Is China Ready for Dementia?

Dementia has become a worldwide public health challenge related to population aging. Globally, one person is diagnosed with dementia every second, with a new dementia patient diagnosed every 7 seconds [1,2]. With the rapid pace of aging, China now faces the world’s largest dementia population, which constitutes one-fifth of the world’s population who suffer with the condition [1-3]. Dementia has a profound negative impact not only on the affected individual, but also on the families and caregivers, in terms of quality of life, health, and loss of income. It is estimated that one in four dementia caregivers suffer from depression and informal caregivers have a higher mortality risk compared to the general population [4,5]. In the Chinese context of filial piety and the one-child policy, dementia caregivers are mostly spouses, children, or children-in-law. Given a typical family size of five people spanning three generations, at least 30 million to 35 million people in China are directly or indirectly affected by dementia [6]. Undoubtedly, dementia is a major public health crisis in China and ways to meet the challenges are urgently needed. This brief report will present China’s dementia initiatives during the past two decades.

Alzheimer’s’ disease and dementia are listed under the diagnostic category of “organic mental disorders” in the Chinese Classification of Mental Disorders (CCMD-3). Dementia was further categorized under “mental disorders due to psychoactive substances or non-addictive substances” [7]. According to a dementia study on the Chinese population, a growing trend of public awareness, stigmatization, and social isolation associated with a diagnosis were observed [8]. However, there was no special mental health service, except a small number of in-patient beds in the urban cities, for people living with dementia and their families before 2000.

One of the key milestones was the establishment of Alzheimer’s Disease China (ADC) and being a member of the Alzheimer’s Disease International (ADI) in 2002 [9]. Since that time, the main focus of development has been to improve public awareness of dementia and advocate for anti-discrimination laws. Not until 2012, the Mental Health Law of the People’s Republic of China was enacted, under which patients’ rights of diagnosis, treatment, freedom from discrimination, etc. were protected [10]. Under the Law, it is also mandated that psychiatry specialists are responsible for diagnostic procedures and provide treatment prescriptions supported by a nursing care workforce. Even with the initial development of healthcare and social support services for people living with dementia and their families still remains scarce [6,11,12]. Specialists in mental health care are available only at special hospitals, often named “mental health centers” and located in urban areas. In the 12^th Five-Year Development Plan for population aging in China, the need of early intervention for age-related diseases including dementia was first time emphasized, and a goal of 40% early detection was proposed in 2011 [13]. Subsequently, many mental health centers were opened nation-wide and the first Memory Clinic Guide in China was published in 2014 to provide a community resource information to the public [14].

In the 13^th Five-Year Development Plan, Health Management for Adults Aged 65 and Older stressed the important role of Residential Committees (RC) and Village Committees (VC) in both urban and rural regions of China in 2018. The Plan proposed that health profiles be built and disease management be executed for over 70% of older adults living in the same RC. Moreover, technology-supported, community-based long-term care for older adults with functional limitations was emphasized [15]. Even though dementia was not mentioned specifically, it is generally understood to be one of the chronic conditions which is included under the health management system. In 2019, the National Health Commission of the People’s Republic of China issued the Prevention and Treatment Guide for Alzheimer’s disease, which provided definitions and guidelines for prevention, treatment, and developing a friendly social environment. This Guide was disseminated to all levels of the health-care system in China [16].

The above initiative highlights that China has begun to make plans in order to meet the dementia public health challenges by improving the public awareness of the disease, advocating anti-discrimination by law, developing disease management systems and practice guidelines. In 2018, over 100 memory clinics were operating under mental health centers in all four municipal cities and the majority of provinces providing screening and early diagnostic services. Likewise, over 9,000 neighborhood health service centers provided more than two million in-patient care and 6.4 million times of out-patient consultations in over 8,000 communities in Mainland China [17]. This network could be leveraged to prepare China enhancing the dementia care.