Marieke Cornelia Johanna Dekker

Parkinson's disease (PD) is a complex, progressive neurodegenerative disorder requiring comprehensive, long-term management. PD affects millions of people globally and presents with motor and non-motor symptoms that progressively impair function and quality of life. While pharmacological therapy remains effective, optimal care extends beyond medication management. Traditional care models for PD often rely heavily on doctors and primarily target motor symptoms and motor complications, with less attention to non-motor symptoms, many of which remain under-recognized. This imbalance contributes to fragmented care and unmet patient needs. These challenges highlight the need for a multidisciplinary care team to address the full spectrum of patient needs. Therefore, integrating a multidisciplinary approach is essential for comprehensive PD management. This manuscript proposes a scalable, multidisciplinary care team model designed to optimise clinical outcomes, enhance quality of life, and remain adaptable across diverse healthcare systems worldwide. It addresses global challenges associated with MDT implementation and outlines potential future solutions. The manuscript also highlights stakeholder engagement in Community Engagement and Involvement (CEI), including initiatives in Tanzania and Thailand to raise community awareness. In particular, the “CheckPD” project and integrated “eat, move, sleep” lifestyle interventions promote lifestyle-based strategies for PD prevention and improved long-term management of PD. Overall, the model emphasises coordinated, patient-centred care that integrates medical, rehabilitative, psychological, and social support services.

Background The global burden of Parkinson′s disease (PD) has increased substantially over recent decades, driven by population ageing and rising age–standardized prevalence. In Africa, accurate estimates remain limited due to a lack of recent, methodologically robust population–based studies. Objectives To determine the current age–standardized and sex–specific prevalence rates of PD in Nigeria. Methods We conducted a 2–stage, cross-sectional population–based door–to–door survey among adults aged ≥18 years in two densely populated urban local government areas in Lagos State, Nigeria, between April 1, 2024 and January 31, 2025. The first stage involved a household census and screening for parkinsonism using a standardized screening tool. The second stage consisted of in–person clinical assessment and diagnostic confirmation by physicians using established clinical diagnostic criteria. Crude and age–standardized prevalence rates (to the World Health Organization World Standard and European Standard Populations) were calculated. Results 31,009 individuals (52.7% female) from 13,222 households were surveyed, and 70 persons were diagnosed with PD. The crude prevalence ratio was 225.7 per 100,000, with higher prevalence in males (53/14658, 361.6) than females (17/16,351, 104.0). The age–standardized prevalence rate (95% confidence interval) was 193 per 100,000 (150 — 245) (females: 86 (50 — 137); males: 277 (207 — 362)), and increased with advancing age. The diagnostic gap (previously undiagnosed) was 60.0% (42/70). Treatment gap (never treated) was 44/70 (62.9%). Conclusions The age–standardized prevalence of PD is higher than previously reported in sub-Saharan Africa. These findings provide contemporary data to inform updated estimates of disease burden and support health systems planning.

Background: Traditional health practitioners (THP) and complementary and alternative medicines (CAM) play a well‐recognized role in Africa. However, their role in treating movement disorders (MD) remains poorly studied. Objective: This large multicenter continental study aimed to investigate the prevalence of seeking and consulting THPs and using CAMs among people with MDs in different African countries and the associated factors of their use. Methods: This study involved 12 sites within 11 African countries. We developed and distributed a structured questionnaire that documented frequency, attitudes, beliefs, and factors related to patients' engagement with THPs and use of CAMs. Results: We surveyed 1158 participants with MDs from 11 African countries in different regions of the continent. Overall engagement with THP and CAM use were reported in about a third (319 [27.5%] and 356 [30.7%], respectively) of individuals with MDs, which was associated with delayed diagnosis and medical treatment initiation and significantly varied by country, reaching up to 80%, particularly among individuals from sub‐Saharan Africa (SSA) and those with hyperkinetic MDs. Common contributing factors included unavailability, unaffordability, and lack of access to health services; misconceptions regarding disease nature; lack of curative response to medications; feeling of stigma; rural residence and patients' ethnicity; and levels of education and employment. These factors were more pronounced in patients in SSA. Conclusion: Seeking THPs and using CAM are widespread practices in African countries and have a negative impact on patients' care. Their use is related to inadequate health‐care services, misconceptions, and other factors, which are modifiable and mandate immediate and comprehensive actions. © 2026 International Parkinson and Movement Disorder Society.

Extrapulmonary tuberculosis can present with a large variety of mimics of other, treatable, disorders. We present a young man with advanced cranial disease responding to tuberculostatic treatment but posing significant diagnostic and therapeutic challenges.

