The Growing Dementia Burden in Pakistan: Prioritising Prevention and Early Detection

By Saniya Raghib Sabzwari

Affiliations

1. Department of Family Medicine and Education Development, The Aga Khan University Hospital, Karachi, Pakistan

doi: 10.29271/jcpsp.2025.10.1225

According to the World Health Organization (WHO), by 2030, every sixth individual in the world will be aged 60 years or older, with two-thirds residing in low-to middle-income countries (LMICs). This demographic transition will also be seen among patients with dementia, the majority of whom are expected to reside in LMICs. Currently, 57 million people are affected by dementia, and the numbers are expected to triple by 2050.¹ Dementia is the seventh leading cause of death. Among all geriatric illnesses, it is responsible for the highest rates of disability and loss of functionality, affecting not only the lives of individuals but also their families. Moreover, treatment efficacy remains mild to moderate.^2,3 In response to the increasing global burden, the WHO declared dementia a public health priority.⁴ In 2017, the Lancet Commission on Dementia also identified risk factors, prevention, and management strategies.⁵

Data on dementia in Pakistan remains limited, with numbers ranging from 200,000 to 400,000 individuals.⁶ With the high prevalence of hypertension and diabetes,⁷ numbers are expected to rise with increasing life expectancy. Yet, dementia remains under-recognised, especially in its early stages,⁸ under-researched, and under-prioritised in our healthcare system. There are many reasons for this. It is a common misconception that dementia is part of normal aging. There is a lack of understanding of its symptomatology. Many family members or caregivers assume that preservation of long-term memory negates the presence of dementia. Our healthcare system is burdened with communicable and non-communicable illnesses. With limited geriatric expertise, healthcare providers fail to prioritise the declining memory of older adults, which is identified later, thereby limiting intervention efficacy. The consequences of late diagnosis are profound: falls, medication errors, poor nutrition, and social withdrawal. Caregivers, often untrained and unsupported, experience high levels of stress, depression, and financial burden.^9,10

For a developing country such as Pakistan, tackling the growing risk of dementia requires two key actions: emphasising prevention and ensuring timely recognition and intervention. A 10–20% reduction in risk factors such as low education, hypertension, obesity, physical inactivity, diabetes, and air pollution may lower the risk of dementia prevalence.¹¹ Nutrition is also emphasised as a preventive factor for dementia, especially the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay).¹² This diet recommends the use of green leafy vegetables, nuts, berries, whole grains, and fish, while limiting the use of red meat and processed foods. In addition, religion and spirituality have been identified as beneficial to cognitive function for both middle-aged and older adults.¹³ Physical activity that targets resistance training, endurance, balance, and strength is not only useful for non-communicable diseases but may also prevent cognitive decline. However, people in Pakistan are generally not inclined to exercise.¹⁴ Healthcare providers must target these risk factors and encourage lifestyle changes early, ideally in the fourth or fifth decade of life, not only to prevent cardiovascular diseases but also to reduce the risk of dementia.

As a second step, recognising the varied manifestations of dementia is important. These can range from memory loss to new-onset anxiety, from getting lost in familiar surroundings to agitation, from refusing to shower to sleep cycle reversal, and from social withdrawal to complete dependence on others. Symptoms vary depending on the type and stage of dementia. While memory impairment is the hallmark of Alzheimer’s disease, other forms, such as vascular dementia or frontotemporal dementia, may present with executive dysfunction, personality changes, language deficits, or psychiatric symptoms such as apathy, depression, or halluci-nations.¹⁵ Over time, dementia affects not just cognitive function but psychosocial, functional, and mobility domains. In many patients, these symptoms are mistakenly attributed to depression or other medical conditions, leading to missed opportunities for timely diagnosis and management.

With limited geriatricians worldwide, the primary care pro-viders remain at the forefront of dementia prevention, diagnosis, and management. They should maintain a high index of suspicion when evaluating older adults presenting with cognitive or behavioural complaints, and screen for cognitive impairment in high-risk populations, especially those with functional or psychosocial decline. Early recognition not only improves prognosis but also reduces the cost of care.¹⁶

Various tools for diagnosis are available, and Urdu transla- tions of MMSE and Montreal Cognitive Assessment (MOCA) are available. Screening tools such as the Mini-Cog can be used in community settings.¹⁷

Clinicians seeing older adults can educate patients and families about prevention strategies, optimise risk factors, recognise early warning signs, initiate drug and non-drug treatment, and establish referral pathways for complex cases to maximise functionality and quality of life.

Community health workers and nurses can help with early detection of dementia using simplified, validated tools such as Mini-Cog.¹⁸ Their role also extends to educating families in symptom recognition and management via cognitive stimulation, physical activity, social engagement of patients, and stress mitigation of family members.¹⁹

Furthermore, we must advocate for national strategies for dementia care, incorporating public awareness campaigns, caregiver training programmes, and memory clinics in tertiary and even secondary care settings.

Dementia is not just a medical condition; it is a public health crisis in the making. Healthcare professionals must lead the charge in prevention and early recognition to ensure better outcomes and manage dementia with the same urgency and compassion as they do for other chronic diseases.

COMPETING  INTEREST:
The  author  declared  no  conflict  of  interest.

AUTHOR’S  CONTRIBUTION:
SRS: Conceived the idea, wrote the editorial, and approved the final version of the manuscript to be published.

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