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

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. 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

97. • 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

98. 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

99. 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

100. 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

101. Quality of life in dementia by disease stage
According to the person with dementia According to the carer (proxy)