Lifetime risk and projected burden of dementia
Open accessAbstract
Understanding the lifetime risk of dementia can inform public health planning and improve patient engagement in prevention. Using data from a community-based, prospective cohort study (n = 15,043; 26.9% Black race, 55.1% women and 30.8% with at least one apolipoprotein E4 (APOE ε4) allele), we estimated the lifetime risk of dementia (from age 55 years to 95 years), with mortality treated as a competing event. We applied lifetime risk estimates to US Census projections to evaluate the annual number of incident dementia cases from 2020 to 2060. The lifetime risk of dementia after age 55 years was 42% (95% confidence interval: 41-43). Rates were substantially higher in women, Black adults and APOE ε4 carriers, with lifetime risks ranging from approximately 45% to 60% in these populations. The number of US adults who will develop dementia each year was projected to increase from approximately 514,000 in 2020 to approximately 1 million in 2060. The relative growth in new dementia cases was especially pronounced for Black adults. These results highlight the urgent need for policies that enhance healthy aging, with a focus on health equity.
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After age 55, lifetime dementia risk is 48% for women and 35% for men.
“with lifetime dementia risk reaching 48% for women and 35% for men after age 55”
From Review of Artificial Intelligence for Clinical Use in Alzheimer's Disease and Related Dementias (2026) · cites this paper as [3]
U.S. dementia cases are projected to double by 2060, reaching 1 million annually.
“U.S. cases projected to double by 2060 to 1 million annually.3”
From Review of Artificial Intelligence for Clinical Use in Alzheimer's Disease and Related Dementias (2026) · cites this paper as [3]
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Is screening for Alzheimer’s disease ready for prime time? Ask Wilson and Jungner
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“Dementia currently affects 3% of 65–70-year-olds and 35% of ≥90-year-olds, often with accompanying profound cognitive, behavioral, and functional consequences [18,19].”
Recent Advances in the Application of Artificial Intelligence in Alzheimer's Disease
Yao, L., Ni, J., Wei, M., Li, T., Li, F., Wang, T., Xiao, W., Shi, J., & Tian, J. (2025) · Current Alzheimer Research · doi:10.2174/0115672050410489250930175402 · Cited by 2 · see citing works
Raikes, A. C., Bhattrai, A., Wang, T., Wiegand, J. L., & Brinton, R. D. (2026) · Frontiers in Neuroscience · doi:10.3389/fnins.2026.1843319 · Cited by 2 · see citing works
“Without effective treatments, the prevalence is expected to exceed 12.7 million by 2050 with new diagnoses exceeding 1 million per year (Alzheimers Dementia, 2025; CDC, 2025; Fang et al., 2025).”
InfluentialBrain-derived neurotrophic factor supports pericyte and vascular homeostasis in the aging brain
Luo, Q., Quan, W., Cao, Q., Scheffel, C., Hao, W., Yang, J., Furihata, T., Peng, G., Tang, Z., & Liu, Y. (2025) · Acta Neuropathologica Communications · doi:10.1186/s40478-025-02181-y · Cited by 2 · see citing works
Tallman, M. D., Timblin, H., Maynard, T. R., Kelly, B. E., & MacAulay, R. K. (2025) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/13803395.2025.2609824 · Cited by 2 · see citing works
“…2024; Brown & Patterson, 2020; Brown et al., 2022; CDC, 2019; Manly et al., 2022; Petersen et al., 2010), women compose two-thirds of adults aged 65 or older diagnosed with AD, with projections for this gender divide to increase over the next 35 years (Fang et al., 2025; Rajan et al., 2021).”
