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

Abstract

Background: An estimated 50 million people worldwide have Alzheimer's disease and related dementias (ADRD), and this number is projected to increase with the growth of the aging population, with the largest growth occurring in low and middle-income countries. Diagnostic coverage for dementia is estimated to be only 5-10% in low-and middle-income countries. Timely diagnosis of ADRD could prompt early access to information, medical treatments, and support for caregivers. The aim of this study was to assess how healthcare workers in rural southwestern Uganda assess for and diagnose ADRD. Methods: We used in-depth interviews to investigate the medical knowledge and clinical practices surrounding ADRD diagnoses among 42 healthcare workers employed at mid-tier health facilities in southwestern Uganda. Qualitative content analysis was used to identify distinct categories and themes. Results: Our findings show that healthcare workers without specific mental health training assessed and diagnosed dementia based on history and physical examination alone. On the other hand, healthcare workers with some specialized training in mental health were more likely to use neuropsychological tests, blood tests, urine tests, and brain imaging in the diagnosis of dementia. Collateral history from caregivers was noted to be very important in proper assessment and diagnosis of dementia among all categories of healthcare workers. The majority of healthcare workers regarded memory loss as part of the normal aging process and reported that it does not need any specific treatment. Other healthcare workers could recognize signs and symptoms of dementia, but focused on managing other medical problems at the expense of assessing cognitive decline and mental health. Diagnostic practices did not differ based on age, years of experience, or gender of the healthcare workers. Conclusion: These results indicate that specialized training in mental health among healthcare workers is crucial for the assessment and diagnosis of ADRD in rural southwestern Uganda.

Prevalence of Severe Neurocognitive Impairment and Its Association with Socio-Demographics and Functionality Among Ugandan Older Persons: A Hospital-Based Study

“…Many patients have sought alternative modes of treatment before they reach the hospitals and at the healthcare facilities; the health workers have limited knowledge about neurocognitive disorders due to various myths and lack of skills by the healthcare providers. 50,51 Majority of the care for elders with neurocognitive disorders is by the caregivers, community, and village health teams whose perception do not promote adequate management. 9,[52][53][54] Thus, patients reaching the health facility late and mortality become inevitable during admission.…”

Mbarara University Research Training Initiative: Experiences and Accomplishments of the MEPI Junior D43 TW010128 Award in Uganda

“… 46 Alzheimer’s disease and its related dementias (AD/ADRD). We realized 08 publications from the MADRI trainees in this area: (i) PMC7544160; (ii) PMC7379317; 47 (iii) PMC7268702; 48 (iv) PMC7206770; 49 (v) PMC6935120; 50 (vi) PMC7158106; 51 (vii) PMC7011370. 52 Spin-off publications.…”

Motoric Cognitive Risk Syndrome: Symptoms, Pathology, Diagnosis, and Recovery

“…The world geriatric population shows an unprecedented and rapid increase, with a >8.5% aged about 65 years and above. Dementia is a common problem among elderly individuals, and the statistics claimed that ~50 million people had been living with dementia in 2019, with a predicted rise of over 150 million in 2050 (Kamoga et al, 2019 ; Vellani, 2019 ). In fact, abnormal aging bears immeasurable adverse effects, which appears as a key burden on the patients themselves, families, government, and the health system and economy of the country (2001, 2012).…”