- 1. Visualising the global challenge of dementia Ageing is a
development issue. Healthy older persons are a resource for their
families, their communities and the economy (WHO Brasilia
Declaration on Ageing, 1996) Global aging is the dominant threat to
global economic stability - without sweeping changes to age-related
public spending, sovereign debt will soon become unsustainable
(Standard and Poors Global Aging 2010: an irreversible truth)
Martin Prince, Kings College London
2. Global Observatory for Ageing and Dementia Care
www.alz.co.uk/1066 3. The impact of dementia Mainly through years
lived with disability, not mortality Among older people, dementia
contributes much more than other chronic diseases to Disability
(Sousa et al, Lancet, 2009) Needs for care (Sousa et al, BMC
Geriatrics, 2010) Carer strain (Honyashiki M, Int Psychogeriatrics
2011) Societal costs (Liu, Z, KCL PhD thesis, 2013) 4. Care needs
begin early and evolve rapidly Short intervals of care, often
requiring constant monitoring and coordination Compared to other
conditions more personal care, more hours of care, and more
supervision higher carer strain carers likely to give up or cut
back on work to care Care is lifelong What is special about
dementia care?
http://www.alz.co.uk/research/WorldAlzheimerReport2013.pdf 5.
Numbers of people with dementia by world region (2015-2050) Europe
Western Europe Central and EasternNorth America Latin America &
Caribbean Africa and the Middle East Asia (high income) Asia (low
and middle income) World 8.20 4.66 18.78 47.47 135.46 3.04 4.73
19.62 3.93 2015 2020 2025 2030 2035 2040 2045 2050 4.7811.74 16.02
12.35 3.24 63.16 8.68 6. Indonesia USA 2050 2045 2040 2035 2030
2025 2020 2015 Population ageing in Indonesia and the USA
(2015-2050) 7. Indonesia USA 2050 2045 2040 2035 2030 2025 2020
2015 Population ageing in Indonesia and the USA (2015-2050) 8.
Indonesia USA 2050 2045 2040 2035 2030 2025 2020 2015 Population
ageing in Indonesia and the USA (2015-2050) 9. Indonesia USA 2050
2045 2040 2035 2030 2025 2020 2015 Population ageing in Indonesia
and the USA (2015-2050) 10. Indonesia USA 2050 2045 2040 2035 2030
2025 2020 2015 Population ageing in Indonesia and the USA
(2015-2050) 11. Indonesia USA 2050 2045 2040 2035 2030 2025 2020
2015 Population ageing in Indonesia and the USA (2015-2050) 12.
Indonesia USA 2050 2045 2040 2035 2030 2025 2020 2015 Population
ageing in Indonesia and the USA (2015-2050) 13. Indonesia USA 2050
2045 2040 2035 2030 2025 2020 2015 Population ageing in Indonesia
and the USA (2015-2050) 14. Indonesia USA 2050 2045 2040 2035 2030
2025 2020 2015 Population ageing in Indonesia and the USA
(2015-2050) 15. 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia
Past cases Current Population ageing is the main driver of the
epidemic (comparing Indonesia and the USA) 0 10 20 30 40 50 60 70
80 90 100 At risk Dementia Past cases Current 2015 Indonesia USA
16. 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia Past cases
Current 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia Past
cases Current 2015 2020 Population ageing is the main driver of the
epidemic (comparing Indonesia and the USA) Indonesia USA 17. 0 10
20 30 40 50 60 70 80 90 100 At risk Dementia Past cases Current 0
10 20 30 40 50 60 70 80 90 100 At risk Dementia Past cases Current
2015 2020 Population ageing is the main driver of the epidemic
(comparing Indonesia and the USA) Indonesia USA 18. 0 10 20 30 40
50 60 70 80 90 100 At risk Dementia Past cases Current 0 10 20 30
40 50 60 70 80 90 100 At risk Dementia Past cases Current 2015 2020
Population ageing is the main driver of the epidemic (comparing
Indonesia and the USA) Indonesia USA 19. 0 10 20 30 40 50 60 70 80
90 100 At risk Dementia Past cases Current 0 10 20 30 40 50 60 70
80 90 100 At risk Dementia Past cases Current 2015 2020 Population
ageing is the main driver of the epidemic (comparing Indonesia and
the USA) Indonesia USA 20. 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At
risk Dementia Past cases Current 2015 2020 Population ageing is the
main driver of the epidemic (comparing Indonesia and the USA)
