Prevalence of Dementia Cases Seen in Consultation at the Neuropsychiatry Department of Toamasina, Madagascar

Abstract

Introduction. Dementia is a growing public health challenge in low- and middle-income countries, yet local hospital-based data remain scarce in Madagascar [1-3]. This study aimed to estimate the prevalence of dementia among adults aged 60 years and older seen in consultation at the Neuropsychiatry Department of the Centre Hospitalier Universitaire Analankininina Toamasina (CHUAT), and to examine the association between sociodemographic profiles, selected clinical risk factors, and dementia severity.

Methods. We conducted a single-centre cross-sectional descriptive and analytical study based on medical records from January 1, 2022 to December 15, 2024. Included participants were outpatients aged 60 years and older who met ICD-11 criteria for major neurocognitive disorder and had complete files [4]. Dementia severity was classified with the Mini-Mental State Examination (MMSE) as mild (21-26), moderate (10-20), or severe (<10) [5,6]. Associations between severity and study variables were assessed using chi-square tests, with p<0.05 considered statistically significant.

Results. Among 2,667 consultations, 348 patients were aged 60 years and older. Seventy-five had major neurocognitive disorders, of whom 57 met the inclusion criteria, yielding a prevalence of 16.38% among older adults seen in consultation. Mean age was 71.42 ± 7.03 years, 52.63% were women, and Alzheimer disease accounted for 50.88% of cases. Moderate dementia was the most frequent severity category (45.61%), followed by mild dementia (42.11%). Greater dementia severity was significantly associated with older age (p=0.0052), male sex (p=0.014), low educational attainment (p<0.0001), chronic alcohol use (p=0.010), and social isolation (p=0.016). Hypertension and prior stroke were not significantly associated with severity.

Conclusion. Dementia represented a substantial proportion of consultations among older adults at CHUAT, with Alzheimer disease predominating. The findings highlight the importance of early case identification, routine cognitive screening, and targeted preventive strategies addressing social isolation, harmful alcohol use, and limited educational reserve in the local context.