Editorial
Dementia warning for the Asia-Pacific region The number of people with dementia worldwide is projected to reach 135 million by 2050 and, as highlighted in a new report, more than half of these people are expected to be living in Asia-Pacific countries. Some countries in the region are preparing for this growing burden by improving awareness, diagnosis, and care for people affected by dementia, but many governments are not doing enough and could be sleepwalking into a dementia crisis. Alzheimer’s Disease International (ADI), a federation for dementia associations around the world, published its report Dementia in the Asia Pacific Region on Nov 7, 2014. The report provides data on current prevalence and costs of dementia, estimates of future prevalence, and a summary of what is being done in the 18 countries and territories represented by its member organisations in the Asia-Pacific region (the 21 countries or territories in the region not represented by ADI are nonetheless included in the total estimates). The report replaces one published in 2006; since then, ADI has gained three new member associations in the region, estimates of dementia prevalence have been refined (eg, a substantial upward revision for China), and several countries have taken steps towards improving their dementia initiatives. The headline figures from the ADI report are that 23 million people are likely to have dementia in AsiaPacific countries in 2015, and the number is expected to be 71 million by 2050 (6 million more than estimated in 2006). The costs associated with dementia in the region are estimated at US$185 billion for 2015, with the greatest costs in Japan and China. Only four of the national associations—those of Australia, South Korea, Japan, and Taiwan—report that their government has a formal national dementia strategy. Some of the other countries and territories covered by the report do have initiatives or policies for care of people with dementia, but several have no governmental dementia strategy, despite the efforts of their dementia associations. This situation needs to change if the Asia-Pacific region is to be ready to cope with the personal, societal, and economic costs of dementia over the next 35 years and beyond. Globally, middle-income and low-income countries are expected to experience disproportionately high increases in numbers of people with dementia, www.thelancet.com/neurology Vol 14 January 2015
and most Asia-Pacific countries are in these income categories. Many countries in the region are experiencing increasing economic migration, so fewer people with dementia have family support nearby. In many countries, barriers to adequate diagnosis and care include low awareness that dementia is a disease rather than a normal part of ageing, limited specialist expertise among general clinicians and health workers, and stigmatisation of people if they seek help from mental health services. The most high profile advances in the region, not surprisingly, have been in high-income countries. For example, when the ADI report was released, the third Global Dementia Legacy Event for G7 countries was being held in Tokyo, Japan. The commitment of the Japanese government is welcome, and countries that are making progress should share knowledge with and support their neighbours wherever possible. But as the ADI report stresses, many steps to improve provision for people with dementia are within reach even for governments with few resources. Suggested measures include legislative changes to protect people with dementia, inclusion of people with dementia and their carers in existing benefits schemes, use of social media to promote awareness and positive attitudes, and incorporating dementia into existing programmes to reduce prevalence of risk factors. As some countries in the region are increasingly adopting a so-called Western lifestyle, reduction of related risk factors such as midlife obesity and physical inactivity could substantially reduce the future prevalence of dementia. Following on from the Global Dementia Legacy Events in G7 countries, WHO will hold the first Ministerial Conference on Global Action Against Dementia in Geneva, Switzerland, in March, 2015. This meeting will include health ministers from all WHO member states, not only those of the G7 countries. Part of the goal of the meeting is to raise political awareness that the burden of dementia can be reduced if governments in both highincome and low-income countries commit together to put in place the necessary policies and resources. The ADI report shows that countries in the Asia-Pacific region have a growing dementia burden that needs to be addressed through such collaboration, and that even governments with limited resources can begin to make a difference. ■ The Lancet Neurology
For more on the estimated global burden of dementia see http://www.alz.co.uk/research/ GlobalImpactDementia2013.pdf For Dementia in the Asia Pacific Region see http://www.alz.co.uk/ adi/pdf/Dementia-AsiaPacific-2014.pdf For more on the Ministerial Conference on Global Action Against Dementia see http:// www.who.int/nmh/conferenceon-dementia-march2015concept-note.pdf
