1. The scale of dementia in Korea
| Metric | Number |
|---|---|
| 2024 dementia patients | ~1 million (10% of 65+) |
| 2030 projected | ~1.42 million |
| 2050 projected | ~3 million |
| Mild cognitive impairment (MCI) | ~2.3 million |
| Annual dementia social cost | ~18 trillion KRW (2023) |
| Average family-caregiving time | 7 hours/day |
Korea ages over the shortest time period in the world; the rate of dementia growth is #1 in the OECD.
2. Lancet Commission 14 modifiable risks (2024)
| Life stage | Risk factor | Population attributable fraction (PAF) |
|---|---|---|
| Childhood | ① Less than secondary education | 5% |
| Midlife (45–65) | ② Hearing loss | 7% |
| Midlife | ③ LDL cholesterol | 7% |
| Midlife | ④ Depression | 3% |
| Midlife | ⑤ Traumatic brain injury | 3% |
| Midlife | ⑥ Physical inactivity | 2% |
| Midlife | ⑦ Smoking | 2% |
| Midlife | ⑧ Hypertension | 2% |
| Midlife | ⑨ Obesity | 1% |
| Midlife | ⑩ Excessive alcohol | 1% |
| Midlife | ⑪ Diabetes | 2% |
| Later life (65+) | ⑫ Social isolation | 5% |
| Later life | ⑬ Air pollution | 3% |
| Later life | ⑭ Vision loss (added 2024) | 2% |
| Combined PAF | 45% | |
Addressing all 14 could prevent 45% of dementia. Korea-specific priorities: ⑧ hypertension (30% under-diagnosed in 50s), ⑪ diabetes (11% in 40+), ⑫ social isolation (lonely death #248), ⑬ air pollution (PM2.5).
3. Cognitive Reserve
A concept by Yaakov Stern (Columbia) in the 1990s. With the same brain damage, those with higher "cognitive reserve" show later symptom onset and milder symptoms.
3 pillars to build reserve
- Cognitive engagement: lifelong learning, language, instruments, chess, reading
- Social engagement: friends, family, community, volunteering
- Physical activity: 150 min/week moderate exercise
Starting in your 30s–40s lowers 80s dementia risk by 30–40% (Wilson et al., 2013).
4. 30s–40s prevention actions
Health management
- Regular checks for hypertension / diabetes / dyslipidemia (annually from age 40)
- BP < 130/80, HbA1c < 5.7, LDL < 130
- If obese (BMI > 25), lose 5–10%
- Quit smoking (including e-cigarettes)
- Alcohol under 7 drinks / week (men) / 4 (women)
Cognitive / social activity
- Learn a new skill (instrument, language, coding) — 1/year
- Read (especially fiction / biography) 1 book/week
- Regular meetings with 5+ friends
- One non-family community (hobby, religion, volunteering)
Physical
- 150 min/week aerobic (walking, cycling, swimming)
- Strength 2×/week
- Sleep 7–8 hours
- Mask in air pollution (PM2.5 > 35)
5. 50s–60s prevention and early detection
- Aggressively manage the 14 risks above
- Annual hearing / vision checks
- MCI self-test (KDSQ-C, Korean cognitive screening)
- If family notices "more than forgetfulness", get free screening at a Dementia Care Center (256 nationwide)
- Intervention at the MCI stage can delay dementia progression by 50%
6. After diagnosis — the Korean system
Medications
- Donepezil (Aricept): first-line for Alzheimer's
- Rivastigmine / galantamine: adjunct
- Memantine (NMDA antagonist): severe
- Leqembi (lecanemab): 2024 FDA, amyloid-clearing antibody; Korean introduction under review
Non-pharmacologic
- Cognitive Stimulation Therapy (CST)
- Music therapy (#233)
- Reminiscence therapy
- Family / caregiver education
System
- National Dementia Responsibility Plan (since 2017)
- Long-term care insurance (65+, with dementia recognition)
- Dementia Care Centers (256 nationwide)
- Dementia-family respite
7. Caregiver care
Families of dementia patients show 4× depression, 2× suicide, 1.5× cardiovascular vs the general population. Caregivers themselves are a clinical population.
- Don't caregive alone — family sharing, care workers, day-care centers
- Dementia-family self-help groups
- Your own psychiatric evaluation and treatment
- Your own physical health, exercise, sleep
- Use respite care
- Prepare legally and financially (guardianship, asset arrangement)
8. Korean resources
- Dementia Care Centers (256 nationwide): free diagnosis, caregiving support
- Central Dementia Center 1899-9988: integrated info
- Dementia Counseling Call Center 1899-9988: 24h
- National Health Insurance Service 1577-1000: long-term care insurance
- University-hospital neurology / psychiatry dementia clinics
- Dementia Family Association: self-help groups
- 1577-0199: caregiver suicide crisis
