Dementia in the Western Pacific region: from risk reduction to care (BSL-interpreted)

What this episode is about

Dementia is a growing crisis in the Western Pacific region, which is projected to see over half of the global dementia cases by 2050, currently grappling with more than 20 million individuals affected. Key challenges include a lack of resources, poor healthcare access, widespread misconceptions about the disease, and insufficient support for family caregivers, making culturally appropriate and targeted strategies essential for risk reduction and care enhancement.

Key takeaways

• Dementia isn't just a number—it's a ticking time bomb for the Western Pacific's aging population.
• 80% of dementia research in the region hails from just three countries, leaving vast knowledge gaps unaddressed.
• Misconceptions label dementia as a 'normal' aging phase, obscuring its preventability and urgent care needs.
• Digital health tools could hold the key to overcoming geographical and economic barriers to dementia care.
• Culturally tailored national strategies are vital; one size doesn't fit all in the fight against dementia risk.

What is discussed, and when

1. 0:00 – 3:00: World Health Organization
2. 3:00 – 6:00: World Health Organization, Australia
3. 6:00 – 9:00: Australia
4. 9:00 – 12:00: Australia, Philippines, Solomon Islands

Notable quotes from "Dementia in the Western Pacific region: from risk reduction to care (BSL-interpreted)"

• Recognition of this global health crisis has led to the World Health Organization global action plan on dementia which urges governments to develop national policies to address this need. At the.

  about World Health Organization · at 4:11

• Despite the growing elderly population, dementia services vary widely across the region. While high-income countries such as Japan and Australia have wellestablished memory…

  about Japan · at 7:22

• We call for greater intergovernmental collaboration to share knowledge and resources across the region. We also suggest expanding the role of virtual memory clinics which…

  about COVID-19 pandemic · at 9:12

• People's republic of China and Australia, a large geographical size poses logistical challenges. While in countries like the Solomon Islands or the Philippines, multiple small…

  about Solomon Islands · at 11:27

Who and what is mentioned in this episode?

Companies & orgs

• World Health Organization — Company · Key organization · 2 mentions · first at 0:22
  Central to the discussion on dementia care strategies in the Western Pacific region

Places & events

• Japan — Place · Country focus · 5 mentions
  One of the three countries contributing to 80% of dementia research in the Western Pacific region
• Australia — Place · Country focus · 3 mentions · first at 3:59
  One of the three countries contributing to 80% of dementia research in the Western Pacific region
  Despite the growing elderly population, dementia services vary widely across the region. While high-income countries such as Japan and Australia have wellestablished memory…
• Fiji — Place · Country focus · 3 mentions
  A low and middle-income country in the Western Pacific region with severe shortages in specialist dementia services
  Region. While high-income countries such as Japan and Australia have wellestablished memory clinics, many low and middle inome countries such as Fiji face severe shortages in…
• Tonga — Place · Country focus · 2 mentions
  A country in the Western Pacific region with no memory clinics available for dementia care
  And middle inome countries such as Fiji face severe shortages in specialist services. And in some countries such as Tonga, there are no memory clinics available at all. One of…
• Solomon Islands — Place · Country focus · 1 mention · first at 11:36
  A country in the Western Pacific region facing logistical challenges in dementia care due to its geography
• Philippines — Place · Country focus · 1 mention · first at 11:39
  A country in the Western Pacific region facing logistical challenges in dementia care due to its geography
  People's republic of China and Australia, a large geographical size poses logistical challenges. While in countries like the Solomon Islands or the Philippines, multiple small…
• COVID-19 pandemic — Event · Historical context · 2 mentions
  Mentioned as a period during which virtual memory clinics gained traction

Full transcript with timestamps

0:06 The Western Pacific is home to approximately 20% of the world's population, but is projected to contribute to more than half of the 152.8 million individuals estimated to be living with dementia by 2050. The World Health Organization's global action plan on dementia aims to improve diagnosis, treatment, and care by 2025. But as of 2022, many of these targets were far from being met. This region has a very high incidence of dementia, currently estimated as more than 20 million people living with dementia. This number is only going to increase with an aging population.

