Affected people also suffer optic atrophy and sensory neural deafness, on both sides of the body. There is neurological damage to the pyramidal tract of the spinal cord. For these older patients, evidence of malnutrition is rarer, and improving nutrition does not improve symptoms.Most of those with the older-onset form have symptoms in their legs, but a third to a half also have arm symptoms. Symptoms tend to worsen during the rainy season (see monsoon, harmattan), and are often worse at night. Symptoms associated with the lower cranial nerve are rarer; most patients do not show them. These symptoms include dysarthria (difficulty articulating words), dysphagia (difficulty swallowing), shortness of breath, and dysphonia (difficulty speaking); dysphonia is more common in women, and shows as hypophonia (lack of co-ordination in the vocal cords) and an inability to shout. Treatment
Nutritional improvements; supplying nutritional yeast, teaching improved cassava preparation, and ceasing cassava consumption. Outlook
Unclear, with contradictory reports from different studies. Research directions
A 2016 review listed twenty-one open research questions. The value of international co-operation on TAN research has also been highlighted. Epidemiology
TAN has only been described as developing in Africa, South-east Asia, and the Caribbean (if Guiana be included). It does not seem to occur in temperate countries. People affected by TAN tend to be poor and live in rural areas. In some areas, more than a quarter of the population are affected. In India and Africa, more women are affected; in Africa, the elderly are most likely to suffer, and in India, people in their thirties.
Historical data suggests that, in the 1960s, TAN in Africa was most common in people in their 30s and 40s.While the areas affected roughly correspond to the areas in which cassava is grown, some people in non-cassava-growing populations get TAN, and some cassava-growing populations do not get TAN. It is possible that there are several diseases being categorized as TAN.It has been estimated that 5% of surviving World War II prisoners of war held in the Far East acquired TAN; while they were held for 3.5 years or less, the TAN symptoms persisted chronically after they returned to temperate climates. Other animals
The behaviour and neurology of malnourished and cassava-fed rats has been compared to that of humans with TAN. See also
Konzo, a diet-based tropical neuropathy
Lathyrism, a diet-based neuropathy
Tropical spastic paraparesis, and infectious tropical myeloneuropathy
Neglected tropical diseases
Beri-beri


== References ==