Presidential Lecture
Global trends in dementia strategies
2025 年 11 巻 p. 3-5
詳細
2025 年 11 巻 p. 3-5
The global number of dementia cases is expected to increase to 152 million by 2050, particularly in low- and middle-income countries, significantly impacting individuals, families, and economies.
Various organizations and academic groups have proposed indicators for addressing dementia. The World Health Organization (WHO) indicators focus on early detection, prevention, public health measures, and national policies for dementia, especially from an international perspective. From an academic perspective, the Lancet Commission, which began in 2017 and updated in 2020 and 2024, proposes a comprehensive life course model for dementia prevention. Additionally, the American Heart Association (AHA) expands its cardiovascular health strategy to include dementia prevention through its Life’s Essentials 8 guidelines. Therefore, this review outlines and compares these guidelines and strategies against dementia.
In Japan, the Basic Law for the Promotion of Dementia Measures, enacted in 2023, emphasizes social initiatives alongside individual health management. This study also indicates that with the advent of disease-modifying drugs for Alzheimer’s disease in countries including Japan, the need for early detection and comprehensive care may increase.
The incidence of dementia is declining in developed countries such as Europe, North America, and Japan1) due to the rise in health literacy among society and individuals and the efforts taken by each country to tackle dementia. However, the number of people with dementia worldwide is expected to increase to 152 million by 2050, with cases rising in low- and middle-income countries, which account for two-thirds of dementia patients. Dementia affects individuals, families, and economies, with an estimated global cost of approximately $1 trillion per year2).
Various organizations and academic societies worldwide have proposed recommendations and guidelines for addressing dementia. The World Health Organization (WHO)3) and the Lancet Commission4,5) proposes the leading guidelines. The WHO response to dementia in 2017 through the Global Action Plan aims to improve the lives of people with dementia, their families, and caregivers. The Lancet Commission reconvened the 2017 Lancet Commission on Dementia Prevention, Intervention, and Care to assess the most significant progress since the paper was published and build on those findings.
Following decades of declining mortality rates from cardiovascular disease (CVD), the American Heart Association (AHA) expanded its focus from addressing existing CVD and risk factors to adding the following strategies6). In 2010, the AHA introduced a strategy to promote both population and individual health, known as the AHA Life’s Simple 7. This approach aims to create a novel operational definition of cardiovascular health (CVH). In 2017, the guidelines were updated to include a new section on sleep, leading to an upgraded strategy called AHA Life’s Essential 8.
In this review, the author aims to outline these guidelines and strategies against dementia. Finally, with the advent of disease-modifying drugs for Alzheimer’s disease, the author anticipates the onset of a new era of treatment.
WHO’s approach to dementia began in 2006 with the publication of the “Guidelines for Dementia.” In 2017, the “Global Action Plan” was developed to strengthen the public health responses to dementia until 2025. The “Decade of Healthy Ageing: Plan of Action” was announced in 2020, outlining a 10-year plan till 2030. Additionally, in 2021, the “Toolkit for Comprehensive Dementia Response” was launched.
The WHO indicators focus mainly on dementia prevention and management from an international perspective. The “Decade of Healthy Ageing: Plan of Action” proposes specific initiatives for dementia prevention, while the “Risk Reduction of Cognitive Decline and Dementia: WHO Guidelines” promotes early detection and appropriate responses to dementia by healthcare professionals and policymakers.
The key points of the WHO’s dementia countermeasures are as follows:
1. Early detection and diagnosis: Early detection and accurate diagnosis of dementia are crucial for appropriate interventions and treatments.
2. Comprehensive care: Comprehensive care is necessary for patients with dementia and their families, which includes medical care, nursing care, and social support.
3. Prevention: Strengthening measures to reduce dementia risk by promoting healthy lifestyles and activities that maintain good brain health is significant.
4. Education and awareness: Knowledge of dementia is necessary to encourage understanding and support throughout society.
5. Research and innovation: Extensive research on dementia causes and treatments is crucial to support the development of new remedies and interventions.
Implementing WHO dementia prevention indicators includes specific actions and lifestyles that can reduce the risk of dementia.
1. Healthy diet: Consume a balanced diet, especially foods rich in vitamins and minerals.
2. Moderate exercise: Exercise regularly to maintain brain health, targeting 150 minutes of moderate exercise per week.
3. Brain stimulation: Engage in brain-stimulating activities, such as reading, solving puzzles, and learning.
4. Social connections: Maintain contact with family and friends to support mental health.
5. Sleep quality: Ensure adequate sleep to maintain cognitive function.
6. Stress management: Manage stress effectively and have time to relax.
The WHO act various commitments towards the prevention and management of dementia. It has announced the Global Dementia Observatory (GDO), a platform developed by the WHO to monitor and share information on dementia at the global, regional and national levels7). The GDO monitors the implementation of the Global action plan on the public response to dementia 2017–25. It collects data from WHO Member States on 35 key dementia indicators to strengthen countries’ ability to respond to the needs of people with dementia, their careers and families.
• GDO builds a comprehensive model to track progress across seven strategic areas of the Global dementia action plan.
