The 130 million missing patients: why APAC’s Alzheimer’s challenge is bigger than we think

Across the Asia-Pacific region, 130 million people are biologically developing Alzheimer’s disease without knowing it — and health systems are almost entirely unprepared to find them

When a family first notices that something is wrong — a forgotten name, a missed appointment, a moment of confusion that lingers a little too long — the journey to an Alzheimer’s disease diagnosis has already begun. But that journey is rarely short. In most parts of the Asia-Pacific region, it takes years. Multiple appointments. Repeated tests. Specialists who are too few and too far away. And at the end of that road, a confirmed diagnosis of Alzheimer’s disease that arrives, in many cases, too late for the most effective interventions to make a meaningful difference.

This is the reality for the 26 million people across the Asia-Pacific region currently living with diagnosed dementia. That number drives policy, shapes health budgets, and defines the region’s response to one of its most pressing public health challenges. And yet it captures only a fraction of the true scale of the challenge.

Because beneath the surface — invisible to clinicians, policymakers, and the health systems designed to protect them — there are an estimated 130 million more people in this region who are already developing Alzheimer’s disease. They have no symptoms. They have received no diagnosis. And right now, there is almost no policy mechanism anywhere in the region designed to find them.

This is the Alzheimer’s iceberg. But the region’s response is only calibrated to what sits above the waterline.

The scale of what we’re not counting

Globally, around 55 million people are currently living with dementia — a figure projected to rise to 139 million by 2050 as populations age.¹ The Asia-Pacific region will bear a disproportionate share of that burden. Cases in the region are expected to surge from approximately 26 million in 2025 to nearly 71 million by 2050, at which point more than half of all people living with dementia worldwide will reside here.¹ ² In China alone, modelling published in The Lancet projects that dementia cases could reach up to 66 million by 2050 under upper-bound scenarios.³

Alzheimer’s disease is the predominant cause of dementia, accounting for 60 to 80% of all cases.4 But the clinical and policy focus on diagnosed dementia captures only a fraction of the true disease burden.

Global evidence suggests that approximately 315 million people currently carry preclinical Alzheimer’s disease pathology — meaning they have the underlying biological markers of the disease, including amyloid and tau accumulation in the brain, without yet experiencing cognitive symptoms.⁵ In the nine Asia-Pacific economies studied for this analysis, that translates to an estimated preclinical pool of more than 130 million people.

To understand why this matters, it is necessary to understand what preclinical Alzheimer’s disease actually is. The pathological changes that eventually produce dementia — the misfolded proteins, the neuroinflammation, the progressive neuronal loss⁶ — begin accumulating silently, in some cases decades before a person experiences their first symptom⁷.

The disease is progressing during this period. And crucially, this is the stage at which emerging disease-modifying therapies are most likely to be effective: before the damage becomes irreversible, before dependency sets in, before the window for meaningful intervention has closed.

Current policy across almost every Asia-Pacific economy is designed to respond to Alzheimer’s disease after symptoms have appeared. The infrastructure for finding patients earlier — the screening tools, the biomarker pathways, the primary care protocols — is either nascent or entirely absent. The 130 million people with preclinical Alzheimer’s disease are, for practical purposes, invisible to the health system. There is no mechanism to identify them, no pathway to support them, and no plan to prepare them for treatment.

The gap between the scale of preclinical disease and the ambition of the policy response is a planning failure — and one with measurable consequences.

The economics of inaction

The financial case for acting early on Alzheimer’s disease is, at this point, overwhelming — and the cost of inaction is already being paid, across every economy in the region.

In 2019, dementia generated an estimated USD 1.3 trillion in societal costs worldwide, approximately half of which came from informal, unpaid caregiving.⁸ That figure is projected to more than double to USD 2.8 trillion by 2030,¹ and to reach USD 9.1 trillion by 2050.⁹ For the Asia-Pacific region, the trajectory is steeper than the global average.

China offers the clearest illustration. Total dementia-related costs were estimated at approximately USD 233 billion in 2020 and are projected to rise to around USD 494 billion by 2030 — equivalent to almost 2% of gross domestic product, nearly double the global average of approximately 1.1%. Japan and Australia carry similarly heavy burdens, driven by long-term care costs, productivity losses, and the growing weight of informal caregiving.⁸

These figures escalate as disease advances. Evidence from Taiwan demonstrates the cost multiplier effect of disease severity with particular clarity: total dementia care costs for moderate disease are 1.4 times higher than for mild cases, while severe dementia costs are almost double those of mild disease¹². Every stage of progression represents a cost escalation — more supervision, more dependency, greater likelihood of institutionalisation, and higher pressure on both family finances and public health budgets.

A health system that consistently diagnoses Alzheimer’s disease at a moderate or advanced stage locks itself into a permanently escalating cost base, driven by the compounding consequences of late detection. And as the preclinical pool of 130 million people moves — silently, without intervention — through the disease continuum, that cost base will grow faster than any health budget in the region is currently prepared for.

Conversely, the return on earlier action is equally well documented. At the health system level, investing USD 1 in early diagnosis and system preparedness is estimated to save USD 5 in future institutional care spending. Looking across the region as a whole, earlier detection and treatment readiness could help governments avoid at least USD 100 billion in late-stage care costs over the next decade.

The costs of Alzheimer’s disease are already being incurred. The question is whether the region will invest in early detection now, or absorb the far greater expense of managing advanced disease at scale later.

The care trap

There is a third dimension to this crisis that rarely appears in health budgets, because it is almost entirely invisible to them.