HIV-associated neurocognitive disorders (HAND) are highly prevalent in those ageing with HIV. High-income country data suggest that vascular risk factors (VRFs) may be stronger predictors of HAND than HIV-disease severity, but data from sub-Saharan Africa are lacking. We evaluated relationships of VRFs, vascular end-organ damage and HAND in individuals aged ≥ 50 in Tanzania. c-ART-treated individuals were assessed for HAND using consensus criteria. The prevalence of VRFs and end organ damage markers were measured. The independent associations of VRFs, end organ damage and HAND were examined using multivariable logistic regression. Data were available for 153 individuals (median age 56, 67.3% female). HAND was highly prevalent (66.7%, 25.5% symptomatic) despite well-managed HIV (70.5% virally suppressed). Vascular risk factors included hypertension (34%), obesity (10.5%), hypercholesterolemia (33.3%), diabetes (5.3%) and current smoking (4.6%). End organ damage prevalence ranged from 1.3% (prior myocardial infarction) to 12.5% (left ventricular hypertrophy). Measured VRFs and end organ damage were not independently associated with HAND. The only significant association was lower diastolic BP (p 0.030, OR 0.969 (0.943–0.997). Our results suggest that vascular risk factors are not major drivers of HAND in this setting. Further studies should explore alternative aetiologies such as chronic inflammation.

Long-term exposure to pesticides used in agriculture is increasingly being identified as a risk factor for developing Parkinson’s disease. How chronic pesticide exposure might contribute to the growth of Parkinson’s disease in the mainly agricultural communities of Sub-Saharan Africa has thus far received limited attention. There are specific concerns in this area of the world: aging of the population, in combination with chronic exposure to widely used pesticides, including those that have been restricted elsewhere in the world because of neurotoxicity and other health risks. Of interest, the prevalence of Parkinson’s disease among specific (semi)nomadic populations in Tanzania seems very low, possibly due to their lack of exposure to agricultural chemicals. But at the same time, pesticides have also brought important benefits to this part of the world. Specifically, in Sub-Saharan Africa, pesticides have been directly helpful in preventing and controlling famine and in containing major human infectious diseases. This creates a complex risk-benefit ratio to the use of pesticides within a global perspective, and urgently calls for the development and implementation of affordable alternatives for areas such as Sub-Saharan Africa, including non-neurotoxic compounds and non-chemical alternatives for the use of pesticides.

Introduction: A significant number of climbers on Mount Kilimanjaro are affected by altitude-related disorders. The aim of this study was to determine the main causes of morbidity and mortality in a representative cohort of climbers based on local hospital records. Methods: We conducted a 2-y retrospective chart review of all patients presenting to the main referral hospital in the region after a climb on Mount Kilimanjaro, including all relevant records and referrals for postmortem studies. Results: We identified 62 climbers who presented to the hospital: 47 inpatients and 15 outpatients. Fifty-six presented with high altitude illness, which included acute mountain sickness (n=8; 14%), high altitude pulmonary edema (HAPE) (n=30; 54%), high altitude cerebral edema (HACE) (n=7; 12%), and combined HAPE/HACE (n=11; 20%). The mean altitude of symptom onset ranged from 4600±750 m for HAPE to 5000±430 m for HAPE/HACE. The vast majority of inpatients (n=41; 87%) were improved on discharge. Twenty-one deceased climbers, most having died while climbing (n=17; 81%), underwent postmortem evaluation. Causes of death were HAPE (n=16; 76%), HAPE/HACE (n=3; 14%), trauma (1), and cardiopulmonary (1). Conclusions: HAPE was the main cause of death during climbing as well as for hospital admissions. The vast majority of climbers who presented to hospital made a full recovery.

There are over 3 million people in sub-Saharan Africa (SSA) aged 50 and over living with HIV. HIV and combined antiretroviral therapy (cART) exposure may accelerate the ageing in this population, and thus increase the prevalence of premature frailty. There is a paucity of data on the prevalence of frailty in an older HIV + population in SSA and screening and diagnostic tools to identify frailty in SSA. Patients aged ≥ 50 were recruited from a free Government HIV clinic in Tanzania. Frailty assessments were completed, using 3 diagnostic and screening tools: the Fried frailty phenotype (FFP), Clinical Frailty Scale (CFS) and Brief Frailty Instrument for Tanzania (B-FIT 2). The 145 patients recruited had a mean CD4 + of 494.84 cells/µL, 99.3% were receiving cART and 72.6% were virally suppressed. The prevalence of frailty by FFP was 2.758%. FFP frailty was significantly associated with female gender (p = 0.006), marital status (p = 0.007) and age (p = 0.038). Weight loss was the most common FFP domain failure. The prevalence of frailty using the B-FIT 2 and the CFS was 0.68%. The B-FIT 2 correlated with BMI (r = − 0.467, p = 0.0001) and CD4 count in females (r = − 0.244, p = 0.02). There is an absence of frailty in this population, as compared to other clinical studies. This may be due to the high standard of HIV care at this Government clinic. Undernutrition may be an important contributor to frailty. It is unclear which tool is most accurate for detecting the prevalence of frailty in this setting as levels of correlation are low.