Indonesia USA 21. 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia
Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 2015 2020 2025 Population ageing is the
main driver of the epidemic (comparing Indonesia and the USA)
Indonesia USA 22. 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia
Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 2015 2020 2025 Population ageing is the
main driver of the epidemic (comparing Indonesia and the USA)
Indonesia USA 23. 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia
Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 2015 2020 2025 Population ageing is the
main driver of the epidemic (comparing Indonesia and the USA)
Indonesia USA 24. 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia
Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 2015 2020 2025 Population ageing is the
main driver of the epidemic (comparing Indonesia and the USA)
Indonesia USA 25. 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia
Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 2015 2020 2025 Population ageing is the
main driver of the epidemic (comparing Indonesia and the USA)
Indonesia USA 26. 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia
Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 2015 2020 2025 2030 Population ageing
is the main driver of the epidemic (comparing Indonesia and the
USA) Indonesia USA 27. 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At
risk Dementia Past cases Current 2015 2020 2025 2030 Population
ageing is the main driver of the epidemic (comparing Indonesia and
the USA) Indonesia USA 28. 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At
risk Dementia Past cases Current 2015 2020 2025 2030 Population
ageing is the main driver of the epidemic (comparing Indonesia and
the USA) Indonesia USA 29. 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At
risk Dementia Past cases Current 2015 2020 2025 2030 Population
ageing is the main driver of the epidemic (comparing Indonesia and
the USA) Indonesia USA 30. 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At
risk Dementia Past cases Current 2015 2020 2025 2030 Population
ageing is the main driver of the epidemic (comparing Indonesia and
the USA) Indonesia USA 31. 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At
risk Dementia Past cases Current 2015 2020 2025 2030 2035
Population ageing is the main driver of the epidemic (comparing
Indonesia and the USA) Indonesia USA 32. 0 10 20 30 40 50 60 70 80
90 100 At risk Dementia Past cases Current 0 10 20 30 40 50 60 70
80 90 100 At risk Dementia Past cases Current 2015 2020 2025 2030
2035 Population ageing is the main driver of the epidemic
(comparing Indonesia and the USA) Indonesia USA 33. 0 10 20 30 40
50 60 70 80 90 100 At risk Dementia Past cases Current 0 10 20 30
40 50 60 70 80 90 100 At risk Dementia Past cases Current 2015 2020
2025 2030 2035 Population ageing is the main driver of the epidemic
(comparing Indonesia and the USA) Indonesia USA 34. 0 10 20 30 40
50 60 70 80 90 100 At risk Dementia Past cases Current 0 10 20 30
40 50 60 70 80 90 100 At risk Dementia Past cases Current 2015 2020
2025 2030 2035 Population ageing is the main driver of the epidemic
(comparing Indonesia and the USA) Indonesia USA 35. 0 10 20 30 40
50 60 70 80 90 100 At risk Dementia Past cases Current 0 10 20 30
40 50 60 70 80 90 100 At risk Dementia Past cases Current 2015 2020
2025 2030 2035 Population ageing is the main driver of the epidemic
(comparing Indonesia and the USA) Indonesia USA 36. 0 10 20 30 40
50 60 70 80 90 100 At risk Dementia Past cases Current 0 10 20 30
40 50 60 70 80 90 100 At risk Dementia Past cases Current 2015 2020
2025 2030 2035 2040 Indonesia USA Population ageing is the main
driver of the epidemic (comparing Indonesia and the USA) 37. 0 10
20 30 40 50 60 70 80 90 100 At risk Dementia Past cases Current 0
10 20 30 40 50 60 70 80 90 100 At risk Dementia Past cases Current
2015 2020 2025 2030 2035 2040 Indonesia USA Population ageing is
the main driver of the epidemic (comparing Indonesia and the USA)
