Dementia in Developing countries: A Community-Focused Review of Prevalence, Risk Factors, and Public Health Priorities
DOI:
https://doi.org/10.37506/z8c4xd33Keywords:
Dementia, Community based review, public healthAbstract
Background:
Dementia is an emerging public health priority due to rapid population ageing, particularly in low- and middle-income countries (LMICs), where over 60% of affected individuals reside. In India, national estimates overlook substantial regional and rural–urban variation, and community-based evidence remains limited.
Objective:
To review evidence on the prevalence, risk factors, methodological approaches, screening tools, and public health response to dementia, with emphasis on community-based studies from LMICs, especially India.
Methods:
A narrative review of literature published between January 2000 and June 2024 was conducted using PubMed, Scopus, and Google Scholar. Community-based epidemiological studies, relevant reviews, and policy documents were included. Hospital-based studies and those focusing exclusively on pharmacological or molecular aspects were excluded. Thirty-seven articles were synthesized thematically.
Results:
Global dementia prevalence is projected to increase from about 57 million in 2019 to over 150 million by 2050, with the fastest rise in LMICs. In India, prevalence among adults aged ≥60 years ranges from 4.5% to 11% across states, with higher burden influenced by education, lifestyle, and healthcare access. Nearly 45% of dementia cases are attributable to modifiable life-course risk factors. Community-based studies using culturally appropriate screening tools provide more accurate estimates, though methodological challenges persist.
Conclusion:
Addressing dementia as a public health priority requires strengthening community-based research and integrating prevention, early detection, and care into existing health systems in LMICs.
References
GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022 Feb;7(2):e105–25.
GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. Lancet Public Health. 2022 Feb;7(2):e105–25.
Report_Population_Projection_2019.pdf [Internet]. [cited 2025 Feb 24]. Available from: https://nhm.gov.in/New_Updates_2018/Report_Population_Projection_2019.pdf
Alzheimer’s disease and other dementias - Level 3 cause | Institute for Health Metrics and Evaluation [Internet]. [cited 2024 Dec 5]. Available from: https://www.healthdata.org/research-analysis/diseases-injuries-risks/factsheets/2021-alzheimers-disease-and-other-dementias
Avan A, Hachinski V. Global, regional, and national trends of dementia incidence and risk factors, 1990–2019: A Global Burden of Disease study. Alzheimer’s & Dementia [Internet]. 2023 Apr [cited 2024 Dec 5];19(4):1281–91. Available from: https://alz-journals.onlinelibrary.wiley.com/doi/full/10.1002/alz.12764
Islam B, Li T, Xu M, Yang D, Lv H, Gassara G, et al. Emerging trends in cognitive impairment and dementia among older populations in Asia: A systematic review. J Glob Health [Internet]. [cited 2024 Dec 6];14:04233. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11544519/
Lee J, Meijer E, Langa KM, Ganguli M, Varghese M, Banerjee J, et al. Prevalence of dementia in India: National and state estimates from a nationwide study. Alzheimers Dement [Internet]. 2023 July [cited 2024 June 26];19(7):2898–912. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10338640/
Liu CC, Liu CH, Sun Y, Lee HJ, Tang LY, Chiu MJ. Rural-urban Disparities in the Prevalence of Mild Cognitive Impairment and Dementia in Taiwan: A Door-to-door Nationwide Study. J Epidemiol. 2022 Nov 5;32(11):502–9.
Nunes B, Silva RD, Cruz VT, Roriz JM, Pais J, Silva MC. Prevalence and pattern of cognitive impairment in rural and urban populations from Northern Portugal. BMC Neurol [Internet]. 2010 June 11 [cited 2025 Feb 25];10(1):42. Available from: https://doi.org/10.1186/1471-2377-10-42
Nakamura K, Kitamura K, Watanabe Y, Shinoda H, Sato H, Someya T. Rural-urban differences in the prevalence of cognitive impairment in independent community-dwelling elderly residents of Ojiya city, Niigata Prefecture, Japan. Environ Health Prev Med. 2016 Nov;21(6):422–9.
