teaching hospital with specialized centers and institutes that attract patients from across Uganda. The physicians and caretakers have the same passion to do good for their patients, and are very eager to learn as much as possible to do more to help their patients. While dealing with a different constellation of diseases – such as AIDS and malaria – and different health systems and equipment, the Ugandans were very devoted to providing excellent medical care. For instance, Uganda was among the first to intervene when the AIDS epidemic took hold.
Science of Aging: What are the differences between US Alzheimer’s/neurodegenerative care and what African countries are experiencing?
John Trojanowski: Non-communicable diseases – such as stroke, diabetes, heart disease and obesity – are on the rise, not unlike the U.S. Our hosts, Stan Jacobson and Seggane Musisi, were very interested in gathering information about progressive neurological diseases like Alzheimer’s and Parkinson’s, especially as progress is made in caring for tuberculosis, vitamin deficiencies, and other prevalent conditions. Dr. Musisi, the Chair of Psychiatry at Makerere University’s Medical School, noted that approximately 40 percent of the patients he sees with psychiatric complaints who are over 60 years old have dementia.
One of the main differences is that there aren’t many diagnostic tools being used to determine the presence of diseases like Alzheimer’s or Parkinson’s. For instance, in the United States, a neuropathologist conducts an autopsy following a patient’s passing to confirm a diagnosis. There is no neuropathologist in Uganda (there are very few training spots available in the U.S. as well).
In Uganda, neurologists and psychiatrists base their assessment on clinical exams, in lieu of advanced imaging techniques using PET scans or MRIs, or spinal fluid biomarker tests that can be used to detect signs of Alzheimer’s pathology.
Science of Aging: Are there any opportunities for Penn Medicine experts to collaborate with colleagues at Makerere?
Dr. Trojanowski: Yes. Penn’s Gerard Schellenberg, PhD, Professor of Pathology and Laboratory Medicine and leader of the National Institute on Aging-funded Alzheimer’s Disease Genetics Consortium, is looking into partnerships to gather genetic information from patients to include in large genetic studies for both autism as well as neurodegenerative diseases like Alzheimer’s.
In addition, we’re exploring the idea of a fellowship to train a neuropathologist from Uganda in our lab, so their team can learn about how we analyze tissue and diagnose neurodegenerative diseases.
Science of Aging: Outside of the trip, what was Kampala like?
Dr. Trojanowski: Kampala was what you’d expect from a contemporary capital city – hustling and bustling with high rises, hotels, and traffic jams. The equatorial weather was great – 90 degrees and hot in the day, but considerably cooler in the mornings and evenings.
We had an opportunity to visit the Serengeti, a short flight over Lake Victoria to Arusha at the foot of Mt. Kilimanjaro in Tanzania. It was absolutely phenomenal. We found out that 30 percent of Tanzania is set aside for wildlife preservation, to restore populations of native animals, like the rhinoceros; there are only a few rhinos left in the Serengeti.
I waved to a lion from the jeep we were in – he looked directly at me and roared, like the MGM lion, but thankfully he didn’t pounce on the truck. The awesomeness of nature, these spectacular animals – it was very Darwinian; if you go slow, you’re more likely to get eaten.
Science of Aging: Were there any other moments that will stick with you?
Dr. Trojanowski: Yes. While we were at the airport, I met a young soldier from Sweden who was returning home briefly between stints in the Sudan. His role is to disentangle combatants from opposing groups (North and South Sudan, rival groups, etc). He has been there for three years already. I asked him how he continues to do such difficult work. He said, “No matter how horrific things are, I’m a Swedish soldier, and I am committed to the mission.” To which I responded, “sometimes it seems very difficult to find a cure for Alzheimer’s disease, but we can’t stop trying either.”
No matter how difficult, we have to keep going.