38. 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia Past cases
Current 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia Past
cases Current 2015 2020 2025 2030 2035 2040 Indonesia USA
Population ageing is the main driver of the epidemic (comparing
Indonesia and the USA) 39. 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At
risk Dementia Past cases Current 2015 2020 2025 2030 2035 2040
Indonesia USA Population ageing is the main driver of the epidemic
(comparing Indonesia and the USA) 40. 0 10 20 30 40 50 60 70 80 90
100 At risk Dementia Past cases Current 0 10 20 30 40 50 60 70 80
90 100 At risk Dementia Past cases Current 2015 2020 2025 2030 2035
2040 Indonesia USA Population ageing is the main driver of the
epidemic (comparing Indonesia and the USA) 41. 0 10 20 30 40 50 60
70 80 90 100 At risk Dementia Past cases Current 0 10 20 30 40 50
60 70 80 90 100 At risk Dementia Past cases Current 2015 2020 2025
2030 2035 2040 2045 Population ageing is the main driver of the
epidemic (comparing Indonesia and the USA) Indonesia USA 42. 0 10
20 30 40 50 60 70 80 90 100 At risk Dementia Past cases Current 0
10 20 30 40 50 60 70 80 90 100 At risk Dementia Past cases Current
2015 2020 2025 2030 2035 2040 2045 Population ageing is the main
driver of the epidemic (comparing Indonesia and the USA) Indonesia
USA 43. 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia Past
cases Current 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia
Past cases Current 2015 2020 2025 2030 2035 2040 2045 Population
ageing is the main driver of the epidemic (comparing Indonesia and
the USA) Indonesia USA 44. 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At
risk Dementia Past cases Current 2015 2020 2025 2030 2035 2040 2045
Population ageing is the main driver of the epidemic (comparing
Indonesia and the USA) Indonesia USA 45. 0 10 20 30 40 50 60 70 80
90 100 At risk Dementia Past cases Current 0 10 20 30 40 50 60 70
80 90 100 At risk Dementia Past cases Current 2015 2020 2025 2030
2035 2040 2045 Population ageing is the main driver of the epidemic
(comparing Indonesia and the USA) Indonesia USA 46. 0 10 20 30 40
50 60 70 80 90 100 At risk Dementia Past cases Current 0 10 20 30
40 50 60 70 80 90 100 At risk Dementia Past cases Current 2015 2020
2025 2030 2035 2040 2045 2050 Population ageing is the main driver
of the epidemic (comparing Indonesia and the USA) Indonesia USA 47.
0 10 20 30 40 50 60 70 80 90 100 At risk Dementia Past cases
Current 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia Past
cases Current 2015 2020 2025 2030 2035 2040 2045 2050 Population
ageing is the main driver of the epidemic (comparing Indonesia and
the USA) Indonesia USA 48. 0 10 20 30 40 50 60 70 80 90 100 At risk
Dementia Past cases Current 0 10 20 30 40 50 60 70 80 90 100 At
risk Dementia Past cases Current 2015 2020 2025 2030 2035 2040 2045
2050 Population ageing is the main driver of the epidemic
(comparing Indonesia and the USA) Indonesia USA 49. 0 10 20 30 40
50 60 70 80 90 100 At risk Dementia Past cases Current 0 10 20 30
40 50 60 70 80 90 100 At risk Dementia Past cases Current 2015 2020
2025 2030 2035 2040 2045 2050 Population ageing is the main driver
of the epidemic (comparing Indonesia and the USA) Indonesia USA 50.
0 10 20 30 40 50 60 70 80 90 100 At risk Dementia Past cases
Current 0 10 20 30 40 50 60 70 80 90 100 At risk Dementia Past
cases Current 2015 2020 2025 2030 2035 2040 2045 2050 Population
ageing is the main driver of the epidemic (comparing Indonesia and
the USA) Indonesia USA 51. USA 0 10 20 30 40 50 60 70 80 90 100 At
risk Dementia Past cases Current 0 10 20 30 40 50 60 70 80 90 100
At risk Dementia Past cases Current Indonesia 2015 2020 2025 2030
2035 2040 2045 2050 Population ageing is the main driver of the
epidemic (comparing Indonesia and the USA) 52. USA 0 10 20 30 40 50
60 70 80 90 100 At risk Dementia Past cases Current 0 10 20 30 40
50 60 70 80 90 100 At risk Dementia Past cases Current Indonesia
2015 2020 2025 2030 2035 2040 2045 2050 Population ageing is the
main driver of the epidemic (comparing Indonesia and the USA) 53.
