Countries in the Middle East will face a tidal wave of dementia cases by 2050 if nothing is done to prevent it. This disturbing forecast by research scientists was published in The Lancet Public Health in 2022. Qatar and the UAE, for example, will see unprecedented increases in cases of dementia by 2050, which are projected to rise from current levels by a massive 1926% and 1795% respectively. Other countries in the region are also forecast to experience exceptionally large increases in dementia. Middle East Health speaks to Paolo Barbarino, CEO, Alzheimer’s Disease International, to find out more about these forecasts and what can be done to mitigate these distressing projections.
The number of adults (aged 40 years and older) living with dementia worldwide is expected to nearly triple, from an estimated 57 million in 2019 to 153 million in 2050, due primarily to population growth and population ageing, according to a Global Burden of Disease study published in The Lancet Public Health [1].
In the Middle East and North Africa (MENA), cases are predicted to grow by 367%, from almost 3 million to nearly 14 million, with worryingly large increases in Qatar (1926%), the United Arab Emirates
(1795%), and Bahrain (1084%).
Paolo Barbarino, CEO, Alzheimer’s Disease International (ADI), said these distressing figures are credible and are similar to their own forecasts. However, she added, the MENA forecasts are probably predicated on a low base figure due to under-reporting of dementia in the region.
“Dementia may have been severely under-reported,” said Barbarino. “We know this happens in other countries where governments are in denial about dementia. Although that’s not the case in the Middle East where governments in general are aware that it exists, it may still have been under-reported. This is not unusual, since the care for persons with dementia would have happened primarily in the home and would not have been recorded.”
She said that more research is needed to show why there has been under-reporting.
“Is it due to home-based care or a lack of awareness, for example?”
Regarding potential lack of awareness, Barbarino referred to a global survey ADI conducted in 2019 in which 62% of the healthcare professionals surveyed around the world did not consider dementia a disease, but rather that dementia was caused by normal ageing.
“62% is a massive figure,” Barbarino emphasised. It speaks volumes to the lack of attention this disease has been afforded in the recent past.
More dementia research needed Although there has been an increase in research on dementia in general and Alzheimer’s Disease in particular, it is still relatively small. Barbarino referred to a report by ADI in 2017 that showed that for every 12 studies on cancer worldwide there was only one on neurodegenerative diseases.
“This highlights the disproportionate knowledge we have about dementia compared to cancer. And even though there has been an increase in funding for dementia research, the bulk of this funding is being used to find a pharmacological treatment for the disease, when actually we need all kinds of research – research on risk-reduction, research on care, and research on psychosocial intervention, for example,” said Barbarino.
At government level, the United States is putting the most money into research by a long way, she said. This is followed by the UK, Australia and Canada. There is a research in all high-income countries, but on a relatively small scale.
“At ADI we advocate for 1% of the societal cost of the disease to be spent on research – which we have estimated for each country. However, only the United States comes close to this,” she pointed out.
“We need research on all aspects of dementia. However, diagnostics research is particularly important. We recently published a report on this, because at the moment you can only get a confirmatory diagnosis of Alzheimer’s by doing a PET scan and by doing a lumber puncture. A lumber puncture is painful and invasive and people generally don’t like them. A PET scan is, in many cases, prohibitively expensive if it is available at all. So we need more research in this area.”
She noted that there has been some progress on the development of blood-based biomarkers for diagnosis, which show a lot of promise. “But they are not quite there yet,” she added.
Early warning signs and risk reduction
Barbarino explained that there are early warning signs for dementia and they can help people prepare for the onset of dementia and potentially delay its onset through various lifestyle or behavioural changes.
Early signs and symptoms of dementia include: memory impairment, such as difficulty remembering events; difficulty concentrating, planning or problem-solving; problems finishing daily tasks at home or at work, such as writing or using eating utensils.
“In Japan they diagnose people at risk as young as the late 30s, or at least in their
40s. The earlier the diagnosis, the better. There seems to be no doubt in the scientific community that you can start lifestyle interventions to reduce your risk of dementia, such as changing your physical habits, doing more exercise, and changing your eating habits to eat more healthy food.
“There are ongoing studies that indicate that early interventions can lower the risk factors for dementia.
“For example, there is evidence that traumatic brain injury causes dementia. So for sportspeople who have been playing football or rugby for many years, stopping playing the sport may help.
“Can you do anything to reverse it? This is not known. So really all we have at this stage is risk reduction. Risk reduction seems to slow it down.”
Barbarino advised that public health stakeholders and governments in the Middle East, who are facing this impending tidal wave of dementia over the next few decades, should now start promoting early diagnosis of risk at the level of primary care so that early interventions can be implemented to reduce the risk and slow the on-set of dementia.
The role of ADI
Talking about the role of ADI, Barbarino explained that the organisation “exists to increase awareness of dementia at all levels, including the public, healthcare workers, governments and the people who make the policies. We help dementia-related organizations in countries around the world become stronger, so they can advocate better. But fundamentally, we also exist to spread awareness of the best way for people with dementia and their families to live their lives after they’ve been diagnosed.
“We also exist to provide clarity, to provide information about what is real and what is disinformation with regards dementia.”
Public health stakeholders and governments in the Middle East, who are facing this impending tidal wave of dementia over the next few decades, should now start promoting early diagnosis of risk at the level of primary care so that early interventions can be implemented to reduce the risk and slow the onset of dementia.
She explained there is a lot disinformation about treatments and cures which have to be corrected as there is no evidence to support them. There is no cure, she emphasised.
“When requested to, we also provide advice and recommendations to government about dementia.” For example, she said Ukraine had approached ADI for recommendations on the best way to design care homes to cater for people with dementia.
“However, usually we advise governments to work with our local member, the local Alzheimer’s organisation in that specific country. We believe the local organisation will have the best local knowledge.”
- To learn more about ADI, visit: www.alzint.org
References:
Estimation of the global prevalence of dementia in 2019 and forecasted prevalence
in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health
2022 Published online January 6 2022. https://bit.ly/31KORwW
Early warning signs of dementia
These are some common early symptoms that may appear some time before a diagnosis of dementia. They include:
- memory loss
- difficulty concentrating
- finding it hard to carry out familiar daily tasks, such as getting confused over the correct change when shopping
- struggling to follow a conversation or find the right word
- being confused about time and place
- mood changes
These symptoms are often mild and may get worse only very gradually. It’s often termed “mild cognitive impairment” as the symptoms are not severe enough to be diagnosed
as dementia.
Symptoms specific to Alzheimer’s disease
The most common cause of dementia is Alzheimer’s disease. Common symptoms of Alzheimer’s disease include:
- memory problems, such as regularly forgetting recent events, names and faces
- asking questions repetitively
- increasing difficulties with tasks and activities that require organisation and planning
- becoming confused in unfamiliar environments
- difficulty finding the right words
- difficulty with numbers and/or handling money in shops becoming more withdrawn or anxious
Source: NHS UK
https://www.nhs.uk/conditions/dementia/symptoms-and-diagnosis/symptoms/
