To analyze long-term trends in the prevalence, incidence, mortality, and disability burden of Alzheimer’s disease and other dementias among older adults in Pakistan and its provinces from 1990 to 2023.

Alzheimer’s disease and related dementias (ADRDs) are a growing public health concern in low- and middle-income countries due to population aging. However, comprehensive regional data from Pakistan remain limited. This study provides updated epidemiological estimates from the Global Burden of Disease (GBD) 2023 study.

Data on prevalence, incidence, deaths, disability-adjusted life years (DALYs), and years lived with disability (YLDs) among adults aged ≥70 years were extracted from the GBD 2023 database for Pakistan and its provinces (1990–2023). Age-standardized rates (per 100,000) and annualized average percent changes (AAPCs) with 95% confidence intervals were calculated to assess temporal trends.

From 1990 to 2023, prevalent cases increased from 134,937 to 632,593, with a modest rise in the age-standardized prevalence rate (4,698 to 4,968; AAPC = 0.16%). Incidence increased from 11,251 to 55,870 new cases, with a slight rise in incidence rate (AAPC = 0.12%). Mortality showed a sharper increase, with deaths rising from 5,594 to 24,057 and the death rate increasing significantly (AAPC = 1.73%). DALYs nearly doubled from 27,954 to 64,205, although the DALY rate declined (1,146 → 981; AAPC = –0.52%). YLDs increased in absolute number (18,368 → 68,962) but slightly declined in rate (AAPC = –0.13%). Females consistently exhibited higher prevalence and YLD rates. Provincial disparities were evident: Balochistan showed the highest increase in prevalence, while Punjab had the largest absolute burden.

The burden of Alzheimer’s disease and other dementias among older adults in Pakistan has risen substantially over the past three decades, driven by population aging and regional disparities. Strengthened dementia care strategies, provincial-level surveillance, and caregiver support systems are urgently needed to address the escalating challenge.