4 Special reportDementia The EconomistAugust 29th 2020
2 Swaffer, an Australian diagnosed with de-
mentia in 2008 who chairs Dementia Alli-
ance International, a campaigning group,
sums up the advice she got: “Go home and
prepare to die.”
Dementia used to be called “senile de-
mentia” or simply “senility”. But a small
minority of sufferers are not old at all. In
1906 Alois Alzheimer, a German psychia-
trist, conducted an autopsy on Auguste De-
ter, a woman who had developed dementia
in her 40s. He noticed abnormalities also found in the brains of
older people with dementia. Of the dozens of forms of dementia
identified, the pathology known as “Alzheimer’s disease” is the
commonest, accounting for between 60% and 80% of cases. Next,
each accounting for 5-10%, are vascular dementia, caused by an in-
adequate flow of blood to the brain, and Lewy body dementia.
All forms of dementia become more prevalent in old age, and so
will become more widespread as life expectancy rises. As people in
less well-off parts of the world enjoy longer lives, that is where
three-quarters of new cases will arise. In 2015 the oecd estimated
that by 2030 the number of cases of dementia would increase by
50% in rich countries and 80% in poorer ones. Some 82m people
will have dementia by 2030 and 152m by 2050. Encouraging recent
research in America and parts of Europe suggests that changing
lifestyles may be bringing down the incidence of age-specific de-
mentia. But it appears to be rising elsewhere, so global projections
are unlikely to be revised downwards.
Dementia disproportionately affects women, even allowing for
their longer life expectancy. In America two-thirds of people with
Alzheimer’s are female, and 60% of carers at home are women.
China has more people with dementia than any other country—an
estimated 9.5m people (it includes Taiwan in its total). India, a
younger country, with a median age of 28 compared with China’s
38, and lower life expectancy (70 compared with 77) had some 4m
in 2018, mostly undiagnosed, a number that may reach 7.5m by- Other places with big numbers are the European Union, with
an estimated 9.1m in 2018, America (about 6m) and Japan (5m).
Set against the size of the world’s population, these numbers
may seem manageable. That is illusory. Nowhere in the world, rich
or poor, is equipped to deal with the scale of the problems created
by dementia. No cure exists, and even the most hopeful new thera-
pies will have only a mild impact. So all these dementia patients
will need to be cared for—often for many years.
Humane care will require vast numbers of people, and huge
sums of money. An estimate cited by the World Health Organisa-
tion (who) put the annual global cost of caring for people with de-
mentia at $1trn in 2018, rising to $2trn by
2030, a total “that could undermine social
and economic development globally and
overwhelm health and social services, in-
cluding long-term care systems specifi-
cally”. In Japan, governments have for de-
cades tried to create systems to deal with
the problem, but officials admit they are
unsustainable. There will be neither mon-
ey nor carers enough to cope. In 2018 the
average lifetime cost of care for an Ameri-
can with dementia was put at nearly
$350,000, with 70% being the costs of care
at home by families. Many poorer coun-
tries have yet to confront the problem at all.
The covid-19 pandemic has shown the
fragility of many health-care systems, and
drawn attention to the large numbers of
people with dementia who occupy hospital beds mainly because
of a lack of alternative facilities to care for them. When the virus is
defeated, dementia will continue to spread. In her book “Where
Memories Go”, a memoir of her mother who had Alzheimer’s, Sally
Magnusson, a journalist, calls dementia “perhaps the greatest so-
cial, medical, economic, scientific, philosophical and ethical chal-
lenge of our times”. Hyperbole? Yet many politicians seem to agree
with Ms Magnusson.
In 2013 David Cameron, Britain’s prime minister, used his
chairmanship of the g8 to convene a “dementia summit”. Other
leaders have adopted the cause. Moon Jae-in, South Korea’s presi-
dent, campaigned on a pledge to get the state to take on more of the
burden of dementia care. In 2017 the whopublished a “global ac-
tion plan on the public-health response to dementia”.
So dementia could hardly be said to be below the radar. In Brit-
ain, for example, 52% of people know somebody with the condi-
tion. And it has not spared the famous: Ronald Reagan and Marga-
ret Thatcher had dementia, along with many other statesmen,
sports stars and writers.Eminently forgettable
Yet campaigners working for dementia charities around the world
have a point when they argue that theirs is an underfunded cause.
Covid-19 is likely only to make things worse, as the pandemic
sucks in money and medical expertise. Already dementia research
receives far less money than cancer or coronary heart disease
(chd). A global study in 2018 found 250,000 papers on dementia
compared with 3m on cancer. That matches funding in Britain, ac-
cording to the charity Alzheimer’s Research uk, where dementia
attracts 7.4% of the sums that go into cancer, and 12% of the money
forchd. And everywhere, the costs of long-term care for people
with dementia can be crippling—and are not usually covered by
health insurers.
The comparative neglect of dementia has several causes. One is
that it often falls between different government agencies. In the
absence of useful medical interventions, health ministries do not
want the strain of looking after untreatable and perhaps otherwise
healthy people on their budgets. Often the provision of long-term
care is the responsibility of local governments, so its availability
and quality vary wildly.
More fundamentally, the old notion that dementia is a natural
part of the ageing process is deep-rooted—held by two-thirds of
people and even by 62% of medical practitioners, according to a
survey last year by Alzheimer’s Disease International (adi), an ad-
vocacy group. It also found that one in five people attributed de-
mentia to bad luck and almost 10% to God’s will. As many as 2%
blamed witchcraft. That belief, held in some African countries,
where those with dementia may be
shunned or persecuted, is the starkest ex-
ample of the stigma attached to dementia.
No other disability, Ms Swaffer points out,
is treated in the way hers was dismissed.
As adiputs it in its 2019 annual report:
“When a person has dementia, the condi-
tion takes over as the main descriptor of
who they are. The stigma cancels the indi-
vidual’s personality or personal history.”
On top of the stigma the condition
brings, there is another reason why people
prefer not to confront the dementia emer-
gency: fear. Knowing how likely they are to
develop it, and seeing the difficult lives of
those who already have, they prefer to look
the other way—and just hope that a cure
will one day be found. 7On the up
Global dementia prevalence, m
Countries by income groupSource:Alzheimer’sResearchUK6040200
504540353025202015HighUpper middleLower middle
LowFORECASTAnother estimate
is that, at the age
of 85, between a
third and a half
of people have
dementia