Dementia Across Countries: Where You Live Shapes Diagnosis, Drugs and Support

Where a person with dementia lives shapes whether they are ever diagnosed, what medicines they are given and what support reaches them and their family. Among countries that could report a figure to the World Health Organization in 2024, the median dementia diagnostic rate was 62% in high-income countries and 6% in low- and middle-income countries^[1].

For families, these gaps are practical. In one country, memory changes lead to an assessment, a diagnosis, a named contact and some help at home. In another, the same changes go unrecorded, there is no service to refer to, and care falls entirely to relatives. This article sets out what the international evidence can and cannot show about diagnosis, numbers, antipsychotic use, care settings and national plans, and why the gaps it reveals are gaps in health systems, not in the people living with dementia.

Most people with dementia live in low- and middle-income countries, and that is where numbers will grow fastest

The WHO estimates that 57 million people were living with dementia worldwide in 2021, more than 60% of them in low- and middle-income countries, with nearly 10 million new cases each year^[3]. Yet most of the detailed data on dementia, from diagnosis registers to prescribing audits, comes from a small number of high-income countries. The places where most people with dementia live are the places with the least evidence about them.

The Global Burden of Disease (GBD) 2019 forecast, published in 2022, produced country-level estimates of dementia prevalence and forecast them to 2050. It estimated that the number of people with dementia would rise from 57.4 million in 2019 to 152.8 million in 2050^[4]. The same model found that age-standardised prevalence stayed essentially flat over that period (a global change of 0.1%): the growth comes from population growth and population ageing, not from a higher risk at any given age. Women outnumbered men with dementia by about 1.69 to 1 in 2019^[4].

The projected growth is very uneven. The smallest increases were forecast for high-income Asia Pacific (53%) and western Europe (74%), and the largest for north Africa and the Middle East (367%) and eastern sub-Saharan Africa (357%). Population growth drives most of the rise in sub-Saharan Africa, and population ageing most of it in east Asia^[4].

In some high-income countries, the risk of developing dementia at a given age appears to be falling. Pooling seven population-based cohort studies in the United States and Europe (49,202 people, 1988 to 2015), the Alzheimer Cohorts Consortium found that the incidence rate of dementia declined by 13% per calendar decade^[5]. That trend comes from cohorts in a handful of wealthy countries and should not be assumed elsewhere. Our article on dementia prevalence projections looks at the forecasts and their assumptions in more detail.

Diagnosis rates are about ten times higher in richer countries, where they can be measured at all

A diagnosis is how people with dementia and their families reach treatment, information, care planning and support. WHO’s global action plan set a target that at least half of countries should diagnose at least half of the people estimated to have dementia by 2025^[1]. The WHO’s December 2024 progress report shows how far away that is. Of the 78 countries taking part in its Global Dementia Observatory, only 37 (47%) could report a dementia diagnostic rate at all. Among those that could, the median rate was 26%: 62% across 17 high-income countries and 6% across 14 low- and middle-income countries^[1].

Peer-reviewed studies point the same way. A 2017 meta-analysis of 23 community studies estimated that 61.7% of dementia went undetected, with higher rates of underdetection in China and India than in Europe and North America^[6]. These studies screened people in the community and compared the results with existing diagnoses, so they measure something different from a national diagnosis rate.

England offers a worked example of how a national rate is built, because it publishes one routinely. On 30 June 2026, 516,230 patients had a recorded diagnosis of dementia on GP records, and 66.2% of people aged 65 and over who are estimated to have dementia had a recorded diagnosis, slightly down from 66.3% on 31 March 2026^[7]. The rate is recorded diagnoses divided by a modelled estimate of how many people should have dementia, so it depends on that model as much as on the GP records. Our article on dementia diagnosis rates covers how rates are measured and how they vary within countries.

Antipsychotic use varies several-fold between countries, and within them

Antipsychotic medicines are sometimes prescribed for distress, agitation or psychosis in people with dementia, and they carry serious risks for this group. How often they are used is widely tracked as a marker of the quality of dementia care, but there is no single international measure, so the evidence comes from separate studies with different populations and definitions.

A 2016 review of 37 studies of antipsychotic use in Western European nursing homes found that the share of residents prescribed antipsychotics ranged from 12% to 59%. The highest rates were found in Austria, Ireland and Belgium, and the authors concluded that Norway did best, with low antipsychotic use^[2]. Those figures cover nursing home residents generally, not only people with dementia.