0:55 The Western Pacific region is a diverse region both culturally and economically which affects the prevalence of dementia risk factors. Our knowledge of the prevalence of these risk factors is also affected by regional variation in risk factors as well as poor access to health care due to economic hardship, geographical location and a lower health literacy. Overall, the region is underprepared for the structural, financial and human resources required for adequate dementia care. Existing work shows a prominent misconception among the public that dementia is a normal part of aging and is not preventable. Most people living with dementia are cared for by family members who do not have adequate training or governmental support. Stigma relating to the disease also influences health care seeking behaviors. In this context, targeted and culturally appropriate approaches to limit disease onset and

1:55 progression in the Western Pacific region are vital. The major risk factors, whether they're societal, biological, lifestyle related, or metabolic, can affect both disease onset and disease progression and vary dependent on the type of dementia. Even with adequate detection of disease, much of the Western Pacific region is under resourced to manage the predicted dementia epidemic. With the breadth of established risk factors, a multiddisciplinary approach is critical. This includes documenting the prevalence of risk factors and how they interact in different populations to affect disease onset and progression. Education of the public on how to detect and manage risk factors. Patients will need access to biomarker and imaging assessments and consideration must be given to the use and reimbursement of genotype testing.

2:48 Government infrastructure is required to enable access to diagnosis and available and emerging treatments. And also support is needed for tailored versions of multi-dommain intervention trials comprising of diet, physical and social activity and cognitive training and vascular and metabolic monitoring to try and slow the disease onset and disease progression. Partnerships are also required between government clinicians and pharmaceutical companies to ensure equal access across the region to emerging and investigational treatments.

3:23 We strongly advocate for the rapid development of whole of society adaptive and targeted approaches for dementia risk factor reduction and care in the Western Pacific region. Within the Western Pacific, country level estimates predict that the lowest increase in dementia will be in higher inome countries and the greatest increase in dementia will be in the lower middle inome countries. In contrast, our systematic analysis of the published research on dementia from the Western Pacific region found that 80% of this work were from three countries, Japan, China, and Australia, with a scarcity of published research from the Pacific Islands and territories, as well as other more populous Western Pacific countries.

4:11 Recognition of this global health crisis has led to the World Health Organization global action plan on dementia which urges governments to develop national policies to address this need. At the time of this review, eight of the 37 countries and territories in the Western Pacific region have developed a formal national dementia strategy. There is a rich diversity in culture and heritage in the Western Pacific region. This means that culturally and religiously relevant national strategies that increase public awareness and education on dementia are needed to help dispel common misconceptions that deter diagnosis and foster a dementia inclusive society, which will in turn better support individuals living with dementia and their caregivers. National dementia screening tools may also help improve diagnosis in racial and ethnic populations living in the region since studies have shown that clinical

5:04 dementia screening tools developed in countries with predominant European ancestry are less accurate in other racial groups. Mutations in different pathogenic genes have been associated with different clinical symptoms and disease trajectories underscoring the importance of identifying the genetic risk factors for dementia in different regions. The establishment of multic-enter nationwide networks and databases in China and Japan represent concerted efforts towards identifying the pathological genes that drive dementia in Chinese and Japanese patients with familial diseases. Studies in postmortem brain tissue have significantly advanced our understanding on the pathogenesis of dementia and have enabled the refinement of diagnostic criteria to improve the clinical recognition of these brain changes in patients during life.

5:55 However, a large majority of brain banks recruiting tissue from patients with dementia are located in Europe and North America and they report an under representation from ethnic and racial groups. Brain banks are expensive to operate and within the Western Pacific have predominantly been established in highincome countries. Importantly, they provide an invaluable resource to improve understanding of the pathobiology of dementia in different ethnic and racial populations that will likely be relevant not only to the region but also to underserved populations in the UK and US. Digital technology has the potential to empower and extend the length at which people living with dementia can continue living in their community and receive care that is aligned with their preferences. This includes inbuilt alerts to emergency services and wearable fitness trackers and mobile phone based applications that

6:48 can facilitate increased social engagement as some examples. There is no one uniform strategy particularly given the diversity in the region and economic and societal demographics will influence national priorities for the relevant health innovations and their translation into dementia care. However, this represents a promising area for capacity building that can be incorporated into culturally relevant national dementia strategies in different countries within the Western Pacific region and that may serve to alleviate some economic burden.

7:22 Despite the growing elderly population, dementia services vary widely across the region. While high-income countries such as Japan and Australia have wellestablished memory clinics, many low and middle inome countries such as Fiji face severe shortages in specialist services. And in some countries such as Tonga, there are no memory clinics available at all. One of our key focuses is the region's readiness for amalloid targeting therapies for Alzheimer's disease. These therapies represent a significant advancement but also bring new challenges. The availability of necessary diagnostic tools like PET scans and MRI machines is uneven and only a few countries have the specialized personnel needed. In countries with limited infrastructure, the implementation of these treatments could be significantly delayed. However, there's hope on the horizon with the emergence of plasma biomarkers. These

8:22 innovative tools have the potential to revolutionize the diagnostic landscape by offering a less invasive, more coste effective alternative to PET scans. Plasma biomarkers could significantly improve early diagnosis rates, especially in resource limited settings. As countries in the Western Pacific gear up for these new technologies, the potential for more equitable access to dementia diagnostics is promising. We have identified, however, several barriers to improving dementia care in the region. And these include the high cost of treatments, lack of infrastructure, low awareness about dementia, and significant gaps in healthcare access between urban and rural areas. Despite these challenges, there are opportunities for improvement.

