Policy Brief: The Global Impact of Dementia 2013

Policy Brief for Heads of Government

The Global Impact of Dementia 2013–2050

ALZHEIMER’S DISEASE INTERNATIONAL · THE GLOBAL VOICE ON DEMENTIA

Introduction

Alzheimer’s Disease International (ADI) published

global prevalence data on dementia in the World

Alzheimer Report 2009

based on a systematic

review of 154 studies conducted worldwide, and

United Nations population projections through to

the year 2050. We estimated 36 million people with

dementia in 2010, nearly doubling every 20 years to

66 million by 2030 and to 115 million by 2050.

Key ﬁndings included

• 58% of those affected lived in low and middle

income countries, underlining the high impact of

the condition in those regions, where awareness

is low, health and social care are poorly

developed and social protection is limited.

• Population ageing is the main driver of projected

increases.

• We assumed that age-speciﬁc prevalence

would remain constant. This assumption is

challenged by recent evidence suggesting a

modest recent decline in dementia prevalence

in some higher income countries (HIC), but an

increase in prevalence in China, likely linked to

recent changes in population health, particularly

exposure to cardiovascular risk factors.

• Since population ageing is occurring at an

unprecedentedly fast rate in middle income

countries, the bulk of the increase in numbers

through to 2050 will occur in those regions. By

2050 71% of those with dementia would be living

in what are currently lower and middle-income

countries (LMIC).

The Global Impact of Dementia 2013–2050

Although high income countries, including the G8, have borne the brunt of the dementia

epidemic, this is a global phenomenon. Most people with dementia live in low and

middle income countries, and most of the dramatic increases in numbers affected,

through to 2050, will occur in those regions. In a spirit of international cooperation and

solidarity we urge the G8 governments to sponsor intergovernmental action to make

dementia a global priority. Crucially, this must include opening up access to diagnosis

and current evidence-based treatment and care. All countries worldwide are failing in

this basic objective. Action to address this problem should be balanced, as a priority,

with research to improve treatment options and quality of care.

Since 2009, the global evidence base has

expanded, most particularly with a new

systematic review of the prevalence of

dementia in China

comprising 75 studies,

most published in Chinese language journals,

and with seven studies from ﬁve sub-

Saharan African countries, where previously

only one study from Nigeria had been

available.

The G8 Dementia Summit on 11 December

2013 provides a timely opportunity to

reassess and update evidence on the scale

and the distribution of the global dementia

epidemic, in particular its impact on more

developed (G8, G20, OECD and ‘high

income’ countries) and less developed ‘low

and middle income’ countries.

For the current update, we carried out a

limited review, focusing on the new evidence

emerging from China and the sub-Saharan

African regions, and applied the new

prevalence proportions to the latest (2012)

UN population projections

. Details of the

methodology are provided in Annex 1.

The work on this report has been a joint

effort of the Global Observatory for Ageing

and Dementia Care (Prof Martin Prince,

Dr Maëlenn Guerchet and Dr Matthew Prina),

and the ADI ofﬁce.

Figure 1 Original (2009 World Alzheimer Report) and updated age-specific prevalence of dementia (%) by region,

showing impact of new data from Asia East (China) and Sub-Saharan Africa

Results

The prevalences of dementia estimated from the

recent more comprehensive review and meta-

analysis of China studies

and our own meta-

analysis of studies from sub-Saharan Africa were

substantially higher than those used in the 2009

World Alzheimer Report. Age-standardised to a

standard West European population, prevalence

for East Asia increased from 4.98% to 6.99%

and in the sub-Saharan African regions from a

range of 2.07% to 4.00%, to 4.76% (Figure 1).

The net effect, as more data becomes available,

is to further reduce the variation in prevalence

between world regions.

The number of people living with dementia

worldwide in 2013 is estimated at 44.35 million,

reaching 75.62 million in 2030 and 135.46 million

in 2050 (Figure 2). The updated estimates are

higher than our original estimates reported in the

2009 World Alzheimer Report, by 15% in 2030,

and by 17% in 2050.

