Milken Institute calls for greater investment in dementia research and development to help boost global healthspan and longevity.
This month, the Milken Institute, a think tank focused on health, finance and philanthropy, released its Mind the Gap report, highlighting a pressing global challenge: dementia’s role in the healthspan–lifespan gap. While people are living longer than ever, many are spending their final decade in poor health, and dementia is one of the leading drivers of this, with global cases expected to nearly triple to 152 million by 2050.
While new diagnostics, disease-modifying drugs and lifestyle interventions offer hope, the institute argues that progress depends on sustained investment. The report calls for urgent global action across prevention, detection, treatment and caregiver support to extend both healthspan and “brainspan.”
Longevity.Technology: The economic and social stakes associated with dementia are enormous. Global dementia costs are projected to reach $2.8 trillion by 2030, with family caregivers providing the majority of care. Yet public policy is lagging, with only a third of countries having national dementia plans and research funding still lagging behind other major diseases. Mind the Gap calls for urgent investment in prevention, early detection, targeted treatments, and caregiver support.
With sustained global action, the report’s authors say that dementia can be reframed as a preventable and treatable condition, and extending brain health can become central to the promise of longer, healthier lives. To learn more, we sat down with Mike Brown, co-author of the report, who leads the Milken Institute’s Alliance to Improve Dementia Care.
According to Brown, there is growing global recognition that action is needed to stem what is expected to become a tsunami of dementia cases in the coming years.
“The numbers are staggering,” he says. “Global dementia cases are expected to nearly triple to 150 million over the next 25 years. Yet 50–60% of cases still go undiagnosed, meaning many people miss out on support and care.”
In May, the World Health Organization extended its Global Action Plan on the Public Health Response to Dementia from 2017–2025 out to 2031.
“That demonstrates real commitment, but progress remains slow – only about a third of member states have national dementia plans in place,” says Brown. “Our report calls for stronger top-down leadership, with governments investing in prevention, early diagnosis, treatment, and care.”
Dementia is not ‘normal’ aging
One of the most important points that the Mind the Gap report addresses is that dementia is not a normal part of aging. Incredibly, a survey by Alzheimer’s Disease International found that 80% of people still believe dementia is simply normal aging.
“That stigma remains one of the biggest barriers to progress,” says Brown. “Dementia is not a single disease, it is a syndrome caused by various underlying pathologies, including Alzheimer’s disease, Lewy body disease, and frontotemporal degeneration, among others. Recognizing this can help shift thinking away from dementia as “just aging” and toward precision neurology, where targeted diagnostics and therapies are developed for specific diseases.”
The report recognizes the significant advances made in dementia research and treatments over the last 25 years, such as the shift from PET imaging and cerebrospinal fluid analysis to the exciting promise of blood-based tests.
“Blood-based biomarkers were recently approved for symptomatic testing, which is a significant breakthrough,” says Brown. “Physicians can now use a blood test to confirm or rule out elevated amyloid levels after initial cognitive assessments. It’s not perfect, but it’s an important step forward and will only improve with time.”
“The next frontier will be brain-aging clocks – tools that help people measure and track their rate of cognitive aging, similar to how we track weight, blood sugar, or cholesterol. This could provide the motivation people need to stick with lifestyle or therapeutic interventions long term.”
Alzheimer’s drug progress is ‘meaningful’
Brown also hails the progress seen from new therapeutics, like Leqembi and Kisunla, which have come to market in recent years.
“These are not just symptom-management drugs; they are disease-modifying therapies targeting the underlying biology of Alzheimer’s,” he says, pushing back on those who say that the drugs aren’t effective enough. “The progress is meaningful because these drugs are showing sustained effects. They reduce amyloid buildup and slow progression, keeping people functional for longer. That means people may be able to remain independent, avoid moving into assisted living, and reduce reliance on caregiving.”
Critically, says Brown, new innovations are also emerging. He highlights Roche, which recently presented data on trontinemab, which combines an antibody with a so-called “Brainshuttle” transporter that helps it cross the blood–brain barrier more effectively.
“Early results are promising, showing faster amyloid clearance with fewer side effects,” says Brown. “That’s a strong sign that innovation is accelerating.”
Another positive sign for the field is the increasing variety of approaches being taken to target dementia, of which 60-80% of cases are due to Alzheimer’s disease.
“About 80% of Alzheimer’s therapeutics in clinical trials are now targeting mechanisms other than amyloid, such as inflammation and vascular pathways,” says Brown. “Most trials span across different stages of dementia, but the strongest therapeutic impact has been seen in the earliest stages, including mild cognitive impairment and mild dementia due to Alzheimer’s.”
“Ultimately, dementia treatment will likely involve combination therapies and earlier interventions, even at the asymptomatic or “preclinical” stage. This shifts the trajectory so that people may ultimately delay symptoms long enough to die from something else.”
Sustained investment needed
According to Brown, today’s biggest challenge is coverage and access – regulatory bodies have been hesitant to broadly approve or reimburse these new therapeutics, citing safety and cost concerns.
“Progress is being made, but approval is often limited to specific genetic or clinical profiles,” he says. “The key is ensuring patients at the right stage – mild cognitive impairment or early dementia – are identified early enough to benefit. Every day, about 3,000 people in the US progress beyond that therapeutic window. That’s why early detection, testing, and family involvement are critical.”
Importantly, acknowledges Brown, many of the key breakthroughs made to date were seeded by decades of public funding.
“In the US, the National Institute on Aging now invests about $4 billion annually into Alzheimer’s research,” he says. “But there’s concern that funding growth may stall, which could slow the pace of therapeutic innovation.”
Drug development is a long game – the average Alzheimer’s drug has taken 13 years and $5.7 billion to bring to market – so the report emphasizes a long-term, diversified investment approach.
“We need global prevention efforts, better tools for detection and diagnosis, targeted treatments, and robust care systems,” says Brown. “If we get this right – by identifying people earlier, supporting caregivers, and bending the cost curve – we can dramatically improve quality of life while easing the enormous strain on health systems and families. If we don’t, the economic and toll on caregivers will be overwhelming.”
“Ultimately, I hope – and expect – that dementia will increasingly be recognized not as ‘normal aging,’ but as a group of treatable and manageable diseases.”
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