Prevention in name only: Are national dementia plans delivering on their promises?

The number of people living globally with dementia has been increasing and is projected to continue to do so; from 55 million in 2019, to 139 million by 2050.

The greater numbers of people with dementia – particularly severe dementia, will heighten both practical and financial pressures on unpaid carers and health and social care services.

In fact, the global cost of dementia care is expected to rise from $1.3 trillion in 2019 to $2.8 trillion by 2030.

Modifiable risk factors that could reduce dementia cases

There is currently no cure for dementia, so prevention is key. Two pieces of research from Livingston et al. in 2017 and 2024 (see references below) identify 14 modifiable risk factors, which if addressed could reduce dementia cases by over a third. Of note, it is clear these risk factors are either other chronic illness diagnoses in themselves, or modifiable lifestyle factors common to a number of other chronic health conditions:

The WHO has identified dementia as a public health priority in 2017, when developing their Global Action Plan. Their aim is for countries to devolve power and find effective strategies to deliver funding and support prevention and care for people with dementia, while improving the skills and knowledge of the general public and care professionals alike.

In this paper, Andreoletti and Blasimme (2025) aimed to synthesise the evidence available from National Dementia Plans (NDP) of Western European and North American countries, to identify the importance each country gives to different aspects of dementia prevention and management.

Are there any common policy priorities and strategies for action in Western Europe and Northern America, when it comes to dementia prevention?

Methods

The authors sourced data from the Alzheimer’s Disease International (ADI) database, and subsequently identified national strategies and plans for dementia (NDPs) from respective government sources.

Two-strands of data extraction and analysis were used to identify:

1. Information on each country’s national dementia plan (NDP) focus, in relation to priorities in dementia prevention; and
2. Qualitative themes across NDPs, related to the tangible aims and objectives of dementia prevention strategies.

This study identified national dementia plans (NDPs) from governmental sources in Western Europe and North America, to assess their stated policy aims and objectives, and tangible measures taken for dementia prevention.

Results

Sixteen relevant NDPs were identified, from the following countries: Canada (CAN), Spain (ESP), United States (USA), Finland (FIN), Greece (GRC), France (FRA), Ireland (IRE), Netherlands (NED), Germany (DEU), Italy (ITA), Luxembourg (LUX), Malta (MLT), United Kingdom (UK), Austria (AUT), Liechtenstein (LIE) and Switzerland (CHE). These NDPs were developed between 2009 (UK) to 2023 (USA).

The authors identified a great deal of variance across the countries in their aims and implementation of preventative approaches for dementia, across two main themes in their qualitative analysis:

• “Prevention as a strategic goal” : The analysis demonstrates that while most countries include this in their NDP, some are more exhaustive in their discussion of dementia prevention – identifying specific measures to be implemented. Others include prevention more broadly construed, including education and knowledge building.
• “Actions”: this comprises five sub-themes related to different areas of dementia prevention. The authors discuss if and how these five areas are addressed in each country’s NDP.

In terms of comprehensiveness, only one country – Canada – incorporates all five areas within their NDP. Half (8) of the countries identified include either 0 or only 1 of the five areas in their NDP. Three countries – Austria, Liechtenstein and Switzerland – included no identified action areas in their NDP.

Common NDP goals are identified below:

