World Alzheimer’s Month: Never too early, never too late

 Dr. Pranjal Jyoti Chakravarty

(pranjaljc@gmail.com)

The month of September is annually observed as the world’s Alzheimer’s month. It is an opportunity to raise awareness of this disease, which is in epidemic proportion both globally and in the Indian context. It is estimated that there are 8.8 million people living with dementia in India today, out of which 60–80% account for Alzheimer’s dementia only. Globally, every three seconds, a person is newly diagnosed with dementia. The burden the disease incurs is huge. It may be financial, which is estimated to be 1,18,908 crore and is projected to be tripled by 2036 in India. Further, the burden on the carer is immense. Burnout, anxiety, and depression among carers are common phenomena. Dementia is a syndrome due to a disease of the brain, usually of a chronic and progressive nature, in which there is a disturbance of multiple higher functions, including memory, thinking, orientation, comprehension, calculation, language, and judgment.

The most predominant form of dementia is Alzheimer’s, named after Dr. Alois Alzheimer. Alzheimer’s dementia accounts for 60–80% of all dementia cases. Alzheimer’s Disease International (ADI) is the international federation of 105 dementia and Alzheimer’s associations from around the world and is in official relations with the World Health Organisation (WHO). ADI’s vision is prevention, care, and inclusion today, and cure tomorrow. Every year, September 21 is observed as World Alzheimer’s Day. This year’s theme is ‘Never too early, never too late’ and focuses on identifying risk reduction measures to delay and potentially even prevent the onset of dementia. It highlights the importance of identifying and addressing risk factors at any stage of the disease. Creating awareness among the public would possibly reduce the stigma associated with the condition. Eighty percent of the general population is not aware of the condition, and access to treatment is very poor, with a treatment gap as high as ninety percent. As Alzheimer’s dementia is a progressively degenerative disease of the brain, currently available treatment options aim to delay or slow the progress of deterioration. Common symptoms of the condition include a progressive decline in memory, mood changes, confusion about time and place, and difficulty processing new information and learning new things, which ultimately hamper the day-to-day functioning of the person. Memory loss is a common phenomenon with ageing; however, such a person usually does not need assistance for activities of daily living from others.

The exact cause of Alzheimer’s dementia is not known; however, increasing age and genetics are the most consistent risk factors. Twelve other modifiable risk factors have been highlighted, the identification and management of which, at any stage of the disease, will slow down the process of dementia to a significant extent. These are physical inactivity, smoking, excessive alcohol consumption, air pollution, head injury, infrequent social contact, less education, obesity, hypertension, diabetes, depression, and hearing impairment. Therefore, it is a good idea to screen any elderly person over 65 years of age, specifically if the person has memory loss, a family history of dementia, a history of diabetes, hypertension, or other risk factors. This would aid in early diagnosis and treatment and would further reduce carer burden. Despite various efforts, dementia, specifically Alzheimer’s dementia remains a silent epidemic in India, possibly due to ignorance, stigma, commitment, and a lack of proper policy. The National Programme for the Health Care of the Elderly (NPHCE) was launched more than a decade ago; however, its implementation is not adequate. The World Health Organisation calls upon its member states to develop a global action plan on dementia by 2025. In India, there are initiatives from various non-governmental organisations, such as the Dementia India Alliance, working relentlessly to support family carers of dementia for a better quality of life for the person with dementia and the family. Therefore, a comprehensive and holistic action plan for dementia is the need of the hour.