The dementia epidemic is unfolding rapidly across the country.
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With India’s elderly population expected to touch 20 crore in 2031, there is a growing demand for a national action plan to tackle rising cases of Alzheimer’s , the most common form of dementia which can impair memory and significantly lower quality of life.

Estimates based on a recent multi-centric study reveal a dementia prevalence rate of 7.4% among those aged 60 years and above, translating to nearly 9 lakh Indians currently living with dementia. From an estimated 88 lakh in 2016, the prevalence of dementia is projected to increase to 1.7 crore by 2036. The study titled ‘Prevalence of dementia in India: National and State estimates from a nationwide study’ was published in July this year in Alzheimer’s and Dementia, the journal of the Alzheimer’s Association.

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A. B. Dey, former head of the department of Geriatric Medicine at AIIMS, New Delhi, who is the co-principal investigator of the study, said it revealed that States like Jammu and Kashmir, Odisha and West Bengal reported much higher rates of dementia. “This is contrary to the earlier belief that southern States with higher ageing populations would have a higher prevalence rate of dementia,” he said.

In 2012, WHO declared dementia a public health priority and launched the Global Action Plan on the public health response to dementia (2017 – 2025), which emphasises critical areas such as dementia awareness, risk reduction, diagnosis, treatment, caregiver support, and research.

Despite advances in drug development, risk reduction remains the only proven prevention tool, Alzheimer’s Disease International (ADI), the global federation of over 100 Alzheimer’s and dementia associations, has warned. Calling on governments around the world to urgently fund dementia risk-reduction research, education, and support services, ADI has said that nearly 40% of projected dementia cases can be delayed or potentially even avoided by addressing the risk factors. While 40 governments worldwide have so far developed national dementia plans, the proposal is yet to gain momentum in India.

Cost implications

According to a study published in the Indian Journal of Public Health in 2013, the cost of dementia care in India in 2010 for 37 lakh people was ₹23,300 crore annually. It is estimated that the families of 88 lakh people with dementia would be spending about ₹1,18,902 crore to take care of their kin with dementia in a year at present. The enormity of the economic burden on the households to take care of 1.7 crore people with dementia in 2036, based on the current projections will be about ₹3, 08,395 crore annually, experts pointed out.

P.T. Sivakumar, professor and Head of the Geriatric Psychiatry Unit at NIMHANS, said dementia is a major public health problem requiring multi-sectoral intervention to address the whole spectrum of services from prevention to rehabilitation and caregiver support. There is widespread ignorance, low awareness, and stigma surrounding this condition leading to almost 90% of people never getting a diagnosis, he said.

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“India contributes to more than 15% of the global prevalence of dementia. This estimate is much higher than the prevalence estimated earlier based on smaller studies. The burden due to dementia is not merely due to the increasing number of cases. It is compounded by the extent of caregiver burden and the lack of adequate health and social care services,” the doctor said.

NIMHANS and Dementia India Alliance (DIA) are working with the Karnataka government on chalking out a Karnataka State Dementia Action Plan. DIA president Radha S. Murthy said the State-level plan will align with WHO’s global action plan, positioning Karnataka as a pioneer in India to formulate a comprehensive action plan for dementia.

Dr. Dey said the framework for the national dementia action plan needs to include awareness generation, early detection, clinical management and long-term care planning. “The Lancet Commission on dementia has been regularly updating the modifiable risk factors. There is a need for healthcare providers and the general public to be educated about these risk factors to prevent dementia. The Longitudinal Aging Study in India Diagnostic Assessment of Dementia (LASI DAD) Wave 1 has provided information on several such risk factors and the ongoing Wave 2 is also focusing on new risk as well as protective factors. Diet seems to have an important protective role,” he added.

(yasmeen.afshan@thehindu.co.in)