Australasia

Asia Pacific

Oceania

Asia E

Asia S

Asia SE

Asia Central

Europe W

Europe Central

Europe E

America N

Caribbean

Latin America

N Africa/ Middle East

SSA W

SSA E

SSA Central

SSA S

Standard Prevalence (%)

Updated

Original

105

140

2010 2013 2030 2050

Original

Updated

People with dementia (millions)

million

115

million

135

million

Figure 2 Increase in numbers of people with dementia worldwide (2010-2050), comparing original and

updated estimates

3POLICY BRIEF FOR HEADS OF GOVERNMENT: THE GLOBAL IMPACT OF DEMENTIA 2013–2050

ALZHEIMER’S DISEASE INTERNATIONAL · THE GLOBAL VOICE ON DEMENTIA

The largest increases in projected numbers of

people with dementia are those for the Asia East

and Sub-Saharan African regions, accounted

for by the higher age-speciﬁc prevalence of

dementia estimated in our new reviews of survey

data from those regions (Annex 2). Hence, in

2050 we are now estimating 33.61 million people

with dementia in Asia East (an increase of 49%

from the previous estimate of 22.54 million) and

5.05 million older people with dementia in SSA

(an increase of 136% from the previous estimate

of 2.14 million). However, the new estimates of

numbers of people with dementia are higher for

all GBD regions than those estimated in 2009.

This is explained by the underestimation of

current numbers of older people in the previous

UN population estimates (affecting the 2013

ﬁgures), and revision upwards of probability of

survival into older age (affecting the 2030 and

2050 projections).

We now estimate that while 32% of people

with dementia live in G8 countries and 38%

in high income countries, 62% live in low and

middle income countries (Table 1). By 2050, the

proportion living in G8 countries will have shrunk

to 21%, while the proportion living in what are

currently low and middle income countries will

have increased to 71%.

Region

People with dementia millions

(% of world total)

Proportionate increase

(%)

2013 2030 2050 2013-2030 2013-2050

G8 14.02 (32%) 20.38 (27%) 28.91 (21%) 45 106

G20 33.93 (76%) 56.40 (75%) 96.61 (71%) 66 185

OECD 18.08 (41%) 27.98 (37%) 43.65 (32%) 55 142

High income 17.00 (38%) 25.86 (34%) 39.19 (29%) 52 131

Low and middle income 27.84 (62%) 49.76 (66%) 96.27 (71%) 79 246

World 44.35 75.62 135.46 71 205

100

125

150

2013 2015 2020 2025 2030 2035 2040 2045 2050

Low and middle income countries

High income countries

Millions of people with dementia

Year

Table 1 Updated estimates of the number of people with dementia living in G8, G20,

OECD, LMIC and HIC countries, and as a percentage of world total

Figure 3 Number of people with dementia in low and middle income countries

compared to high income countries

diagnosis; case management across the

course of the illness; support, education and

training for carers; optimising physical health;

acetylcholinesterase inhibitors; cognitive

stimulation; and non-pharmacological

interventions for behavioural disturbance.

Currently less than half of those in high

income countries and fewer than 10% of

those in LMIC have received a dementia

diagnosis.

8 There are lessons to be drawn from the

HIV epidemic. First, new and dramatically

effective treatments can only be scaled up

when diagnostic and care systems are well

established. Second, affordable access

to new diagnostic technologies and drug

therapies will need rapidly to be extended

to low and middle income country markets,

where most of those who might beneﬁt live.

Third, those countries that where involved

in ‘global trials’ should also beneﬁt from

treatments being made available at subsidised

cost with adequate standards of care in place.

9 ADI and the World Health Organization have,

in their joint report Dementia: a public health

priority

, called upon all Governments to

make dementia a public and health priority. As

part of this process, all governments should

initiate national debates regarding the future

provision and ﬁnancing of long-term care

(see World Alzheimer Report 2013: Journey

of Caring

). However, most are woefully

unprepared for the dementia epidemic with

only 13 countries having funded and sought to

implement a national dementia plan. Without

a plan, the risk is that health and social care

systems will not cope with the increase

in numbers and operate in crisis mode,

escalating costs even further.

10 At the eve of the G8 Dementia Summit in

London, UK, it is not just the G8 countries,

but all nations that must commit to a

sustained increase in dementia research and

a comprehensive plan for collaborative action

involving all relevant government sectors,

industry and civil society. International

cooperation will be essential. There is a

need for a collaborative, global action plan

for governments, industry and non-proﬁt

organisations like Alzheimer associations.

Priorities include; breaking down barriers to

effective research; promoting rapid translation

and ensuring equitable access to promising

technologies and treatments; technical

support for policymaking, health and social

care service and system development.

1 Dementia, including Alzheimer’s disease,

is one of the biggest global public health

challenges facing our generation. Newly

available data suggests that the current

burden and future impact of the dementia

epidemic has been underestimated,

particularly for the Asia East and Sub-Saharan

African regions.