• It measures countries’ contributions towards achieving global targets through a core set of indicators.
The Lancet Commission proposes indicators for dementia prevention from an academic perspective, which differs from the WHO perspective. In 2017, it published a comprehensive report on “Dementia Prevention, Intervention, and Care,” which identified individual risk factors and proposed measures for each.
This study identified nine modifiable risk factors for dementia: low levels of education, hypertension, hearing impairment, smoking, obesity, depression, low physical activity, diabetes, and poor social contact. In 2020, the report4) was updated to recognize highly impacting evidence of progress and identified three additional risk factors: excessive alcohol consumption, traumatic brain injury, and air pollution. Consequently, a comprehensive life- course model for dementia prevention was proposed with targets to be achieved by each generation.
The latest report5) published in 2024 incorporated new evidence. In this report, vision loss and high LDL cholesterol levels were added as risk factors, totaling 14 factors. Eliminating these risk factors could potentially reduce the incidence of dementia by approximately 45%.
The recommendations of the Lancet Commission identified the risk factors for dementia and suggested specific measures to manage them. The key features are:
1. Identifying risk factors: Fourteen factors affecting the risk of developing dementia were identified, including high LDL cholesterol, uncorrected vision loss, depression, social isolation, lack of exercise, and air pollution.
2. Prevention and delay: Improving these risk factors can delay or prevent dementia onset, reducing the risk of dementia by approximately 45%1).
3. Education and awareness: Promoting knowledge about dementia prevention and encouraging understanding and support throughout society is crucial.
4. Promoting healthy lifestyles: Encouraging lifestyles, such as healthy eating, moderate exercise, stress management, high-quality education, and social connections, is essential to maintaining brain health.
In 2017, AHA added sleep to Life’s Simple 7 and updated it to AHA Life’s Essential 8.
The AHA Life’s Essential 8 is an important indicator for improving and maintaining cardiovascular health, and practicing it can reduce the risks of heart disease and dementia. These indicators are scored and can help guide individual patients. The eight health behaviors and factors are as follows:
1. Balanced diet: Aim for an overall healthy eating pattern, including vegetables, fruit, low-fat protein, nuts, seeds, and non-tropical oils (e.g., olive oil and canola oil)
2. Moderate physical activity: Adults should aim for 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity physical activity per week, while children should aim for 60 minutes of physical activity per day.
3. Stop smoking: Stop smoking or using e-cigarettes.
4. Good quality sleep: Adults should aim for 7–9 hours of sleep each night, and children should also get adequate sleep based on age.
1. Weight management: Maintain a body mass index (BMI) between 18.5 and less than 25 to keep a healthy weight.
2. Cholesterol management: Manage non-HDL cholesterol levels (bad cholesterol).
3. Blood glucose management: Manage high blood glucose to ensure long-term control.
4. Blood pressure management: Keep blood pressure within an appropriate range (ideally less than 120/80 mmHg).
The WHO, Lancet, and AHA indicators offer unique characteristics. The WHO provides comprehensive guidelines to promote healthy living. Regarding dementia prevention, it emphasizes the importance of proper nutrition, regular exercise, and maintaining social connections.
The Lancet, a medical journal, publishes research on dementia prevention. The Lancet indicators focus on lifestyle habits that contribute to brain health, such as acquiring a high level of education, occupational activity, and social participation.
The AHA Life’s Essential 8 is an indicator for preventing heart disease but is also pertinent to dementia prevention. This indicator underscores the significance of a healthy diet, appropriate exercise habits, avoiding smoking, and maintaining an appropriate body weight.
While each indicator uniquely supports general health, they all indicate the importance of a healthy lifestyle. The most suitable indicator can vary based on the individual’s lifestyle and health condition, making it crucial to consider which guidelines are appropriate in situations such as national policymaking and when doctors guide individual patients.
The three guidelines outlined in this review highlight the importance of social initiatives in addition to individual health management. Notably, the implementation of these measures and social initiatives differs across countries. In Japan, the Basic Act for Dementia Policy Promotion was enacted in 2023, introducing legal measures to create a society in which people with dementia coexist. Recently, anti-Aβ antibody therapy for Alzheimer’s disease has been introduced in Japan and some other countries, which may raise awareness of dementia and its treatment. Against this backdrop, efforts may be made not only to prevent dementia but also to detect and diagnose it at the level of mild cognitive impairment and early dementia, linking this effort to effective treatment. The WHO, Lancet Commission and AHA have not issued any formal statements on anti-Aβ antibody therapy. However, the Lancet did publish an editorial entitled “Divisions over lecanemab: keeping an open mind”8). In it, it states, “lecanemab—the first disease-modifying drug for the disease—has been approved in some regions and refused in others, highlighting wide divisions within the medical community. Although debates about the efficacy and safety of lecanemab are necessary, regulators and clinicians should remain receptive to new evidence and advances that have the potential to transform the lives of people with Alzheimer’s disease.” Considering this social context, society may continue to advance efforts in the future.
The Author has no potential conflicts of interest to declare.
