Seggane Musisi and Stanley Jacobson (eds.)Brain Degeneration and Dementia in Sub-Saharan Africa10.1007/978-1-4939-2456-1_16

16. Neuropsychological Cases in a Low-Income National Referral Hospital

Janet Nakigudde¹

(1)

Department of Psychiatry, Mulago National Referral Hospital, Kampala, 35350, Uganda

Janet Nakigudde

Email: janetnakigudde@gmail.com

Abstract

Neuropsychological assessment in Low and Middle Income Countries (LMIC) is clearly in its infancy. Often there are no neuropsychologists making it a big area of challenge for neuropsychology in the LMIC, especially in Africa, including Uganda.

This chapter will review cases of adult patients who suffered from cognitive deficits including dementia, that underwent psychometric assessment. However the tests that were done were limited showing a need to do more specific and comprehensive tests in order to ascertain the nature of dementias or other lesions which the different patients had. This calls for advanced training and obtaining the necessary testing tools as a means to advance the field of neuropsychology and assessment in Uganda.

Keywords

NeuropsychologyAssessmentDementiaLow and middle income countryAlcoholTraumaHIV/AIDS

Background

Neuropsychology is a discipline entity that is concerned with the way behavior is expressed in brain dysfunction [1]. It is a quantitative assessment of obtaining information regarding behavior and brain functioning. Whereas this discipline has evolved since the first and second World Wars in Europe and the US, it is a recent phenomenon in Africa and it is clearly in its infancy. In Sub-Sahara Africa, South Africa is the leading neuropsychology site but still with only a burgeoning specialty [2]. Elsewhere in the rest of Sub Saharan Africa as in most Low and Middle Income Countries (LMIC), neuropsychology is taught at university in the departments of Psychology but mainly as an elementary introduction course unit for the Masters programs in Psychology. As such not much is done in the way of assessing neuropsychological disorders, and rehabilitation of individuals of these disorders. Considering that Sub Sahara Africa has one of the highest prevalence of infectious diseases including HIV and its related neurological complications, and also that Africa has one of the highest alcohol consumption rates and subsequently high incidences of accidents there is a need to pay attention to this young discipline as a way of furthering management of neuropsychological/neuropsychiatric cases in these low income settings. Although Uganda has a relatively young population with over 50 % of the population comprising of children of 0–15 years, the country still has a population that gets into old age. This subsequently exposes the elderly to geriatric neuropsychological complications requiring assessment and rehabilitation.

Infections may affect behavior and brain functioning and it is well documented that HIV/AIDS will commonly manifest with neurological impairments [3]. Neuropsychological screening and assessment of HIV-infected patients will typically show cognitive deficits in psychomotor speed, attention and frontal lobe function as well as in verbal and non-verbal memory [4]. The following case report illustrates a typical patient with HIV neurological complications in the Ugandan setting.

HIV/AIDS Associated Dementia

JB was a 74 year old male retired civil servant with an education level of 16 years. He was referred by a psychiatrist to a psychologist for psychometric assessment because of progressive forgetfulness and a change in his behavior. His wife reported that prior to the change in behavior, the patient was known to be financially responsible and would not carelessly spend his money. Collateral history showed that the patient was sexually and financially disinhibited at the time of referral. With changes in his behavior, the patient gradually became more and more extravagant and was progressively unable to account of how he was spending money. This caused a financial loss to the family and alarmed his wife. The patient was also easily suggestible and he would readily agree to other people’s suggestions regarding his estate. This caused intense distress to the family because they feared that they would lose their property if he sold it. They wanted something to be done. JB had no previous psychiatric history and he did not abuse alcohol or drugs. Whereas he was previously a well kempt elderly man, he had stopped taking care of himself and would spend many days without bathing. He, however, readily took a shower whenever it was pointed out that he had not had a shower in a long time. He would also readily change into fresh clothes if this was also pointed out to him.

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