A call for action to tackle the growing burden of dementia

In the Statement, IAP highlights the fact that, worldwide, the proportion of the population that is 65 years of age or greater has grown over the last decades, and this trend will continue. Also, because advancing age is the greatest known risk factor for dementia, the number of individuals living with dementia worldwide will nearly triple by 2050. Most of this increase – from 47.5 million people to some 135.5 million – will occur among people living in low- and middle-income countries.

A mixture of brain diseases often underlies dementia, with many people showing changes consistent with both Alzheimer’s disease (the most common form of dementia) and cerebrovascular disease. But while we are learning more about the risk factors commonly associated with dementia (e.g. smoking and diabetes that are linked with stroke and heart disease), dementia continues to be a slowly progressive illness where the diagnosis is made after the process has been present for years.

In addition, while young onset (under 60 years) dementia is rare in many countries, this may not be the case where HIV/AIDS is prevalent, such as in sub-Saharan Africa and other low-income countries. Thus young people in such countries may bear a disproportionately greater burden of dementia in years to come.

Dementia also does not affect men and women equally. Women are at both greater risk of developing dementia and then living longer with the condition. Women also provide most of the informal (unpaid) care for people living with dementia.

The IAP for Health Statement, therefore, specifically calls on governments and other healthcare providers to implement a number of practices, including:

• Increasing awareness by educating the public about dementia, how to maintain brain health, and on accepting people with dementia as they are, accommodating to their remaining abilities;
• Supporting research to find and implement effective approaches (both pharmacological and non-pharmacological) to delay, prevent, slow-down, treat, ameliorate, and eventually cure the common causes of dementia;
• Investing in national healthcare systems, including both training a sufficient number and mix of providers as well as building the necessary infrastructure to ensure timely, competent person-centered care is available to those living with dementia and their caregivers through all stages of the illness.

 “Our Call for Action is one which aims at developing an evidence-based and a public health orientated approach to this looming problem,” explains Howard Chertkow, chair of the IAP for Health working group that prepared the Statement. “Ultimately each country should make a clear assessment for each population of the potential for primary or upstream prevention of dementia. This should be followed by plans for secondary prevention, i.e. early detection followed by effective treatment, which is considered to be more effective at that stage than later. Such treatment would include both what is currently available and what should soon be developed through therapeutic trials. So-called tertiary prevention (mitigation of dementia and its ramifications through various therapies and end of life care for those with dementia) also needs to be ramped up.”

Depei Liu of the Chinese Academy of Engineering and co-chair of IAP for Health, says: “The growing issue of dementia is affecting all countries, whether they are developed or developing. By releasing this Statement, we hope that IAP for Health and its member academies, representing the global medical science community, will be able to raise awareness of what needs to be done to get ahead of the curve. We expect that our member academies will now present it directly to their national governments and disseminate it through their national scientific and medical networks so that our recommendations can begin to be implemented. I especially call on low- and middle-income countries to do all they can to respond to this burgeoning crisis.”

IAP for Health’s other co-chair, Detlev Ganten of the German National Academy of Sciences, Leopoldina, added: “Like all IAP Statements, this Statement on dementia has been thoroughly reviewed. It presents – based on the latest evidence from our member academies – the best impartial advice to policy-makers in national ministries of health and social welfare, to healthcare agencies and other relevant institutions, and to decision-makers at the international level. The burden of dementia is growing, especially in countries with an ageing society, and it is time to take action.”

Working group
• Dr. Howard Chertkow, Canada (Chair)
• Prof. Ama de-Graft Aikins, Ghana
• Dr. Liaquat Ali, Bangladesh
• Dr. Laila Asmal, South Africa
• Prof. Hayrunnisa Bolay Belen, Turkey
• Prof. Carol Brayne, United Kingdom
• Dr. Josef Priller, Germany
• Prof. Lars Lannfelt, Sweden
• Prof. Alan Leshner, USA
• Dr. Ninoslav Mimica, Croatia
• Prof. Maryam Noroozian, Iran
• Prof. Adesola Ogunniyi, Nigeria
• Prof. Juha Rinne, Finland
• Prof. Paolo Maria Rossini, Italy
• Dr. Jonas Alex Morales Saute, Brazil
• Dr. Philip Scheltens, Netherlands
• Dr. Ales Stuchlik, Czech Rep.