How is shared decision making used in the treatment of patients with liver disease? a scoping review.

Dementia is an increasing global public health concern [], with prevalence rising rapidly as populations age worldwide [, ]. Although most individuals living with dementia currently reside in high-income countries [], the number of affected persons in low- and middle-income countries is increasing, and epidemiological data from sub-Saharan Africa remain limited []. In Uganda, where more than 70% of the population is younger than 40 years [], the growing population of older adults is emerging in the context of constrained health care systems and a scarcity of geriatric specialty services both in rural and urban setting []. These limitations contribute to underdiagnosis of cognitive disorders and a limited understanding of potentially modifiable risk factors for dementia []. Malnutrition is common among older adults and represents a major yet frequently overlooked determinant of health in geriatric populations [–]. Age-related physiological changes, chronic diseases, functional impairment, and socioeconomic vulnerability predispose older individuals to inadequate nutritional intake and poor nutritional status [, ]. In low-income settings, these risks are further compounded by food insecurity and limited access to health care services []. Geriatric malnutrition has been associated with increased morbidity, functional decline, prolonged hospitalization, and mortality []; however, its role in cognitive impairment and dementia remains incompletely characterized, particularly in resource-limited environments [, ]. Emerging evidence from high-income countries suggests that poor nutritional status is associated with impaired cognitive performance, accelerated cognitive decline, and higher incidence of dementia []. Proposed mechanisms include micronutrient deficiencies, chronic inflammation, oxidative stress, sarcopenia, and frailty, all of which may contribute to neurodegeneration and synaptic dysfunction [–]. In addition, dementia itself may worsen nutritional status through appetite loss, impaired feeding behaviour, and increasing dependence on caregivers, suggesting a complex and potentially bidirectional relationship []. Despite this growing body of literature, data from African populations remain sparse, and the relevance of these findings to low-income settings is uncertain.