9:12 We call for greater intergovernmental collaboration to share knowledge and resources across the region. We also suggest expanding the role of virtual memory clinics which gained traction during the CO 19 pandemic as a way to increase accessibility. Additionally, there could be a push for more training of primary care providers to better diagnose and manage dementia, especially in countries with fewer specialists. Ensuring timely diagnosis and adequate post-dagnosed dementia care and support has been a long-standing issue in many developed countries.

9:54 Equity of access to post-dagnosis care is likely to become a pressing issue in countries with rising dementia prevalence rates and comparatively limited health resources. In the absence of cures for dementia, it is essential to focus on appropriate and accessible post-dagnosis care pathways for people living with dementia and their families. Despite decades of research concerning the importance of post-dagnosis dementia care, what constitutes post-dagnosis care in formal services is highly variable. What is known is that there are strong benefits of behavioral, cognitive environmental psychological and psychosocial interventions for people living with dementia. For example, interventions such as physical exercise, cognitive stimulation therapy, and cognitive training improve the health and well-being of people living with dementia. Mindfulness-based interventions multicomponent interventions, psycho education and

11:11 psychotherapy counseling are highly recommended for family carers of people living with dementia. One challenge facing postdagnosis dementia care is geographical size. In countries like the people's republic of China and Australia, a large geographical size poses logistical challenges. While in countries like the Solomon Islands or the Philippines, multiple small islands create difficulty accessing necessary services for people living with dementia and their families. Other key challenges include logistical infrastructure and models, societal culture and educational training necessary for postdagnosed dementia care. Our work here has been significant, but we know this is just the first step. There is an urgent need for future research on dementia service needs and gaps in the lower and middle inome countries in the region.

12:23 The region itself reflects extreme diversity. Most countries in the region do not have a national dementia plan. So what we wanted to do as part of our road map is to combine and create a collective impact such that we could lead a road map towards improved diagnosis, treatment, management and care support. So the first part of the road map describes the establishment of dementia as a global health policy. We went on to dementia risk reduction and importantly 40% of risk factors can be avoided or modified in this region such that it can have a significant effect on dementia and this includes education background, social interaction, treating issues such as depression very actively and effectively looking at vascular risk factors particularly blood pressure, obesity and diabetes. We need to improve the rates of activity and reduce alcohol excess. And as a general community approach, we need to reduce air

13:29 pollution. The next part of our road map focused on building capacity to improve dementia support, care, diagnosis, and treatment. We want to institute multiddisciplinary care models that are culturally appropriate across the region. We need to support carers more. Next we need to really focus on the early diagnosis and have a target of approximately 50%. Currently an early diagnosis is reached by 25% of appropriate individuals. Separately we know that we need to make the region ready for monoconal antibbody therapies which are now becoming available at a global level. Our next focus clearly is on dementia research and innovation and for this we need clear improvements in infrastructure.

14:15 In particular, we need to develop national international global registries. We need to support brain banks. We need to improve and extend our biomarket support. Clearly, integration of these infrastructure facilities requires economic policy. We need policy makers at the table to help move this road map forward. This is the plan for the Western Pacific region, which is also relevant for dementia populations at a global level. We look forward to seeing the institution of these plans moving forward.

Questions about this episode

What is "Dementia in the Western Pacific region: from risk reduction to care (BSL-interpreted)" about?

Dementia is a growing crisis in the Western Pacific region, which is projected to see over half of the global dementia cases by 2050, currently grappling with more than 20 million individuals affected. Key challenges include a lack of resources, poor healthcare access, widespread misconceptions about the disease, and insufficient support for family caregivers, making culturally appropriate and…

What is mentioned in this The Lancet episode?

8 people, works and ideas are mentioned, including World Health Organization, Japan, Australia, Fiji, Tonga, Solomon Islands. Each one on this page links to its own page with every episode that mentions it.

How long is "Dementia in the Western Pacific region: from risk reduction to care (BSL-interpreted)"?

The episode runs 15 min; the transcript is about 1,925 words in 17 timestamped sections.

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