Aranda, M., Camacho, D., Liang, J., & Jang, Y. (2026) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-081423-032154 · Cited by 2 · see citing works
Shahrestani, M. N., Gardener, H. E., Veledar, E., Agudelo, C., Elkind, M. S. V., Gutierrez, J., Wright, C. B., Tom, S. E., & Rundek, T. (2026) · Neurology Open Access · doi:10.1212/wn9.0000000000000065 · Cited by 3 · see citing works
Karmakar, V., Ghosh, A., Deb, P. K., & Gorain, B. (2026) · Inflammopharmacology · doi:10.1007/s10787-026-02153-1 · Cited by 2 · see citing works
Epilepsy and Alzheimer Disease
Devinsky, O., Leitner, D., Kamondi, A., & Wısnıewskı, T. (2026) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000200589 · Cited by 3 · see citing works
Collaborators, G. 2. S. (2026) · Schizophrenia Bulletin Open · doi:10.1093/schizbullopen/sgag012 · Cited by 2 · see citing works
“…regimes, 43,44 social isolation and loneliness, 45,46 and economic and technological barriers to accessing care 47,48 ) with special attention directed to the needs of older women specifically (eg, an increased risk for cardiovascular disease and osteoporosis relative to older men 49,50 ).”
Sex-dependent interferon signaling contributes to female-biased vulnerability in Alzheimer’s disease
López-López, V., Iniesta, G., Galán-Ganga, M., Exposito-Coca, A., Durán-Laforet, V., Bhojwani-Cabrera, A. M., Navarrón, C. M., Guillot-Fernández, M., Venero, J. L., Sanchez-Mut, J. V., et al. (2026) · Journal of Neuroinflammation · doi:10.1186/s12974-026-03840-0 · Cited by 4 · see citing works
“With an aging global population, the number of individuals affected by AD is projected to exceed 100 million by 2050, placing an enormous burden on healthcare systems and caregivers [1, 3–5].”
Prevalence of Subjective Cognitive Decline Among Older Multiracial Adults, 2019–2023
Lam-Hine, T., Odden, M. C., James, B. D., & Rehkopf, D. H. (2025) · Journal of Aging and Health · doi:10.1177/08982643251377230 · Cited by 2 · see citing works
“…fi ed racial and ethnic disparities in the prevalence of dementia and cognitive impairment; however, estimates for the Multi-racial population remain unknown ( “ 2024 Alzheimer ’ s Disease Facts and Figures, ” 2024; Fang et al., 2025; Manly et al., 2022; Matthews et al., 2019; Rajan et al., 2021).”
Bellio, T. A., Krunic, A., Campion, M. S., Dupaguntla, R., Labadorf, A. T., Stein, T. D., Lin, H., Mellott, T. J., & Blusztajn, J. K. (2025) · Aging Cell · doi:10.1111/acel.70148 · Cited by 3 · see citing works
New Frontier, New Challenges—Recognizing and Managing Adverse Effects of Antiamyloid Therapies
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Cerebral small vessel disease and multiple sclerosis: Similarities and differences
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Sex/gender differences in lifetime dementia risk among Asian American and White older adults
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An Electronic Health Record Algorithm's Performance to Identify Cognitive Impairment in Primary Care
Kistler, C. E., Lynch, M., Lin, F., Yang, Y., Frazier, W. T., & Hanson, L. C. (2025) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2025.105949 · Cited by 1 · see citing works
Nutritional strategies against dementia in rural populations
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“The lifetime risk for dementia in individuals over 55 years old in the U.S. is 42%, with elevated risk in females, black adults, and APOE4 gene carriers (3).”
Lee, E. B., Hwang, J., Kim, D. W., Choi, B. Y., Bae, H., Won, S., Park, Y. H., & Kim, S. (2025) · BMC Neurology · doi:10.1186/s12883-025-04583-w · Cited by 1 · see citing works
“Its incidence rises steeply with advancing age [2], and recent longitudinal analyses suggest that roughly 40% of adults may develop dementia over the course of their lifetime [3].”
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“15 Moreover, the recent expansion of coverage for amyloid-PET testing under the Centers for Medicare & Medicaid Services (CMS), and the predicted increased demand for con fi rmatory testing in order to prescribe DMTs, may contribute to increased costs.”
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“By 2060, the annual number of new ADRD cases is projected to nearly double, from 0.5 million to about 1 million, with women having a much higher lifetime risk of dementia [2].”