Global Distribution of Incident Dementia (7.7 million new cases per
year) WHO Report 2012 Dementia a Public Health Priority One new
case every 4 seconds! 54. Can prevention help to reduce the burden
of dementia? Exposure Meta-analysed RR - association with AD
Population attributable risk fraction (PARF%) Diabetes 1.39
(1.17-1.66) 2.4% Midlife hypertension 1.61 (1.16-2.24) 5.1% Midlife
obesity 1.60 (1.34-1.92) 2.0% Physical inactivity 1.82 (1.19-2.78)
12.7% Smoking 1.59 (1.15-2.20) 13.9% Depression 1.90 (1.55-2.33)
10.6% Low education 1.59 (1.35-1.86) 19.1% COMBINED TOTAL 50.7%
(Barnes and Yaffe 2011) More realistically.. (WHO Report, 2012) 10%
reduction in risk exposure 250,000 fewer new cases (3.3% reduction)
25% reduction in risk exposure 680,000 fewer new cases (8.8%
reduction 55. 0 100 200 300 400 500 600 Deaths New cases Annual
growth 0 1 2 3 4 Prevalence 2015 The balance of deaths and new
cases (incidence) determines growth in prevalence (numbers)
(thousands) (millions) 56. 0 100 200 300 400 500 600 Deaths New
cases Annual growth The balance of deaths and new cases (incidence)
determines growth in prevalence (numbers) 0 1 2 3 4 Prevalence 2015
2020 (millions)(thousands) 57. 0 100 200 300 400 500 600 Deaths New
cases Annual growth 0 1 2 3 4 Prevalence 2015 2020 The balance of
deaths and new cases (incidence) determines growth in prevalence
(numbers) (thousands) (millions) 58. 0 100 200 300 400 500 600
Deaths New cases Annual growth 0 1 2 3 4 Prevalence 2015 2020 The
balance of deaths and new cases (incidence) determines growth in
prevalence (numbers) (thousands) (millions) 59. 0 100 200 300 400
500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence 2015
2020 The balance of deaths and new cases (incidence) determines
growth in prevalence (numbers) (thousands) (millions) 60. 0 100 200
300 400 500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence
2015 2020 The balance of deaths and new cases (incidence)
determines growth in prevalence (numbers) (thousands) (millions)
61. 0 100 200 300 400 500 600 Deaths New cases Annual growth 0 1 2
3 4 Prevalence 2015 2020 2025 The balance of deaths and new cases
(incidence) determines growth in prevalence (numbers) (thousands)
(millions) 62. 0 100 200 300 400 500 600 Deaths New cases Annual
growth 0 1 2 3 4 Prevalence 2015 2020 2025 The balance of deaths
and new cases (incidence) determines growth in prevalence (numbers)
(thousands) (millions) 63. 0 100 200 300 400 500 600 Deaths New
cases Annual growth 0 1 2 3 4 Prevalence 2015 2020 2025 The balance
of deaths and new cases (incidence) determines growth in prevalence
(numbers) (thousands) (millions) 64. 0 100 200 300 400 500 600
Deaths New cases Annual growth 0 1 2 3 4 Prevalence 2015 2020 2025
The balance of deaths and new cases (incidence) determines growth
in prevalence (numbers) (thousands) (millions) 65. 0 100 200 300
400 500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence
2015 2020 2025 The balance of deaths and new cases (incidence)
determines growth in prevalence (numbers) (thousands) (millions)
66. 0 100 200 300 400 500 600 Deaths New cases Annual growth 0 1 2
3 4 Prevalence 2015 2020 2025 2030 The balance of deaths and new
cases (incidence) determines growth in prevalence (numbers)
(thousands) (millions) 67. 0 100 200 300 400 500 600 Deaths New
cases Annual growth 0 1 2 3 4 Prevalence 2015 2020 2025 2030 The
balance of deaths and new cases (incidence) determines growth in
prevalence (numbers) (thousands) (millions) 68. 0 100 200 300 400
500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence 2015
2020 2025 2030 The balance of deaths and new cases (incidence)
determines growth in prevalence (numbers) (thousands) (millions)
69. 0 100 200 300 400 500 600 Deaths New cases Annual growth 0 1 2
3 4 Prevalence 2015 2020 2025 2030 The balance of deaths and new
