Changing demography and the challenge of dementia in India

Abstract

In India, increasing lifespan and decreasing fertility rates have resulted in a growing number of older persons. By 2050, people over 60 years of age are predicted to constitute 19.1% of the total population. This ageing of the population is expected to be accompanied by a dramatic increase in the prevalence of dementia. The aetiopathogenesis of dementia has been the subject of a number of prospective longitudinal studies in North America and Europe; however, the findings from these studies cannot simply be translated to the Indian population. The population of India is extremely diverse in terms of socio-economic, cultural, linguistic, geographical, lifestyle-related and genetic factors. Indeed, preliminary data from recently initiated longitudinal studies in India indicate that the prevalence of vascular and metabolic risk factors, as well as white matter hyperintensities, differs between urban and rural cohorts. More information on the complex role of vascular risk factors, gender and genetic influences on dementia prevalence and progression in Indian populations is urgently needed. Low-cost, culturally appropriate and scalable interventions need to be developed expeditiously and implemented through public health measures to reduce the growing burden of dementia. Here, we review the literature concerning dementia epidemiology and risk factors in the Indian population and discuss the future work that needs to be performed to put in place public health interventions to mitigate the burden of dementia.

Rural-urban and gender differences in metabolic syndrome in the aging population from southern India: Two parallel, prospective cohort studies

“…With the role of vascular and metabolic risk factors being increasingly recognized in the pathogenesis and progression of dementia, 45 it is essential to longitudinally follow up these individuals while monitoring for cognitive changes. Further, urgent public health measures are necessary to ensure screening and early diagnosis of metabolic syndrome and its components, so that appropriate interventional strategies including lifestyle changes can be initiated.…”

Normative data for three physical frailty parameters in an aging, rural Indian population

“…The phenomenon of population aging that is taking place across the world is conspicuous in India. 9 According to the last population census, India is home to over 104 million older persons aged 60 years and above. Further, considering the current demographic trend, this number is projected to increase drastically in the coming years (projected 353 million in 2050).…”

Public mental health: An opportunity to address implementation failure

“…Three factors account for such a large proportion of disease burden: the first is the high prevalence with 14.3% of the population in India affected by mental disorder in 2017 (excluding substance use disorder and dementia) (ISDBIMDC, 2020),[ 4 ] more than 5% with substance use disorders (Ambekar et al ., 2019),[ 6 ] and up to 10% of older people with dementia (Ravindranath and Sundarakumar, 2021). [ 7 ] The second reason is that the majority of lifetime mental disorder arises before adulthood and then often reoccurs across the life course (Jones, 2013). [ 8 ] The third is the broad consequences of mental disorder (Campion, 2019):[ 9 ] health impacts include increased health risk behaviors (such as self-harm, physical inactivity, and use of alcohol, drugs, and tobacco), physical illness, and mortality (Campion, 2019)[ 9 ] with most of the excess mortality associated with mental disorder due to physical illness (Walker et al ., 2015).…”