Hot topic: Can the world cope with a tripling of dementia cases by 2050?

September is World Alzheimer’s Month, and while advances in treatment of the degenerative brain disease have been big news over the last couple of years, it is worth reflecting on the wider picture.

Alzheimer’s – together with other forms of dementia – become much more frequent as people age. The growing incidence of dementia worldwide is therefore largely a function of the growth in the numbers of older people.

Between now and 2050 the number of over 65s globally is set to double, from roughly 700 million to 1.5 billion. Meanwhile, the number of over 80s is due to almost treble from around the 150 million mark now, to some 400 million in 2050.

It comes as no surprise then that the number of dementia cases is due to roughly triple, from an estimate 57 million worldwide now to 153 million in 2050.

That’s in just 25 years. And incidence won’t magically stop rising in 2050 – it’ll keep going up.

This explains the urgency with which the research community has been trying to find effective disease-modifying treatments that can slow (or ideally stop) the degeneration of the brain, and the euphoria felt by many with the approval by US FDA and Europe’s EMA of the first two such drugs – lecanemab (Eisai’s Leqembi) and donanemab (Eli Lilly’s Kisunla) – although the balance of risks and benefits with these two is hotly debated. Improved drugs capable of safely arresting disease progression in Alzheimer’s and other forms of dementia are desperately needed.

Scientists are also putting huge efforts into being able to reliably detect dementia early in the course of disease, before major damage has been wreaked, as the earlier effective drugs can be given, the better.

There is now much more optimism that safe and effective anti-dementia drugs, as well as accurate early-stage diagnosis, are within reach.

Yet even if we reach these incredible milestones, the world faces a massive challenge dealing with the rising number of people who have dementia.

New drugs – and testing programmes – will be costly. How will ‘rich’ countries like the UK – which is already struggling under the burden of growing healthcare costs – afford them? For that matter, what about middle-income and poorer countries?

In the longer term, the wonder drugs of tomorrow will go off-patent, making them cheaper …. but that is a very long time in the future.

Given the complexity of dementias of all types, and despite the huge progress being made, it also seems unlikely scientists will come up with a “silver bullet” medicine that helps everyone. A personalised combination of therapies may well be the way forward.

With all this in mind, countries can’t afford to imagine that the dementia problem will simply be solved by science. Serious thought needs to be put into how we care for those affected, who cares for them, and how we afford that care.