Perspectives: Advancing Dementia Care Continuity: The 3A (Awareness, Attitude, Action) Framework

As the world observes World Alzheimer’s Month 2025 under the theme “Ask About Dementia, Ask About Alzheimer’s”, the global community confronts an urgent imperative to address dementia as one of the most formidable public health challenges of our era. More than 55 million people worldwide currently live with dementia, with projections indicating this number will nearly double every two decades. China, experiencing rapid population aging, shoulders a particularly substantial burden, with an estimated 16 million people affected by dementia in 2021 (1–2).

The impact extends far beyond those receiving a diagnosis. Caregivers — predominantly family members — endure profound psychological, physical, and financial strain, with nearly 40% experiencing anxiety or depression (3). Continuity of care, encompassing timely detection, accurate diagnosis, evidence-based intervention, and comprehensive caregiver support, remains essential for mitigating this multifaceted burden (4).

Despite significant advances in diagnostic criteria and therapeutic options, substantial gaps persist between scientific progress and real-world care delivery. Dementia remains widely underdiagnosed globally, with approximately 60% of cases going undetected and even lower diagnosis rates documented in underrepresented regions of China (5–6). The overall proportion of undetected dementia reaches 85.8% nationally, with rates of 77.5% in urban areas and 93.5% in rural areas (7). Furthermore, care-seeking behavior demonstrates considerable delays, with individuals typically waiting 2–3 years after symptom onset before pursuing medical evaluation (8). Low public awareness, persistent stigma, limited trained workforce capacity, and fragmented healthcare systems represent the primary drivers of this diagnostic gap.

While symptomatic medications remain available and affordable in China, more than 10% of diagnosed patients receive no treatment, and nearly 30% rely exclusively on lifestyle modifications (9). Non-pharmacological interventions (NPIs), though critical for maintaining functional capacity and quality of life, are inconsistently prescribed, inadequately funded, and rarely covered by reimbursement systems (10). This fundamental mismatch between patient needs and available services perpetuates significant inequities in healthcare access.

Meanwhile, routine cognitive screening remains substantially underutilized across healthcare settings. Although older adults generally value early detection opportunities, concerns regarding stigma and potential psychological distress reduce screening uptake (11–13). Integrating personalized health promotion strategies with ongoing support systems could effectively bridge this gap, particularly in the emerging era of disease-modifying therapies (14).

The World Health Organization (WHO) officially adopted the Global Action Plan on the Public Health Response to Dementia (2017–2025) in May 2017, establishing seven key action areas. This WHO global action plan provides implementation guidance for international, regional, and national decision-makers while setting ambitious global targets for 2025. National dementia action plans continue to expand worldwide, with increasing emphasis on early detection, prevention strategies, and improved care access. However, few countries have successfully implemented systematic brain health screening programs (15).

China has systematically integrated dementia into its national health priorities (16). The Healthy China Initiative (2019–2030) identified slowing dementia prevalence as a critical public health objective. On December 31, 2024, the National Health Commission, in collaboration with 14 ministries and central government bodies, launched the comprehensive National Action Plan on Response to Dementia (2024–2030). This national dementia action plan establishes a robust framework aligned with the WHO Global Action Plan by highlighting seven main tasks (Table 1), setting eight anticipatory indicators, and designing nine specialized initiatives (referred to as “zhuan lan” or focused programs) (Table 1) (17). The plan emphasizes a “whole-of-society” approach, mobilizing healthcare, civil affairs, education, and media sectors to transform dementia from a private family burden into a shared public responsibility.