InfluentialBesser, L. M., Chang, L., Evenson, K. R., Galvin, J. E., Heckbert, S. R., Hirsch, J. A., James, P., Jimenez, M. P., Kaufman, J., Lockhart, S. N., et al. (2026) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-026-03075-7 · Cited by 1 · see citing works
Herpes simplex virus 2 and dementia risk: a systematic review and meta-analysis
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“By 2050, dementia cases are projected to increase from 57.4 million in 2019 to 152.8 million globally (Nichols et al., 2022), with the number of yearly dementia diagnoses in the United States expected to nearly double from 514,000 to over one million (Fang et al., 2025).”
InfluentialLinguistic Barriers in U.S. Neuropsychological Assessment: A State-of-the-Art Review
Martin, A. (2025) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acaf091 · Cited by 1 · see citing works
“To contex-tualize how disparate the clinician bottleneck is, consider the following: across 1 year in the USA, half a mill ion individuals are diagnosed with dementia (Fang et al., 2025).”
Qian, Y., Gettel, C. J., Su, J. I.-S., Grogan, E. F. L., Cohen, I., Rothenberg, C., Chen, X., & Hwang, U. (2026) · Journal of the American Geriatrics Society · doi:10.1111/jgs.70421 · Cited by 1 · see citing works
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Diffusion weighted imaging abnormalities and cerebral ischemia in a cohort of patients on lecanemab
Ryan, D., Lutz, M. W., Sides, T. R., O’Brien, R., & Johnson, K. (2026) · Alzheimer s & Dementia · doi:10.1002/alz.71392 · Cited by 1 · see citing works
O'Neill, M. (2026) · International Journal of Cognitive Sciences · doi:10.3390/ijcs2020012 · Cited by 1 · see citing works
“Americans over 55 face a 42% lifetime risk of developing dementia (Fang et al., 2025), with 7.2 million aged 65 and older currently living with Alzheimer’s disease (Alzheimer’s Association, 2025).”
InfluentialPromoting Brain Health in the Context of Normal Aging and Mild Cognitive Impairment: A Tutorial
Cohen, M. L., Lanzi, A. M., Rothbart, A., Keatley, E. S., Seagly, K., Strong, K. A., Paul, D. R., & Sohlberg, M. M. (2026) · American Journal of Speech-Language Pathology · doi:10.1044/2026_ajslp-25-00494 · Cited by 2 · see citing works
Liu, Y., Yao, Z., Zhu, L., & Peng, W. (2026) · Journal of Nanobiotechnology · doi:10.1186/s12951-026-04705-7 · Cited by 1 · see citing works
“Dementia as a whole affects more than 55 million people worldwide, with AD accounting for an estimated 60–70% of cases, imposing a rapidly increasing social and economic burden [1–3].”
Midlife Vascular Risk Burden and Dementia-Free Survival Years
Hu, J., Coresh, J., Smith, J. R., Sharrett, A. R., Gottesman, R. F., Lutsey, P. L., Mosley, T. H., Selvin, E., Fang, M., & Weiss, J. (2026) · Neurology Open Access · doi:10.1212/wn9.0000000000000152 · Cited by 1 · see citing works
Self-citationUrinary metabolomics data and cognitive performance in an adult population
Kneipp, A., Kirchberger, I., Freuer, D., Christine, M., & Linseisen, J. (2026) · Metabolic Brain Disease · doi:10.1007/s11011-026-01977-8 · Cited by 1 · see citing works
Amoatika, D. A., Absher, J. R., Khan, M. T. F., & Miller, M. C. (2025) · Biomedicines · doi:10.3390/biomedicines13061321 · Cited by 1 · see citing works
“Additionally, females tend to have longer survival times than males, thus resulting in lower mortality risk when compared to males [43].”
