The Rise of Dementia through Time and Space
Author: Janna Dinneweth
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Imagine being 51 years old, gradually losing your grip on reality. Your memory begins to fail, language slips away, familiar faces become unrecognisable, and daily routines unravel into confusion...
What is Alzheimer's disease?
The first known case of Alzheimer’s disease
After Auguste Deter died in 1906, Alois Alzheimer conducted a post-mortem examination, identifying hallmark abnormalities in her brain (amyloid plaques and neurofibrillary tangles) that would later define the condition bearing his name. Although descriptions of dementia date back to antiquity, Alzheimer’s observations marked the beginning of its modern medical conceptualisation. What began as a rare case study has since evolved into one of the most pressing public health concerns in ageing societies, with Alzheimer’s disease now recognised as the most common form of dementia.
In Belgium, as in many high-income countries, dementia has emerged as a leading cause of death, particularly among older women. Changes in disease classification, improved awareness among physicians, and the demographic transition have all contributed to this rise. By the early 21st century, dementia was no longer merely a comorbid condition, but frequently cited as the primary cause of death, reflecting both epidemiological trend and sociocultural transformations in end-of-life care and certification practices.
History
People have been aware of memory problems in old age since ancient times. The Greek thinker Pythagoras compared old age to childhood, saying it brings a decline in thinking ability (Jameson, 1811). Another Greek, Solon, warned that aging could affect decision-making (Freeman, 1926). Doctors like Hippocrates and philosophers like Aristotle thought these changes were caused by problems in the body—such as imbalances in fluids or too much black bile (Papavramidou, 2018).
By the 1600s, doctors started to describe dementia more clearly. Thomas Willis connected changes in the brain to changes in behaviour. In the 1700s, William Cullen described “amentia senilis” as memory loss in old people (Berchtold & Cotman, 1998). In 1838, Jean Esquirol separated dementia caused by aging from intellectual disabilities that started at birth. But not everyone agreed—Belgian records still grouped them as late as 1869 (Caixeta et al., 2014; Guislain, 1852).
In the late 1800s, scientists began looking more closely at the brain. Samuel Wilks linked dementia to the shrinking of the brain, and Otto Binswanger described a form caused by blood vessel problems (Berchtold & Cotman, 1998; Grand & Feldman, 2007). In the early 1900s, Alois Alzheimer studied the brain of a woman named Auguste Deter and found unusual changes now known as plaques and tangles. In 1910, Emil Kraepelin named the condition “Alzheimer’s disease” (Goedert & Ghetti, 2007). For much of the 1900s, Alzheimer’s was thought to be rare. That changed in the 1970s, when it was found to be the main cause of dementia in older adults (Assal, 2019; Vatanabe et al., 2020).
Today, scientists have developed new ways to detect and treat Alzheimer’s, including tools that look at brain changes and drugs like Leqembi, which was approved in 2023 to help slow the disease (Maheshwari & Singh, 2024). Still, there is no cure, and dementia remains a difficult condition with many unanswered questions.
Dementia in Belgium Through Time
The figure shows how deaths caused by dementias, including Alzheimer’s disease, have changed over time in Belgium. In the early 1980s, dementia accounted for less than 1% of all deaths. Since then, the number has risen sharply, reaching around 9% by 2019. A small drop is noticeable in 2020, likely due to the effects of the COVID-19 pandemic, which may have disrupted diagnosis or reporting.
Dementia now accounts for a greater share of deaths among women than among men. This gender difference has become more pronounced over time. Interestingly, this growing gap in dementia deaths occurs even though men and women in Belgium are now living to more similar ages than they did in the past (Eggerickx et al., 2020).
Dementia in Belgium Through Space
When we looked at where people died from dementia in Belgium, we noticed some clear patterns. In 1970 and 1990, deaths from dementia were mostly clustered in Flanders. By 2000, this pattern had changed; dementia mortality was spread more evenly across the country, and this continued in 2010. But in 2019, something shifted again: Flanders showed a noticeable rise in dementia-related deaths, breaking the previous trend.
One possible reason for this could be that people in Flanders tend to live longer than in other regions (Eggerickx et al., 2020), and dementia is more common at older ages. Still, since we adjusted our data to account for age differences, it’s likely that other factors like social or environmental conditions also help explain why dementia death rates remain higher in Flanders.
Inequality in Dementia Mortality?
Not everyone has the same risk of dying with dementia. When we looked at Belgians aged 65 and older between 2011 and 2016, we found clear differences between social groups. People with lower levels of education (only primary school or less) were more likely to die with dementia. Among them, men were about 1.2 times more likely to die with dementia, and women were more than 1.3 times more likely, compared to people with higher education levels.
Source: Statistics Belgium, calculations by author
When we look at income, we also see differences in the risk of dying with dementia. Among men, there is a clear pattern: those in the lowest income group are almost 1.2 times more likely to die with dementia than men in the highest income group. This difference becomes smaller in the higher income groups but remains important. For women, the differences are less clear. The first two income groups do not show a significant difference, but women in the third income group are about 1.1 times more likely to die with dementia than those in the highest income group.
Conclusions
Further Reading
Want to know more about our research on dementia? You can explore our published articles below.
- Dinneweth, J., & Gadeyne, S. (2024). Socioeconomic Disparities in Neurodegenerative Disease Mortality: A Population-Based Study among Belgian Men and Women Aged 65 or Older. INQUIRY: The Journal of Health Care Organization, Provision, and Financing, 61, 00469580241237113.
- Dinneweth, J., & Gadeyne, S. (2024). Unravelling the Evolution of Neurodegenerative Disease Mortality: Insights from 50 Years of Belgian Data. Espace populations sociétés. Space populations societies, (2023/3-2024/1).
- Dinneweth, J., & Gadeyne, S. (2025). Linking Social and Environmental Indicators to Neurodegenerative Disease Mortality in Belgian Municipalities Using Spatial Regression Analysis. Vrije Universiteit Brussel, Vakgroep Sociologie, BRISPO. https://doi.org/10.5281/zenodo.14859170
Sources and Literature
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Ineqkill Digital Atlas of Health Inequalities in Belgium provides detailed historical information about mortality and diseases in Belgium from 1820 to 2025.
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e-mail: sylvie.gadeyne@vub.be
