Challenges in the diagnosis of dementia: insights from the United Kingdom-Brazil Dementia Workshop

Abstract

ABSTRACT. In July 2019, a group of multidisciplinary dementia researchers from Brazil and the United Kingdom (UK) met in the city of Belo Horizonte, Minas Gerais, Brazil, to discuss and propose solutions to current challenges faced in the diagnosis, public perception and care of dementia. Here we summarize the outcomes from the workshop addressing challenges in diagnosis. Brazil faces a major problem in dementia underdiagnosis, particularly involving the population in an adverse socioeconomic context. There is poor availability of resources and specialists, and the knowledge of general practitioners and other healthcare professionals is far from satisfactory. Low education level is a further obstacle in diagnosing dementia, as the most commonly used screening tests are not designed to evaluate this population. Patients and their families must overcome the stigma of a diagnosis of dementia, which is still prevalent in Brazil and increases the burden of this condition. Whilst the UK has greater resources, dedicated memory services and a National Dementia Strategy plan, the National Health Service (NHS) has limited funding. Therefore, some challenges regarding diagnosis are common across both countries. The authors suggest possible solutions to confront these, with the goal of improving assessment and recognition of dementia and reducing misdiagnosis.

Feasibility indicators of telemedicine for patients with dementia in a public hospital in Northeast Brazil during the COVID-19 pandemic

“…Another possible reason is that rehabilitation care prescribed during the remote consultation was often not provided to the patients due to few public rehabilitation centers being available as well as mobility constraints requiring home care. Home care rehabilitation services are seldom provided in a public setting in Northeast Brazil [ 38 ]. In addition, the intervention involved only care delivered by a single physician, though dementia management requires a multidisciplinary approach [ 37 ].…”

Multidimensional Clinical Assessment in Frontotemporal Dementia and Its Spectrum in Latin America and the Caribbean: A Narrative Review and a Glance at Future Challenges

“…Most of the instruments that have been validated in LAC are specifically for a literate population with, in general, a minimum of 4 years of education, which presents a significant drawback for the assessment of the illiterate and low-educated population ( 268 ). The absence of validated tests for the low-educated population is a significant limitation in assessment since years of education and age are two of the main variables affecting performance in cognitive assessments ( 261 ).…”

“…In addition, about 10–17% of the LAC population is indigenous, with an estimated 400 indigenous languages spoken, along with Spanish and Portuguese ( 271 ). Finally, there is an increased percentage of non-Spanish or Portuguese-speaking migration ( 268 ). For example, in Chile, a large population of Creole-speaking Haitian citizens has recently arrived in the country, which generates a challenge and a limitation regarding the tools currently used in Chile.…”

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“…37 Some tests are not even designed to evaluate this population. 38 The executive functioning performance also seems to be linked to educational level, as a community sample of Rio de Janeiro showed. 39 One possible explanation is the influence of educational level in the formation of cognitive reserve.…”

“… 37 Some tests are not even designed to evaluate this population. 38 The executive functioning performance also seems to be linked to educational level, as a community sample of Rio de Janeiro showed. 39 …”