Menesgere A, Sundarakumar JS, Shahul Hameed SK, Teams S& TS, Ravindranath V. Comparison of risk factors for dementia among rural and urban elderly adults-data from two cohort studies in India. Alzheimer’s & Dementia [Internet]. 2023 [cited 2025 Feb 25];19(6):2443–9. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/alz.12715
K S S, A T J, N G, S B, A D, M P, et al. The dementia India report: prevalence, impact, costs and services for dementia. Alzheimer’s & Related Disorders Society of India (ARDSI); 2010.
Raina SK, Raina S, Chander V, Grover A, Singh S, Bhardwaj A. Is Dementia Differentially Distributed? A Study on the Prevalence of Dementia in Migrant, Urban, Rural, and Tribal Elderly Population of Himalayan Region in Northern India. N Am J Med Sci [Internet]. 2014 Apr [cited 2024 Feb 5];6(4):172–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024584/
Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. The Lancet [Internet]. 2017 Dec [cited 2024 Nov 5];390(10113):2673–734. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673617313636
Dementia [Internet]. [cited 2024 Nov 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/dementia
Chen S, Cao Z, Nandi A, Counts N, Jiao L, Prettner K, et al. The global macroeconomic burden of Alzheimer’s disease and other dementias: estimates and projections for 152 countries or territories. The Lancet Global Health [Internet]. 2024 Sept [cited 2024 Nov 6];12(9):e1534–43. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2214109X2400264X
Campbell J, Lavoie L, Farraia M, Huelin R, Zhang Q, Tahami Monfared AA. Quality of Life in Mild Cognitive Impairment and Mild Dementia Associated with Alzheimer’s Disease: A Systematic Review. Neurol Ther [Internet]. 2024 Nov 3 [cited 2024 Nov 7]; Available from: https://doi.org/10.1007/s40120-024-00676-9
Sabatini S, Martyr A, Hunt A, Gamble LD, Matthews FE, Thom JM, et al. Comorbid health conditions and their impact on social isolation, loneliness, quality of life, and well-being in people with dementia: longitudinal findings from the IDEAL programme. BMC Geriatr [Internet]. 2024 Jan 5 [cited 2024 Nov 6];24(1):23. Available from: https://doi.org/10.1186/s12877-023-04601-x
Wurm R, Stögmann E. Epidemiology of dementia—the epidemic we saw coming. Wien Med Wochenschr [Internet]. 2021 Sept 1 [cited 2024 Nov 7];171(11):247–8. Available from: https://doi.org/10.1007/s10354-021-00838-6
Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, Banerjee S, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet [Internet]. 2020 Aug [cited 2024 Nov 5];396(10248):413–46. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673620303676
Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet [Internet]. 2024 Aug [cited 2024 Nov 5];404(10452):572–628. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673624012960
Bransby L, Rosenich E, Maruff P, Lim YY. How Modifiable Are Modifiable Dementia Risk Factors? A Framework for Considering the Modifiability of Dementia Risk Factors. J Prev Alzheimers Dis [Internet]. 2024 Jan 1 [cited 2024 Nov 7];11(1):22–37. Available from: https://doi.org/10.14283/jpad.2023.119
Global Status Report on the Public Health Response to Dementia. 1st ed. Geneva: World Health Organization; 2021. 1 p.