Pike, J., Conant, R., Rosen, J., Stratton, L., Pace, D. D., Baumgart, M., Evans, K., Fazio, S., Hill, C. V., Moreno, M., et al. (2025) · Public Policy & Aging Report · doi:10.1093/ppar/praf015 · Cited by 1 · see citing works
Sex-dependent interferon signaling drives female-biased vulnerability in Alzheimer’s diseasePreprint
López-López, V., Iniesta, G., Galán-Ganga, M., Exposito-Coca, A., Bhojwani-Cabrera, A. M., Guillot-Fernández, M., Giralt, A., & López‐Atalaya, J. P. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.08.22.671724 · Cited by 1 · see citing works
Small-Sized Reasoning Language Models for Linguistic Screening of Alzheimer’s DiseasePreprint
Addepalli, V. R., Abdalnabi, N., Kummerfeld, E., Hembroff, G. C., Kiselica, A. M., Rao, P. K., & Lee, K. (2026) · medRxiv · doi:10.64898/2025.12.24.25342972 · Cited by 1 · see citing works
Alzheimer’s Polygenic Risk Scores Are Not Interchangeable: Evidence from 1,752 ModelsPreprint
Ward, E. L., Nelson, P. T., Katsumata, Y., Fardo, D. W., Jicha, G. A., Initiative, A. D. N., & Miller, J. B. (2026) · medRxiv · doi:10.64898/2026.09.02.26362060 · Cited by 1 · see citing works
Adams, M. L. (2025) · medRxiv · doi:10.1101/2025.01.27.25321203
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Targeting blood pressure to protect the brain
Coresh, J., Virani, S. S., & Gottesman, R. F. (2025) · Nature Medicine · doi:10.1038/s41591-025-03694-8
Self-citationA University’s Role in Developing a Regional Network of Dementia Friendly Communities
Reyes, L. S., Ehlman, M. C., Leahy, S., & Lawrence, R. (2025) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph22050721
“…of academic–community-based partnerships in creating dementia-friendly communities is critical because the current lifetime risk of dementia is higher than once thought and communities are increasingly going to be challenged to provide support and environments where all can thrive [54].”
Modifiable risk factors for dementia
Veverová, K., Nováková, J. M., Sečník, J., Šteiner, J., Karamazovová, S., Chmátalová, Z., & Lerch, O. (2025) · Neurologie pro praxi · doi:10.36290/neu.2025.040
Gaster, B., Suchsland, M. Z., Liao, J. M., McKiddy, S., Fitzpatrick, A. L., Belza, B. L., Hsu, A. P., & Raetz, J. (2025) · Journal of the American Geriatrics Society · doi:10.1111/jgs.19565
Societal Gender Norms and Their Influence on Late Life Cognition
Stites, S. D., Kuz, C., Halberstadter, K., Humphreys, V., Cousins, K. A. Q., & Mechanic-Hamilton, D. J. (2025) · Neurodegenerative Diseases · doi:10.1159/000547115
“Prior studies have shown that timing and the passage of time is germane to AD research [10, 45, 47, 54, 70, 79].”
How your research can survive a US federal grant termination
Gewin, V. L. (2025) · Nature · doi:10.1038/d41586-025-02007-w
Andrews, S. J., Sharma, R. U., Mitchell, B. A., Tong, T., Bonham, L. W., Renton, A. E., Zhang, X., Sirota, M., Tosun, D., Yaffe, K. S., et al. (2025) · medRxiv · doi:10.1101/2025.07.16.25331683
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Vaccines hold tantalizing promise in the fight against dementia
Kumar, A., & Rehman, J. (2025) · doi:10.64628/aai.x7qr7vu6k
Largent, E. A., Grill, J. D., Karlawish, J. H., & Bleakley, A. (2025) · Alzheimer s & Dementia Behavior & Socioeconomics of Aging · doi:10.1002/bsa3.70035 · Cited by 1 · see citing works
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“Female sex represents an intersecting vulnerability: females have a higher lifetime prevalence of dementia 50,51 and experience abrupt endocrine transitions that impact FC 52 – 54 .”