cases (incidence) determines growth in prevalence (numbers)
(thousands) (millions) 70. 0 100 200 300 400 500 600 Deaths New
cases Annual growth 0 1 2 3 4 Prevalence 2015 2020 2025 2030 The
balance of deaths and new cases (incidence) determines growth in
prevalence (numbers) (thousands) (millions) 71. 0 100 200 300 400
500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence 2015
2020 2025 2030 2035 The balance of deaths and new cases (incidence)
determines growth in prevalence (numbers) (thousands) (millions)
72. 0 100 200 300 400 500 600 Deaths New cases Annual growth 0 1 2
3 4 Prevalence 2015 2020 2025 2030 2035 The balance of deaths and
new cases (incidence) determines growth in prevalence (numbers)
(thousands) (millions) 73. 0 100 200 300 400 500 600 Deaths New
cases Annual growth 0 1 2 3 4 Prevalence 2015 2020 2025 2030 2035
The balance of deaths and new cases (incidence) determines growth
in prevalence (numbers) (thousands) (millions) 74. 0 100 200 300
400 500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence
2015 2020 2025 2030 2035 The balance of deaths and new cases
(incidence) determines growth in prevalence (numbers) (thousands)
(millions) 75. 0 100 200 300 400 500 600 Deaths New cases Annual
growth 0 1 2 3 4 Prevalence 2015 2020 2025 2030 2035 The balance of
deaths and new cases (incidence) determines growth in prevalence
(numbers) (thousands) (millions) 76. 0 100 200 300 400 500 600
Deaths New cases Annual growth 0 1 2 3 4 Prevalence 2015 2020 2025
2030 2035 2040 The balance of deaths and new cases (incidence)
determines growth in prevalence (numbers) (thousands) (millions)
77. 0 100 200 300 400 500 600 Deaths New cases Annual growth 0 1 2
3 4 Prevalence 2015 2020 2025 2030 2035 2040 The balance of deaths
and new cases (incidence) determines growth in prevalence (numbers)
(thousands) (millions) 78. 0 100 200 300 400 500 600 Deaths New
cases Annual growth 0 1 2 3 4 Prevalence 2015 2020 2025 2030 2035
2040 The balance of deaths and new cases (incidence) determines
growth in prevalence (numbers) (thousands) (millions) 79. 0 100 200
300 400 500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence
2015 2020 2025 2030 2035 2040 The balance of deaths and new cases
(incidence) determines growth in prevalence (numbers) (thousands)
(millions) 80. 0 100 200 300 400 500 600 Deaths New cases Annual
growth 0 1 2 3 4 Prevalence 2015 2020 2025 2030 2035 2040 The
balance of deaths and new cases (incidence) determines growth in
prevalence (numbers) (thousands) (millions) 81. 0 100 200 300 400
500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence 2015
2020 2025 2030 2035 2040 2045 The balance of deaths and new cases
(incidence) determines growth in prevalence (numbers) (thousands)
(millions) 82. 0 100 200 300 400 500 600 Deaths New cases Annual
growth 0 1 2 3 4 Prevalence 2015 2020 2025 2030 2035 2040 2045 The
balance of deaths and new cases (incidence) determines growth in
prevalence (numbers) (thousands) (millions) 83. 0 100 200 300 400
500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence 2015
2020 2025 2030 2035 2040 2045 The balance of deaths and new cases
(incidence) determines growth in prevalence (numbers) (thousands)
(millions) 84. 0 100 200 300 400 500 600 Deaths New cases Annual
growth 0 1 2 3 4 Prevalence 2015 2020 2025 2030 2035 2040 2045 The
balance of deaths and new cases (incidence) determines growth in
prevalence (numbers) (thousands) (millions) 85. 0 100 200 300 400
500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence 2015
2020 2025 2030 2035 2040 2045 The balance of deaths and new cases
(incidence) determines growth in prevalence (numbers) (thousands)
(millions) 86. 0 100 200 300 400 500 600 Deaths New cases Annual
growth 0 1 2 3 4 Prevalence 2015 2020 2025 2030 2035 2040 2045 2050
