Dementia in the Middle East and North Africa: an integrative narrative review of epidemiology, risk structure, and health system implications

Background: Dementia prevalence in the Middle East and North Africa (MENA) is projected to rise exponentially, with estimates suggesting increases of 367% by 2050. This region faces distinctive challenges, including rapid demographic transition, high rates of modifiable risk factors, and fragmented health systems. This paper examines region-specific risk factors and pooled prevalence rates of dementia across the MENA region. Methods: We conducted a narrative review of dementia risk factors in the MENA region, including analysis of population-attributable risk (PAR) estimates and pooled estimates of dementia prevalence among adults aged 50 years and older. Results: Dementia prevalence was estimated at 1.84% among individuals aged 50 years and older, increasing to 3.81% among those aged 60 years and older, with substantial variability across countries. Smoking (>30%), physical inactivity ( ~ 50%), and high burdens of diabetes, hypertension, and obesity were consistently associated with increased dementia risk. Additional region-specific drivers include nutritional transitions, gut dysbiosis, consanguinity, and environmental risk factors such as air pollution and climate-related heat stress. Critical barriers to prevention and care include limited research infrastructure, low health literacy, stigma, and inequitable health care access. Conclusions: Dementia prevalence in MENA is rising rapidly, driven by demographic change and high exposure to modifiable risk factors that are relatively region-specific in terms of their contribution. Strengthening prevention, early detection, and equitable access to care should be regional health priorities.