Identifying Gaps and Barriers in Alzheimer’s Disease and Related Dementia Research and Management in Low- and Middle-Income Countries: A Survey of Health Professionals and Researchers

Article type: Research Article

Authors: Babulal, Ganesh M.^{a; b; c; d; *} | Zha, Wenqing^a | Trani, Jean-Francois^{b; c; e} | Guerra, Jorge Llibre^a | Tee, Boon Lead^{f; g} | Zhu, Yiqi^h | Chen, Yaohuaⁱ | Chen, Ling^j | Bubu, Michael^k | Josephy-Hernandez, Sylvia^l | Wandera, Stephen^m | Karanja, Wambūi^{n; 1} | Ellajosyula, Ratnavalli^{o; 1} | Caramelli, Paulo^{p; 1} | for the Diversity and Disparity Professional Interest Area, Low-and-Middle-Income Working Group

Affiliations: [a] Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA | [b] Institute of Public Health, Washington University, St. Louis, MO, USA | [c] Centre for Social Development in Africa, Faculty of Humanities, University of Johannesburg, Cnr Kingsway & University Roads, Auckland Park, Johannesburg, South Africa | [d] Department of Clinical Research and Leadership, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA | [e] National Conservatory of Arts and Crafts, Paris, France | [f] Global Brain Health Institute, University of California, San Francisco, CA, USA | [g] Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA | [h] School of Social Work, Adelphi University, Garden City, NY, USA | [i] Department of Geriatrics, Univ Lille, CHU Lille, Lille Neurosciences & Cognition, UMR-S1172, Degenerative and Vascular Cognitive Disorders, Lille, France | [j] Division of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA | [k] Departments of Psychiatry, Neurology, and Population Health, NYU Grossman School of Medicine, New York, NY, USA | [l] Department of Neurology, Hospital México, Caja Costarricense de Seguro Social, San José, Torre A - Centro Corporativo Internacional, Barrio don Bosco, Costa Rica | [m] Department of Population Studies, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala, Uganda | [n] AKU Brain & Mind Institute, Nairobi, Kenya | [o] Cognitive Neurology Clinic, Manipal Hospital & Annasawmy Mudaliar Hospital, Bangalore, India | [p] Behavioral and Cognitive Neurology Unit, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil

Correspondence: [*] Correspondence to: Ganesh M. Babulal, OTD, PhD, Washington University School of Medicine, 660 South Euclid Ave., Campus Box 8111, St. Louis, MO 63110, USA. E-mail: [email protected].

Note: [1] Senior Co-authorship.

Abstract: Background:The significant increase in Alzheimer’s disease and related dementia prevalence is a global health crisis, acutely impacting low- and lower-middle and upper-middle-income countries (LLMICs/UMICs). Objective:The objective of this study is to identify key barriers and gaps in dementia care and research in LLMICs and UMICs. Methods:We conducted an international, cross-sectional survey among clinicians and healthcare professionals (n = 249 in 34 countries) across LLMICs and UMICs, exploring patient demographics, use of clinical diagnosis, dementia evaluation, screening/evaluation tools, and care and treatment. Results:Significant disparities were found in diagnostic practices, access to assessments, and access to care. On average, clinicians in LLMICs saw more patients, had less time for evaluations, lower use of formal screening and tools, and less access to biomarkers. They were also under-resourced compared to UMICs. Conclusions:The findings provide insights for policymakers, healthcare organizations, and researchers to address the complex challenges associated with dementia care in diverse settings. Addressing these challenges requires a multipronged approach involving local, national, and international stakeholders.

Keywords: Alzheimer’s disease, dementia, disparity, low and middle-income countries, resources, underserved

DOI: 10.3233/JAD-240650

Journal: Journal of Alzheimer's Disease, vol. 101, no. 4, pp. 1307-1320, 2024