Old age is like a second childhood – an adage we have heard and seen before our eyes for generations. As our grandparents grow older, their memories often start to wane, their social behaviours tend to change along with limitations to their mobility, disorientation and difficulty making decisions, and more. All of these are symptoms of dementia, long understood as a brain degenerative condition that affects the elderly. Studies suggest that nearly 8.8 million Indians are diagnosed with dementia, with the number projected to double by 2036. What’s more, the incidence of early onset dementia, before the age of 60 or 65 years, is also emerging as a significant public health concern.
Patients getting younger
“The common age for dementia is 65 years or older,”says Dr Rajat Chopra, senior consultant and head of department, neurology at Yatharth Hospital in New Delhi. “Although younger adults are typically less likely to be affected by dementia, it can occur in individuals in their 30s and 40s as well,” he says, noting that such cases are becoming more and more frequent now.
“The rates of dementia and Alzheimer’s are growing in India,” he says, adding that “they are driven by population ageing and increasing risk factors like diabetes and hypertension”.
Dr PN Renjen, senior consultant at Indraprastha Apollo Hospitals, adds, “The increasing number of cases being discovered at an earlier stage has also been attributed to urbanisation and higher life expectancies. More patients are showing up with cognitive problems that start to affect their ability to function socially and professionally at comparatively earlier ages.”
Speaking from his experience with patients, Dr Renjen says that many patients who come to him for neurological evaluation are in their 40s or 50s. “But there have been instances of symptoms manifesting earlier due to genetic or lifestyle factors,” he notes, especially among those with family history of neurological disorders or vascular risk.
It is estimated that up to 5% of people with Alzheimer’s globally have younger-onset disease. Younger-onset Alzheimer’s is often misdiagnosed.
Symptoms known, cure unknown
Dr Chopra says that while dementia is a treatable condition, it has no cure as it is a neurodegenerative condition. “Management of the symptoms includes staying physically and mentally active through exercise and hobbies, maintaining a healthy lifestyle with a balanced diet and regular doctor visits, and using memory aids like calendars and written lists.” Engaging in social activities with friends and family and establishing calming routines is also advised, he adds.
While at present, there is no definitive cure for dementia or Alzheimer’s disease, Dr Renjen holds that early intervention and a structured treatment plan can help slow disease progression and improve quality of life. “Medical management includes cognitive-enhancing medications, therapy for behavioural symptoms, and supportive care. Non-pharmacological approaches such as occupational therapy, routine, and family counselling are equally vital,” he says.
Dr Renjen describes warning signs of early onset dementia as including persistent memory lapses, difficulty concentrating, challenges with language or decision-making, personality changes, disorientation, and a decline in work performance or social engagement. “If such symptoms are noticed frequently, a professional neurological assessment is strongly recommended,” he advises.
This neurodegenerative disorder can have a variety of causes, starting from family history to lifestyle habits. The risk can be increased by long-term stress, brain trauma, alcohol abuse, and irregular sleep patterns. Dr Renjen further explains, “The complexity of genetic and environmental components in the progression of dementia is shown by the fact that in certain people, the precise etiology is still unknown.”
Dr Chopra from Yatharth Hospital lists causes such as genetic mutations in APP, PSEN1 and PSEN2, which are genes that code for proteins involved in Alzheimer’s Disease, along with other neurodegenerative diseases like FTLD (frontotemporal lobar degeneration), DLB (dementia with Lewy bodies), and Huntington’s chorea, which has physical as well as cognitive and psychiatric impacts on the patient.
According to the Alzheimer’s Association of India, Alzheimer’s disease is the most common form of dementia. In the early stage, dementia symptoms may be minimal, but as the disease causes more damage to the brain, symptoms worsen. The rate at which the disease progresses is different for everyone, but on average, people with Alzheimer’s live for eight years after symptoms begin.
Bracing for the storm
According to experts, certain lifestyle modifications can help in maintaining brain health, if not entirely rule out the risk. For example, Dr Chopra lists controlling blood sugars, blood pressure and regular walking, healthy food, playing mind games, and avoiding smoking and alcohol as some basic preventative measures.
Dr Renjen insists that preventive measures play a crucial role in maintaining long-term brain health. “Adopting a balanced diet rich in fruits, vegetables, and omega-3 fatty acids, engaging in regular physical activity, maintaining sleep hygiene, and keeping stress under control can help delay or reduce the risk of dementia,” he says, adding: “Cognitive exercises, social interactions, and lifelong learning also contribute to improved brain resilience. Managing blood pressure, glucose, and cholesterol levels is particularly important, as vascular health is closely linked to cognitive well-being.”
Estimates suggest that there are fewer than 50 dedicated memory care homes, or residential dementia care facilities across the country, with most of them being concentrated in metros. However, Dr Renjen says that medical recourses for those diagnosed with dementia are quite accessible. “Upon diagnosis, patients have access to various medical resources depending on their location. Tertiary care hospitals and neurology centres offer multidisciplinary management, including consultations with neurologists, psychiatrists, and neuropsychologists.” He adds that many urban hospitals now also have dedicated memory clinics that focus on early detection and cognitive rehabilitation.
Speaking of the medications generally prescribed for such conditions, Chopra says, “These include cholinesterase inhibitors (like donepezil, rivastigmine, and galantamine) for memory and thinking, and memantine for moderate to severe Alzheimer’s disease. Other medicines are for specific symptoms like depression (antidepressants), anxiety (anxiolytics), and agitation (antipsychotics).”
However, it is widely understood that treatment for brain degenerative disorders are neither accessible nor affordable for all. “Although neurologists and therapeutic alternatives are more readily available to urban and affluent people, many people still face obstacles related to pricing and awareness,” observes Dr Renjen, adding: “Dementia care is therefore typically concentrated in urban areas and among those with greater socioeconomic status.”
A few initiatives have emerged in some states like Karnataka and Kerala, among others. While Kerala launched the State Initiative on Dementia in 2014, Karnataka declared dementia a public health priority in 2023, which was followed by the submission of the draft Karnataka State Dementia Action Plan, a collaboration between NIMHANS, the Dementia India Alliance (DIA) with pan India organisations like the Alzheimer’s Association India or the Dementia India Alliance. Some other states have also followed suit in providing awareness on dementia in elderly care. The risk of early onset dementia is slowly making its way into discussions as well, alongside the rising number of diagnoses.
BOX 1 – Minimising risks
- Engage in regular physical activity
- Maintain sleep hygiene
- Keep stress under control
- Manage blood pressure, glucose, and cholesterol levels
- Adopt balanced diet
- Engage in social interactions
- Undertake cognitive exercises
BOX 2 – Warning bells
- Persistent memory lapses
- Difficulty concentrating
- Personality changes
- Challenges with language or decision-making
- Disorientation
- Decline in work performance or social engagement