China’s Dementia Challenge

Cesar Chelala

The government of China is facing the challenge of having to care for increasing numbers of dementia patients. This is due, to a large extent, to a steady increase in ageing patients. While life expectancy was 45 in 1960, it was 76.34 in 2015, according to the National Bureau of Statistics. One person in six is over 60 now, and one in four will be by 2025.  Although China has approximately 10 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 daily life incidents. The disease affects people from all social and economic conditions. The first signs and symptoms of the disease may be subtle. However, later on, language and emotional problems and a decrease in motivation appear as additional symptoms of this troubling condition.

Dementia has been mentioned in medical texts since antiquity. In the 7^th century BC Pythagoras, the Greek philosopher and mathematician, describes the “senium” period of mental and physical decay that occur after the age of 73. 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 which couldn’t be prevented.

Old Chinese medical texts also mentioned this deterioration of the intellectual faculties, calling it 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.

Before the 20^th century, dementia was relatively rare, because a long lifespan was uncommon in preindustrial times. Following WWII, however, there was an increase in life expectancy, and the number of people over 65 in developed countries started to increase rapidly, and so did dementia.

Alzheimer’s disease is the most common type of dementia, which account for 50 to 70 percent of cases. Other kinds of dementia include vascular dementia, Lewy body dementia and frontotemporal dementia. Sometimes more than one type of dementia may exist in the same person. In a small number of cases, dementia may run in families. Today, dementia is one of the most common causes of disability and poor health among older people.

According to Alzheimer’s Disease International, there were approximately 50 million people living with dementia in 2017. The incidence of the disease is three percent among people between the ages of 65-74, nineteen percent on those between 75 and 84 and nearly fifty percent on those over 85 years of age. According to some estimates, the incidence of dementia will increase by 100 percent in the coming 20 years. Before a person with dementia dies, it may experience several years of discapacity.

In the U.S., public awareness of Alzheimer’s disease increased greatly when former US President Ronald Reagan announced in 1994 that he was suffering from the condition. Today, although many more people know about dementia, those in China are lagging behind. Even more seriously, family members frequently do not understand the condition, so that more than 90 percent of dementia cases go undetected.

In China, there are few facilities for diagnosing and treating senile dementia, and they are located at a few top hospitals. To make matters even more complex, there are only a few hundred doctors experienced enough to make an early diagnosis. 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.

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. Dementia places a heavy economic burden both in families and in society. It is estimated that the total cost of dementia in China will be US$ 110 billion by 2030.

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. The Chinese government should have an improved strategy of mass communication and education about the disease, intensive training of physicians and health care workers on diagnosis and treatment, and develop a national plan of action that addresses the main needs for caring for all kinds of patients with dementia.