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Dementia warning for the Asia-Pacific region The number of people with dementia worldwide is projected to reach 135 million by 2050 and, as highlighted in a new report, more than half of these people are expected to be living in Asia-Pacific countries. Some countries in the region are preparing for this growing burden by improving awareness, diagnosis, and care for people affected by dementia, but many governments are not doing enough and could be sleepwalking into a dementia crisis. Alzheimer’s Disease International (ADI), a federation for dementia associations around the world, published its report Dementia in the Asia Pacific Region on Nov 7, 2014. The report provides data on current prevalence and costs of dementia, estimates of future prevalence, and a summary of what is being done in the 18 countries and territories represented by its member organisations in the Asia-Pacific region (the 21 countries or territories in the region not represented by ADI are nonetheless included in the total estimates). The report replaces one published in 2006; since then, ADI has gained three new member associations in the region, estimates of dementia prevalence have been refined (eg, a substantial upward revision for China), and several countries have taken steps towards improving their dementia initiatives. The headline figures from the ADI report are that 23 million people are likely to have dementia in AsiaPacific countries in 2015, and the number is expected to be 71 million by 2050 (6 million more than estimated in 2006). The costs associated with dementia in the region are estimated at US$185 billion for 2015, with the greatest costs in Japan and China. Only four of the national associations—those of Australia, South Korea, Japan, and Taiwan—report that their government has a formal national dementia strategy. Some of the other countries and territories covered by the report do have initiatives or policies for care of people with dementia, but several have no governmental dementia strategy, despite the efforts of their dementia associations. This situation needs to change if the Asia-Pacific region is to be ready to cope with the personal, societal, and economic costs of dementia over the next 35 years and beyond. Globally, middle-income and low-income countries are expected to experience disproportionately high increases in numbers of people with dementia, www.thelancet.com/neurology Vol 14 January 2015
and most Asia-Pacific countries are in these income categories. Many countries in the region are experiencing increasing economic migration, so fewer people with dementia have family support nearby. In many countries, barriers to adequate diagnosis and care include low awareness that dementia is a disease rather than a normal part of ageing, limited specialist expertise among general clinicians and health workers, and stigmatisation of people if they seek help from mental health services. The most high profile advances in the region, not surprisingly, have been in high-income countries. For example, when the ADI report was released, the third Global Dementia Legacy Event for G7 countries was being held in Tokyo, Japan. The commitment of the Japanese government is welcome, and countries that are making progress should share knowledge with and support their neighbours wherever possible. But as the ADI report stresses, many steps to improve provision for people with dementia are within reach even for governments with few resources. Suggested measures include legislative changes to protect people with dementia, inclusion of people with dementia and their carers in existing benefits schemes, use of social media to promote awareness and positive attitudes, and incorporating dementia into existing programmes to reduce prevalence of risk factors. As some countries in the region are increasingly adopting a so-called Western lifestyle, reduction of related risk factors such as midlife obesity and physical inactivity could substantially reduce the future prevalence of dementia. Following on from the Global Dementia Legacy Events in G7 countries, WHO will hold the first Ministerial Conference on Global Action Against Dementia in Geneva, Switzerland, in March, 2015. This meeting will include health ministers from all WHO member states, not only those of the G7 countries. Part of the goal of the meeting is to raise political awareness that the burden of dementia can be reduced if governments in both highincome and low-income countries commit together to put in place the necessary policies and resources. The ADI report shows that countries in the Asia-Pacific region have a growing dementia burden that needs to be addressed through such collaboration, and that even governments with limited resources can begin to make a difference. ■ The Lancet Neurology
For more on the estimated global burden of dementia see http://www.alz.co.uk/research/ GlobalImpactDementia2013.pdf For Dementia in the Asia Pacific Region see http://www.alz.co.uk/ adi/pdf/Dementia-AsiaPacific-2014.pdf For more on the Ministerial Conference on Global Action Against Dementia see http:// www.who.int/nmh/conferenceon-dementia-march2015concept-note.pdf
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