INTRODUCTION: Dementia prevalence is increasing in sub-Saharan Africa, potentially due to population growth and aging. Resource-constrained settings such as Northeastern Nigeria face challenges in dementia management. METHODS: We assessed dementia burden and management at the Federal Neuropsychiatric Hospital Maiduguri, the only neuropsychiatric facility in Northeastern Nigeria. This retrospective analysis included patient records from 1999 to 2023 for individuals 60 year of age and older with a dementia diagnosis. RESULTS: Of the 1216 cases reported, Alzheimer's disease (60.5%) was the most common subtype, followed by vascular dementia (24.5%). Hypertension (41.6%) was the most frequent comorbidity. Memory loss was present in all cases, whereas behavioral symptoms like agitation presented in some cases. Treatments included cognitive enhancers (donepezil), supplements (gingko biloba), and non-drug therapies (psychoeducation). DISCUSSION: The increasing burden of dementia at this sole facility highlights the urgent need for targeted interventions and further research to understand the underlying factors contributing to dementia in this population. HIGHLIGHTS: Dementia trends and management in a neuropsychiatric facility serving over 26 million people in Northeastern Nigeria. Alzheimer's disease accounted for 60.5% of the dementia cases reported, with hypertension as the leading comorbidity. There is an urgent need for improved diagnostic tools and health care infrastructure to address dementia in resource-constrained settings. The findings lay the foundation for developing a dementia cohort as part of the Northern Nigeria Dementia Research Group.