Is Brazil ready for the expected increase in dementia prevalence?

Abstract

It is estimated that around 50 million people worldwide were living with dementia in 2019, with roughly 60% living in low-and middle-income countries 1 . This represents a new case of dementia every three seconds 1 . Further, the World Health Organization (WHO) reported that by 2050 (i.e., 30 years later), the expected prevalence of Alzheimer's disease and other dementias is of 152 million cases 1 . While the incidence of dementia is stabilizing in some high-income countries 2 , low-and middleincome countries are experiencing a rise in dementia incidence especially due to low educational level and high prevalence of cardiovascular risk factors such as physical inactivity and high fasting plasma glucose 3,4,5 .Since 1990, the prevalence, morbidity, and mortality attributable to dementia in Brazil increased by 2.5, 3.4, and 2.3-fold, respectively (Institute for Health Metrics and Evaluation. GBD results tool. http://ghdx.healthdata.org/gbd-results-tool%20). These sustained growths led the country to the second-highest age-standardized prevalence of dementia worldwide in 2016 6 . Brazil is facing a demographic transition, with the proportion of the population aged 60 or over reaching 13% in 2018, expected to double in the next decades. Furthermore, roughly 40% of dementia cases worldwide can be attributable to modifiable risk factors 7 . This proportion might be even higher in less developed regions such as Latin America, where the proportion of potentially preventable cases of dementia reached 56% 8 . A previous study indicated that if no action is taken to reduce the prevalence of such risk factors (e.g., physical inactivity, low educational level), Brazil will face a 4-fold increase in the number of people living with dementia from approximately 927,000 in 2010 to 3,728,000 in 2050 9 .Nevertheless, the prevalence of these risk factors has increased in the past decade in Brazil. From 2006 to 2018 the prevalence of diabetes in men and women increased 54% and 28%, respectively, while the proportion of Brazilians with overweight (body mass index -BMI ≥ 25kg/m 2 ) increased 19.7% and 38.9%, respectively 10 . Also, in 2019 one third of Brazilian adults aged 25 or over did not complete primary education. Moreover, only 39% of the adult population in Brazil achieved the WHO guidelines for physical activity in 2019 10 . Although this proportion increased from 19.4% in 2010 11 , older adults (i.e., 65+ years) were less active in 2019 (24.4%) compared to 2010 (36.7%). The lack of sufficient awareness about the importance of controlling these and other risk factors at the populational level might underestimate the calculated number of people living with dementia in Brazil in the next 30 years.

Preparedness of the Brazilian health‐care system to provide access to a disease‐modifying Alzheimer's disease treatment

“…25 Yet, there is an urgent need to tackle this challenge because population aging and an increasing burden of cardiovascular risk factors mean that Brazil, unlike several high-income countries that benefit from tighter risk factor control, will experience a growing dementia burden. 26 There is also a higher burden of dementia in individuals below age 65 in Brazil than in high-income countries. 27 Other countries with limited capacity for specialty dementia care are responding by shifting more responsibilities to primary care settings.…”

The Resounding Sound of Silence: Giving Voice to Persons Living With Dementia Who Took Part in Cognitive Stimulation Therapy and Virtual Cognitive Simulation Therapy Groups

“…Despite those numbers, there is a significant lack of investment in dementia-specific programs or research in Brazil, with most funding coming from private or international institutions (Feter & Leite, 2021). Additionally, Brazil has no national dementia control plan, dementia awareness campaigns, or reliable data on diagnostic rates (Feter & Leite, 2021).…”

“…Despite those numbers, there is a significant lack of investment in dementia-specific programs or research in Brazil, with most funding coming from private or international institutions (Feter & Leite, 2021). Additionally, Brazil has no national dementia control plan, dementia awareness campaigns, or reliable data on diagnostic rates (Feter & Leite, 2021). A national plan for dementia should go beyond informing and providing support for family members and care partners of PlwD, presenting the basis for appropriate diagnosis procedures, training health professionals to detect and treat dementia, coordinating actions between private and public health services, and adapting existing health systems to specific needs (Manes et al, 2016).…”

“…These numbers are probably lower than the reality given that many people never get a proper diagnosis or even have access to a specialist and the estimation is that only 20% of PlwD are formally diagnosed, with Alzheimer's disease being responsible for 40 to 60% of cases (Nakamura et al, 2015). Although Brazil has the highest prevalence of Alzheimer'sdisease and other dementias in Latin America there is no dementia awareness campaign, no national control plan, and data about diagnostic rate is not available (Feter & Leite, 2021). Only recently the Brazilian Senate received the first law project to create a national dementia plan but it hasn't moved ahead due to the lack of political support (Feter & Leite, 2021).…”

“…Although Brazil has the highest prevalence of Alzheimer'sdisease and other dementias in Latin America there is no dementia awareness campaign, no national control plan, and data about diagnostic rate is not available (Feter & Leite, 2021). Only recently the Brazilian Senate received the first law project to create a national dementia plan but it hasn't moved ahead due to the lack of political support (Feter & Leite, 2021).…”