Dementia is a growing public health crisis, particularly in low and middle-income countries (LMIC). With limited resources and infrastructure, these countries face unique challenges that exacerbate the impact of dementia, including limited healthcare resources, inadequate diagnostic tools, and a shortage of trained professionals capable of providing specialized care [1].
Managing dementia presents a complex challenge, especially when considering the frequent presence of comorbidities [2,3]. As dementia progresses, people with dementia may develop (or already have) conditions such as cardiovascular disease, diabetes, or depression, further increasing the complexity of care. The impact of the comorbidities in the LMIC may be higher than in the developed regions. For example, comorbidities are associated with increased economic burden in LMIC [4]. Besides that, comorbidities are also associated with increasing mortality and caregiver burden [5]. Balancing the management of dementia symptoms with addressing these comorbidities demands expertise to ensure optimal patient outcomes. In this editorial, we will discuss major factors leading to suboptimal management of comorbidities in LMIC and we will outline potential strategies that could be implemented to improve them.
Limited healthcare availability significantly impacts the management of comorbidities in people with dementia. In resource-constrained settings, early diagnosis and timely interventions may be delayed, leading to disease progression and increased complications. The lack of specialized healthcare professionals and diagnostic tools can delay accurate assessment and treatment of both dementia and associated comorbidities [6]. Additionally, many people in LMIC lack health insurance, limiting access to essential medications and therapies which can compromise outcomes and leave people vulnerable to financial hardship when seeking care. As a result, individuals with dementia and comorbidities in these regions often face poorer health outcomes and reduced quality of life [5]. Additionally, many people in LMIC live in rural areas with limited access to specialized healthcare services [7].
People with dementia often struggle with complex medication regimens, especially when multiple comorbidities are present [8]. Cognitive decline can impair their ability to understand instructions, remember dosage schedules, and recognize medications. This can lead to medication errors, such as missed or incorrect dosages, or accidental ingestion of a wrong medication. Additionally, physical limitations may hinder their ability to open medication bottles or administer medications correctly. These challenges can significantly impact treatment adherence and overall health outcomes for individuals with dementia. Additionally, people with dementia are at increased risk of adverse drug events due to polypharmacy and age-related physiological changes [9]. When multiple medications are prescribed to manage dementia and comorbidities, the risk of drug interactions and side effects rises significantly. Cognitive impairment can impair patients’ ability to report adverse symptoms, leading to delayed detection and treatment. Additionally, age-related changes in metabolism and kidney function can affect drug absorption, distribution, metabolism, and excretion, increasing the likelihood of adverse reactions [10]. In low- and middle-income countries, these difficulties are even more pronounced, for several reasons. For example, the presence of a primary care physician is less common than in high-income countries, which forces people with dementia to consult with numerous specialists, such as cardiologists and endocrinologists, who generally prescribe regimens without concern for avoiding polypharmacy or adapting the therapeutic regimen to the presence of dementia.
Lack of training of primary care physicians significantly hinders the effective management of dementia and its comorbidities, particularly in low-resource settings. Many healthcare professionals lack the specialized knowledge needed to identify early signs of cognitive decline or deal with multiple chronic conditions, such as hypertension, diabetes, and cardiovascular disease, which require careful attention and coordination. Time constraints during consultations further exacerbate these challenges. In many healthcare systems, especially in LMIC, primary care physicians face overwhelming patient loads, leaving limited time to address the complex needs of individuals with dementia and their comorbidities [11]. As a result, key symptoms may go unaddressed, and treatment plans may lack the depth needed for effective disease management. Additionally, fragmented care coordination poses a significant barrier to optimal treatment. People with dementia often require input from multiple specialists, including neurologists, geriatricians, and psychiatrists, but communication and coordination between these providers are frequently inadequate. This disjointed approach can result in inconsistent treatment plans, medication errors, and unnecessary duplication of diagnostic tests, all of which compromise the quality of care [12].
Limited data and research on dementia and its comorbidities in many regions, particularly low-income countries, difficult effective management and intervention strategies [7]. In a recent systematic review about the management of comorbidities in people with dementia, only 3 studies were conducted in LMIC (all in China) [13]. The scarcity of comprehensive health records, challenges in data collection, and limited research infrastructure hamper a clear understanding of the prevalence, impact, and optimal management of these conditions. This lack of robust evidence-based information limits the development of targeted interventions and the ability to assess the effectiveness of existing approaches.
Effectively managing comorbidities in people with dementia requires a multi-faceted approach that addresses the unique challenges faced by individuals with dementia and their caregivers. Below we discuss some strategies that can be implemented to help improve the care of comorbidities in people with dementia in LMIC (see Table 1).
Table 1.
Barriers to optimal management of comorbidities in people with dementia and strategic actions to face them.
| Barrier | Actions |
|---|---|
| Limited healthcare availability |
|
| Lack of training of primary care physicians |
|
| Complex medication regimens |
|
| Limited data and research on dementia |
|
| Awareness/Stigma |
|
| Culturally appropriate interventions |
|
| Supporting caregivers |
|
1. Strengthening healthcare systems
A robust healthcare system is essential for effective dementia care. Investing in primary care services can facilitate early detection, diagnosis, and management of comorbidities. Specialized dementia care units within hospitals and long-term care facilities can provide comprehensive care for individuals with complex needs. Telehealth services can expand access to specialized care, especially in rural and underserved areas.
2. Training healthcare professionals
Well-trained healthcare professionals are crucial for providing quality dementia care. Geriatric training programs can enhance the knowledge and skills of physicians, nurses, and pharmacists in geriatrics and dementia care. Interdisciplinary collaboration between neurologists, geriatricians, psychiatrists, and social workers can ensure comprehensive care.
3. Raising awareness and reducing stigma
Public health campaigns can raise awareness about dementia and its associated comorbidities, reducing stigma and encouraging early diagnosis and treatment. Community education programs can provide information to caregivers, families, and community members, promoting understanding and empathy. In these educational campaigns, it is essential to reinforce that people with dementia continue to have diseases that must be diagnosed and treated appropriately.
4. Supporting caregivers
Caregivers play a vital role in supporting individuals with dementia. Caregiver training programs can equip caregivers with the necessary skills to manage dementia comorbidities, including medication administration and symptom management.
5. Developing culturally appropriate interventions
Cultural sensitivity is essential when developing and implementing dementia care interventions. Tailoring interventions and communication strategies to the specific cultural and linguistic needs of different populations can enhance engagement and adherence to care plans. Community engagement can involve community leaders and organizations in the development and implementation of dementia care programs, ensuring that interventions are culturally relevant and acceptable.
6. Research and innovation
Research is crucial to advance our understanding of dementia comorbidities. Data collection and analysis can provide valuable insights into the prevalence, risk factors, and progression of these conditions. Investing in drug development can lead to new treatments for dementia and its associated conditions. Innovative technologies, such as wearable devices and digital health tools, can be used to monitor and manage dementia comorbidities, improving patient outcomes and reducing caregiver burden.
In conclusion, by implementing these strategies, healthcare systems can improve the quality of life for individuals with dementia and their caregivers. Addressing the challenges of managing comorbidities requires a collaborative effort involving healthcare providers, policymakers, researchers, and community members.
Funding Statement
This paper was not funded.
Disclosure statement
No potential conflict of interest was reported by the author(s).
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