Dementia

In the majority of LMIC, and in some high-income countries, the
growing prevalence and impact of dementia is not well understood.
This is likely to be reflected in a lack of policy direction and programme
development and in inappropriate allocation of funding. It is
obvious that dementia, its consequences and responses can no
longer be neglected and that it is time that dementia is considered
part of the public health agenda by all stakeholders. Chronic diseases
are gradually gaining attention in the public health arena. In
September 2011, the United Nations convened a summit on noncommunicable
diseases at which it adopted a “political declaration”
which included the acknowledgement that “the global burden and
threat of non-communicable diseases constitutes one of the major
challenges for development in the twenty-first century” (Item 1) and
the recognition that ”mental and neurological disorders, including
Alzheimer’s disease, are an important cause of morbidity and contribute
to the global non-communicable disease burden” (Item 18) (8).
Objectives of the report
The purpose of this report is to raise awareness of dementia as a
public health priority, to articulate a public health approach, and
to advocate for action at international and national levels based on
the principles of inclusion, integration, equity and evidence.
The report provides information and aims to encourage country
preparedness by strengthening or developing policy and implementing
it through plans and programmes which enhance dementia care
in order to improve the social well-being and quality of life of those
living with dementia and their caregivers. It is hoped that this will
lead to international and national advocacy efforts and the prioritization
of dementia on the global health agenda. The target audiences
are national and state ministries of health, policy-makers, and health
and social sector planners, as well as academics and researchers.
In addition, as a practical tool for improvement of dementia care and
support, the report will be useful to organizations (both governmental
and nongovernmental) involved in education and health and
social service provision for older people and people with disabilities.
Development of the report:
methods
The information included in the report is derived from three
primary sources:
• reports from four working groups (on epidemiology; national
policies, plans and resources; awareness and the health workforce;
and caregivers) that reviewed existing literature (including
scientific literature and reports) and collected case examples
relevant to each group;
• an online survey of available resources in 30 countries selected
to represent high, middle and low incomes across the six WHO
regions (Box 1.2); and
• additional information provided by stakeholders from 16 countries
who attended a meeting in Geneva on 27–28 September
2011 (including representatives from public health, academia and
advocacy groups).
Contents of the report
The report has been developed to provide information to countries
that will assist them to develop a response to dementia that is
tailored to harmonize with their particular health and social care
systems. The report is not comprehensive but is a selected review
of information, evidence and current practices and policies. The
management interventions (including psychosocial and pharmacological
ones), have been covered in WHO’s mhGAP Intervention
Guide for mental, neurological and substance use disorders for
non-specialized health settings (9, 10).
The report provides an overview of the current impact of dementia
worldwide. The main focus of the report is dementia in LMIC, where
the impact of dementia is likely to be high and the current level of
preparedness is particularly low. However, the problems described
are by no means confined to developing countries and the report
is useful for all countries. It reviews current resources and strategies
in a number of countries and includes examples of national,
regional and local interventions from which approaches can be
drawn. Examples from specific countries used to illustrate various
issues should not be viewed as assessments of countries overall
health systems, nor should they be taken to mean that any country
is more or less advanced in its approach to dementia than others.
Chapter 2 provides an overview of the global epidemiology of
dementia. It provides a comprehensive evidence-based summary
from epidemiological research pertaining to the global prevalence
of dementia; the prevalence of young onset dementia; dementia
subtypes; the global incidence of dementia; dementia-associated
mortality; the global societal economic cost of dementia; and the
etiology of dementia, and opportunities for prevention.
Chapter 3 includes a description of national-level approaches to
dementia, including policy and plans where they exist, and key
elements for developing a national approach. It reviews issues
relating to the legal and financial support required for people with
dementia and their caregivers, and highlights the ethical implications
that affect all levels of decision-making and planning.
Chapter 4 examines the role of health and social support systems
and their capacity to provide clinical management and long-term
care. This chapter explores the issues around capacity-building of
the health and social care workforce and how this can be enhanced.
Chapter 5 focuses on the caregivers of persons with dementia. It
discusses the key issues that many caregivers experience as a
result of providing long-term and, often, physically and psychologically
demanding care. It identifies the barriers to accessing support,
including the provision of care, and resources that could enable
and improve effective informal care provision.
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