Dementia assessment and diagnostic practices of healthcare workers in rural southwestern Uganda: a cross-sectional qualitative study

摘要

BackgroundAlzheimer’s disease and related dementias (ADRD) affect approximately 50 million people worldwide, and this number is currently increasing due to the growth of the aging population, with the global prevalence expected to reach 152 million by 2050 [1]. Most of this increase is projected to occur in low- and middle-income countries (LMIC) [1,2,3]. Over 58% of people with ADRD currently live in LMIC including Sub-Saharan Africa, where more than 1.69 million people are estimated to be living with dementia [4]. ADRD is the most important independent cause of disability among the older people in LMIC [5].Despite availability of numerous dementia diagnostic tools, 62% cases of ADRD worldwide are undiagnosed, while 91% are diagnosed very late [3, 6,7,8]. Missed or delayed diagnosis magnifies the socioeconomic burden on families and healthcare systems through heavy expenditures on unnecessary investigations, treatments driven by vague symptoms, and lack of counseling of family and caregivers [7, 9,10,11,12]. Early diagnosis could prompt early evaluation for reversible dementia syndromes as well as timely access to information, medical treatment, advice and support for caregivers, and targeted community interventions from the time of diagnosis to end of life [10, 13, 14].Consensus guidelines on the assessment for ADRD includes medical history, physical examination, laboratory tests, cognitive assessment, and brain imaging [15]. Prior case reports have described the assessment and diagnosis of ADRD in sub-Saharan Africa and Uganda [16,17,18], but little is known about broader trends in dementia assessment and treatment in rural primary care settings in Uganda. The aim of the study was to assess how healthcare workers in health facilities in rural southwestern Uganda assess for and diagnose ADRD.