Revealing a hidden problem. An evaluation of a community dementia case-finding program from the Indian 10/66 dementia research network

Abstract

Background: Dementia in India is largely a hidden problem with no community awareness and little help seeking from affected families, despite high levels of strain. Cases must therefore be identified before practical help can be offered.

Method: After two and a half hours of formal training, local community health workers in rural Kerala were asked to identify possible cases of dementia from the community they served. Diagnoses were then verified by a senior local psychiatrist with clinical and research interests in old age psychiatry.

Results: The community health workers identified 51 out of 1979 over 60 year old residents (a prevalence of 2.6%) as suspected cases of dementia. Following the psychiatrist's assessment, 33 met DSM-IV criteria for dementia. The majority of confirmed cases were of the Alzheimer's Disease sub-type. Most "non-cases" were found to be suffering from other major psychiatric disorders, with substantial unmet need. The positive predictive value of the community health workers informal screening was 64.7%.

Conclusions: This simple cost-effective case-finding method can be of practical use in the development of community based dementia care services in India and other developing countries with similar health care systems.