China is facing a rapidly aging population, significantly impacting public health and healthcare systems. According to the “National Report on the Development of Undertakings for the Aged (2022),” there are 280 million people aged 60 years and above in China, accounting for 19.8% of the total population (Fig. 1A) [
1]. This percentage has steadily increased from 14.3% in 2012. Projections indicate that by 2050, the elderly population in China will peak at approximately 487 million, representing 34.9% of the total population [
2]. In this perspective article, we analyze the current challenges facing China’s dementia prevention and control system, with the aim of presenting policy recommendations to effectively address these issues.
Currently, dementia affects approximately 11.3% of the elderly population in China, with its prevalence increasing with age. The global dementia prevalence starts at 2.1% among individuals aged 65–69 years and increases to 35.9% in those over 90 years old [
3]. Alzheimer’s disease (AD) is the primary cause of dementia, accounting for 60%–80% of all cases (Fig. 1B) [
4]. According to the Alzheimer’s Disease International (ADI) 2022 report, there are over 55 million dementia cases worldwide [
5], with China alone accounting for approximately 15 million cases [
6]—about one-quarter of the global burden. When including mild cognitive impairment (MCI), which is widely recognized as the early-stage of dementia, the number of affected individuals in China reaches 54 million [
6].
The implications of the growing prevalence of dementia are profound, leading to increased morbidity, mortality, and healthcare costs, which collectively impose significant socioeconomic challenges on Chinese society. Over the past two decades, deaths caused by dementia have surged by 140%, far outpacing other major causes of death [
7]. Consequently, Alzheimer’s disease has risen to become one of the top six causes of death in China [
6]. The burden on caregivers is substantial, as each patient requires far more caregivers than the number of patients. This caregiving responsibility severely impacts their health. Based on previous literature reports, 84.5% of caregivers are reporting sleep problems [
8], and 43.6% are experiencing anxiety [
9] (Fig. 1C). Additionally, caregiving accounts for over 50% of healthcare costs related to dementia, placing enormous financial strain on families [
10].
In 2015, the annual cost of dementia care in China was approximately US$168 billion, and this figure is projected to surge to US$1.887 trillion by 2050—an increase of more than 11 times (Fig. 1D) [
10]. Currently, the annual healthcare and long-term care costs for a dementia patient are about three times higher than those for individuals without dementia [
7]. A nationwide multicenter random sampling study found that the annual cost per patient with Alzheimer’s disease was US$19 144.36, exceeding the global average [
10]. Despite the urgent need for effective dementia care, the current prevention and control system remains inadequate. High rates of missed diagnoses, particularly at the grassroots level, a shortage of trained professionals, lagging drug development, and the lack of a comprehensive long-term care insurance system further exacerbate the situation.
Given the increasing challenges posed by dementia in China, it is essential to assess the current prevention and control framework, which reveals several issues and shortcomings that must be addressed to enhance care for those affected.
Lack of effective coordination mechanisms One of the main challenges is the absence of a robust multi-sectoral coordination mechanism. The World Health Organization (WHO) emphasizes the importance of integrating diverse resources across healthcare, research, environment, and infrastructure to effectively address dementia [
11]. In contrast, China’s current approach lacks this integration, resulting in fragmented efforts that fail to address the comprehensive needs of dementia care. For instance, while the National Health Commission (NHC) has started the “Alzheimer’s Disease Prevention and Treatment Promotion Action (2023–2025)” [
12], it does not sufficiently cover critical areas beyond healthcare service quality. The establishment of a comprehensive coordination network, like the successful model in the United States, is essential for encouraging collaboration among multiple government departments.
Insufficient three-level prevention and control technical systems China’s dementia prevention and control framework remains inadequate at all levels. Dementia often goes undetected at the primary healthcare level: the 2021 World Alzheimer Report by ADI notes that 75% of global dementia cases are undiagnosed (Fig. 2A) [
13], whereas this number goes up to 85.8% in China (Fig. 2A) [
14]. Limited capacity and coverage in primary care—where early intervention is critical—exacerbate this issue, alongside demographic risk factors such as female gender, rural residence, younger age (< 75 years), and illiteracy [
14]. Then, the lack of routine memory screenings further hinders timely diagnosis and management. Meanwhile, the tertiary level lacks memory clinics with specialists and technologies: although guidelines recommend one memory clinic per 50 000 residents aged 65 years and above [
15], each of China’s 3523 tertiary hospitals [
16] would need at least one. Yet only 660 memory clinics currently operate nationwide [
17], leaving a huge gap in meeting China’s growing needs (Fig. 2B).
Lagging drug development and marketing There is a pressing need to accelerate new drug development and marketing. AD therapeutics have faced challenges: in the late 1990s and early 2000s, several symptomatic treatments (treatments aimed at alleviating symptoms, primarily acetylcholinesterase inhibitors and glutamate receptor antagonists) were approved (Fig. 2C, Table 1), yet they only provided about 6–9 months of symptom relief without slowing progression [
18]. After numerous clinical trial failures, the West has advanced its disease-modifying therapies (DMTs, treatments designed to change the course of the disease or slow its progression) targeting amyloid-β (Fig. 2C, Table 1). Meanwhile, China has made limited contributions, such as GV-971 (sodium oligomannate capsules), an innovative drug currently undergoing confirmatory trials for comprehensive regulatory approval (Fig. 2C). Additionally, an herbal oral solution can also be found on the NMPA website.
