Alzheimer’s Disease – A Global Response to a Global Challenge

The Global Challenge

Alzheimer’s Disease remains both a current issue and a future challenge. Levels of the disease in the European Union have been predicted to double from the current estimate of 7,853,705 to 14,298,671 by 2050 while levels in the wider European region will increase from 9,780,678 to 18,846,286 (1). The  Alzheimer’s Disease Facts and Figures report issued by the Alzheimer’s Association revealed that the cost of care for Alzheimer’s disease or other dementias in the US is expected to exceed a quarter of a trillion dollars for the second year in a row (2).

Image credit: Biophys Ltd.

These figures, significant as they are, can be considered to be the tip of the iceberg. The incidence has been quantified as being at about 5% in Europe (3). In the WHO European Region, dementia is the leading cause of dependency and disability among older people. In the developing world, particularly Asia, the incidence of dementia is set to grow even faster due to existing under-reporting and the demographics of an increasingly ageing population (4).  About 60% of people with dementia live in low- and middle-income countries, but by 2050 this will rise to 71%. The fastest growth in the elderly population is taking place in China, India, South Asia and the Western Pacific regions (5) There are also a number of social factors that influence the reporting of Alzheimer’s Disease among certain communities. The Alzheimer’s Association reported that 34% of Asian Americans have experienced some form of discrimination when seeking Alzheimer’s care. The rate among white Americans was much lower, at 9%. A report suggested that Chinese Americans were embarrassed about having a relative with Alzheimer’s Disease (6).

In addition to the growing incidence and social factors that affect how Alzheimer’s Disease is reported in different regions and among different ethnicities, there is also an ongoing debate about the causative factors (and therefore possible preventative measures) that affect the occurrence and development of Alzheimer’s Disease. Some of these factors influence national and regional responses to the disease. It is timely to provide a high-level overview of global approaches and attitudes to Alzheimer’s Disease and to consider how these might influence approaches to mitigate the effects of the disease in an ageing global population.

Global Responses

International

Both the UN and the WHO have initiatives based around healthy ageing. According to the WHO, currently more than 55 million people live with dementia worldwide, and there are nearly 10 million new cases every year. Alzheimer's disease is the most common form of dementia and may contribute to 60-70% of cases. Dementia is currently the seventh leading cause of death among all diseases and one of the major causes of disability and dependency among older people globally. Globally, over 60% of those suffering from dementia are living in low- and middle-income countries.

The WHO have launched a Global Exchange Platform for dementia which encourages countries to share best practice – https://globaldementia.org/en. The WHO Toolkit for Dementia-friendly activities has been launched – https://www.who.int/publications/i/item/9789240031531.

The UN Health Agency launched a global monitoring system for dementia in 2017 – https://news.un.org/en/story/2017/12/638622-un-health-agency-launches-first-global-monitoring-system-dementia. In addition, the UN has initiated a Decade of Healthy Ageing with a “pledge to take meaningful action to improve the lives of older people, their families and communities.” – https://www.decadeofhealthyageing.org/. It is unclear how this will be translated into actions.

Europe

There are a number of national and European bodies that are involved in research and the consequences of Alzheimer’s Disease. These include Alzheimer Europe (https://www.alzheimer-europe.org/) and Alzheimer’s Societies under the banner of Alz.org in several countries including France (https://www.alz.org/fr/dementia-alzheimers-france.asp), the UK (https://www.alzheimers.org.uk/), Germany (https://www.alz.org/de/dementia-alzheimers-germany.asp), Italy (https://www.alz.org/it/dementia-alzheimers-italy.asp) and others.

The EU and its agencies (including the Joint Research Centres (JRCs) have initiated a number of studies including the production of certified reference material (7), the European Platform for Neurodegenerative Diseases (EPND) and the European prevention of Alzheimer’s dementia consortium (EPAD – https://www.imi.europa.eu/projects-results/project-factsheets/epad) , both of these are part of the EU Innovative Medicines Initiative (https://www.imi.europa.eu/). The EU Joint Programme on Neurodegenerative Disease (JPND) is the is the largest global research initiative on neurodegenerative diseases (https://www.neurodegenerationresearch.eu/). It also has a research mapping database which contains data on the scope and spread of research related to neurodegenerative disease in 27 member countries.

The US

There are a number of initiatives in the US including those coordinated by the Alzheimer’s Association, which is the biggest non-profit funder of Alzheimer’s research (https://www.alz.org/research). The National Alzheimer’s Project Act was signed into law in 2011. The aim of the National Plan was to “effectively treat and prevent Alzheimer’s and related dementias by 2025”. This remains an aspiration. Government funded work is funded and coordinated through the National Institute of Health, National Institute in Aging (https://www.nia.nih.gov/about/nia-and-national-plan-address-alzheimers-disease). Much of the interest in the microbial basis for Alzheimer’s Disease (8) has been supported by the NIH (9).

The development of effective treatments for Alzheimer’s Disease and for coping with the societal consequences of the disease will require global efforts and the effective translation of research to low- and middle-income countries. Without such cooperation, the ‘epidemic’ of Alzheimer’s Disease and the cost and burden of the consequences of it will pose a threat on the scale of a pandemic.

References

1. https://www.alzheimer-europe.org/Publications/Dementia-in-Europe-Yearbooks
2. https://www.alz.org/media/Documents/alzheimers-facts-and-figures.pdf
3. Niu H, Álvarez-Álvarez I, Guillén-Grima F, Aguinaga-Ontoso I. Prevalence and incidence of Alzheimer's disease in Europe: A meta-analysis. Neurologia. 2017 Oct;32(8):523-532. English, Spanish. doi: 10.1016/j.nrl.2016.02.016. Epub 2016 Apr 26. PMID: 27130306
4. Taichi Inui , Bryan Hanley, E-Siong Tee, Jun Nishihira, Kraisid Tontisirin, Peter Van Dael, Manfred Eggersdorfer. The role of nutrition in ageing Asia: what can be implemented with the existing insights Nutrients – 2021, 13, 2222
5. https://www.alzint.org/about/dementia-facts-figures/dementia-statistics/
6. Jang Y, Yoon H, Park NS, Rhee M-K, Chiriboga DA. Asian Americans’ concerns and plans about Alzheimer’s disease: The role of exposure, literacy and cultural beliefs. Health Soc Care Community. 2017;00:1–8.  https://doi.org/10.1111/hsc.12509
7. Boulo S, Kuhlmann J, Andreasson U,et al. First amyloid β1-42 certified reference material for re-calibrating commercial immunoassays. Alzheimer’s Dement.2020;16:1493–1503 https://doi.org/10.1002/alz.12145
8. Schnaider L, Arnon ZA, Gazit E. Reevaluating the Microbial Infection Link to Alzheimer's Disease. J Alzheimers Dis. 2020;73(1):59-62. doi: 10.3233/JAD-190765. PMID: 31796672
9. https://grants.nih.gov/grants/guide/notice-files/NOT-AG-19-012.html