• “Increase public awareness”– Eight countries’ NDPs (CAN, ESP, USA, GRC, IRE, ITA, MLT, UK) highlight the need for greater knowledge of dementia as a condition, the risk factors for dementia, and how people can reduce their likelihood of developing dementia. The majority of the measures appear to focus on providing members of the public opportunities to actively engage in developing their knowledge of dementia and risk factors, and in early recognition of symptoms of dementia.
• “Identification of risk factors”– Six countries (CAN, ESP, USA, FIN, IRE, NED) included this in their NDP, planning to implement measures to support risk identification, and measures to reduce the prevalence of risk factors. The authors also note that these eight countries highlight the need to adapt their interventions depending on pre-disposition to risk factors (e.g. family history of certain health conditions). To do this, several countries highlight their plan to rollout interventions at the wider community level, but also interventions that can focus on specific population groups with greater risk.
• “Advancing research”– Six countries (CAN, ESP, USA, FIN, NED, DEU) highlight this in their NDP demonstrating the value they place in research to support identification of risk factors, and the importance of evidence-based interventions to support positive improvements in measuring and altering susceptibility to dementia risk factors at the individual and population level.
• “Promotion of healthy aging” – Five countries’ NDPs (CAN, ESP, FIN, GRC, FRA) highlight this area, which the authors discuss as providing ‘a clear commitment to cultivating an environment that fosters the wellbeing and vitality of aging population.’  These countries advocate for supporting older people to maintain physical and mental health by being active and engaging in activities which support cognition.
• “Lifestyle interventions” – Several nations’ NDPs (CAN, ESP, FIN, GRC, FRA, LUX) include an assortment of lifestyle factors, either as standalone factors, or modifiable risk factors for dementia – such as the level of alcohol consumption and physical activity. Overall, countries differ notably in how they intend to implement lifestyle interventions. Specifically, the authors identified that Canada focused on person-centred factors, unlike France, which focused on lifestyle-modification factors at large. This indicates the importance of including both population and targeted interventions to have the greatest possible impact.

While 16 countries’ NDPs were reviewed, only Canada substantially led the field with actions planned across all relevant domains to tackle education and risk factor modification for dementia.

Conclusions

The authors conclude that NDPs are in place in several nations of Western Europe and North America, demonstrating variable commitment to implementing interventions and supporting people to make changes in lifestyle as a means to prevent the development of dementia from direct or indirect risk factors.

It is evident that countries place different importance in the five identified action categories of dementia prevention, demonstrating varied ways in which they can implement interventions to improve knowledge and make appropriate lifestyle changes. It is also evident that some countries’ NDPs do not identify clear preventative strategic goals or follow-up actions, which further underlines the heterogeneity of care a person with dementia may receive from state-to-state.

Overall, the authors highlight that any NDP’s utility is limited, existing ‘in very general terms, lacking specific implementation plans.’  The authors provide a suggestion: that countries should move to a more ‘horizontal’ approach to dementia prevention: meaning implementing strategies to increase awareness and knowledge of lifestyle and comorbidity risk factors across multiple health conditions, rather than maintaining a ‘vertical’ focus on dementia alone.

This research shows that many countries talk about dementia prevention, but few have clear, measurable plans to act on it.

Strengths and limitations 

Although this paper extracts some overarching detail about countries’ intentions, the heterogeneity of goals across NDPs and particularly the 15-year range of when the NDPs were developed until the time of research review, makes it difficult to standardise a comparison of plans for dementia prevention against each other.

It is difficult to know that each NDP truly reflects the outlook and priorities of a country to dementia prevention and management, years later in 2025. It is also difficult to know to what degree dementia risk factor interventions have already been implemented in each country, or whether their success has been benchmarked and future plans made in line with evidence-based medicine. As a result, there is limited comparative evidence, and we cannot see whether their respective approaches are beneficial or need adapting. Further, the assessment of priorities across these countries’ NDPs, does not account for the significant and evolving social changes and resource disparities, which have occurred over the years since NDPs were first developed.

Finally, the inclusion of only Western European and North American countries limits not only the geographic representativeness of the research but also the generalisability of outcomes for countries to learn from others. Even within the included countries, although they are more ethnically diverse than ever and encompass people from all over the world speaking hundreds of different languages, there were no clear NDP initiatives on engagement with diverse communities. It is essential that services understand how to effectively engage with the entirety of their population, rather than limiting their reach due to an inability to engage in culturally, or linguistically, appropriate discussions.

Overall, despite the high-level policy overviews within the scope of this study, the authors ground their research in real-world challenges – highlighting that population-level accessibility of information and support are the critical actions required to improve public awareness of dementia – creating the best chance for initiatives to reduce the impact of risk factors for dementia.

The authors identify that evidence-based updates on action priorities in dementia prevention, recommend 26 targeted population-level interventions backed by a moderate to high quality of evidence, which can be used to guide legislative and structural measures for dementia prevention Walsh et al (2024). Nonetheless, in a vicious cycle of sorts, the authors also acknowledge that this best practice research, may itself experience funding and support challenges due to legislative and structural difficulties (Walsh et al, 2023).