Recent DMT milestones have revived hope but require caution. Aducanumab showed inconsistent findings (EMERGE vs. ENGAGE) [
19,
20], while lecanemab and donanemab offer modest CDR-SB improvements of only 27%–28.9% and impose strict patient selection criteria [
21,
22]. Thus, unmet therapeutic needs remain significant. Traditional Chinese medicine (TCM), backed by centuries of clinical experience and multi-target, multi-component strategies, could help; yet no new TCM drugs for AD have reached the market in the past three decades, widening the gap between demand and treatment options. Combining modern pharmaceutical standards with TCM’s comprehensive methods may offer new choices for AD patients.
Absence of a comprehensive long-term care insurance system The lack of a comprehensive long-term care insurance system poses a significant challenge for dementia patients and their families. Globally, many countries have long-term care insurance systems, like Germany’s Pflegeversicherung and Japan’s Chōki Kaigo Hoken, funded jointly by government and society to support dementia and chronic disease patients. Currently in China, 77.2% of dementia patients rely solely on family members for care [
23], placing an immense burden on informal caregivers, many of whom lack the necessary training and resources to provide adequate support [
7]. The absence of formalized care structures and financial support mechanisms exacerbates the difficulties faced by families, hindering effective management of dementia and increasing the risk of caregiver burnout.
To effectively address the multifaceted challenges posed by dementia in China, we propose a comprehensive and coordinated approach to enhance China’s dementia prevention and control system. Our recommendations focus on four key areas:
Establish cross-sectoral coordination for dementia We propose establishing a China Dementia Prevention and Control Coordination Committee led by the State Council, and involving multiple agencies—such as the National Health Commission (NHC), TCM Administration, National Development and Reform Commission (NDRC), Healthcare Security, Ministry of Science and Technology (MOST), Ministry of Education (MOE), and Ministry of Civil Affairs (MCA). Next, we recommend establishing the Chinese Alzheimer’s Disease Association under the Chinese Association for Science and Technology (CAST), alongside developing and promoting a China National Action Plan for Dementia Prevention and Control under the NHC guidance. Finally, we propose creating a National Alzheimer’s Disease Center, jointly led by NHC and TCM Administration, to coordinate regional centers and serve as a national technical platform.
Set up a three-level prevention and control system We propose that the NHC, in collaboration with relevant departments, establish a comprehensive three-tier dementia prevention and care system. This system should encompass: (1) First Level: Community-based memory screening services that enhance early detection through standardized cognitive assessments and training for healthcare workers; (2) Second Level: Memory clinics in tertiary hospitals, equipped with advanced diagnostic technologies, standardized protocols, refined referral networks, and integrated TCM approaches; and (3) Third Level: Specialized care facilities focusing on long-term care services, including day care centers and nursing homes, supported by professional staff training and caregiver support systems. During implementation, the large number of primary healthcare facilities and the widespread resource constraints compared to secondary and tertiary medical facilities are potential obstacles to policy implementation. It is necessary for the government to coordinate efforts across departments, increase investment, and establish a targeted assistance and referral mechanism to promote the accessibility of high-level resources to the public. This multi-level approach will strengthen dementia screening capabilities and ensure comprehensive care for patients.
Strengthen national scientific and technological support We propose a comprehensive scientific and technological support system to advance dementia research and treatment. For early diagnosis, it is crucial to prioritize the development of novel diagnostic devices and artificial intelligence-based screening methods. For therapeutic innovations, research efforts should focus on new drug discovery, drug repurposing strategies, combination therapy approaches, validation of ancient TCM formulas, development of TCM-based medicine, and advancing integrated multidisciplinary treatment (MDT) plans. For cognitive enhancement, emphasis should be placed on developing and promoting evidence-based interventions such as Qigong, music therapies, physical exercises, cognitive training tools, and smart memory-improving devices. Finally, robust policy support is essential to guide and implement major technology research and development.
Improve policies and institutional safeguards We propose comprehensive policy reforms and institutional safeguards to address dementia. Specifically, the Ministry of Human Resources and Social Security, in collaboration with other relevant departments, should strengthen policy frameworks by incorporating cognitive screening into employees’ annual physical exams for early detection, diagnosis, and treatment; integrating dementia into the existing chronic disease management system in tandem with cardiovascular and cerebrovascular disease protocols; revising the National Essential Medicines List to ensure adequate supply, distribution, and insurance coverage of dementia medications; establishing an online registration system for real-time monitoring and targeted prevention; and expanding medical insurance to cover long-term and end-stage care, thus providing comprehensive support for patients and their families. Japan and South Korea have integrated dementia risk management into their national long-term strategies, with governments spearheading the development and execution of relevant care policies. These policies encompass a range of services and interventions, including preventive measures, rehabilitation care, in-home respite services, home modifications for the elderly, and the establishment of “dementia-friendly” communities, all aimed at improving support for elderly individuals with dementia and their caregivers [
24]. Given our country’s unique context and the need for targeted adjustments, these experiences can be flexibly adopted.
Overall, dementia poses critical challenges for China, requiring a comprehensive, coordinated, and targeted approach. By putting these policy recommendations into action, we aim to establish a Chinese-style dementia care system that effectively addresses the pressing issues of high misdiagnosis rates, limited specialist care, slow drug development, and inadequate long-term care support. This approach is essential for improving the prevention and control system for dementia and laying a solid foundation for national health in China.
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