Decoding the drivers of Alzheimer's disease and other dementias mortality in Asia, 1990-2023: a Global Burden of Diseases Study 2023.

BACKGROUND: Despite the burden of Alzheimer's disease and other dementias (ADOD) in Asia, evidence on patterns of mortality attributable to risk factors remains limited. METHODS: We used data from the Global Burden of Diseases Study (GBD) 2023 to examine mortality from ADOD attributable to GBD-quantified risk factors in Asia from 1990 to 2023. Analyses included 34 countries and territories. These were grouped into five regions according to the GBD classification: Central Asia, East Asia, South Asia, Southeast Asia, and the high-income Asia Pacific. ADOD was defined as dementia characterized by progressive cognitive decline with functional impairment. ADOD mortality attributable to air pollution, tobacco use, high fasting plasma glucose(FPG), and high body mass index was assessed among adults aged ≥70 years using the GBD comparative risk assessment framework. The Das Gupta decomposition method was applied to quantify the contributions of population growth, population aging, and epidemiological change. Uncertainty was reported as 95% uncertainty intervals (UIs) derived from 250 posterior draws. RESULTS: In 2023, ADOD mortality rates in Asia showed marked variation, with the highest burden in high-income Asia Pacific (661.10 [95% UI, 189.78-1504.67] per 100,000 population) and the lowest in Central Asia (273.00 [65.15-695.77]). From 1990 to 2023, the burden attributable to high FPG increased across all regions. High-income Asia Pacific remained the highest, increasing from 75.60 (95% UI, 17.97-204.39) per 100,000 population to 139.21 (32.10-323.57). Air pollution remained a major driver, while tobacco-attributable burden in 2023 remained concentrated in East Asia (16.86 [95% UI, 3.38-41.27] per 100,000 population). The burden increased steeply with age and differed by sex, with higher burdens from air pollution and high FPG in females and from tobacco in males. Decomposition analyses showed varying contributions of population growth, population aging, and epidemiological change to changes in attributable mortality. The Maldives showed the largest increases for air pollution, high FPG, and tobacco. CONCLUSIONS: The substantial heterogeneity in risk-attributable ADOD mortality across regions, age groups, and sexes supports risk- and region-specific prevention priorities across Asia. Dementia prevention should be aligned with local cardiometabolic, tobacco, and air-pollution risk profiles, while future studies should assess whether reducing these exposures translates into lower ADOD mortality.