Dementia, including vascular dementia, affects 47 million people worldwide and this number will treble by 2050. Currently, only around half of those in high income countries, and one in ten or less in low and middle income countries have received a diagnosis. Expanding coverage of services for increasing numbers of people with dementia can only be achieved – and a crisis averted – by boosting capacity, and the efficiency with which care is delivered.

The report highlights that dementia care being provided mainly by specialist doctors is a key barrier to progress. Greater involvement of non-specialist primary care staff in treating vascular dementia can unlock capacity to meet increasing demand for dementia care, and could make the cost of care per person up to 40% cheaper. Primary care services will need to be strengthened and supported to take on this role, through specialists providing guidance and support. Affordability of new treatments is critical to ensuring equity and social justice for the two-thirds of people with dementia living in low-resourced countries.

Clear ‘care pathways’ would define roles and responsibilities within the care system, and establish standards to be monitored and met. Care pathways, a structured and organised approach to the coordination, resourcing and delivery of continuing care, are now a common component of chronic disease care for other conditions including diabetes, hypertension, and cancer care. Case management of vascular dementia supports coordination and integration of care, and can help ensure that services are both person-centred and efficient.