The RightTimePlaceCare study used one method across eight European countries. Among 791 people with dementia recently admitted to long-term care, 37.4% were receiving antipsychotics, ranging from 12% in Sweden to 54% in Spain. The odds of antipsychotic use were lower where the facility had a dementia-specific unit^[8], an association which suggests that the setting, and not only the person’s needs, may matter.

Variation inside a single country can be as wide as between countries. Denmark’s national registers show that in 2012, 20.7% of people aged 65 and over with dementia used antipsychotics, ranging from 17.0% to 23.3% across the five regions and from 7.5% to 33.1% across the 98 municipalities^[9]. Gaps on that scale, within one health system, are more likely to reflect differences in local practice than in the people being treated. These figures are not directly comparable with each other: they differ in setting, age, year and definition.

Care and support for families depend heavily on where they live

Where people with dementia live, and who cares for them, varies with each country’s long-term care system. Few countries publish comparable figures. Canada is one that does: in 2015–16, 69% of residents of long-term care homes had dementia, and about a third of older people under 80 who had been diagnosed with dementia lived in long-term care homes, rising to 42% of those aged 80 and over^[10]. Those figures describe people with a diagnosis in one country’s data and cannot be applied elsewhere, least of all where formal long-term care barely exists.

The WHO’s 2024 survey shows how wide the service gap is. Community-based dementia services were available in 50 of the 78 participating countries, but in low- and middle-income countries access was often confined to cities: only 6 of 43 reported rural access, compared with 26 of 35 high-income countries^[1]. Services for carers followed the same pattern. They were available in 89% of high-income participating countries but only 35% of low- and middle-income ones, and rural access was reported by 21 of 35 high-income countries but only 4 of 43 low- and middle-income countries^[1].

Where formal services are missing, care falls to families, and WHO notes that women carry a disproportionate share as primary carers^[1]. The scale of that unpaid care, and how little support reaches carers even in wealthy countries, is set out in our article on unpaid dementia carers.

Only a quarter of countries have a national dementia plan

National dementia plans are how governments commit to diagnosis, care, carer support and research. The global action plan, endorsed by the World Health Assembly in 2017, called for 75% of Member States to have one by 2025. In 2024, only 26% of countries (50 of 194) met that target, and six more Observatory participants were developing dementia policies. WHO reported that countries with dementia plans were more likely to meet other key dementia targets^[1].

Progress was short of target across the plan. In 2024, 40 of 78 participating countries reported a dementia awareness-raising campaign, and 31 of 78 (40%) said no dementia data had been compiled in a report for policy, planning or management in the past two years. WHO concluded that no target was on track to be met by 2025^[1], and the global action plan has since been extended to 2031^[3].

Why country figures rarely line up

Dementia figures for two countries often look comparable when they are not. National figures measure different things:

• Recorded diagnoses. England counted 516,230 people with a dementia diagnosis on GP records in June 2026^[7]. This counts people known to the health system, not everyone with dementia.
• Modelled estimates. The Alzheimer’s Association estimates that 7.4 million Americans aged 65 and over are living with Alzheimer’s dementia in 2026, about 1 in 9 people in that age group^[11]. That is an estimate of one type of dementia in one age band, derived from population studies, not a count of diagnoses.
• Global models. GBD and WHO figures combine surveys and statistical modelling to fill gaps where countries have little or no data^[3][4].

Comparisons also founder on age bands (all ages, 40 and over, 65 and over), on setting (community or care homes), on year, and on how dementia is defined and coded. Survey-based comparisons have their own limits: the WHO Global Dementia Observatory figures come from 78 of 194 Member States that chose to take part, and the diagnostic rates from the 37 of them able to report one^[1]. Countries with weaker information systems are the least likely to appear in the data at all, so the reported figures may well flatter the global picture.

None of this makes international comparison pointless. Large and consistent gaps, such as diagnostic rates of 62% against 6%, or carer services in 89% against 35% of countries, are unlikely to be explained by differences in method alone^[1]. Smaller differences between two countries’ headline figures usually are.

What the evidence asks of us

The evidence points to four things governments, health systems, funders and international bodies can do, measured against targets they have already agreed:

• Adopt and fund national dementia plans. Only 50 of 194 countries had one in 2024, against an agreed target of 75%, and countries with plans were more likely to meet other targets^[1]. The extension of the global action plan to 2031 gives governments a second chance to act on it^[3].
• Make diagnosis possible everywhere, including outside cities. A median diagnostic rate of 6% in reporting low- and middle-income countries means most people with dementia there have no route into care^[1]. Diagnostic capacity, workforce and rural services are where investment is most needed.
• Support carers as part of the health system. Carer services reached rural areas in only 4 of 43 low- and middle-income countries in the WHO survey^[1].
• Count dementia, and publish the counts. Forty per cent of participating countries had compiled no dementia data report in two years^[1]. Routine, published indicators, including antipsychotic use, make variation like Denmark’s visible and open to improvement^[9].

