China’s Dementia Challenge

At a speed unanticipated some years ago, China’s government is facing the challenge of having to care for increasing numbers of dementia patients. This is due to a large extent by a parallel increase in aging patients.

Life expectancy was 45 in 1960, it is 77 now. While one in six persons is over 60 now, by 2025 one in four will be.

Despite the fact that China now has nine million people with some form of dementia, the government is not yet prepared to deal effectively with this situation.

Dementia covers a broad category of brain diseases that cause a long term and frequently gradual decrease in the ability to think and remember things in their daily life, affecting people from all social and economic conditions.

Language, emotional problems and a decrease in motivation are other common symptoms of this troubling condition.

The historical roots

Dementia has been mentioned in medical texts since antiquity. In the 7th century BC, the Greek philosopher and mathematician Pythagoras describes the “senium” period of mental and physical decay — the years after the age of 73 years old.

Aristotle and Plato also spoke of mental decay in advanced age and viewed it as an inevitable process that affected old men and women and that couldn’t be prevented.

Old Chinese medical texts also mention this deterioration of the intellectual faculties as the age of the “foolish old person.” Byzantine physicians also wrote about dementia, and mentioned at least seven emperors older than 70 who displayed signs of cognitive decline.

In Hamlet and King Lear, Shakespeare mentions the loss of mental function in old age.

Dementia was relatively rare before the 20th century, because such lifespan was uncommon in preindustrial times.

Following WWII, there was an increase in life expectancy, and the number of people over 65 in developed countries started to increase rapidly. So did dementia.

Global prevalence

Alzheimer’s disease is the most common type of dementia, which makes up between 50 and 70% of cases. Other kinds of dementia include vascular dementia, Lewy body dementia and front temporal dementia.

The other types of dementia are much less frequent. Sometimes more than one type of dementia may exist in the same person.

In a small number of cases, dementia may run in families. It is one of the most common causes of disability and poor health (morbidity) among older people.

Globally, dementia affects almost 40 million people. Ten million of those are in China. The incidence of dementia is 3% in people between the ages of 65 and 74, 19% in those between 75 and 84, and nearly 50% in those over 85 years of age.

It is estimated that the incidence rate of dementia will increase by 100% in the coming 20 years. Before a person with dementia dies, he or she may go through several years of incapacity.

Public awareness of dementia, particularly Alzheimer’s disease, increased greatly when former U.S. President Ronald Reagan announced in 1994 that he was suffering from the condition.

Today, although several more people know about dementia, those in China are lagging behind. Approximately 10 million people in China suffer from some form of dementia.

Even more seriously, family members frequently do not understand the condition, so that more than 90% of dementia cases go undetected.

There are few facilities for diagnosing and treating senile dementia and they are located at a few top hospitals. At the same time, there are only a few hundred doctors experienced enough to make an early diagnosis.

In addition, most nursing care facilities in China can’t offer appropriate care for patients with dementia. In Shanghai, for example, where an estimated 120,000 residents have some form of dementia, there are only a handful of nursing homes trained to care for these patients.

Expensive healthcare

Dementia exacts a heavy burden on families and society. Because of its effect on families, dementia has been called a “family disease,” particularly because patients need long-term care.

In addition, dementia places a heavy economic burden on families. It has been estimated that the worldwide cost of dementia was $18 billion in 2015.

This figure includes both direct costs of medical and social care and those attributed to informal care.

Many countries have national plans or strategies and consider caring for dementia patients a national priority, and invest considerable resources in the different areas of care.

David Cameron, the UK’s Prime Minister, has called dementia a “national crisis,” since it affects 800,000 people in the United Kingdom alone.

The Chinese government should consider dementia as the national emergency it truly is. It should have a strategy of improved mass communication and education about the disease, training of physicians and health care workers on diagnosis and treatment, and development of a national plan of action that addresses the main needs of care for all cases of dementia.