More older Rwandans are seeking medical care for memory loss, confusion and behavioural changes associated with dementia, a condition that gradually affects a person's ability to think, remember and perform everyday activities, a geriatric specialist has said. ALSO READ: Dementia: Understanding its severity, causes and prevention Dr Protogene Ngabitsinze, a geriatric medicine specialist at Rwanda Military Referral and Teaching Hospital, said the risk of dementia rises with age, with Alzheimer's disease and vascular dementia being the most common forms. At Rwanda Military Referral and Teaching Hospital, patients aged 60 years and above account for more than one-third of all admissions in the internal medicine department, he said. Many of these older patients have cognitive impairment that requires further assessment for dementia, although not all cognitive impairment is caused by dementia. He cited a recent study showing that 45 percent of older adults admitted to the hospital's internal medicine department had cognitive impairment. At the hospital's outpatient geriatric clinic, memory complaints and cognitive decline are among the leading reasons older adults seek medical care. Patients often arrive too late Dr Ngabitsinze said many patients only reach specialised care after dementia has significantly progressed. He recalled the case of a 78-year-old woman from Rwamagana whose family noticed memory loss and behavioural changes for nearly four years before she was referred to the hospital. Over time, she became increasingly confused, failed to recognise relatives and frequently wandered away from home, prompting her family to keep her indoors. Earlier this year, she was admitted after suffering a fall that caused a large haematoma on her thigh. When we assessed her, she was already in an advanced stage of dementia, Dr Ngabitsinze said. She was completely confused and disoriented, could not recognise family members and had developed urinary incontinence. Although she had visited health centres and district hospitals several times, the family underestimated the seriousness of her condition because she could still eat and carry out some daily activities. Further tests confirmed advanced Alzheimer's disease, with brain scans showing significant brain shrinkage. Although the disease could not be reversed, doctors helped the family understand how to care for her safely and reduce the risk of further falls. In another case, a 98-year-old woman was initially believed by her family to be under spiritual attack after reporting that deceased people visited her at night and tried to take her into a forest. Medical assessment later revealed she was experiencing hallucinations. She responded well to treatment. Her son later told us she was sleeping well again, had become cooperative and was doing much better, Dr Ngabitsinze said. These cases show why changes in memory, thinking and behaviour among older people should always be medically assessed. Growing public health concern With Rwanda's life expectancy now approaching 70 years, dementia is becoming an increasingly important public health issue. A 2025 study on the health and well-being of older adults in rural and urban Rwanda, conducted by researchers from the University of Global Health Equity (UGHE), Rwanda Biomedical Centre (RBC) and other institutions, assessed 4,369 adults aged 40 years and above. It found that three percent of participants had probable dementia, while 8.6 percent showed signs of possible dementia. Meanwhile, a Global Burden of Disease 2019 analysis published in The Lancet Public Health estimated that Rwanda had about 24,700 people living with dementia in 2019. That number is projected to rise to nearly 125,000 by 2050—a more than fourfold increase—largely due to population ageing and growth. Recognising the warning signs Dr Ngabitsinze said many families dismiss early symptoms as part of normal ageing. Warning signs include forgetting recent conversations or events, repeatedly asking the same questions, struggling with familiar tasks such as managing finances or medication, losing track of time or place, and getting lost in familiar surroundings. Other symptoms include changes in personality or behaviour, withdrawal from family and social activities, aggression and difficulty finding the right words during conversations. He added that repeated or unexplained falls among older adults should also be medically assessed, as dementia can affect balance, concentration and spatial awareness. In geriatrics, falls, cognitive impairment, urinary incontinence and joint problems are known as the geriatric giants because they commonly affect older adults. Urinary incontinence should not automatically be dismissed as a normal part of ageing, especially when it develops suddenly, as it may indicate an underlying medical condition, he said. Why diagnosis is often delayed Late diagnosis remains a major challenge both globally and in Rwanda. Many families only seek medical attention when symptoms become severe, such as aggression, severe confusion or failure to recognise close relatives. Limited public awareness means that memory loss and behavioural changes are often mistaken for normal ageing, emotional stress or spiritual causes. Dr Ngabitsinze stressed that not every cognitive or behavioural change is dementia. Some conditions, including psychosis, can improve significantly with early diagnosis and treatment. He explained that diagnosing dementia requires a comprehensive assessment, including medical history, cognitive testing, physical and neurological examinations, laboratory tests and, where necessary, brain imaging. While these services are available at referral hospitals, access remains limited in many lower-level health facilities. Need for stronger support systems As dementia progresses, many patients require constant supervision. Some may wander away, forget to eat, struggle with personal care or become unable to live independently. For families, caring for someone with dementia often brings emotional, physical and financial challenges, including the cost of adult diapers, transport to medical appointments and equipment to prevent complications such as pressure sores. Dr Ngabitsinze said family dynamics and cultural expectations can also complicate caregiving. He called for more rehabilitation and long-term care centres to support people with advanced dementia, noting that hospitals cannot provide prolonged care indefinitely and many families lack adequate resources to care for patients at home. He also highlighted the high cost of dementia medicines, which remain out of reach for many households. Rwanda should prepare for new Alzheimer's treatments being developed internationally by building systems that can assess and provide access to appropriate therapies when they become available, he said. Early diagnosis gives families time to plan care, manage risks and improve the quality of life of people living with dementia.
