Dementia: A looming crisis for an ageing Europe

By 2050, the proportion of people over the age of 55 in Europe is projected to reach 40.6% of the population. The prevalence of all-cause dementia is expected to double to almost 20 million cases.

As the seventh leading cause of death and a major cause of disability and dependence, dementia poses one of the greatest health challenges of the future and must become a clinical, public health, and social care priority across the world.

In an Editorial, editors of The Lancet Regional Health – Europe provide insights on the three major bottlenecks to addressing the disease—namely a lack of effective drugs for treatment, poor societal awareness about the disease and its management, and high economic costs.

A study by Erik Meijer and colleagues suggests the estimated annual costs of dementia among 11 European countries are exorbitantly high—from 162.9 million EUR in Estonia to 32,606.9 million EUR in Germany—and that informal care constitutes between 50% and 90% of the total costs for the disease.

“Rising costs of dementia care as well as shortages of skilled care staff will pose a challenge for European societies, and accurately projecting resource utilisation and costs of dementia care is important for policy development”, writes Linus J?nsson in a linked Comment.

Efforts to reduce the prevalence of dementia and its economic and social burden are likewise essential. A Health Policy from the European task force for brain health services outlines recommendations for dementia prevention in memory clinics across Europe, with authors pointing to a mitigation strategy involving early detection, risk communication to patients, risk reduction strategies, and cognitive enhancement.

At the other end of the scale is treatment. One hope for dementia treatment came earlier in the year, on 6 January, after the US FDA approved Lecanemab for patients with dementia with mild cognitive impairment or mild dementia. This was on the basis of clinical trials demonstrating the drug removed brain amyloid deposits—predictive of clinical benefit.

While Lecanemab is yet to be approved by the European Medicines Agency, Linus J?nsson and colleagues have estimated its cost burden for the 5.4 million people eligible for treatment across 27 EU countries. Assuming the drug is priced similarly as in the US (26,500 USD per person annually), it would cost a staggering 133 billion EUR a year—over half of the total pharmaceutical expenditure in the EU. Authors warn that disparities in accessing such treatments could deepen health inequalities across the region.

Currently, over 55 million people live with dementia. As populations continue to age in the EU and around the world, it is imperative countries allocate resources more effectively, increase research efforts, and implement robust policies to prevent the unwieldy public health crisis dementia threatens to become.

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This article was written by Pooja Jha and Daniela Marín, Editor-in-Chief and Senior Editor of The Lancet Regional Health – Europe. Information is correct as of 15 June, 2023.

Learn more about dementia as a public health crisis in The Lancet Regional Health - Europe. All pieces quoted in this article can be accessed via the list below:

• Editorial: Challenges for addressing dementia
• Article: Economic costs of dementia in 11 countries in Europe: estimates from nationally representative cohorts of a panel study
• Comment: The personal economic burden of dementia in Europe
• Health Policy: Dementia prevention in memory clinics: recommendations from the European task force for brain health services
• Viewpoint: The affordability of lecanemab, an amyloid-targeting therapy for Alzheimer's disease: an EADC-EC viewpoint