The world-wide projections of the prevalence of dementia in the coming decades have been a source of great concern to health systems and societies around the world. The World Alzheimer Report 2010 estimated that there were 36 million people with dementia in 2010, with an expected doubling every 20 years to nearly 115 million in 2050. These sobering figures are based on assumptions that the age-adjusted prevalence of dementia would remain constant and the population would continue to age at the current rate.
The assumption that the incidence of dementia will remain stable is now being put into question. There is emerging evidence to suggest that the incidence of dementia in older individuals may be declining. It appears that this change may be recent and has possibly occurred only in the last one to two decades. It may also be restricted so far to high income countries, although data from low and middle income countries are lacking.
The reasons for this change are not understood, but education, more stimulating environments and better control of vascular risk factors may have contributed. The data are still preliminary and more studies are needed to establish the extent of this change and understand its causes. It should be noted that the decline is not large enough to offset the increase in prevalence of dementia due to the ageing of the population and therefore investment and efforts to develop better treatments and care for people with dementia need to continue.
The fact that dementia rates are malleable is an encouraging finding but the reduction cannot be taken for granted as gains in population health can easily be lost if societies do not remain vigilant and continually proactive. These preliminary findings provide a strong argument for large scale Government investment in dementia-prevention strategies, which should start from early life.