A Manifold Framework for Interpretable Brain Age Estimation and Aging Trajectory MappingPreprint
Liang, Z., Szczepanski, C. J., Li, C., Li, J., Rusinek, H., Ge, Y., & Zhang, J. (2025) · bioRxiv (Cold Spring Harbor Laboratory) · doi:10.1101/2025.09.24.678174
“Chronological age is the strongest known risk factor for late-onset AD 56,57 , yet brain age more closely predicts disease likelihood 58–60 .”
Ernst, M. E., Sheets, K. M., Webb, K. L., Fravel, M. A., Woods, R. L., Beilin, L. J., Orchard, S. G., Shah, R. C., Polkinghorne, K. R., Reid, C. M., et al. (2025) · Journal of Human Hypertension · doi:10.1038/s41371-025-01087-5
“…fertility combined with increases in life expectancy ensure the upward trend for more people living at the oldest ages will persist, and the number of persons with dementia will nearly triple in the coming decades, from 57.4 million cases in 2019 to an estimated 152.8 million cases in 2050 [2, 3].”
InfluentialGallingani, C., Miller, Z., Mandelli, M. L., Rosen, H. J., Ezzes, Z., Lin, M., Rodriguez, D., Grinberg, L. T., Spina, S., Seeley, W. W., et al. (2025) · medRxiv · doi:10.1101/2025.10.28.25338977 · Cited by 1 · see citing works
“Additionally, the population is aging worldwide, and the number of US dementia cases are expected to double by 2060, reaching 1 million annually 3 .”
Stonkute, D., Lorenti, A., Korhonen, K., Martikainen, P., & Myrskylä, M. (2025) · Age and Ageing · doi:10.1093/ageing/afaf361
“In the United States, the lifetime risk of dementia at age 55 has been estimated at 42% [38], while mortality-linked studies suggest that 20–39% of adults have dementia in the years preceding death [39].”
Demenz: Welche Rolle spielen Nährstoffe?
Schmiedel, V. M. (2025) · Deutsche Heilpraktiker-Zeitschrift · doi:10.1055/a-2672-4482
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Cell Dysfunctions and Regulators of Longevity
Ng, B. (2025) · Springer eBooks · doi:10.1007/978-3-031-94431-4_8
Neurocognitive assessment in Alzheimer's disease clinical research
Moelter, S. T. (2025) · Elsevier eBooks · doi:10.1016/b978-0-443-30008-0.00004-1
Unique Challenges of Shared Decision-Making in Colorectal Surgery for the Elderly Patient
Nishtala, M. V., & Berian, J. R. (2025) · Clinics in Colon and Rectal Surgery · doi:10.1055/a-2760-7343
Riquelme-Contreras, P., Mery, I., Aguilera, S., Henriquez, F. A., Medel, V., Ferreira, P. C. L., Bellaver, B., Karikari, T. K., Pascoal, T. A., Thumala, D., et al. (2026) · Research Square · doi:10.21203/rs.3.rs-8621977/v1
“Age-related cognitive impairment and dementia represent rapidly growing public health challenges worldwide, driven by the accelerated aging of the global population (Fang et al., 2025).”
Does type or diversity of activities delay aging-related cognitive decline?
Glei, D. A., Lee, C., Brown, C. K., & Weinstein, M. (2026) · Innovation in Aging · doi:10.1093/geroni/igaf133
Young Adult Substance Use as a Predictor of Poor Self-Rated Memory Decades Later in Midlife
Patrick, M. E., Pang, Y. C., Terry‐McElrath, Y. M., & Jang, J. B. (2026) · Journal of Aging and Health · doi:10.1177/08982643261431007
A Preventive Neurology Perspective on Promoting Brain Health and Preventing Cardiovascular Disease
Murray, S., Akiyoshi, K., Isaacson, R., Dayspring, T. D., & Niotis, K. (2026) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2025.12.009
Gut microbes affect cognition during ageing
Cheng, Y.-T., & Mazmanian, S. K. (2026) · Nature · doi:10.1038/d41586-026-00492-1
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“Dementia, in turn, involves more pronounced cognitive deterioration, is associated with poorer mental health outcomes, and represents one of the primary causes of disability worldwide [18,19].”
