Prevalence of dementia and associated factors among Ugandan adults aged 60 years and above attending care at St. Mary’s Hospital Lacor

Abstract

Background: Dementia is currently the seventh leading cause of death among all diseases and one of the major causes of disability and dependency among older people globally. Currently, over 55millions people are living with dementia worldwide and nearly 10millions cases new cases every year and nearly two thirds of these cases are in low- and middle-income countries. Dementia is underdiagnosed in Africa due to lack of awareness and understanding of disease, resulting in stigmatization and barriers to care. Already a high prevalence of 20% has been reported in western Uganda. Due to regional and ethnic variation in the burden, there is no Study on Prevalence and associated factors in northern Uganda in order to influence and make strategic dementia policy in this population. Study objective: To determine the prevalence and risk factors associated with dementia in Ugandan adults attending care at St. Mary’s Hospital Lacor. Methods: This was a cross sectional study in which adult patients aged 60 years and above presenting to the medical outpatient department of the hospital from March 2022 to April 2022 were screened and those eligible were subsequently enrolled consecutively. Patients were subjected to dementia in Africa and Instrumental activities of daily living brief Cognitive test for dementia and a standardized questionnaire administered to elicit factors of association. Multivariable logistic regression was used to estimate correlates of dementia. Results: Of the 271 eligible participants at the medical outpatient, majority were age 60-69 years, and were peasants. Males accounted for 60% of the patients. The prevalence of dementia was 17.7% (48), severe dementia (20), moderate dementia (28) using the Identification of Dementia in Africa and Instrumental activities of daily living cognitive screen. On multivariable regression, we estimated the following correlates of dementia: Age 80-89 (OR 9.7, p< 0.001), family history of dementia (OR 3.4, p=0.001). History of depression (OR 2.7, p=0.003). Physical activity was a highly associated protective factor (OR 0.1, p< 0.001) and finally cognitive exercise was also an associated protective factor (OR 0.2, p<0.002). Conclusion and recommendation: There are a high screening prevalence of dementia, occurring almost one fifth among Ugandan adults aged 60 years and above at the medical outpatient. Modifiable factors of association included: history of depression, physical inactivity, and involvement in cognitive exercises. We recommend outpatient screening of dementia using the Identification of dementia in Africa and instrumental activities of daily living which is a simple and culturally validated tool. Patients should be offered lifestyle modification education to mitigate future risk. A large a multicenter study to assess the true burden of dementia in northern Uganda is urgently required.