Key strategies within China’s national action plan include: 1) Raising awareness through nationwide campaigns and comprehensive healthcare provider education. 2) Integrating screening and early intervention into primary care and community health services, supported by dedicated cognitive training centers. 3) Advancing multidisciplinary care through memory clinics, tiered referral systems, and coordinated hospital–community–home care pathways. 4) Supporting caregivers through psychological counseling, respite services, and structured training programs. These initiatives create opportunities to establish a comprehensive closed-loop system encompassing prevention, detection, intervention, and long-term management — ensuring more equitable and continuous care delivery. The key tasks align with these strategies and reflect a complete continuum of dementia care and prevention — from raising awareness (Task #1) and promoting positive attitudes toward dementia (Tasks #5 and #7), to implementing concrete action by improving access to dementia care services and driving innovation in care technology (Tasks #2, #3, #4, and #6).

The theme of World Alzheimer’s Month 2025, “Ask About Dementia, Ask About Alzheimer’s”, emphasizes that knowledge serves as the foundation for meaningful change. However, awareness alone proves insufficient to transform lives. To translate knowledge into sustained impact, we propose the 3A approach — Awareness, Attitude, and Action — as a comprehensive framework for advancing continuity of care (18–20).

Awareness: Elevating public awareness and disseminating evidence-based knowledge about dementia represents a fundamental priority. Although most individuals recognize dementia symptoms, public understanding of when and where to seek professional support — and how to effectively support those living with dementia — remains critically inadequate (18). This health literacy gap extends beyond the general population to encompass community healthcare providers and medical students, who will serve as frontline care providers for older adults (19–20). Strategic communication and comprehensive public education campaigns serve as essential tools for enhancing health literacy, dismantling stigma, and promoting early detection, diagnosis, and intervention. China’s National Health Commission exemplifies this approach by leading nationwide awareness campaigns during global observances such as World Alzheimer’s Month to strengthen public understanding of dementia.

Attitude: People living with dementia frequently encounter challenges with memory, recognition, and environmental comprehension that can result in behaviors others may perceive as disruptive or inappropriate. These manifestations often trigger negative attitudes toward both the individual and their family members. Furthermore, the pervasive misconception that dementia remains untreatable fosters therapeutic nihilism and persistent pessimism throughout existing care systems (21). Such attitudes perpetuate disadvantage and discrimination against affected individuals and families. Countering these harmful perspectives requires improving both the quality and accessibility of dementia services and care. Cultivating positive societal and professional attitudes becomes essential for fostering inclusive, person-centered care approaches. The integration of dementia into national public health agendas represents a promising advancement, reflecting governmental commitment to inclusivity and comprehensive care.

Action: Providing timely support to individuals with dementia and their caregivers remains a formidable challenge. Many families delay seeking diagnosis or appropriate care, and even when a diagnosis is established, post-diagnostic support is frequently inadequate, leaving individuals and families ill-equipped to navigate the necessary adjustments. Moreover, care systems typically operate in silos, with health, social, and community services functioning independently rather than collaboratively. While social prescribing has recently emerged as a promising approach to bridge medical and social care, as illustrated in Figure 1, the mechanisms for effective inter-sectoral collaboration remain underdeveloped and require substantial exploration to enhance both feasibility and operational efficiency (22).

Figure 1. 

Inter-sectoral collaboration of the integrated dementia care system.

Furthermore, significant regional disparities persist in both access to and utilization of dementia care resources across China, reflecting broader systemic inequities in service availability and quality (23). These disparities arise primarily from the uneven geographic distribution of trained specialists and specialized dementia care facilities nationwide. Implementing a comprehensive tiered referral system, coupled with multi-level training and supervision programs for primary care physicians and dementia specialists, will serve as critical enablers in establishing coordinated care across all healthcare system levels (Figure 2). To strengthen clinical management and disease control, there is an urgent imperative to translate existing policies and scientific advancements into accessible, equitable, and integrated services that seamlessly combine medical, social, and community support. The nine specialized initiatives outlined in China’s national dementia action plan have established clear priorities for the next five years, targeting measurable improvements in dementia care and prevention — ultimately aiming to decelerate the rising prevalence of dementia nationwide.

Figure 2. 

Coordinated care across different levels of healthcare institutions.