Dementia: A Concern Of Ageing Population

Dementia is one of the most challenging health issues of the 21st century, affecting millions of individuals worldwide and placing significant burdens on families, healthcare systems, and society at large. With its staggering prevalence, devastating individual and societal impacts, and the burden on healthcare systems worldwide, understanding the epidemiology of dementia is critical. While aging is the most significant risk factor, its global rise is influenced by complex demographic, lifestyle, and health trends. 

Defined as a group of cognitive disorders that severely impair memory, reasoning, and other mental capabilities, dementia is not a specific disease but rather an umbrella term for conditions like Alzheimer’s disease, vascular dementia, and Lewy body dementia. Despite its increasing prevalence, public awareness and understanding of dementia remain insufficient. It is imperative to explore its implications, the barriers to addressing it effectively, and potential solutions to this pressing issue.

Epidemiology

Globally, approximately 55 million people are living with dementia, a figure projected to rise to 139 million by 2050, according to the World Health Organisation (WHO, 2024). The increase is primarily attributed to the aging population. As medical advancements reduce mortality rates from other diseases, more people are living to older ages, where dementia risk increases significantly. The incidence of dementia, or the rate of new cases, remains high. Globally, around 10 million new cases are diagnosed annually, equivalent to one diagnosis every three seconds. These figures highlight the urgency of the issue, as health systems worldwide are often unprepared to meet the growing demand for dementia care and management.

Dementia prevalence varies significantly across regions, reflecting disparities in healthcare access, diagnostic capacity, and risk factors. High-income countries, such as those in North America and Western Europe, report higher prevalence rates due to longer life expectancy and advanced diagnostic capabilities. However, low- and middle-income countries (LMICs) are seeing the fastest growth in dementia cases, accounting for nearly 60 per cent of current cases, a proportion expected to rise to 70 per cent by 2050.

In LMICs, limited healthcare infrastructure exacerbates the problem. Many individuals with dementia go undiagnosed, and those who are diagnosed often lack access to proper care. Additionally, the stigma surrounding dementia in some cultures can delay diagnosis and treatment, compounding the problem. While aging is the most significant risk factor for dementia, it is not the sole determinant. Other non-modifiable risk factors include genetics and family history. However, modifiable risk factors also play a crucial role. Cardiovascular health is a significant determinant, with conditions like hypertension, diabetes, and obesity linked to an increased risk of dementia. Smoking, excessive alcohol consumption, and physical inactivity further exacerbate this risk.

Education and socioeconomic status also influence dementia risk. Studies have consistently shown that lower levels of education are associated with higher rates of dementia, likely due to reduced cognitive reserve. This finding underscores the importance of early-life interventions and lifelong learning as potential protective factors. Emerging evidence also highlights the role of environmental factors, including air pollution, in increasing dementia risk. As research in this area grows, it is likely to uncover new avenues for prevention and mitigation.

Epidemiological studies have revealed a striking gender disparity in dementia prevalence. Women are disproportionately affected, accounting for nearly two-thirds of all cases worldwide. This disparity is partly because women live longer on average than men, giving them more years of exposure to dementia risk factors. However, biological differences, including hormonal changes during menopause, may also contribute to this gap. Understanding these gender differences is crucial for tailoring prevention and care strategies. For example, promoting brain health through physical activity and cognitive stimulation may benefit women more during key life stages.

Prevention

While the lack of a cure for dementia is disheartening, there is growing evidence that lifestyle changes can reduce the risk of developing the condition. Regular physical activity, a healthy diet, and social engagement are all associated with better cognitive health. Managing chronic conditions like hypertension, diabetes, and obesity can also play a preventive role. Education and lifelong learning are particularly important. Studies have shown that higher levels of education and cognitive activity are linked to a lower risk of dementia, likely because they help build cognitive reserve. This suggests that policies promoting education and mental stimulation could have long-term benefits for public health.

Societal challenge

Dementia is not just a medical issue; it is a societal challenge that touches nearly every aspect of life, from healthcare and economics to family dynamics and community well-being. Addressing it requires a shift in how we think about aging, mental health, and caregiving. At its core, tackling dementia is about valuing human dignity. Every person with dementia deserves compassionate care, access to resources, and the opportunity to live as fully as possible. This can only be achieved through collective action by governments, healthcare systems, communities, and individuals.

The rising tide of dementia is not an insurmountable problem. With the right investments in research, education, and care, we can mitigate its impact and improve the lives of millions. But time is of the essence. As the global population ages, the window for action is closing. It is our responsibility to ensure that the future is one where dementia no longer casts such a long shadow over humanity.

(Dr. Lohani is the executive director at the Health Concern. lohanis@gmail.com.)