Kalaria R, Maestre G, Mahinrad S, Acosta DM, Akinyemi RO, Alladi S, et al. The 2022 symposium on dementia and brain aging in low- and middle-income countries: Highlights on research, diagnosis, care, and impact. Alzheimer’s & Dementia [Internet]. 2024 [cited 2024 Nov 7];20(6):4290–314. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1002/alz.13836
World Health Organization. Global action plan on the public health response to dementia 2017–2025 [Internet]. Geneva: World Health Organization; 2017 [cited 2024 Nov 5]. 44 p. Available from: https://iris.who.int/handle/10665/259615
Wang S, Molassiotis A, Guo C, Leung ISH, Leung AYM. Association between social integration and risk of dementia: A systematic review and meta-analysis of longitudinal studies. Journal of the American Geriatrics Society [Internet]. 2023 [cited 2024 Nov 7];71(2):632–45. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jgs.18094
Long JM, Holtzman DM. Alzheimer Disease: An Update on Pathobiology and Treatment Strategies. Cell [Internet]. 2019 Oct 3 [cited 2025 Feb 24];179(2):312–39. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6778042/
Madhu MT, Balaji O, Kandi V, Ca J, Harikrishna GV, Metta N, et al. Role of the Glymphatic System in Alzheimer’s Disease and Treatment Approaches: A Narrative Review. Cureus [Internet]. 2024 June 29 [cited 2025 Feb 24];16(6). Available from: https://www.cureus.com/articles/263076-role-of-the-glymphatic-system-in-alzheimers-disease-and-treatment-approaches-a-narrative-review
Hladky SB, Barrand MA. The glymphatic hypothesis: the theory and the evidence. Fluids and Barriers of the CNS [Internet]. 2022 Feb 3 [cited 2025 Feb 24];19(1):9. Available from: https://doi.org/10.1186/s12987-021-00282-z
Cummings J, Osse AML, Cammann D, Powell J, Chen J. Anti-Amyloid Monoclonal Antibodies for the Treatment of Alzheimer’s Disease. BioDrugs [Internet]. 2024 [cited 2025 Feb 24];38(1):5–22. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10789674/
Flicker L, Anstey KJ, Almeida OP, Waller M, Fitzgerald P, de Crespigny F, et al. Differing Methodologies Are Required to Estimate Prevalence of Dementia: Single Study Types Are No Longer Reliable. Journal of Alzheimer’s Disease [Internet]. 2022 Aug 2 [cited 2025 Feb 24];88(3):943–8. Available from: https://journals.sagepub.com/doi/abs/10.3233/JAD-220093
1995_Ganguli_HindiMMSE.pdf [Internet]. [cited 2023 Dec 9]. Available from: https://www.dementia-epidemiology.pitt.edu/wp-content/uploads/IndoUS_Publications/1995_Ganguli_HindiMMSE.pdf
Stanley R, Kuruvilla A, Kumar S, Gayathri K, Mathews P, Abraham V, et al. The Vellore screening instruments and strategies for the diagnosis of dementia in the community. International Psychogeriatrics [Internet]. 2009 June 1 [cited 2025 Apr 21];21(3):539–47. Available from: https://www.intpsychogeriatrics.org/article/S1041-6102(24)05780-6/fulltext
Storey J, Rowland JTJ, Conforti DA, Dickson HG. Rowland Universal Dementia Assessment Scale [Internet]. 2014 [cited 2025 Apr 21]. Available from: https://doi.apa.org/doi/10.1037/t28535-000
MoCA-8.3-English-Test-2018-04.pdf [Internet]. [cited 2025 Apr 21]. Available from: https://geriatrictoolkit.missouri.edu/cog/MoCA-8.3-English-Test-2018-04.pdf
Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW. Studies of Illness in the Aged: The Index of ADL: A Standardized Measure of Biological and Psychosocial Function. JAMA [Internet]. 1963 Sept 21 [cited 2025 Apr 21];185(12):914–9. Available from: https://doi.org/10.1001/jama.1963.03060120024016
Graf C. The Lawton Instrumental Activities of Daily Living (IADL) Scale.
Yi Y, Ding L, Wen H, Wu J, Makimoto K, Liao X. Is Barthel Index Suitable for Assessing Activities of Daily Living in Patients With Dementia? Front Psychiatry [Internet]. 2020 May 8 [cited 2025 Apr 21];11:282. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225343/
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Varalakshmi B, T Suriyakumar, Prahankumar Rajendiran
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.