As September marks World Alzheimer’s Month globally, Bangladesh is at a critical juncture in its demographic landscape. The country is witnessing a shift towards an aging population due to decreasing fertility rates and longer life expectancies. Despite this shift, the focus of the national health system remains primarily on infectious diseases, maternal and child healthcare, and basic cardiovascular health, overlooking the looming crisis of Alzheimer’s disease and related dementias.
Recent epidemiological studies conducted by icddr,b, the Directorate of Health Services, and the National Institute of Neurosciences and Hospital in 2019 revealed that around 8% of individuals aged 60 and above in Bangladesh are living with dementia. The prevalence is higher among women and can exceed 12% in certain regions like Rajshahi and Rangpur. It is projected that by 2025, over 1.3 million older adults in the country could have cognitive impairment, a number expected to surpass 2.4 million by 2041 without timely interventions.
In Bangladesh, dementia poses a significant challenge for households as affected individuals often have co-existing non-communicable conditions such as hypertension and clinical depression. Due to the lack of cognitive screening tools and geriatric training at primary healthcare levels, early symptoms often go unnoticed until severe behavioral issues arise, leading families to seek care at overwhelmed tertiary facilities in urban areas, resulting in substantial financial and logistical burdens.
The country’s high out-of-pocket health expenditure, which accounts for over 79% of total healthcare spending, exacerbates the financial strain on families dealing with chronic neurodegenerative illnesses like dementia. Economic evaluations indicate that the cost of managing dementia escalates significantly from $590 annually in mild stages to over $25,500 in severe stages, driven by constant supervision, palliative care, and long-term medication.
Moreover, in low- and middle-income countries like Bangladesh, the majority of the economic burden of dementia, about 58%, is borne by unpaid family caregivers, predominantly women. This unpaid caregiving responsibility not only impacts household incomes but also diminishes female workforce participation, widening gender disparities and reducing the national tax base.
To address these challenges, there is a need for increased public investment in the prevention and early detection of Alzheimer’s disease. Studies suggest that managing modifiable risk factors like hypertension, diabetes, smoking, and physical inactivity can prevent or delay a significant portion of dementia cases globally. By focusing on cardiovascular health and lifestyle modifications at community healthcare centers, the onset and progression of dementia can be delayed, reducing the economic burden associated with advanced stages of the disease.
Achieving this transformation requires a coordinated effort across multiple government ministries in Bangladesh. The Ministry of Health and Family Welfare should incorporate cognitive screening tools in primary healthcare settings to detect early cognitive decline. The Ministry of Social Welfare could reform the old age allowance system to provide additional support to households caring for dementia patients. Additionally, the Ministry of Local Government, Rural Development, and Co-operatives should establish community-based respite care programs to assist informal caregivers.
Dementia should not be a silent burden carried by families alone but must be addressed as a pressing public health and economic issue requiring government intervention. By investing in prevention, early detection, and social protection measures, Bangladesh can safeguard household finances, support women in the workforce, and ensure dignity for its aging population.