Over the last 15 years, Western countries have had variable priorities in dementia prevention –  viewing it ‘vertically’ as a single disease process, rather than ‘horizontally’ targeting risk factors, across conditions and communities.

Implications for practice

The authors of this study, while comparing high-level stated policy intentions of NDPs, highlight the importance of using tangible targeted & population-level interventions to actually manage the prevalence and impact of dementia risk factors, in any country.

These practical actions can help to reduce the number of people bearing the profound impact of dementia on their lives, as a person living with, or caring for somebody with, dementia. The authors do however acknowledge in discussion, that there can be significant challenges to undertaking evidence-based research and implementing evidence-based recommendations. These challenges continue to be more impactful on practice than ever – across the studied countries, disparities between stated NDP goals and current research and actions towards dementia prevention, grow starker by the day.

For instance, while the United Kingdom NDP was developed in 2009, the most recent Institute for Government Performance Tracker (Hoddinott, 2025) identifies that the proportion of older adults who receive long-term care in 2023-24 (3.6%), is now only half the number of older adults receiving the same in 2003-04 – a discrepancy attributed not to a reduction in need, but to 15 years of health and social service budget cuts for older adults since 2010. Hence, it is vital that people be supported to reduce their likelihood to develop illness in older age, if resources for that population continue to dwindle.

More recently, unprecedented cuts to NIH research funding for dementia risk factor prevention projects in the USA, such as deCarli lab in California, which were only reinstated following significant appeals and national lawsuits (Anderson, 2025) indicate that even the priorities of a relatively recent NDP from 2023, are vulnerable to sociopolitical change. In this respect, it is important for legislators and policymakers to routinely review documents like NDPs with broad ‘aims’, to ensure that tangible actions based on those goals can continue even in a time of social upheaval.

Prevention is often better (and cheaper) than cure – but especially where there is no cure, it is critical that countries provide the knowledge and facilities for people to make informed choices about their “lifestyle” such as smoking cessation, sight loss treatment or increased exercise – with the central goal to developing evidence-based actions to reduce the risk of dementia (and a raft of other health conditions) in the population.

Countries will need more than good intentions – it is time to implement inclusive education and supports in the population to reduce the impacts of lifestyle risk factors on developing dementia, backed by evidence and structures resilient to sociopolitical change.

Statement of interests

No conflicts of interest.

Links

Primary paper

Andreoletti M and Blasimme A (2025). Examining the prevention approach in National Dementia Plans from European and North American countries. Front. Dement. 3:1463837. doi:  0.3389/frdem.2024.1463837

Other references

Anderson, C. Sweeping NIH cuts jolt UC Davis dementia research team and scientists nationwide. Sacramento Bee. 2025 Apr 21. Available at: https://www.sacbee.com/news/equity-lab/article304041321.html

Hoddinott, S. “Adult social care across England” Performance Tracker. Institute for Government. 25 June 2025. Available at: https://www.instituteforgovernment.org.uk/publication/performance-tracker-local/adult-social-care

Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, Ballard C, Banerjee S, Burns A, Cohen-Mansfield J, Cooper C, Fox N, Gitlin LN, Howard R, Kales HC, Larson EB, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care. Lancet. 2017 Dec 16;390(10113):2673-2734. doi: 10.1016/S0140-6736(17)31363-6

Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, Ames D, Banerjee S, Burns A, Brayne C, Fox NC, Ferri CP, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Nakasujja N, Rockwood K, Samus Q, Shirai K, Singh-Manoux A, Schneider LS, Walsh S, Yao Y, Sommerlad A, Mukadam N. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024 Aug 10;404(10452):572-628. doi: 10.1016/S0140-6736(24)01296-0

Walsh S., Wallace L., Kuhn I., Mytton O., Lafortune L., Wills W., et al. (2023). Are population-level approaches to dementia risk reduction under-researched? a rapid review of the dementia prevention literature. J. Prev. Alzheimer’s Dis. 2023:57. 10.14283/jpad.2023.57

Walsh S., Wallace L., Kuhn I., Mytton O., Lafortune L., Wills W., et al. (2024). Population-level interventions for the primary prevention of dementia: a complex evidence review. eClinicalMedicine 70:102538. 10.1016/j.eclinm.2024.102538

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