Elsevier

The Lancet Neurology

Volume 15, Issue 5, April 2016, Pages 455-532
The Lancet Neurology

The Lancet Neurology Commission
Defeating Alzheimer's disease and other dementias: a priority for European science and society

https://doi.org/10.1016/S1474-4422(16)00062-4Get rights and content

Section snippets

Executive summary

Alzheimer's disease (AD) is the leading cause of dementia, and because the primary risk factor for AD is old age, the prevalence of the disease is increasing dramatically with ageing populations worldwide. Even in high-income countries, the cost of medical care and associated societal burdens of dementia threaten to become overwhelming as more people live into old age. In view of the lack of progress in developing a cure for AD and the rapidly increasing costs of dementia, policy makers and

Health economics of Alzheimer's disease

AD has a substantial economic impact for each person and family affected. A 2011 study8 of a multinational (Spain, Sweden, the UK, and the USA) sample of 1222 patients estimated that societal costs amount to about €14 500 per year in patients at home with a high level of autonomy in activities of daily living (ADL), but rises up to €72 500 per year in patients who need residential care. In 2014, the direct cost of AD for payers in the USA alone was estimated to be $214 billion.9 For comparison,

Epidemiology of Alzheimer's disease and dementia

The burden of AD and other dementias, which is projected to surge in the coming decades, poses a serious threat to the sustainable development of economies and the social welfare systems of Europe. Epidemiological studies generate knowledge about the occurrence (eg, prevalence and incidence), distribution (eg, demographic, geographical, and temporal variations), determinants (eg, genetic and non-genetic risk or protective factors), health economics (eg, costs of health care and

Prevention of cognitive impairment and dementia

WHO3 and health and science ministers of the G8 dementia summit173 have recognised dementia as a public health priority, and prevention has been identified as one of the key elements in addressing the dementia epidemic, as for other major non-communicable diseases (eg, cardiovascular disease). It is estimated that a third of AD cases worldwide might be attributable to seven modifiable risk factors—low education, midlife hypertension, midlife obesity, diabetes, physical inactivity, smoking, and

Genetic risk of Alzheimer's disease: individual susceptibility

Evidence from genetic studies explains how genetic variability, present in DNA from conception, contributes to the development of AD later in life. Genetic epidemiology attempts to understand how genetic make-up lends resistance or vulnerability to environmental exposures, such as lifestyle factors and medical illnesses. The effect of individual genetic susceptibility on the occurrence of AD is substantial, with the heritability of AD usually estimated to be greater than 60% (ie, >60% of

Biology of Alzheimer's disease

In 1906, Alois Alzheimer described the pathological changes present in the brain of the first patient with AD, Auguste D. In the past 110 years, substantial knowledge has been gained about the genetic and environmental factors that contribute to the disease (sections 3, 4). However, what triggers the characteristic pathology of AD and which mechanisms drive the progression of the disease remain unknown. Understanding of the basic biology of AD pathogenesis and the way in which clinical dementia

Diagnosis and clinical assessments in Alzheimer's disease

The consequences of a diagnosis of AD for patients and their families are complex. AD is one of the diseases most feared by the general public, and the disclosure of a dementia diagnosis can result in severe mental distress, with evidence of an increased risk of suicide after diagnosis.319 However, with the right approach, evidence suggests that a diagnosis can relieve symptoms of anxiety in patients because it explains a frightening loss of cognitive capacities.320 At more advanced stages of

Pharmacological treatment of Alzheimer's disease

The increasing number of people with AD is leading to substantially more use of pharmacological treatments and greater medication costs. For example, in Sweden, the total drug costs for people with dementia constituted about 1·1% of the societal costs of dementia in 2000, 1·6% in 2005, and 1·8% in 2012.375 Although drug costs are a small proportion of the total societal cost of dementia (the largest proportion of costs, around 80%, is within the municipal sector, for long-term care), they

Non-pharmacological interventions for dementia and mild cognitive impairment

Although considerable efforts have been made to improve understanding of the neurobiology of AD (section 5) and to identify and evaluate candidate disease-modifying therapies (section 7), far less effort has been focused on the development and implementation of non-pharmacological interventions. Insufficient focus on these approaches represents a missed opportunity, because the identification of effective non-pharmacological interventions for key indications is a much more tractable short-term

Formal and informal care for people with dementia

People with dementia need care and support in many areas of their lives. This support might be provided by health-care, social-care, housing, transport, leisure, or other sectors. Irrespective of the provider, support can be grouped into three main domains: support in basic ADL, support in IADL, and supervision to safeguard individuals from harm.485 In addition to these forms of care and support, individuals with dementia might receive care from specific medical services, such as injections,

Ethical considerations

With expanding knowledge of the genetics (section 4) and biology (section 5) of AD, and innovation in the diagnostic and management options for patients (sections 6–9), new ethical issues require careful attention to ensure improved quality of life and wellbeing for this vulnerable group. These issues—which pertain to prevention, diagnosis, guidance in advanced-care decision making, treatment, and policy making—affect both research and care.

The rapidly growing number of people with AD and other

G8 targets: towards an international dementia data-sharing network

One of the main targets agreed at the G8 dementia summit is for researchers to work together and share data from their studies, including sharing initiatives for so-called big data (ie, the analysis of large datasets, mostly acquired by online tracking of a large population's behavioural patterns).552 However, many obstacles need to be overcome in sharing research and clinical data for dementia research. For example, data sharing demands the safeguarding of relevant privacy and legal issues,

Conclusion and future European perspectives

AD is the leading cause of dementia, and because the primary risk factor for AD is old age, the prevalence of the disease is increasing dramatically as life expectancy increases worldwide. The explosion in care costs and associated societal burdens of AD and other dementias threatens to become overwhelming, even in resource-rich countries. However, AD is not an inevitable consequence of ageing, and further work is needed to identify modifiable risk factors and protective factors—including a

First page preview

First page preview
Click to open first page preview

References (560)

  • HH König et al.