The balance of deaths and new cases (incidence) determines growth
in prevalence (numbers) (thousands) (millions) 87. 0 100 200 300
400 500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence
2015 2020 2025 2030 2035 2040 2045 2050 The balance of deaths and
new cases (incidence) determines growth in prevalence (numbers)
(thousands) (millions) 88. 0 100 200 300 400 500 600 Deaths New
cases Annual growth 0 1 2 3 4 Prevalence 2015 2020 2025 2030 2035
2040 2045 2050 The balance of deaths and new cases (incidence)
determines growth in prevalence (numbers) (thousands) (millions)
89. 0 100 200 300 400 500 600 Deaths New cases Annual growth 0 1 2
3 4 Prevalence 2015 2020 2025 2030 2035 2040 2045 2050 The balance
of deaths and new cases (incidence) determines growth in prevalence
(numbers) (thousands) (millions) 90. 0 100 200 300 400 500 600
Deaths New cases Annual growth 0 1 2 3 4 Prevalence 2015 2020 2025
2030 2035 2040 2045 2050 The balance of deaths and new cases
(incidence) determines growth in prevalence (numbers) (thousands)
(millions) 91. 0 100 200 300 400 500 600 Deaths New cases Annual
growth 0 1 2 3 4 Prevalence 2015 2020 2025 2030 2035 2040 2045 2050
The balance of deaths and new cases (incidence) determines growth
in prevalence (numbers) (thousands) (millions) 92. 0 100 200 300
400 500 600 Deaths New cases Annual growth 0 1 2 3 4 Prevalence
2015 2020 2025 2030 2035 2040 2045 2050 The balance of deaths and
new cases (incidence) determines growth in prevalence (numbers)
(thousands) (millions) 93. Prevalence may already be falling in HIC
e.g MRC CFAS (England) 1993-2011 Standardised prevalence 1993 -
8.3% 2011 - 6.5% Prevalence of dementia nearly one third lower in
2011 compared with 1993 OR 0.7 (0.6-0.9) Matthews et al, Lancet
2013 94. Meta-regression of European prevalence (46 studies)
(Prince et al ADRD 2013) Study characteristic Model 1 Model 2 (+
country) Design Two phase survey incorrectly applied 1 (ref) 1
(ref) Two phase survey correctly applied 0.81 (0.61-1.09) 0.98
(0.70-1.36) One phase survey 0.68 (0.53-0.85) 0.91 (0.65-1.27) Year
1980 - 1989 1 (ref) 1 (ref) 1990 - 1999 1.36 (1.06-1.75) 1.15
(0.83-1.59) 2000 - 0.74 (0.48-1.13) 0.69 (0.43-1.10) Dementia
ascertainment Informant interview included 1.13 (0.91-1.41) 1.27
(0.98-1.65) Heterogeneity Alpha 0.10 (0.60-0.16) 0.07 (0.04-0.11)
95. The prevalence of dementia in China 1990-2010 Chen et al,
Lancet 2013 1990 2010 Increasing prevalence of dementia in China?
3.5% 5.1% 46% increase 1990-2010 96. World Alzheimer Day, September
21st, London, 2010 Global Societal Economic cost $604bn 1% of GDP
Equivalent to worlds 18th largest economy Larger than the annual
turnover of Walmart Anders Wimo Karolinska Institute, Sweden Martin
Prince Kings College London, UK 97. 0% 10% 20% 30% 40% 50% 60% 70%
80% 90% 100% % H IC U M IC LM IC LIC Direct medical Direct social
Informal care Worldwide distribution of costs by sector 98. Global
Challenges Sustainability of traditional family care system Late
stage of dementia diagnosis Low awareness/ limited expectations
Lost opportunities for early and effective intervention Advanced
care planning Lack of continuity of care post-diagnosis Lack of
coordination and integration of services Insufficiently
person-centred packages of care Cost containment imperative
http://www.alz.co.uk/research/WorldAlzheimerReport2013.pdf 99.
Conclusions The extent, course and distribution of the dementia
epidemic is all too predictable We should be realistic about the
potential impact of modifying lifestyles and behaviours We need to
focus much more on improving access to and increasing coverage of
services Cost-effectiveness Integration Scalability (e.g. new
treatment by 2025) Financing 100. Quality of life in dementia by
disease stage According to the person with dementia According to
the carer (proxy)