Visualising the global
challenge of dementia
 “Ageing is a development issue.
Healthy older persons are a resource
for th...
Global
Observatory
for Ageing and
Dementia Care
www.alz.co.uk/1066
The impact of dementia
• Mainly through years lived with disability, not
mortality
• Among older people, dementia contribu...
• Care needs begin early and evolve rapidly
• Short intervals of care, often requiring
constant monitoring and coordinatio...
Numbers of people with dementia
by world region (2015-2050)
Europe Western
Europe Central and EasternNorth America
Latin A...
Indonesia USA
2050
2045
2040
2035
2030
2025
2020
2015
Population ageing in Indonesia and the USA (2015-2050)
Indonesia USA
2050
2045
2040
2035
2030
2025
2020
2015
Population ageing in Indonesia and the USA (2015-2050)
Indonesia USA
2050
2045
2040
2035
2030
2025
2020
2015
Population ageing in Indonesia and the USA (2015-2050)
Indonesia USA
2050
2045
2040
2035
2030
2025
2020
2015
Population ageing in Indonesia and the USA (2015-2050)
Indonesia USA
2050
2045
2040
2035
2030
2025
2020
2015
Population ageing in Indonesia and the USA (2015-2050)
Indonesia USA
2050
2045
2040
2035
2030
2025
2020
2015
Population ageing in Indonesia and the USA (2015-2050)
Indonesia USA
2050
2045
2040
2035
2030
2025
2020
2015
Population ageing in Indonesia and the USA (2015-2050)
Indonesia USA
2050
2045
2040
2035
2030
2025
2020
2015
Population ageing in Indonesia and the USA (2015-2050)
Indonesia USA
2050
2045
2040
2035
2030
2025
2020
2015
Population ageing in Indonesia and the USA (2015-2050)
0
10
20
30
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100
At risk Dementia
Past cases
Current
Population ageing is the main driver of the epidemic
...
0
10
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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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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
Pas...
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...
USA
0
10
20
30
40
50
60
70
80
90
100
At risk Dementia
Past cases
Current
0
10
20
30
40
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90
100
At risk Dementia...
Global Distribution of Incident Dementia
(7.7 million new cases per year)
WHO Report 2012 – Dementia a Public Health Prior...
Can prevention help to reduce the burden of
dementia?
Exposure Meta-analysed
RR - association
with AD
Population
attributa...
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 (in...
0
100
200
300
400
500
600
Deaths New cases
Annual growth
The balance of deaths and new cases
(incidence) determines growth...
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 case...
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 case...
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 case...
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 case...
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...
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...
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...
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...
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...
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 an...
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 an...
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 an...
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 an...
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 an...
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 deat...
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 deat...
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 deat...
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 deat...
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 deat...
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...
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...
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...
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...
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...
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 balan...
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 balan...
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 balan...
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 balan...
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 balan...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
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 ...
Prevalence may already be falling in HIC…
e.g MRC CFAS (England) 1993-2011
Standardised prevalence
1993 - 8.3%
2011 - 6.5%...
Meta-regression of European prevalence (46 studies)
(Prince et al ADRD 2013)
Study characteristic Model 1 Model 2 (+ count...
The prevalence of
dementia in China
1990-2010
Chen et al, Lancet
2013
1990
2010
Increasing prevalence of dementia in China...
• World Alzheimer Day,
September 21st, London,
2010
– Global Societal Economic
cost
– $604bn
– 1% of GDP
– Equivalent to w...
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 d...
Global Challenges
• Sustainability of traditional family care system
• Late stage of dementia diagnosis
– Low awareness/ l...
Conclusions
• The extent, course and distribution of the
dementia epidemic is all too predictable
• We should be realistic...
Quality of life in dementia by disease stage
According to the person with dementia According to the carer (proxy)
Global Dementia Legacy Event: Visualising the Global Challenge of Dementia Professor Martin J Prince
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Global Dementia Legacy Event: Visualising the Global Challenge of Dementia Professor Martin J Prince

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Professor Martin J Prince, Prof. of Epidemiological Psychiatry Co-Director KHP/ LSHTM Centre for Global Mental Health, Kings College London

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Global Dementia Legacy Event: Visualising the Global Challenge of Dementia Professor Martin J Prince

  1. 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 Poor’s – Global Aging 2010: an irreversible truth) Martin Prince, King’s College London
  2. 2. Global Observatory for Ageing and Dementia Care www.alz.co.uk/1066
  3. 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. 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. 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. 6. Indonesia USA 2050 2045 2040 2035 2030 2025 2020 2015 Population ageing in Indonesia and the USA (2015-2050)
  7. 7. Indonesia USA 2050 2045 2040 2035 2030 2025 2020 2015 Population ageing in Indonesia and the USA (2015-2050)
  8. 8. Indonesia USA 2050 2045 2040 2035 2030 2025 2020 2015 Population ageing in Indonesia and the USA (2015-2050)
  9. 9. Indonesia USA 2050 2045 2040 2035 2030 2025 2020 2015 Population ageing in Indonesia and the USA (2015-2050)
  10. 10. Indonesia USA 2050 2045 2040 2035 2030 2025 2020 2015 Population ageing in Indonesia and the USA (2015-2050)
  11. 11. Indonesia USA 2050 2045 2040 2035 2030 2025 2020 2015 Population ageing in Indonesia and the USA (2015-2050)
  12. 12. Indonesia USA 2050 2045 2040 2035 2030 2025 2020 2015 Population ageing in Indonesia and the USA (2015-2050)
  13. 13. Indonesia USA 2050 2045 2040 2035 2030 2025 2020 2015 Population ageing in Indonesia and the USA (2015-2050)
  14. 14. Indonesia USA 2050 2045 2040 2035 2030 2025 2020 2015 Population ageing in Indonesia and the USA (2015-2050)
  15. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 96. • World Alzheimer Day, September 21st, London, 2010 – Global Societal Economic cost – $604bn – 1% of GDP – Equivalent to world’s 18th largest economy – Larger than the annual turnover of Walmart Anders Wimo Karolinska Institute, Sweden Martin Prince King’s College London, UK
  97. 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. 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. 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. 100. Quality of life in dementia by disease stage According to the person with dementia According to the carer (proxy)

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