Across the world, approximately 70% of all dementia care hours are provided by women — unpaid, uncompensated, and largely unacknowledged by the health systems that depend on them.¹³ In the Asia-Pacific region, where cultural expectations around family-based care remain deeply embedded, this figure is likely to be higher still.

The financial scale of this invisible contribution is enormous. In China alone, informal caregiving costs — calculated using the opportunity-cost method to account for lost productivity and foregone economic participation — are projected to rise from approximately USD 130 billion in 2020 to around USD 277 billion by 2030.¹⁰ This represents the majority of China’s total dementia expenditure, and it does not appear in any health ministry’s budget, because it is borne entirely by families.

When the costs of late-stage Alzheimer’s disease are externalised onto unpaid caregivers — disproportionately women — as disease advances beyond what formal health services can manage or afford, female labour force participation is suppressed. This compounds household poverty. It creates cascading inequalities across generations. And because it is invisible to policymakers, it is almost never addressed directly in the dementia strategies that do exist.

Without upstream medical intervention — the early detection and treatment that could slow or modify disease progression before the highest-dependency stages are reached — this burden compounds, year on year, as more of the 130 million people with preclinical Alzheimer’s disease move through the continuum without support, toward the advanced stages where formal care systems are overwhelmed and families bear the remainder.¹⁴

The care trap is a direct consequence of a health system designed to respond to Alzheimer’s disease too late — and early detection is one of the most powerful levers available to address it.

The policy gap

If the scale of preclinical Alzheimer’s disease and the economics of inaction make an urgent case for action, the current state of policy across the Asia-Pacific region suggests that governments have not yet received the message.

Nine economies were assessed for this analysis: Australia, China, Hong Kong, Japan, New Zealand, Singapore, South Korea and Thailand. All share a common approach to address Alzheimer’s disease within broader dementia strategies, ageing frameworks, or non-communicable disease plans. 

Alzheimer’s disease is rarely treated as a distinct policy priority. It competes for attention and resources within frameworks that were not designed with its specific biological, diagnostic, or therapeutic requirements in mind.

The consequences are predictable. Accountability is diffuse. Budget allocation is opaque. The translation of scientific advances — particularly in biomarker diagnostics and emerging disease-modifying therapies — into clinical practice is slow. And critically, no economy in the region currently earmarks a dedicated, costed budget specifically for Alzheimer’s disease programmes.

Countries that invest substantially in dementia broadly — including Australia, Japan, South Korea, and Taiwan — do not ring-fence those commitments for Alzheimer’s disease specifically, meaning there is no mechanism to ensure that resources flow toward the disease-specific priorities that matter most: early detection infrastructure, biomarker pathway development, and treatment readiness.

The result is a structural mismatch between the scale of the challenge and the ambition of the response. The 130 million people with preclinical Alzheimer’s disease across the region are functionally invisible to health policy, because the policies that exist were not designed to find them.

There are no screening programmes targeting cognitively healthy adults at elevated biological risk. There are no funded pathways for biomarker-based early detection at a primary care level. There are no costed national plans for the population-level rollout of disease-modifying therapies as they become available — and this mismatch is widening. The science of Alzheimer’s disease is advancing faster than the policy frameworks designed to govern it.

As disease-modifying therapies move closer to widespread clinical use across the region, health systems that have not invested in early detection infrastructure — the biomarker pathways, the specialist capacity, the diagnostic registries — will find themselves unable to deploy those treatments to the patients who need them most.

What needs to change

The starting point is a conceptual shift that sounds simple but has significant structural implications: governments across the Asia-Pacific region must develop standalone, costed national Alzheimer’s disease programmes — not embedded within broader dementia or ageing frameworks, but ring-fenced, with specific targets, dedicated budgets, and accountability mechanisms. 

It means committing to multi-year investment plans that cover the full patient journey, from early screening and risk assessment through to diagnosis, treatment readiness, and long-term care. 

And it means beginning, now, to build the infrastructure that early detection requires: biomarker testing capacity at a primary care level, expanded specialist and technical workforce, interoperable national data systems, and reimbursement frameworks that reflect the diagnostic and therapeutic realities of the disease-modifying treatment era.

For higher-income economies with more mature health systems — Australia, Japan, South Korea, Singapore, Taiwan, Hong Kong, and New Zealand — the priority is to translate existing dementia commitments into Alzheimer’s-specific action: updating clinical guidelines to reflect biomarker advances, establishing structured early detection pathways, and preparing reimbursement frameworks for diagnostic and therapeutic innovation.

For upper-middle-income economies with emerging systems — China and Thailand — the urgency is greater and the starting point is further back. The scale of the preclinical population, combined with the pace of demographic ageing, means that diagnostic capacity, policy prioritisation, and data integration all require urgent acceleration. These are also the systems where the financial consequences of inaction will be felt most acutely, and where the case for investment in early detection infrastructure is most compelling.

Building the policy and clinical infrastructure for early Alzheimer’s detection across a region as diverse as the Asia-Pacific region — spanning mature and emerging health systems, vast geographic distances, significant cultural variation, and deeply unequal access to specialist care — will require sustained political commitment, cross-sector collaboration, and substantial investment.

The alternative is a future in which the prevalence of Alzheimer’s disease in the Asia-Pacific region triples by 2050 — and 71 million people progress to advanced stages without intervention.¹ ²

The decisions made in the next few years — on policy frameworks, on diagnostic infrastructure, on biomarker reimbursement, on treatment readiness — will determine whether the Asia-Pacific region gets ahead of this challenge, or spends the next three decades managing its consequences.