2 This is a global epidemic – although cases

are disproportionately concentrated in the

world’s richest and most demographically

aged countries, already the clear majority

(62%) of people with dementia live in low and

middle income countries where access to

social protection, services, support and care

are very limited.

3 In the next few decades, the global burden

of dementia will shift inexorably to poorer

countries, particularly rapidly developing

middle income countries that are members of

the G20, but not the G8.

4 The future scale of the dementia epidemic

may be blunted through improvements in

population health, but our best estimates

suggest that only up to 10% of incidence

may thus be avoided

. Public health and

disease control measures targeting smoking,

underactivity, obesity, hypertension and

diabetes should be prioritised. Education and

other factors that enhance brain and cognitive

development will also improve the brain health

of those entering old age, and reduce the

incidence of dementia in late life.

5 Standard & Poor’s has described global

population ageing as the biggest threat to

the sustainability of sovereign debt. Among

the chronic diseases, dementia makes by far

the largest single contribution to disability

and needs for care among older people. The

current (2010) global societal economic cost

of dementia is US$ 604 billion, or 1% of global

GDP

. Costs will escalate proportionately

with numbers affected, and with increased

demand for formal care services, particularly

in low and middle income countries

6 Research must be a global priority if we

are to improve the quality and coverage of

care, ﬁnd treatments that alter the course of

the disease, and identify more options for

prevention.

7 Investment in the search for a cure must be

balanced with initiatives to improve access

to currently available evidence-based

packages of care – these include timely

Conclusions and implications

5POLICY BRIEF FOR HEADS OF GOVERNMENT: THE GLOBAL IMPACT OF DEMENTIA 2013–2050

ALZHEIMER’S DISEASE INTERNATIONAL · THE GLOBAL VOICE ON DEMENTIA

Estimation of the number of people with

dementia

The new rates were applied to the new UN population

estimates for each 5-years age band (60-64, to 100 and

over)

. When rates were not available for one age-band

(i.e. over 90 in SSA and over 100 in China), the rate of

the nearest age-band was applied. As gender-speciﬁc

estimates were available neither for China nor SSA,

we applied the age-speciﬁc estimates to the whole

population and to each gender separately. In the East Asia

region – composed of China, Hong Kong SAR, Macao

SAR, Chinese Taipei and DPR Korea – the new rates were

applied to mainland China, Hong Kong SAR and Macao

SAR, whereas the East Asia rates from the 2009 Word

Alzheimer Report were maintained for the DPR Korea and

Chinese Taipei.

For Sub-Saharan Africa, the new rates were applied to

the countries belonging to the following Global Burden

Disease (GBD) regions: SSA West, SSA Central, SSA East

and SSA Southern. Based on the GBD regions, Algeria

belongs to the North Africa / Middle East, so we therefore

applied the EMRO B rates that are used for some of its

neighbours.

For all the other regions, we applied the rates found in

the 2009 World Alzheimer Report to the new population

estimates from the United Nations

Annex 1: Methods

The prevalence of dementia in China and

Sub-Saharan Africa

The estimates for China were revised based on the recent

meta-analysis published by Chan et al.

. This meta-

analysis included reports for dementia or Alzheimer’s

Disease in mainland China, published in Chinese and

English between 1990 and 2010. The rates applied to the

population estimates were the age-speciﬁc prevalence of

dementia in 2010. A new systematic review of dementia

in China has also been recently published

, together with

a new large multi-centre population-based prevalence

study of dementia in China

. These studies were not

taken into account in our estimates, but will be included in

any future updates.

For Sub-Saharan Africa, we conducted a systematic

review of the literature on the prevalence of dementia with

Pubmed / Medline up to October 2013 using a similar

methodology and inclusion criteria that we used for the

2009 World Alzheimer Report

(see online appendix).

We sought and included population-based studies of the

prevalence of dementia among people aged 60 years

and over for which the ﬁeldwork started on or after 1st

January 1980. Prevalence rates were extracted for seven

studies covering ﬁve different countries

6 -12

. A random

effect exponential (Poisson) model was used to assess

the effects of age on the prevalence of dementia. We

then applied the relevant mean ages to the coefﬁcients

estimated from the model, to estimate prevalence in ﬁve

year age-bands from 65-69 years to 85 years and over,

for both sexes combined.

References

1 Alzheimer’s Disease International: World Alzheimer

Report 2009. 2009.

2 United Nations Department of Economic and

Social Affairs Population Division: World Population

Prospects: The 2012 Revision, DVD Edition. 2013.

