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Article

Global, regional, and national burden of Alzheimer's disease and other dementias, 1990–2016: a sys-tematic analysis for the Global Burden of Disease Study 2016

The Lancet Neurology. 2018. P. 1-12.

Background The number of individuals living with dementia is increasing, negatively affecting families, communities,
and health-care systems around the world. A successful response to these challenges requires an accurate
understanding of the dementia disease burden. We aimed to present the first detailed analysis of the global prevalence,
mortality, and overall burden of dementia as captured by the Global Burden of Diseases, Injuries, and Risk Factors
(GBD) Study 2016, and highlight the most important messages for clinicians and neurologists.
Methods GBD 2016 obtained data on dementia from vital registration systems, published scientific literature and
surveys, and data from health-service encounters on deaths, excess mortality, prevalence, and incidence from
195 countries and territories from 1990 to 2016, through systematic review and additional data-seeking efforts. To
correct for differences in cause of death coding across time and locations, we modelled mortality due to dementia
using prevalence data and estimates of excess mortality derived from countries that were most likely to code deaths to
dementia relative to prevalence. Data were analysed by standardised methods to estimate deaths, prevalence, years of
life lost (YLLs), years of life lived with disability (YLDs), and disability-adjusted life-years (DALYs; computed as the
sum of YLLs and YLDs), and the fractions of these metrics that were attributable to four risk factors that met GBD
criteria for assessment (high body-mass index [BMI], high fasting plasma glucose, smoking, and a diet high in sugar-
sweetened beverages).
Findings In 2016, the global number of individuals who lived with dementia was 43·8 million (95% uncertainty interval
[UI] 37·8–51·0), increased from 20.2 million (17·4–23·5) in 1990. This increase of 117% (95% UI 114–121) contrasted
with a minor increase in age-standardised prevalence of 1·7% (1·0–2·4), from 701 cases (95% UI 602–815) per
100 000 population in 1990 to 712 cases (614–828) per 100 000 population in 2016. More women than men had dementia
in 2016 (27·0 million, 95% UI 23·3–31·4, vs 16.8 million, 14.4–19.6), and dementia was the fifth leading cause of death
globally, accounting for 2·4 million (95% UI 2·1–2·8) deaths. Overall, 28·8 million (95% UI 24·5–34·0) DALYs were
attributed to dementia; 6·4 million (95% UI 3·4–10·5) of these could be attributed to the modifiable GBD risk factors
of high BMI, high fasting plasma glucose, smoking, and a high intake of sugar-sweetened beverages.
Interpretation The global number of people living with dementia more than doubled from 1990 to 2016, mainly due
to increases in population ageing and growth. Although differences in coding for causes of death and the heterogeneity
in case-ascertainment methods constitute major challenges to the estimation of the burden of dementia, future
analyses should improve on the methods for the correction of these biases. Until breakthroughs are made in
prevention or curative treatment, dementia will constitute an increasing challenge to health-care systems worldwide