    The costs of dementia from the societal perspective: is care provided in the community really cheaper than nursing home care?

    J Am Med Dir Assoc

    (2014)
  • A Marengoni et al.

    Aging with multimorbidity: a systematic review of the literature

    Ageing Res Rev

    (2011)
  • J Weuve et al.

    Deaths in the United States among persons with Alzheimer's disease (2010–2050)

    Alzheimers Dement

    (2014)
  • CJ Murray et al.

    UK health performance: findings of the Global Burden of Disease Study 2010

    Lancet

    (2013)
  • M Prince et al.

    Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study

    Lancet

    (2012)
  • RN Kalaria et al.

    Alzheimer's disease and vascular dementia in developing countries: prevalence, management, and risk factors

    Lancet Neurol

    (2008)
  • CP Ferri et al.

    Global prevalence of dementia: a Delphi consensus study

    Lancet

    (2005)
  • KM Langa et al.

    Trends in the prevalence and mortality of cognitive impairment in the United States: is there evidence of a compression of cognitive morbidity?

    Alzheimers Dement

    (2008)
  • KS Hall et al.

    Prevalence rates for dementia and Alzheimer's disease in African Americans: 1992 versus 2001

    Alzheimers Dement

    (2009)
  • WA Rocca et al.

    Trends in the incidence and prevalence of Alzheimer's disease, dementia, and cognitive impairment in the United States

    Alzheimers Dement

    (2011)
  • FE Matthews et al.

    A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II

    Lancet

    (2013)
  • KY Chan et al.

    Epidemiology of Alzheimer's disease and other forms of dementia in China, 1990–2010: a systematic review and analysis

    Lancet

    (2013)
  • LJ Whalley

    Spatial distribution and secular trends in the epidemiology of Alzheimer's disease

    Neuroimaging Clin N Am

    (2012)
  • YT Wu et al.

    Dementia in western Europe: epidemiological evidence and implications for policy making

    Lancet Neurol

    (2016)
  • J Jia et al.

    The prevalence of dementia in urban and rural areas of China

    Alzheimers Dement

    (2014)
  • Diagnostic and statistical manual of mental disorders

    (1987)
  • M Prince et al.

    World Alzheimer Report 2015: The global impact of dementia. An analysis of prevalence, incidence, costs and trends

    (2015)
  • Dementia: a public health priority

    (2012)
  • First WHO ministerial conference on global action against dementia: meeting report

    (2015)
  • European initiative on Alzheimer's disease and other dementias

  • A Wimo et al.

    The worldwide economic impact of dementia 2010

    Alzheimers Dement

    (2013)
  • 2014 Alzheimer's disease facts and figures

    Alzheimers Dement

    (2014)
  • The global economic burden of non-communicable diseases

  • Global Alzheimer's diagnosis and drugs market—growth, trends and forecast (2015–2020)

  • M Prince et al.

    World Alzheimer Report 2011: The benefits of early diagnosis and intervention

    (2011)
  • A Wimo et al.

    Costs of diagnosing dementia: results from SveDem, the Swedish Dementia Registry

    Int J Geriatr Psychiatry

    (2013)
  • A Gustavsson et al.

    Willingness-to-pay for reductions in care need: estimating the value of informal care in Alzheimer's disease

    Int J Geriatr Psychiatry

    (2010)
  • PJ Neumann et al.

    Health utilities in Alzheimer's disease: a cross-sectional study of patients and caregivers

    Med Care

    (1999)
  • L Jönsson et al.

    Patient- and proxy-reported utility in Alzheimer disease using the EuroQoL

    Alzheimer Dis Assoc Disord

    (2006)
  • MM Brown et al.

    Utility values associated with blindness in an adult population

    Br J Ophthalmol

    (2001)
  • B Mulhern et al.

    Development of DEMQOL-U and DEMQOL-PROXY-U: generation of preference-based indices from DEMQOL and DEMQOL-PROXY for use in economic evaluation

    Health Technol Assess

    (2013)
  • L Hausner et al.

    Regional variation on the presentation of Alzheimer's disease patients in memory clinics within Europe: data from the ICTUS study

    J Alzheimers Dis

    (2010)
  • WHO methods and data sources for global burden of disease estimates 2000–2011

  • WHO health statistics and information systems: Estimates for 2000–2012

  • D Chisholm et al.

    Generalized cost-effectiveness analysis for national-level priority-setting in the health sector

    Cost Effect Resource Allocation

    (2003)
  • M Lagergren et al.

    A longitudinal study integrating population, care and social services data. The Swedish National study on Aging and Care (SNAC)

    Aging Clin Exp Res

    (2004)
  • A Sköldunger et al.

    Mortality and treatment costs have a great impact on the cost-effectiveness of disease modifying treatment in Alzheimer's disease—a simulation study

    Curr Alzheimer Res

    (2013)
  • Dementia in Europe yearbook 2013

  • A Joshi et al.

    Comparison of clinical characteristics between familial and non-familial early onset Alzheimer's disease

    J Neurol

    (2012)
  • RL Handels et al.

    Determinants of care costs of patients with dementia or cognitive impairment

    Alzheimer Dis Assoc Disord

    (2013)
  • Cited by (1179)

    View all citing articles on Scopus
    View full text