3 Chan KY, Wang W, Wu JJ, Liu L, Theodoratou E, Car

J, Middleton L, Russ TC, Deary IJ, Campbell H et al:

Epidemiology of Alzheimer’s disease and other forms

of dementia in China, 1990-2010: a systematic review

and analysis. The Lancet 2013, 381(9882):2016-2023.

4 Wu YT, Lee HY, Norton S, Chen C, Chen H, He C,

Fleming J, Matthews FE, Brayne C: Prevalence

studies of dementia in mainland china, Hong Kong

and taiwan: a systematic review and meta-analysis.

PLoS ONE 2013, 8(6):e66252.

5 Jia J, Wang F, Wei C, Zhou A, Jia X, Li F, Tang M, Chu

L, Zhou Y, Zhou C et al: The prevalence of dementia

in urban and rural areas of China. Alzheimers Dement

2013.

6 Hendrie HC, Osuntokun BO, Hall KS, Ogunniyi AO,

Hui SL, Unverzagt FW, Gureje O, Rodenberg CA,

Baiyewu O, Musick BS: Prevalence of Alzheimer’s

disease and dementia in two communities: Nigerian

Africans and African Americans. Am J Psychiatry

1995, 152(10):1485-1492.

7 Guerchet M, Houinato D, Paraiso MN, von Ahsen

N, Nubukpo P, Otto M, Clement JP, Preux PM,

Dartigues JF: Cognitive impairment and dementia

in elderly people living in rural Benin, west Africa.

Dement Geriatr Cogn Disord 2009, 27(1):34-41.

8 Guerchet M, M’Belesso P, Mouanga AM, Bandzouzi B,

Tabo A, Houinato DS, Paraiso MN, Cowppli-Bony P,

Nubukpo P, Aboyans V et al: Prevalence of dementia in

elderly living in two cities of Central Africa: the EDAC

survey. Dement Geriatr Cogn Disord 2010, 30(3):261-268.

9 Paraiso MN, Guerchet M, Saizonou J, Cowppli-Bony

P, Mouanga AM, Nubukpo P, Preux PM, Houinato DS:

Prevalence of dementia among elderly people living

in Cotonou, an urban area of Benin (West Africa).

Neuroepidemiology 2011, 36(4):245-251.

10 Yusuf AJ, Baiyewu O, Sheikh TL, Shehu AU: Prevalence

of dementia and dementia subtypes among community-

dwelling elderly people in northern Nigeria. Int

Psychogeriatr 2011, 23(3):379-386.

11 Longdon AR, Paddick SM, Kisoli A, Dotchin C, Gray

WK, Dewhurst F, Chaote P, Teodorczuk A, Dewhurst M,

Jusabani AM et al: The prevalence of dementia in rural

Tanzania: a cross-sectional community-based study. Int J

Geriatr Psychiatry 2013, 28(7):728-737.

12 Guerchet M, Banzouzi-Ndamba B, Mbelesso P, Pilleron

S, Clement J-P, Dartigues J-F, Preux P-M.: Prevalence of

dementia in two countries of Central Africa: comparison

or rural and urban areas in the EPIDEMCA study.

Neuroepidemiology 2013, 41:223-316.

13 World Health Organization and Alzheimer’s Disease

International, Dementia: a public health priority, Geneva

April 2012, http://www.alz.co.uk/WHO-dementia-report

14 Wimo A, Prince M. World Alzheimer Report 2010; The

Global Economic Impact of Dementia. 2010. London,

Alzheimer’s Disease International

15 World Alzheimer Report 2013, Journey of Caring, An

analysis of long-term care for dementia, http://www.alz.