Dilating the aging clock with light
Jing‐Yi, J. C., Ho, I. Y. M., Quah, C. B., Bai, Y. Y., Ren, J., Foo, A. S. C., & Teh, D. B. L. (2026) · The Innovation · doi:10.1016/j.xinn.2026.101368
“Aging is the principal risk factor underlying a spectrum of chronic diseases, including cardiovascular dysfunction, neurodegeneration, cancer, and ocular pathologies (Figure 1A) such as age-related macular degeneration (AMD), 1–3 neurodegenerative diseases, 4 and metabolic dysfunction.”
Adult Day Centers as Partners in Baccalaureate Nursing Dementia Education
DeBrew, J. K. (2026) · Creative Nursing · doi:10.1177/10784535261439175
“By that time, an estimated 12 million Americans may be living with dementia (Fang et al., 2025).”
Weiner, D. K., Engel, I., Hamm, M., Cardamone, C., Rossi, M. I., Perera, S., Ramos, K., & Porter, L. (2026) · Palliative & Supportive Care · doi:10.1017/s1478951526102144
“Chronic pain and dementia are sources of immeasurable suffering and healthcare resource utilization,andtheprojecteddemographicshiftofourpopulationpredictsasteadyincreaseinboth overtheforeseeablefuture(Huntetal.2015;Fangetal.2025).”
- Authors
- Fang, M., Hu, J., Weiss, J., Knopman, D. S., Albert, M., Windham, B. G., Walker, K. A., Sharrett, A. R., Gottesman, R. F., Lutsey, P. L., Mosley, T., Selvin, E., & Coresh, J.
- Affiliations
- Johns Hopkins University (US)
- New York University (US)
- Mayo Clinic (US)
- Johns Hopkins Medicine (US)
- University of Mississippi Medical Center (US)
- National Institutes of Health (US)
- National Institute of Neurological Disorders and Stroke (US)
- University of Minnesota (US)
- Corresponding author
- Coresh, Josef
- ORCID
- Venue
- Nature Medicine
- Published
- 2025-01-13
- Volume
- 31
- Issue
- 3
- Pages
- 772-776
- ISSN
- 1078-8956 (ISSN-L)
- 1546-170X
- PMC
- PMC12305800
- OpenAlex
- W4406308228
- Cited by
- 153
- References
- 44
- Citations by year
- 2026: 90 · 2025: 62 · 2023: 1
- FWCI
- 102.27
- Type
- journal article
- Language
- en
- Open access
- green
- pmc.ncbi.nlm.nih.gov
- Licence
- Locations
- Nature Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- Funders
- U.S. Department of Health and Human Services (R01AG054787)
- National Institutes of Health (75N92022D00004, 75N92022D00005, 75N92022D00003, 75N92022D00001, 5u01hl096899-08, 5u01hl096902-08, 75N92022D00002, U01HL096899, U01 HL096902)
- National Institute on Aging (RF1AG074044, 75N92022D00001, 75N92022D00004, U01HL096899, U01 HL096902, R01AG054787, 75N92022D00005, 75N92022D00003, 75N92022D00002, R01AG074044, P30AG066507)
- National Heart, Lung, and Blood Institute (K24HL152440, HL152440, 75N92022D00002, U01HL096814, 75N92022D00005, U01-HL-096899, U01-HL-096902, 75N92022D00003, 75N92022D00004, U01HL096917, 75N92022D00001, U01HL096812)
- National Institute of Diabetes and Digestive and Kidney Diseases (K01DK138273)
- National Institute of Neurological Disorders and Stroke (75N92022D00003, 75N92022D00001, U01HL096899, 75N92022D00002, U01 HL096902, 75N92022D00004, 75N92022D00005)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
- Keywords
- dementia, lifetime risk, APOE ε4, sex differences, racial disparities, Black people, healthy aging, health equity
- MeSH terms
- White, Aged, Aged, 80 and over, Black or African American, Dementia, Female, Humans, Male, Middle Aged, Prospective Studies, Risk Factors, United States, Incidence, Cost of Illness, Apolipoprotein E4
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Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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