Behind each gap are people living with dementia whose access to diagnosis and care depends on their country, and often their town, rather than their needs. That is a matter of policy and investment.

Language: this piece uses person-first language ("people living with dementia", "people with dementia"), as most dementia organisations and people with lived experience prefer, and uses clinical terms such as "Alzheimer's disease" or "mild cognitive impairment" only where a study, dataset or diagnosis refers to that specific condition.

Why we're publishing this

Dementia organisations argue for better diagnosis, care and support in their own countries, and international comparison is one of the strongest arguments they have: if other health systems diagnose more people, use fewer antipsychotics or support more carers, the gap is a choice, not a fact of nature. But comparisons used carelessly can mislead, and a figure lifted from one country’s data can be wrong for another. We have brought the main international sources together in one place, with their caveats attached, so that people living with dementia, carers and the organisations that stand with them can use the evidence with confidence. This article is part of our Dementia & Health research library.

How to read this data

This article draws on four kinds of evidence, and they should not be mixed up. Country self-reports to the WHO Global Dementia Observatory (2024) cover 78 of 194 Member States; diagnostic rates are medians of the rates the 37 reporting countries supplied, each calculated in its own way. Modelled estimates (the GBD 2019 forecast, WHO global numbers, the Alzheimer’s Association’s US estimate) depend on their models and assumptions; the GBD forecast was published in 2022 and builds in forecast trends in three risk factors (high body-mass index, high fasting plasma glucose and smoking) and in education. Recorded data (England’s GP registers, Denmark’s and Canada’s national data) count people known to services and miss those never diagnosed. Research studies (the antipsychotic studies and the undetected-dementia meta-analysis) cover particular samples, settings and years.

Figures in the same table or chart are not directly comparable unless we say so. The antipsychotic figures differ in population (nursing home residents generally, people with dementia newly admitted to care, all people with dementia aged 65 and over), year (2012 to 2016 and earlier) and definition. Several figures are a decade old because newer comparable studies were not found; prescribing has changed since. Estimates for the United States refer to Alzheimer’s dementia only. The OECD publishes country-level dementia prevalence and policy comparisons, but its pages could not be accessed for verification while this article was prepared, so its figures are not used here. Evidence from low- and middle-income countries, and from Africa in particular, is thin throughout.

Use this data

Free to cite with attribution to Understanding Aging. Charities, carers' groups, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research and statistics for general information. It is not medical, care or financial advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's memory or health, please speak to a GP or another qualified health professional.

Sources

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2. Janus SI, et al. Psychotropic drug prescriptions in Western European nursing homes. International Psychogeriatrics, 2016. europepmc.org/article/MED/27469071
3. World Health Organization. Dementia: fact sheet. WHO, updated 2026. who.int/news-room/fact-sheets/detail/dementia
4. GBD 2019 Dementia Forecasting Collaborators. Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. The Lancet Public Health, 2022. europepmc.org/article/MED/34998485
5. Wolters FJ, et al. Twenty-seven-year time trends in dementia incidence in Europe and the United States: the Alzheimer Cohorts Consortium. Neurology, 2020. europepmc.org/article/MED/32611641
6. Lang L, et al. Prevalence and determinants of undetected dementia in the community: a systematic literature review and a meta-analysis. BMJ Open, 2017. europepmc.org/article/MED/28159845
7. NHS England. Primary Care Dementia Data, June 2026. NHS England Digital, 2026. digital.nhs.uk/data-and-information/publications/statistical/primary-care-dementia-data/june-2026
8. de Mauleon A, et al. Associated factors with antipsychotic use in long-term institutional care in eight European countries: results from the RightTimePlaceCare study. Journal of the American Medical Directors Association, 2014. europepmc.org/article/MED/25129474
9. Geographical variation in antipsychotic drug use in elderly patients with dementia: a nationwide study. Journal of Alzheimer’s Disease, 2016. europepmc.org/article/MED/27567863
10. Canadian Institute for Health Information. Dementia in long-term care. CIHI, Dementia in Canada. cihi.ca/en/dementia-in-canada/dementia-across-the-health-system/dementia-in-long-term-care
11. Alzheimer’s Association. 2026 Alzheimer’s Disease Facts and Figures. Alzheimer’s Association, 2026. alz.org/alzheimers-dementia/facts-figures