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This Dementia in Europe Yearbook received funding under an operating grant from the

European Union"s Health Programme (2014-2020)

Dementia

in Europe

Yearbook 2019

Estimating the prevalence

of dementia in Europe

This Dementia in Europe Yearbook received funding under an operating grant from the European Union"s Health Pro-

gramme (2014-2020).

The content of this Yearbook represents the views of the author only and is his/her sole responsibility; it cannot be con

sidered to reect the views of the European Commission and/or the Consumers, Health, Agriculture and Food Executive

Agency or any other body of the European Union. The European Commission and the Agency do not accept any respon

sibility for use that may be made of the information it contains.

Dementia

in Europe

Yearbook 2019

Estimating the prevalence

of dementia in Europe |DEMENTIA IN EUROPE YEARBOOK

Table of contents

1. Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . 3

2. Introduction

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4

Background to the report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. 4

Relevance in the European Policy Context

. . . . . . . . . . . . . . . . 4

Overview of literature review

. . . . . . . . . . . . . . 4

Prevalence rates from individual studies

. . . . . . . . . . . . . . . . . . 7

Caveats to the report and its ndings

. . . 8

3. Findings and o verview tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . .9

Prevalence rates by age and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Prevalence applied to population estimates

. . . . . . . . . . . . .11

4. Individual c ountry pro? les . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Austria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Belgium

. . . . . . . . . . . . . . . . . . . . . . 20

Bosnia and Herzegovina

. .22

Bulgaria

. . . . . . . . . . . . . . . . . . . . . . 24

Channel Islands

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Croatia

. . . .28

Cyprus

. . . .30

Czech Republic

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

Denmark

.34

Estonia

. . . .36

Finland

. . . . . . . . . . . . . . . . . . . . . . . .38

France

. . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Germany

. . . . . . . . . . . . . . .42

Greece

. . . . . . . . . . . . . . . . . 44

Hungary

. . . . . . . . . . . . . . . . . . . . . 46

Iceland

. . . 48

Ireland

. . . .50

Israel

. . . . . . . . . . . . . . . . . . . .52 Italy . . . . . . . . . . . . . . . . . . . . 54

Latvia

. . . . . . . . . . . . . . . . . . . . . . . . . .56

Lithuania

. . . . . . . . . . . . . . . . . . . . . . . .58

Luxembourg

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60

Malta . . . . . . . . . . . . . . . . . . .62

Montenegro

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64

Netherlands

. . . . . . . . . . . . . . . . .66

North Macedonia

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .68

Norway

. . . . . . . . . . . . . . . . . . . . . . . .70

Poland

. . . . . . . . . . . . . . . . . . . . . . . . .72

Portugal

. .74

Romania

. . . . . . . . . . . . . . . . . . . . . .76

Slovakia

. . . . . . . . . . . . . . . .78

Slovenia

. 80 Spain . . . . . . . . . . . . . . . . . . .82

Sweden

. . . . . . . . . . . . . . . . 84

Switzerland

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86

Turkey

. . . . . . .88

United Kingdom

. . . . . . . . . . . . . . . . . . . . . . . . . . . 90

Europe

. . . .92

5. Discussion and c onclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . 96

Projected future numbers of people with dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. .96

The need for further disease-speci c research

. . . . . . . . . . . . . . . . . . . . . . . . . . .97

6. Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . 98

7. References

. . . . . . . . . . . . . . . . . . . . . 99

ESTIMATING THE PREVALENCE OF DEMENTIA IN EUROPE |

1. Foreword

It gives me great pleasure to

introduce the 2019 Alzheimer

Europe Yearbook, which focuses

on providing a prevalence esti- mate of the number of people living with dementia in Europe.

This involves utilising the most

recent population level data bro- ken down into ve-year age ranges by sex, whilst using data from the most suitable and recent population stud- ies (which meet pre-de ned criteria) from which prevalence rates for each age range and sex were calculated. As it is more than ten years since Alzheimer Europe worked on this subject as part of the EuroCoDe project, we have used the 2019 Yearbook to produce prevalence estimates based on the most up-to-date studies, applying this to the most recently available population data (2018), as well as for future population projections for 2025 and 2050. Within the report, we provide a country by country breakdown of these population projections, providing the estimated number of people with dementia by age and sex. The most striking discovery from this report is our nding of slightly lower prevalence rates across the majority of age ranges, when compared to those of EuroCoDe. When both sets of prevalence estimates are applied to popu- lation data for 2018, our updated prevalence estimates suggest 1 million fewer people with dementia, compared to th ose of EuroCoDe. Given the strong push on public health messaging on cardio-vascular health, smoking ces- sation etc , it is possible that we are now seeing dementia prevalence following similar trends which we have seen for other conditions. However, the increasing population of Europe coupled with the ageing demographics in many European countries pro- vide a clear indication that the overall numbers of people with dementia are likely to continue to increase signi cantly. Despite the comparative reduction in prevalence, the num- bers of people with dementia are still likely to double by

