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 south western Uganda assess for and diagnose ADRD. 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 south western Uganda. Qualitative content analysis was used to identify distinct categories and themes. Findings showed that healthcare workers without specific mental health training assessed and diagnosed dementia based on history and physical examination alone. Healthcare workers with some specialized training in mental health were more likely to use neuropsychological tests, brain imaging and other tests in diagnosis of dementia. Majority of healthcare workers regarded memory loss as part of the normal aging process with no need for treatment while other healthcare workers could recognize signs and symptoms of dementia, but ignored them. Diagnostic practices did not differ based on age, years of experience, or gender of the healthcare workers. We found that specialized training in mental health among healthcare workers is crucial for the assessment and diagnosis of ADRD in rural south western Uganda.
