Dementia can no longer be excluded from NCDs framework
Dementia is among the three deadliest noncommunicable diseases (NCDs), along with heart disease and lung cancer (CFR Education 2023). However, to individuals living with cognitive decline, like me, the significance of dementia’s effect is the years lived with disability (YLDs) rather than death. With a longer lifespan, people living with dementia will require care for longer periods. Functional independence will be greatly impacted, a crucial factor in maintaining health-related quality of life, and as dementia progresses, higher care needs are required.
Yet, dementia is hardly included in national systems’ response to NCDs prevention and control, despite having high levels of common, preventable risk factors with cardiovascular disease, cancers, chronic respiratory disease and diabetes. 40% of dementia can be prevented, or the onset of cognitive decline can be delayed, if high-risk individuals are detected early and treated. However, a lack of well-equipped primary care doctors in dementia diagnosis and care, coupled with misconceptions by healthcare practitioners and the public that dementia is a natural part of ageing, leads to a delay in diagnosis and receiving timely treatment.
There is also a noticeable gap in dementia rehabilitation services, and even those countries with national plans lack coordinated care between different healthcare professionals and limited access to rehabilitation. Singapore introduced the Chronic Disease Management Programme (CDMP) in 2006, which aims to improve the level of care for people with chronic diseases and make treatment more accessible and affordable for Singaporeans (Ministry of Health Singapore 2024). While dementia is among the 23 chronic diseases covered under the CDMP, there is no mention of rehabilitative therapies under the functional needs assessment of the recommended care components for Major Neurocognitive Disorder (Dementia).
Rehabilitation in dementia is fundamentally crucial to enabling individuals to live independently for the longest possible time, reducing healthcare costs and complications, and improving quality of life. Efforts should be made to increase access and affordability to various rehabilitation services, including cognitive rehabilitation, physiotherapy, occupational therapy, and speech therapy.
With early diagnosis, there is even greater urgency to ensure people diagnosed with mild cognitive impairment and dementia are receiving the needed rehabilitation to maintain their functional independence, reducing care burden on their families. I use assistive devices, allocate more time to execute my tasks, and ensure safety measures are in place to enjoy my modified independence. Many individuals living with mild to moderate dementia can have modified dependence with supervision and moderate assistance instead of becoming completely dependent, when they can still help themselves, a crucial factor to their self-esteem and self-worth.
Moreover, most individuals living with dementia live with at least one chronic disease or multimorbidity, making it advantageous to include dementia in the Chronic Disease Self-Management Programme (CDSMP) to attain optimal management of these conditions. Self-management, a key component of the Chronic Care Model, involves people with chronic disease (s) to gain skills and confidence to manage their health and interact with healthcare providers (Bartlett et al. 2020). Dementia, for example, often makes people cognitively tired and physically lethargic, affecting their moods and emotions. Helping these individuals learn how to manage their fatigue and introduce some relaxation exercises would not only make it much easier to live a healthy life with dementia, but also with other chronic conditions they might have, for example, cancer. Empowered individuals are more likely to have higher self-efficacy, and thus, feel in control of their lives rather than the condition becoming the centre of their lives. Findings from the Stanford Chronic Self-Management Programme showed that participation was associated with improvement in health behaviours, health outcomes (pain, disability, fatigue, depression, health distress, self-rated health) and health-related quality of life (Bartlett et al. 2020).
In conclusion, it is high time that dementia is prioritised at the 4th High-level meeting of the UN General Assembly on the prevention and control of noncommunicable diseases and the promotion of mental health and well-being in September 2025. People living with cognitive decline and dementia, their carers/care partners and families need the commitment from Heads of State and Government and representatives of States and Governments to:
Recognise that the main modifiable risk factors for dementia and the social determinants of health have high commonality with other major noncommunicable diseases, making dementia a rational inclusion in the prevention and control of non-communicable diseases;
Recognise that with the ageing population worldwide, health profiles are rapidly changing, and research has shown that the decline in cognitive function has been closely associated with four major noncommunicable diseases, making it necessary to recognise dementia alongside cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes in prevention and control management;
Recognise that 40% of dementia is preventable and largely driven by the presence of noncommunicable diseases like diabetes, hypertension, obesity, and depression;
Acknowledge that there are evidence-based and cost-effective interventions for preventing, screening, diagnosing, treating, and caring for people living with cognitive decline and dementia and other noncommunicable diseases;
Recognise that people living with dementia and other noncommunicable diseases, and informal carers/care partners have unique experiences, and their first-hand expertise will benefit in designing, implementing and monitoring person-centred prevention, diagnosis, treatment, care (including rehabilitation and palliation) policies and programmes that reflect their needs and address existing gaps.
The political declaration of the fourth high-level meeting of the General Assembly will be instrumental in enhancing the political leadership in dementia, which is seriously lacking globally, and working towards achieving the targets of the WHO Global Dementia Action Plan that has been extended to 2031.
References
Bartlett, Susan J., Sylvie D. Lambert, Jane McCusker, Mark Yaffe, Manon de Raad, Eric Belzile, Antonio Ciampi, Mario Di Carlo, and Anne Lyddiatt. 2020. “Self-Management across Chronic Diseases: Targeting Education and Support Needs.” Patient Education and Counseling 103 (2): 398–404. https://doi.org/10.1016/j.pec.2019.08.038.
CFR Education. 2023. “Noncommunicable Diseases and How They Are Measured.” CFR Education from the Council on Foreign Relations. February 24, 2023. https://education.cfr.org/learn/reading/noncommunicable-diseases-and-how-they-are-measured.
Ministry of Health Singapore. 2024. “Chronic Disease Management Programme (CDMP).” 2024. https://www.primarycarepages.sg/schemes-and-programmes/chronic-disease-management-programme.
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