Straight Talk

Dr Matthew Norton explores recent reports into the prevalence of dementia now and in the future.

Dr Matthew Norton, Head of Policy Alzheimer’s Research UK

hanges in the estimated prevalence of people with dementia have hit the headlines more than once lately. But while the figures are vast and projected to increase still further, there is some encouraging news.

First, the bad news – news that demands attention – is that both the numbers of people with dementia, and the cost of the condition, are still on the rise. The World Alzheimer Report, published last month, estimates that today over 46 million people worldwide are living with dementia, and that the condition is now costing the global economy an eye-watering US$818bn a year, a figure that has soared by 35% in the last five years alone. The majority of this, around 80%, is attributed to the cost of social care and the cost of informal, unpaid care, highlighting the enormous strain this life-shattering condition places on our care system and on families who look after their loved ones.

The outlook for the future shows a worsening picture: the report estimates that by 2030, the number of people with dementia will have reached over 74 million, with the figures set to top 131 million by 2050. Its projections show that in just three years’ time, the condition will cost the global economy more than US$1tn a year. Huge figures like these can be difficult to comprehend, but each tells a story of more and more families hit hard by Alzheimer’s disease and other dementias; diseases that tear lives apart and which currently cannot be stopped or slowed. They are a renewed call to action, and should rally us in our determination to tackle these diseases.

Yet hidden in the detail is a possible silver lining. The report outlines the potential for dementia prevalence to reduce if certain risk factors can be addressed – factors such as low education, smoking, high blood pressure and diabetes. While the figures project that the biggest rise in dementia prevalence will be in low income countries as life expectancy increases, a second report suggests that in some Western European countries, prevalence among people over 65 may even be stabilising. The review, published in The Lancet Neurology, analysed five studies, most of which suggested that there had been no increase in the proportion of older people with the condition in the last decade or more.

In one study reviewed, the estimated number of over-65s with dementia in the UK in 2011 was in fact lower than had been predicted two decades earlier. This suggests that, in the UK, the generation of people who are reaching old age today may have a lower risk of dementia than their parents or grandparents did. One potential reason could be that people from this generation have generally been healthier: they have had better living standards, access to better education and healthcare, and have lived through an era that has seen real advances in public health. Better cardiovascular health, evidenced by a drop in the numbers of people with vascular disease, may have helped drive a fall in the proportion of older people developing dementia.

If this interpretation is correct, this is encouraging news. It tells us that dementia risk is not static – that we can, as individuals and as a society, work to change our risk. But it should also serve as a warning. Public understanding of the risk factors for dementia is still low. The UK currently has rising levels of obesity and diabetes, both risk factors for the condition, and if measures are not taken now to help people become healthier from mid-life, we could see this apparent fall in dementia prevalence reversed in future.

We also should not underestimate the challenge we currently face, even if dementia prevalence stays the same in the coming years. The proportion of older people with the condition may not be rising, but our population is ageing fast, with the first of the baby boomer generation having now reached retirement. With age the biggest risk factor, we can still expect to see the overall number of people with dementia increase – in the UK, that figure is projected to reach 1 million by 2025. With no treatments capable of tackling the diseases that cause it, the potential impact on our care sector is immense. That’s why research into new treatments, as well as preventions, is still vital.

In the meantime, efforts to improve public health must continue, with much more work needed to help people understand the steps they can take to reduce their risk of dementia. Of course, these aren’t sure-fire preventions, and we can’t stop every case of dementia, but if we can create a healthier society now, we could have a real impact on the number of people living with dementia in the future.

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