The World of Dementia Beyond 2020

Authors

  • Henry Brodaty MD, DSc,

    1. From the *Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; School of Medicine, University of Virginia, Charlottesville, Virginia; §Studies Department and **Economics, Finance and Prospective, Fondation Médéric Alzheimer, Paris, France; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm, Sweden; #Division of Psychiatry Research, University of Zürich, Zurich, Switzerland; ††Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands; and ‡‡Center for Human Genetics, KU Leuven, and Department of Molecular and Developmental Genetics, VIB, Leuven, Belgium.
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  • Monique M. B. Breteler MD, PhD,

    1. From the *Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; School of Medicine, University of Virginia, Charlottesville, Virginia; §Studies Department and **Economics, Finance and Prospective, Fondation Médéric Alzheimer, Paris, France; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm, Sweden; #Division of Psychiatry Research, University of Zürich, Zurich, Switzerland; ††Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands; and ‡‡Center for Human Genetics, KU Leuven, and Department of Molecular and Developmental Genetics, VIB, Leuven, Belgium.
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  • Steven T. DeKosky MD,

    1. From the *Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; School of Medicine, University of Virginia, Charlottesville, Virginia; §Studies Department and **Economics, Finance and Prospective, Fondation Médéric Alzheimer, Paris, France; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm, Sweden; #Division of Psychiatry Research, University of Zürich, Zurich, Switzerland; ††Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands; and ‡‡Center for Human Genetics, KU Leuven, and Department of Molecular and Developmental Genetics, VIB, Leuven, Belgium.
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  • Pascale Dorenlot MD, PhD,

    1. From the *Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; School of Medicine, University of Virginia, Charlottesville, Virginia; §Studies Department and **Economics, Finance and Prospective, Fondation Médéric Alzheimer, Paris, France; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm, Sweden; #Division of Psychiatry Research, University of Zürich, Zurich, Switzerland; ††Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands; and ‡‡Center for Human Genetics, KU Leuven, and Department of Molecular and Developmental Genetics, VIB, Leuven, Belgium.
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  • Laura Fratiglioni MD, PhD,

    1. From the *Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; School of Medicine, University of Virginia, Charlottesville, Virginia; §Studies Department and **Economics, Finance and Prospective, Fondation Médéric Alzheimer, Paris, France; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm, Sweden; #Division of Psychiatry Research, University of Zürich, Zurich, Switzerland; ††Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands; and ‡‡Center for Human Genetics, KU Leuven, and Department of Molecular and Developmental Genetics, VIB, Leuven, Belgium.
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  • Christoph Hock MD,

    1. From the *Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; School of Medicine, University of Virginia, Charlottesville, Virginia; §Studies Department and **Economics, Finance and Prospective, Fondation Médéric Alzheimer, Paris, France; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm, Sweden; #Division of Psychiatry Research, University of Zürich, Zurich, Switzerland; ††Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands; and ‡‡Center for Human Genetics, KU Leuven, and Department of Molecular and Developmental Genetics, VIB, Leuven, Belgium.
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  • Paul-Ariel Kenigsberg PhD,

    1. From the *Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; School of Medicine, University of Virginia, Charlottesville, Virginia; §Studies Department and **Economics, Finance and Prospective, Fondation Médéric Alzheimer, Paris, France; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm, Sweden; #Division of Psychiatry Research, University of Zürich, Zurich, Switzerland; ††Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands; and ‡‡Center for Human Genetics, KU Leuven, and Department of Molecular and Developmental Genetics, VIB, Leuven, Belgium.
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  • Philip Scheltens MD, PhD,

    1. From the *Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; School of Medicine, University of Virginia, Charlottesville, Virginia; §Studies Department and **Economics, Finance and Prospective, Fondation Médéric Alzheimer, Paris, France; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm, Sweden; #Division of Psychiatry Research, University of Zürich, Zurich, Switzerland; ††Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands; and ‡‡Center for Human Genetics, KU Leuven, and Department of Molecular and Developmental Genetics, VIB, Leuven, Belgium.
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  • Bart De Strooper MD, PhD

    1. From the *Dementia Collaborative Research Centre, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia; Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands, and German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany; School of Medicine, University of Virginia, Charlottesville, Virginia; §Studies Department and **Economics, Finance and Prospective, Fondation Médéric Alzheimer, Paris, France; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm Gerontology Research Center, Stockholm, Sweden; #Division of Psychiatry Research, University of Zürich, Zurich, Switzerland; ††Department of Neurology and Alzheimer Center, VU University Medical Center, Amsterdam, the Netherlands; and ‡‡Center for Human Genetics, KU Leuven, and Department of Molecular and Developmental Genetics, VIB, Leuven, Belgium.
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Address correspondence to Henry Brodaty, Dementia Collaborative Research Centre, University of New South Wales, Sydney 2052, Australia. E-mail: h.brodaty@unsw.edu.au

Abstract

Counterpoised against dire projections of the tripling of the prevalence of dementia over the next 40 years are major developments in diagnostic biomarkers, neuroimaging, the molecular biology of Alzheimer's disease (AD), epidemiology of risk and protective factors, and drug treatments—mainly targeting the amyloid pathway, tau protein, and immunotherapy—that may have the potential to modify the progression of AD. Drug combinations and presymptomatic treatments are also being investigated. Previous trials of dementia-modifying drugs have not shown benefit, and even if current Phase III trials prove successful, these drugs will not eradicate other dementias, could (if not curative) increase dementia duration and prevalence, and are unlikely to come onto the market before 2020. In the meantime, delaying the onset of dementia by even 2 years would have significant economic and societal effects. This article provides an overview of current achievements and potentials of basic and clinical research that might affect the development of dementia prevalence and care within the near future.

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