Dementia is becoming one of the most pressing challenges facing aging societies, particularly across Asia‑Pacific, where rapid demographic change is driving a sharp rise in prevalence. As life expectancy increases, more families are being confronted with the long‑term medical, financial and caregiving demands associated with progressive cognitive decline. Yet insurance solutions have struggled to keep pace, often reflecting models built for acute illness rather than conditions that unfold over many years.
This article examines how dementia progresses and affects longevity and the growing gap between real‑world dementia costs and insurance solutions typically available today. It also explores the implications for insurers in APAC as emerging treatments, caregiver burdens and sustainability considerations continue to challenge a large proportion of the population without suitable insurance protection.
Dementia is a pathological condition, distinct from normal cognitive aging. It results from abnormal changes in the brain – such as abnormal protein buildup or damaged blood vessels – that progressively impair memory, reasoning and daily functioning. Alzheimer’s disease, the most common cause of dementia, predominantly affects individuals over the age of 65, but dementia is not confined to the elderly.
Unlike age-related forgetfulness, cognitive decline in dementia is often severe enough to interfere with daily life. Over time, it leads to increasing dependency and ultimately total loss of autonomy.
The global total caseload of Alzheimer’s disease is projected to rise from approximately 57 million in 2019 to roughly 153 million in 2050. While the age-standardized prevalence rates (ASPR) of dementia have been stabilizing or even declining in some high-income countries, the total burden of dementia continues to increase due to population aging – a greater number of people living into older, high-risk age groups. See Figure 1 below.
Estimated trends in the global age-standardised dementia prevalence and all-age number of cases, with 95% uncertainty intervals, 2019–50
Figure 1: “Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019”, Nichols E, Steinmetz J, Vollset S et al. Source: The Lancet Public Health. https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667%2821%2900249-8/fulltext
The problem of population aging is particularly acute in APAC as the region is experiencing faster aging than many other parts of the world. Singapore is approaching “super-aged” status (20%+ population over 65) soon, while Japan and Korea have already crossed the threshold.
The challenge is compounded by several countries in East Asia, notably China, continuing to experience rising ASPR.[1] Projections indicate that the number of people living with dementia in APAC will triple between 2015 and 2050, growing from 23 million to almost 71 million. By then, almost half of the total number of people with dementia worldwide will reside in the APAC region.[2]
Dementia is a progressive and ultimately terminal condition, but its trajectory unfolds over time. The level of impairment, and associated financial impact, varies significantly by stage:
Once dementia develops, the progress is an inexorable path to total loss of independence. It is profoundly devastating – not only for patients, but also for those who care for them.
Dementia is considered a terminal illness that significantly reduces life expectancy. It is the 7th leading cause of death globally and a top driver of disability.[3]
Prognosis varies by dementia type:
Conventional dementia treatments, such as cholinesterase inhibitors (e.g. donepezil) and NMDA receptor antagonists (e.g. memantine), can temporarily improve memory and thinking. Non-pharmacological interventions – including memory training and other ancillary, day-care services, also play a valuable role and are often subsidized by public health systems. These approaches, however, do not alter the course of disease progression.
Most recently, novel therapies such as lecanemab and donanemab have been approved to slow the progression of early Alzheimer’s by removing amyloid plaques. While clinically promising, these treatments are extremely costly and often not covered by regular medical plans.
For example, the annual drug cost of lecanemab can reach approximately USD 26,500.[4] Drug cost in Asia may be lower due to marketing factors, but the associated expenses of diagnostic imaging, monitoring and specialist consultations are still formidable.
The rapid rise in dementia prevalence has exposed a glaring protection gap – one that goes beyond product mismatch – posing a strategic risk for insurers seeking relevance in their aging customer base.
Japan & Korea: Both countries provide community-based dementia support, including early detection programmes, caregiver networks, and regional support centres. Yet gaps still exist. Both have national long-term care insurance requiring co-payments of 10-20% – a notable out-of-pocket cost for families. Beyond co-payments, capacity is a critical issue: in Korea alone, over 3,700 elderly applicants died in 2023 while waiting for long-term care eligibility assessment.[5]
Singapore: Community support includes dementia day care centres, outreach teams and caregiver support. However, CareShield Life — the national severe disability scheme — requires inability to perform at least 3 out of 6 ADLs to trigger payouts. Dementia alone does not automatically qualify; a functional assessment is still required, even as cognitive function declines.