2050 (based on prevalence rates remaining consistent per

age range). If such projections prove to be accurate, the number of people requiring care, support and treatment from health and social care systems will require signi cant investment in services; societies will need to adapt to meet the needs of people with dementia ; and , research into the condition must be prioritised. As such, governments must step-up their work in planning and investment to ensure that services and supports, along with clinicians and care providers, are able to provide people with timely and accurate diagnoses, as well as person-cen- tred, community-based support. Underpinning this, planning a governmental response must be based on accurate estimates on the numbers of people with dementia within their countries, but must also con- sider other factors, including geographic distribution within the country. It is therefore vital that countries prioritise research and investment into population monitoring and epidemiological work to ensure that the data on which they base their decision is suitably robust. Alzheimer Europe hopes that this policy report proves use- ful in outlining the prevalence of dementia across Europe, including for the years ahead. It is our intention that this report is a starting point for countries to invest greater resources into identifying their individual country-based prevalence rates in order to be able to better adapt their services and resources to changing needs of the population. I would like to thank all those who have advised us on our approach to this work and who have taken the time to share their data with us to allow this work to be completed. I would also like to acknowledge the work of Christophe Bintener, Project O cer , and Owen Miller, Policy O cer, in examining the literature on recent prevalence studies, com- piling data and writing this report.

Jean Georges

Executive Director

Alzheimer Europe

|DEMENTIA IN EUROPE YEARBOOK

2. Introduction

Background to the report

Over the past three decades, a number of signi cant pieces of work have been undertaken to estimate the prevalence of dementia at a European level, including:

EURODEM study in the early 80s (updated in 2000)

Alzheimer Europe"s project, European Collaboration on Dementia - EuroCoDe (2006-2008)

The 1st EU Joint Action on Dementia - ALCOVE

(2011-2013). However, as the most recent of these studies is six years old, Alzheimer Europe saw value in updating the gures. This report therefore provides the ndings of work undertaken during 2019, following the methodology set out as part of the EuroCoDe project. In this report, we provide an update of the estimated preva- lence rates and numbers of people with dementia, utilising the most recently available population gures (2018 data from the United Nations World Population Prospects), on a country by country basis, as well as contrasting the esti- mated numbers using the EuroCoDe prevalence estimates. There are some exceptions to this approach. For both Bos- nia and Herzegovina, and the Channel Islands, 2018 data was not present, therefore the population projections for

2020 were used instead. For the populations of Israel and

Turkey, national data produced by the respective countries" statistics bodies for 2018 were used. In addition, we provide an estimation of the number of peo- ple with dementia in 2025 and 2050 (again broken down by country) based on future population projections (again taken from the UN"s World Population Prospects data).

Relevance in the European Policy Context

According to the most recent estimates published by EuroStat, life expectancy at birth in 2017 in the EU-28 was at

80.9 (83.5 years for women and 78.3 years for men). Between

2002 (the rst year for which life expectancy data became

available for all EU Member States) and 2017, life expec- tancy in the EU-28 increased by 3.2 years, from 77.7 to 80.9 years, (increasing 2.6 years for women and 3.8 years for men). As the primary risk factor for dementia is age, the contin- ued increase in life expectancy increases the likelihood of more people developing the condition. Knowledge about the numbers of individuals a ected by dementia is essential for the research community, as hypothesis generation is o en driven by epidemiological data. At a regional, national and international level, stra- tegic planning of health and social policy is dependent on accurate estimation of the size of the problem, including the ability to estimate the future cost of the condition for society. Similarly, in their work at a national level, our national members must be aware of the numbers of peo- ple in their countries, to allow them to carry out their role in raising awareness, providing information and engaging with decision makers. For these reasons, it is essential that estimates for the prev- alence of dementia are updated to include the most recent and most robust studies.

Overview of literature review

Approach

In developing this report, we undertook a literature search and review on European prevalence studies, which led to a collaborative analysis of collected prevalence studies and a calculation of prevalence rates and numbers of people with dementia in European countries. Previous papers from the ALCOVE project (1 January 2008-15 September 2011) (n=12), as well as papers from the 2018 study of Bacigalupo et al., (16 September 2011 - 9 July 2018) (n=9), were considered for full review, as the authors adopted the exact same search methodology as set out in EuroCoDe.

ESTIMATING THE PREVALENCE OF DEMENTIA IN EUROPE |

As a follow-up on the systematic review of papers reporting on the prevalence of dementia, we adopted the same search methodology and screening process previously identi ed as part of EuroCoDe. The aforementioned studies used the following search string: "Dementia / Prevalence / Incidence / Epidemiology" or "Alzheimer's Disease / Vascular dementia,

Lewy-body disease / Fronto-temporal dementia/

Incidence / Prevalence / Epidemiology".

We applied this string within PubMed between the date ranges of 9 July 2018 and 5 June 2019, a total of 892 publica- tions were identi ed, which were compiled into a database. In rst instance, we reviewed the titles and abstracts of the

892 studies to determine if the papers were of relevance.

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