Knowledge and attitudes about Alzheimer's disease in Nigerian geriatric outpatients: The role of primary care professionals

The authors present a well-written cross-sectional study on the knowledge and attitudes about dementia and dementia genetics among a cohort of geriatric patients in Nigeria. ¹ The merit of this study lies not only in their courage to showcase this neglected disease (Alzheimer's disease, AD) in many low- and middle-income countries (LMICs) but also provides Nigerian data on the poor level of knowledge about AD and its genetics among the elderly population in Nigeria, supporting findings from many LMICs. ¹

The objective of this commentary is to expand on the discussion of the key finding (poor knowledge of AD among geriatric patients) and highlight the role primary care could play in improving their care, which includes providing education on dementia/AD to geriatric patients and their caregivers.

Given the increasing burden of dementia/AD in LMICs like Nigeria, a high index of suspicion is required from those involved in the care of elderly patients. These stakeholders, depending on the setting, include but are not limited to the geriatric patients themselves, their caregivers, nurses, primary care physicians, geriatricians, neurologists, and neuropsychiatrists. The suspicion of dementia would be predicated on adequate knowledge of the disease. While the present study clearly shows that AD knowledge (including its risk factors) is low among Nigerian geriatric patients, some studies in academic tertiary hospitals suggest inadequate knowledge as well among healthcare professionals (including nursing, medicine, allied health, and support staff).^2–4 This indicates that both the patient and most of their non-specialist healthcare providers lack sufficient knowledge about AD/dementia. This has led many scholars to advocate for improving the undergraduate curriculum to expose them adequately to dementia patients, which would improve their knowledge even after graduation. ⁵ However, given the lack of, or ineffective national policies on the care of the older persons, as well as the limited number of geriatricians and dementia/AD specialists in many LMICs like Nigeria, ⁶ the utility of primary care professionals, especially those practicing in rural areas, where most of the population resides, becomes crucial. Primary care professionals are the first point of contact and sometimes the only contact between most of the population and the healthcare system. Adequate knowledge of dementia/AD among these professionals will promote not only early screening, diagnosis, and care coordination but also an important level for patient and caregiver health education and health promotion activities. ⁷ Although some studies already indicate low AD knowledge among primary care physicians in the US and Peru,^5,8 more multicenter studies among primary care healthcare professionals are needed in LMICs like Nigeria to provide a complete understanding of their knowledge, attitude, and practice of dementia/AD to justify and scale up investments in the training of these professionals on dementia-specific care in particular or geriatric care in general. This training and re-training could be in the form of continuous medical education and certificate courses on different aspects of geriatric care, including dementia. Dementia-specific training has been associated with better knowledge of the disease among healthcare professionals. ²

In summary, the study by Babalola et al. ¹ is a good contribution to the scarcity of data on the knowledge and attitudes regarding dementia/AD in resource-limited settings like Nigeria. The work provides insights into data needed for strategic interventions to improve dementia/AD knowledge among geriatric patients. Overall, this commentary only makes a case for the training and retraining of primary care professionals in the recognition, screening, diagnosis, coordination, and continuity of care for dementia/AD in resource-constrained settings, as it could impact the knowledge and care of the patients, but not to change the originality of the authors’ current work or its merits.