Hong Kong: According to Alzheimer’s Disease International and Global Coalition on Aging, Hong Kong ranked 22nd out of 30 cities, behind Tokyo (7th) and Seoul (11th) and Singapore (16th) in terms of dementia innovation readiness.[6] The city has no national insurance scheme, and the waiting time for screening diagnosis in subsidised public hospitals can be over a year.
Where public systems fall short, the burden shifts to families and to the private sector. But is private insurance sufficient?
Standard private critical illness plans were designed around conditions where a defined event triggers a clear need for intervention or income replacement. Dementia does not fit this mould. It is protracted, degenerative, and financially draining, years before clinical severity triggers a payout.
Families face significant costs during the moderate stage – supervision, medication, lost income. Yet many policies still define coverage around late-stage dependency requiring round-the-clock care, by which point savings may be exhausted. While some plans already cover moderate dementia, the broader challenge remains; dementia is a long, slow decline. A single lump sum, however well-timed, may not align with years of accumulating expenses. In Singapore, for example, lifetime dementia-related costs for a 10-year survivor can reach SGD 1.6 million.[7] Delaying protection benefits until total dependency eventuates leaves families stranded during the most financially vulnerable years.
For every dementia patient, at least one family member typically assumes a caregiving role. If 10% of the population is affected by dementia, another 10-20% bear the associated caretaking burden. The consequences — emotional strain, lost productivity and depleted savings — extend the impact of dementia to nearly one in three people. Ignoring caregivers means overlooking the full scale of the risk.
With the population aging inexorably, demand for dementia-related support will only grow and insurance protection can play an important role. Nonetheless, insurers have a challenging path to navigate as they pursue this opportunity.
Dementia is uniquely difficult to insure. Most critically, the condition is highly susceptible to anti-selection. Biomarkers can appear years before MCI is clinically detectable, and genetic tests can indicate elevated risk well in advance. Furthermore, the duration from MCI to moderate dementia can be very long – sometimes a decade or more – giving individuals who suspect they are at risk of developing dementia or already earlier onset, ample time to seek coverage. This makes traditional risk selection exceptionally challenging.
Beyond anti-selection, there is a more fundamental question: what is the right benefit design? Monetary support would be most meaningful at the earlier stages of the disease, where emerging drug therapies offer the greatest clinical value. However, providing significant benefits at early stages is challenging due to higher risk of anti-selection and difficulty in traditional risk assessment. A standard critical illness payout, designed for acute events, may be ill-suited to a condition that demands sustained support — covering both early treatment access and ongoing non-clinical needs like home modifications and care coordination. Designing alternative benefit structures that balance meaningful support with manageable risk remains an unresolved challenge for the industry.
The very challenges of dementia — its long-tail nature, uncertain trajectory, and mismatch with traditional insurance models — opens a different kind of opportunity. For insurers willing to engage, this is a chance to raise awareness of the condition’s true impact and develop tailored products for an underserved risk. Because dementia emerges later in life, meaningful protection must be purchased well before onset. This is not merely about targeting a niche elderly segment, but also about helping a broader customer base to understand the value of planning ahead.
None of these options are easy to execute but for insurers willing to work through the complexities, dementia represents a growing area of customer need that the industry has only begun to address.
PartnerRe works closely with insurers to navigate these challenges, combining medical insight, underwriting expertise and regional market experience to support the development of sustainable dementia solutions. Contact us to discuss how we can help you respond to the changing needs of aging populations.
Dr. Peter Lau, Chief Medical Officer, Asia Pacific
Bernice Yu, Senior Director, Product & Solutions – Greater China and Southeast Asia, Life & Health
[1] “The current status, trends, and challenges of Alzheimer’s disease and other dementias in Asia (1990–2036)”. | Frontiers
[2] “Dementia in the Asia Pacific Region” | Alzheimer’s Disease International (ADI)
[3] “The top 10 causes of death”, World Health Organization, August 7, 2024.
[4] “Eisai’s Approach to U.S. Pricing for Leqembi™ (lecanemab)”, Eisai Global, January 7, 2023.
[5] “대기 중 사망자 3700명… 노인 요양보험, 뭐가 문제일까?”
[6] “Dementia Innovation Readiness Index 2020”, Alzheimer’s Disease International, Global Coalition on Aging and Lien Foundation.
[7] “The true cost of dementia: It can set a family back by up to $1.6m over 10 years”, The Strait Times, March 31, 2025.