co.uk/research/world-report-2013

Annex 2

GBD Region

Original estimates (2009) Updated estimates

Proportionate increases

(%) for new estimates

2010 2030 2050 2013 2030 2050 2013- 2030 2013- 2050

Asia/Pacific 15.94 33.04 60.92 21.87 39.79 71.84 82 228

Australasia 0.31 0.53 0.79 0.37 0.62 1.02 68 176

Asia Pacific High Income 2.83 5.36 7.03 3.26 5.50 7.58 69 133

Oceania 0.02 0.04 0.10 0.02 0.04 0.09 100 350

Asia Central 0.33 0.56 1.19 0.29 0.44 0.88 52 203

Asia East 5.49 11.93 22.54 10.46 18.83 33.61 80 221

Asia South 4.48 9.31 18.12 4.74 8.50 16.61 79 250

Asia Southeast 2.48 5.30 11.13 2.74 5.87 12.05 114 340

Europe 9.95 13.95 18.65 10.93 14.8 20.75 35 90

Europe Central 1.10 1.57 2.10 1.23 1.69 2.29 37 86

Europe Eastern 1.87 2.36 3.10 1.86 2.03 2.44 9 31

Europe Western 6.98 10.03 13.44 7. 8 4 11.08 16.02 41 104

The Americas 7.82 14.78 27.08 8.77 15.8 30.51 80 248

North America High Income 4.38 7.13 11.01 4.58 7.28 11.74 59 156

Caribbean 0.33 0.62 1.04 0.38 0.63 1.14 66 200

Latin America Andean 0.25 0.59 1.29 0.31 0.64 1.46 106 371

Latin America Central 1.19 2.79 6.37 1.38 2.95 7.07 114 412

Latin America Southern 0.61 1.08 1.83 0.71 1.17 2.13 65 200

Latin America Tropical 1.05 2.58 5.54 1.42 3.13 6.97 120 391

Africa 1.86 3.92 8.74 2.78 5.24 12.35 88 344

North Africa / Middle East 1.15 2.59 6.19 1.47 2.91 7. 2 9 98 396

Sub-Saharan Africa Central 0.07 0.12 0.24 0.13 0.23 0.48 77 269

Sub-Saharan Africa East 0.36 0.69 1.38 0.55 1.06 2.45 93 345

Sub-Saharan Africa Southern 0.10 0.17 0.20 0.19 0.29 0.49 53 158

Sub-Saharan Africa West 0.18 0.35 0.72 0.44 0.76 1.63 73 270

World 35.56 65.69 115.38 44.35 75.62 135.46 71 205

Table 1 Numbers of people with dementia according to GBD regions (in millions, by year)

Acknowledgements

Authors

Prof Martin Prince *

Dr Maëlenn Guerchet *

Dr Matthew Prina *

Alzheimer’s Disease International

* Global Observatory for Ageing and Dementia Care,

Health Service and Population Research Department, King’s College London

Thanks to

Pr Richard Walker, Dr Catherine Dotchin and Dr William Keith Gray from the Northumbria Healthcare NHS Foundation

Trust, the Institute for Ageing and Health, and the Institute of Health and Society, in Newcastle University (UK) for providing

us prevalence rates from their study in Tanzania.

Pr Pierre-Marie Preux, from the UMR Inserm 1094 Tropical Neuroepidemiology in Limoges (France), and the EPIDEMCA

group, for allowing us to include their last results in Central Africa before their publication.

Policy Brief for Heads of Government: The Global Impact of Dementia 2013–2050

Published by Alzheimer’s Disease International (ADI), London. December 2013

7POLICY BRIEF FOR HEADS OF GOVERNMENT: THE GLOBAL IMPACT OF DEMENTIA 2013–2050

ALZHEIMER’S DISEASE INTERNATIONAL · THE GLOBAL VOICE ON DEMENTIA

Alzheimer’s Disease International:

The International Federation

of Alzheimer’s Disease and

Related Disorders Societies, Inc.

is incorporated in Illinois, USA,

and is a 501(c)(3) not-for-proﬁt

organization

Alzheimer’s Disease International

64 Great Suffolk Street

London SE1 0BL

Tel: +44 20 79810880

Fax: +44 20 79282357

www.alz.co.uk

About Alzheimer’s Disease International

Alzheimer’s Disease International (ADI) is the international federation of Alzheimer

associations throughout the world. Each of our 79 members is a non-proﬁt

Alzheimer association supporting people with dementia and their families.

ADI was founded in 1984 and registered as a non-proﬁt organization in the USA.

Based in London, ADI is in ofﬁcial relations with the WHO since 1996 and has

consultative status with the UN since 2012.

ADI’s vision is an improved quality of life for people with dementia and their

families throughout the world. ADI aims to make dementia a global health priority,

to build and strengthen Alzheimer associations, and to raise awareness about

dementia worldwide. Stronger Alzheimer associations are better able to meet the

needs of people with dementia and their carers, and to be the global voice on

dementia.

Global Observatory for Ageing and Dementia Care

The Global Observatory for Ageing and Dementia Care, hosted at the Health

Service and Population Research Department, King’s College London, was

founded in 2013. Supported by Alzheimer’s Disease International and King’s

College London, the Observatory aims to synthesise global evidence for

policymakers and the public through high impact evidence-based reports for

Alzheimer’s Disease International (World Alzheimer Reports 2009, 2010, 2011 and

2013), the World Health Organization (Dementia; a public health priority) and other

relevant intergovernmental organisations. A particular focus is to identify and

promote effective innovations in health and social care policy and practice.