For many countries with ageing populations, dementia presents major challenges: from the provision and costs of social care to the burden of appraising novel medical technologies targeting the dementia care market.
Insurers and reinsurers are not immune from such challenges; improving dementia outcomes could affect mortality rates in our elderly populations, affecting annuities and changing the balance of premiums and payments on protection products.
In England, the NHS estimates that about 6.5% of persons aged 65 and over have dementia, 4.3% with recorded diagnoses, at the start of 2026.
For insurers writing business exposed to longevity risk, the increasing importance of dementia as a cause of death has resulted in an increasing focus on treatments for dementia as a potential source of future mortality improvements.
Treating dementia
The variety of diseases contributing to dementia prevalence, often co-occurring, and the poorly understood causes of disease progression present a challenge for researchers developing novel treatments.
However, these challenges are not without their technological match.
Researchers are taking advantage of rapidly evolving machine learning capabilities to explore predictors of Alzheimer’s disease and identify potential therapeutic targets, as well as to streamline the identification of novel candidate treatments.
Artificial intelligence may also be set to streamline clinical trials for Alzheimer’s disease medications; it is already helping to pinpoint groups of patients who may be more likely than others to benefit from specific treatments.
Diagnosing dementia
NHS England also estimates that around a third of dementia cases in England remain undiagnosed.
Attempts to seek help are often delayed because of patients’ denial, the stigma attached to the condition, fear of loss of autonomy and the lack of any curative treatment.
Barriers to diagnosis may also originate with the medical system, such as lacking time, resources and availability of support services.
This situation could change quite rapidly as a result of progress in the treatment of key causes of dementia.
The ability to significantly slow, halt or reverse disease progression would incentivise earlier diagnosis and remove or reduce key barriers to diagnosis – for example lack of treatment or stigma.
Preventing dementia
The biggest risk factor for dementia is age; the disease can take many years to develop, so individuals living longer gives more time for dementia to arise.
In contrast, inherited risk through genes is very rare for most types of dementia.
One estimate suggests that around 30% of Alzheimer’s disease cases worldwide may be attributable to modifiable risk factors, such as physical inactivity, smoking and depression.
A 2024 report from The Lancet estimated that 45% of all worldwide dementia cases could be prevented or delayed by addressing 14 modifiable risk factors at different stages of life.
However, policies to change behaviours, control population obesity or encourage increased physical activity have had mixed results.
An improvement in diagnosis would, in isolation, have limited impact; unless the disease process can be slowed or halted, knowing that a patient has the disease is of limited value.
Combined with an effective treatment, particularly targeting the early stages of disease, improved diagnosis could increase the impact in the medium-term.
On the other hand, preventative measures such as reducing exposure to modifiable risk factors would have a much longer-term impact.
Challenges remain
If improvements in dementia mortality are to be the “next big longevity event”, then these improvements should come primarily from novel treatments, supplemented by improved diagnosis – spending on which will be more justifiable once a viable treatment is available.
There are still significant challenges facing those developing treatments: both identifying the most effective therapeutic targets and identifying and trialling safe and effective drugs to exploit those targets.
Current trials, at least later-stage trials of drugs for Alzheimer’s disease, include a number of drugs which are similar in nature (monoclonal antibodies) to the first generation of drugs, which demonstrated at best a very limited degree of disease-modification.
We might expect slight improvements in these drugs over time, but a breakthrough drug seems less likely.
Even with advances due to uses of machine learning in both the study of diseases and drug development, a significant advance in treatment seems distant and access to such a treatment could be further delayed depending on national policies concerning the required level of cost-effectiveness of medications before they can be prescribed.
Nevertheless, insurers and reinsurers will want to keep abreast of the outcomes of the range of current and future dementia drug trials; early indications of better-than-anticipated benefits from drugs undergoing phase two trials could be a useful signal that dementia-related mortality improvements might accelerate, giving time for a gradual adjustment of pricing and reserving assumptions.