Alzheimer's disease diagnosis and management: Perspectives from around the world

Abstract

Alzheimer's disease (AD) and other dementias are a global challenge. Early diagnosis is important to manage the disease. However, there are barriers to diagnosis that differ by region. Researchers from Brazil, China, Nigeria, Spain, and Sweden have identified key barriers to AD diagnosis in their countries. In Brazil, socioeconomic inequalities and poor recognition of dementia by physicians can prevent diagnosis. In China, a very large population and lack of physician training in dementia make diagnosis problematic. In Nigeria, socioeconomic inequalities and cultural stigma can stand in the way of diagnosis. In Spain, patient hesitancy and an overloaded health‐care system are barriers to diagnosis. In Sweden, inconsistent use of biomarkers is a prominent barrier to diagnosis of AD. To support diagnosis, more focus is needed on education of patients and physicians, increased use of support services, and improved access to biomarkers to accurately diagnose AD.

How to Prevent and/or Revert Alzheimer’s Disease Continuum During Preclinical Phases

“…However, this strategy depends on the capacity of healthcare systems to monitor changes in these risk factors over several years before a clinical diagnosis is made. However, as indicated in a recent study, vast improvements worldwide are required before these health providers can undertake this task [ 78 ]. That study gave examples of countries needing improvement of their systems.…”

Global rural health disparities in Alzheimer's disease and related dementias: State of the science

“…Rural residents and providers report that even if a diagnosis of dementia is provided and accepted, the lack of services and personnel in dementia care prevents further care, thus accelerating decline 133 . A global lack of local providers, specialty services, and telehealth services due to digital illiteracy and low digital access are barriers, as is the lack of young persons willingness to remain in rural areas who could help address these gaps 134 . There are local health centers in rural and remote areas (e.g., primary care clinics, health promoters, or indigenous systems of health), which tend to be the initial contact for rural older adults.…”

“…133 A global lack of local providers, specialty services, and telehealth services due to digital illiteracy and low digital access are barriers, as is the lack of young persons willingness to remain in rural areas who could help address these gaps. 134 There are local health centers in rural and remote areas (e.g., primary care clinics, health promoters, or indigenous systems of health), which tend to be the initial contact for rural older adults. However, these centers may not be equipped with providers available to engage in ADRD detection, diagnosis, and management; some developing nations provide services with a limited team of specialists that often does not include neuropsychologists or geriatricians.…”

A fresh look at the multi‐level social determinants of disparities in Alzheimer's disease and related dementias

“…In true reflection of the deeply multifaceted nature of this line of inquiry, the topics covered in this special issue span a diverse array of content areas such as SDoH-linked cognitive decline across racial groups, the lack of representativeness in ADRD research, the effects of early life experiences on late-life cognition, the impact of COVID-19 on cognitive impairment in older adults, the economic burden associated with mild cognitive impairment and mild dementia, proposals emanating from workshops and perspectives on improving access to timely diagnosis, differences in performance across racial groups on commonly used instruments for tracking cognitive change, and novel methodologies that can be used to better understand how the environment affects brain health. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] Taken together, the studies in this special issue bring us closer to identifying key constructs related to economic stability, social and community context, access to and quality of health care, and other things that are linked to cognitive outcomes and the progression to ADRD in minoritized older adults. Email: ozioma@medicine.wisc.edu…”