The paper by Melo et al.[1] is an important contribution to understanding the impact of dementia in Brazil and
can help define guidelines for future research and public policies in this area. The
authors of this investigation should be commended for their enormous effort in gathering
data from the Global Burden of Disease, the Brazilian Institute of Geography and Statistics,
the Brazilian Ministry of Health, and several Brazilian epidemiological studies on
dementia. By carefully analyzing these data, the authors were able to produce important
findings that have significant implications for health care and policymaking in Brazil.
The increase in life expectancy over recent decades has caused a rise in the prevalence
of degenerative diseases, which are more common in older adults. Dementia is one of
the most common of these conditions, and despite its massive impact on the health
of individuals, it has been largely neglected in Brazil and other Latin American countries,
not only by policymakers but also by the general public. Estimates indicate that the
prevalence of dementia will increase four-fold between 2015 and 2050 in Latin America[2]. The population is aging rapidly in Brazil, making dementia a growing public health
priority.
In a global context, the most recent figures show that Brazil has the second-highest
age-standardized prevalence of Alzheimer’s disease (AD) and other dementias, after
Turkey[3]. In 2000, AD ranked as the third and fourth most common cause of death in women
and men aged 70 years or older, respectively, but by 2016, it had become the second
most common cause of death for both genders. Moreover, AD was the third main cause
of disability in men and women aged 70 years or older in 2000, but by 2016, it had
become the second leading cause of disability in men in this age group, while remaining
the same for women[1].
One of the most important points emerging from the study is that with the rapid aging
of the population, dementia will significantly rise unless measures are taken now
to curb this scenario. We must remember the role that dementia prevention can have
for future generations[4], especially in developing countries with low levels of education and a lack of adequate
control of conditions such as hypertension, obesity, and diabetes. A recent study[5] suggested that 32.3% of dementia cases in Brazil could be related to seven potentially
modifiable risk factors (diabetes, hypertension, obesity, sedentary lifestyle, depression,
smoking, and low levels of education) and that reducing the prevalence of each of
them by 20% per decade could, by 2050, potentially reduce the prevalence of dementia
in the country by 16.2%.
Another point raised in the study by Melo et al. concerns the costs of dementia, which
mostly fall on the family of dementia patients, particularly on young women, who have
to leave their formal employment to work as untrained caregivers for a family member
with dementia[6].
A consideration of the limitations of the study can help guide recommendations for
future studies to improve the accuracy of data across the country. The first was the
paucity of epidemiological studies on dementia in Brazil, most of them concentrated
in the Southeastern region of the country[7]. The lack of epidemiological studies on dementia from other regions makes it difficult
to have an overview of the situation in regard to the disease throughout the whole
country. The second issue is the lack of homogeneity of diagnostic criteria in the
epidemiological studies that do exist[7]; this subject clearly needs to be addressed when planning future studies.
Regarding death certificates, the authors recommended using the diagnosis of the specific
disease (AD, vascular dementia, frontotemporal dementia, Lewy body dementia, for example)
and not simply dementia because these subtypes are associated with distinctive effects
as to years lost due to disability (YLDs), age-standardized mortality, years of life
lost (YLLs), and disability-adjusted life years (DALYs). However, we note that the
use of death certificates to assess the prevalence of dementia and dementia subtypes
as causes of death has proven challenging in Brazil in the past. In a study conducted
in Catanduva, São Paulo State, AD was mentioned only 4 times and senile dementia only
once in 40 death certificates of individuals with dementia[8]. This study was published 15 years ago, and whether recording specific diseases
on death certificates has become more frequent in Brazil remains to be seen.
Data from the study by Melo et al.[1] and other recent studies show that policymakers need to be aware of the urgency
and the scale of the problem of dealing with dementia in Brazil and the need for more
funding to provide the means to develop a National Dementia Plan[9]. Such a plan could help guide policies on the prevention and treatment of the condition
and establish care strategies and research priorities for dementia in Brazil, taking
into account the well-being of the 1.5 million Brazilians estimated to have dementia
in this paper, as well as their family and caregivers.
