Alzheimer’s disease is about to become a big problem for China. Nearly 30% of all people with the condition or related forms of dementia already live in the country. And with its ageing population and falling birth rate, the burden on health and social welfare is expected to multiply dramatically in the coming decades.
The future of Alzheimer’s treatment
The Chinese government has responded with programmes and funding that are aimed at improving screening, diagnosis and treatment of Alzheimer’s disease by 2030. And the research has started to take off.
Scientists have been working on new drugs and innovative — if controversial — surgical techniques. The government has also encouraged the development of drugs derived from traditional Chinese medicine. And researchers are accelerating the search for biological markers that precede the onset of Alzheimer’s disease, including genetic contributors, which could explain how the condition develops and reveal the best way to identify it early.
Although the investments don’t yet match the level of funding in the United States, the improving quality and quickening pace of clinical and preclinical research has attracted attention from researchers around the world.
“Maybe China is the next place that will take the lead,” says John Hardy, a neurogeneticist at the UK Dementia Research Institute in London, who is also affiliated with the Hong Kong Center for Neurodegenerative Diseases.
Treating the root of the problem
Nearly 17 million people in China had Alzheimer’s disease and related dementias in 2021 — about 9 in 1,000, according to a report published last year1. Projections suggest that this number could reach as high as 66 million by 2050 (see ‘Dementia’s rise’) or even exceed 100 million by then2,3. The problem is compounded by China’s low fertility rate, which means that there will be fewer people of working age to support the growing population of older individuals with debilitating conditions.
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Recognizing this coming wave, Chinese authorities have attempted to lure highly productive researchers in other countries to China. Recruiting Chinese scientists who have studied or worked abroad seems to be a top priority, says Colin Masters, a neuropathologist at the University of Melbourne, Australia, who has multiple collaborators in China. “What we’re seeing now is a very large number of expats coming back into Beijing, Shanghai and Guangzhou,” says Masters.
China has been spending across all research fields, investing around US$91.5 billion in basic and applied research in 2024. Funding specifically for Alzheimer’s research is a small portion of that, but it has been on the rise4.
Weihong Song, a molecular neurobiologist and clinician-scientist, was running a laboratory at the University of British Columbia in Vancouver, Canada, when he accepted an invitation to lead a research lab for Alzheimer’s disease at Wenzhou Medical University. While maintaining his labs there and in Vancouver, he went on to launch an entire centre — the Oujiang Lab, also in Wenzhou, which focuses on regenerative medicine, vision and brain health. It now employs more than 800 scientists and has received roughly US$1.2 billion in funding from the local government, according to Song.
China has focused on young, rising scientists, Song says. “I would say over the past five years, probably a billion Chinese yuan (US$145 million) has been spent on Alzheimer’s disease-focused research projects,” says Song. By comparison, the US National Institutes of Health spent $3.6 billion on all Alzheimer’s disease research in 2024 alone — several orders of magnitude greater.
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The work being funded in China is diverse. Keqiang Ye, a neurochemist at Shenzhen University of Advanced Technology, and his team are working on a drug called BrAD-R13, which is designed to mimic a protein called brain-derived neurotrophic factor (BDNF) that enables neurons to connect and communicate with each other. People with Alzheimer’s disease have low levels of BDNF in their brains. BrAD-R13 activates a receptor called TrkB, a natural target of BDNF5. This in turn protects neurons, possibly by reducing the formation of the amyloid plaques and tau neurofibrillary tangles that are hallmarks of Alzheimer’s disease.
Other teams around the world are also working on TrkB receptor agonists, but Ye says his team is making good strides in the clinic. His group completed safety testing for BrAD-R13 last September, and intends to launch a trial in the United States and China later this year that will begin to assess efficacy in humans.
This is part of a rapid growth in clinical research for China. In 2021, China listed nine clinical trials for Alzheimer’s disease treatments, but by 2024 there were 107 in total1.
Another candidate progressing through clinical trials is a drug containing a compound called DI-3-n-butylphthalide (NBP), which is derived from Chinese celery (a variety of Apium graveolens) — a food that is used in traditional Chinese medicine. Preclinical studies have shown that NBP was associated with increased BDNF levels and improved performance in cognitive tests in rats6, and reduced amyloid plaque deposits in a mouse model of Alzheimer’s disease7. In a 12-month randomized trial, including 270 people with mild cognitive impairment associated with Alzheimer’s dementia, NBP seemed to reduce the severity of symptoms8.
Other clinical trials have tested NBP alongside other drugs such as donepezil, which is used to treat symptoms of Alzheimer’s disease, or memantine, which helps to slow disease progression. NBP has also been tested with a cocktail of traditional Chinese medicines known as Shengui Yizhi Fang, which includes ginseng (Panax ginseng), tuckahoe (Wolfiporia extensa) and Rehmannia glutinosa root.
Surgery holds promise
In 2012, a research group at the University of Rochester in New York identified a previously undescribed system that helps to remove cellular waste from the brain9, much as the lymphatic system does for the rest of the body. Several Chinese research teams have been looking into whether this ‘glymphatic’ system might become clogged as people age and thereby lose its ability to help to clear the precursors of amyloid plaques and tau tangles.
Xie Qingping, a microsurgeon at Hangzhou Qiushi Hospital, pioneered a procedure called lymphatic venous anastomosis (LVA) for Alzheimer’s disease. The procedure, in which lymph vessels are connected to veins, allowing fluid to drain into the circulatory system, has been used to treat swelling in different parts of the body caused by a condition known as lymphoedema. It is now being tested for Alzheimer’s disease in China and throughout the world.
China’s ageing population will increase the burden on health and social welfare.Credit: Billy Hustace/Getty
Zhenhu Ren, a surgeon and researcher at Shanghai Jiao Tong University, is part of a team that developed a variation of the procedure called cervical shunting to unclog cerebral lymphatic systems (CSULS). The procedure involves relieving pressure in large lymph vessels deep in the neck10. As of August 2024, Ren’s team had performed CSULS on 20 people, and reported benefits that include improved function of the glymphatic system and better scores on cognitive-function tests for a handful of individuals that have been tracked so far.
But hundreds of other people have also had the procedure, after its popularity was “exploited by some ill-intentioned doctors”, Ren says. Some hospitals have exaggerated its benefits and have offered the surgery despite not having the ability to perform it, he says.
In July 2025, China’s National Health Commission banned doctors from using LVA to treat people with Alzheimer’s, while it progresses through formal clinical testing by teams such as Ren’s.
