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)