Are medical doctors in Latin America prepared to deal with the dementia epidemic?

It is estimated that 60% of all people living with dementia today reside in low and middle-income countries, like those in Latin America, and this proportion is expected to increase (WHO, 2015). In some of these countries, providing an accurate diagnosis of dementia and achieving effective care remains as a serious issue. In our region, the division of public and private health systems often determines the quality and promptness of diagnoses (Nitrini et al., 2009) and the subject level of care.

This study is a descriptive and cross-sectional study aimed at investigating physicians’ knowledge related to dementia in Latin America. Participants were medical doctors recruited by a banner ad on the home page of the IntraMed web site (the largest online Spanish speaking medical community) that invited them to voluntarily access an online questionnaire regarding dementia care. All statistical analyses were conducted using the IBM-SPSS 19.0 package. The survey was answered by 5119 physicians (representing 15.4% of the subjects exposed to the banner), whose mean age was 46 years (SD 12.45). The subjects were grouped in three different categories: specialists (neurologists, psychiatrists, and geriatricians), generalists (general practitioners, family physicians, and internal medicine specialists), and others.

The most requested routine tests were laboratory (85%), neuroimaging (47%), and neuropsychological tests (43%). Only 55.8% of the physicians indicated pharmacological treatment to their patients as a standard of care. Less than half of the medical doctors prescribed drugs, such as acetylcholinesterase inhibitors or memantine, as recommended by international guidelines. Meanwhile, many of them prescribe other drugs with no clear evidence of efficacy. Of those surveyed, 86% indicated non-pharmacological treatment.

Of all the medical doctors, 59% reported that their knowledge about dementia was insufficient or null. Neurologists, geriatricians, and psychiatrists reported a better knowledge about dementia than either generalist or other specialties (Figure 1).

Figure 1. Self-reported knowledge about dementia according to medical specialties.

The role of general practitioners is becoming more relevant to provide both adequate diagnosis and treatment to a growing number of dementia patients. The results are very similar to previous studies in other countries that showed that general practitioners don´t see themselves sufficiently trained for diagnosing and treating patients with dementia (Wilkinson et al., 2004). A British study found that only one-third of the general practitioners felt prepared to provide a correct dementia diagnosis, while two-thirds expressed they had insufficient skills to manage behavioral symptoms (Turner et al., 2004). In our study, even when the patients have received a dementia diagnosis there is an inadequate prescription of pharmacological treatments (Michalowsky et al., 2018). In summary, although this study has the intrinsic limitations of a self-reported survey, it shows that there is some evidence of insufficient training of Latin-American generalists to deal with the upcoming dementia epidemic. It’s important to consider strategies to solve this issue as a priority.