low levels of education and awareness. The uneven distribution of cases across states and
sub-populations means control protocols require different levels of local planning and
support, says Dr AB Dey, AIIMS
A
countrywide study conducted to gauge the prevalence of dementia has found that
the
condition
is prevalent among 7.4 per cent of seniors, doubling earlier than expected,
with
older
estimates having predicted a surge by 2030. It is higher among women, almost
double
than that
of men. If the current rate of prevalence holds, then the number of people with
dementia
is projected to reach 16.9 million in 2036 as India’s older Indian population
increases.
The study
was conducted by researchers from the University of Southern California (USC)
and
AIIMS-Delhi, in collaboration with 18 other institutes, including Mumbai’s JJ
Hospital.
The
findings were published in “Alzheimer’s & Dementia,” the journal of the
Alzheimer’s
Association.
Dr AB Dey, professor and former HOD of Geriatric Medicine, AIIMS, who was
part of
the study, says the research will now be conducted every two-and-a-half years
and
will go
on till 2040 in phases.
What was
the study all about?
It’s a
GoI project and was started in 2009 under the national programme for the
healthcare of
the
elderly. This was a part of the main study and the second phase will begin soon.
We
analysed
32,000 subjects from the 60+ population and looked at their brain ageing more
intensely
to understand the extent of dementia in India.
How did
the study diagnose dementia in the sample population?
Dementia
diagnosis is questionnaire-based and there is no gold standard like you do for
diabetes
or Covid and categorise the result as negative or positive. It’s a complex
diagnostic
process
of mapping or examining various parts of brain function, speech capability,
thinking
capability
and memory. Then the questionnaire makes a composite score and concludes that a
person
may have dementia or not.
As per
the Longitudinal Ageing Study in India (LASI), a sample of adults over and
above 60
were
recruited and were subjected to a rich battery of neuropsychological tests and
an
informant
interview between 2018 and 2020. The study was conducted state-wise, using the
2011
census listing directory of districts, sub-districts (tehsils), which were the
primary
sampling
units. Researchers conducted door-to-door household interviews. For large
states, a
larger
sample size proportionate to the population was considered. In addition, we
oversampled
individuals aged 65 and older to achieve a better representation of this group.
What were
the causes behind dementia?
The
number one cause of dementia is Alzheimer’s Disease but it was difficult to
segregate it
from
vascular dementia or frontotemporal dementia as the study was largely based on
field
work. It
doesn’t matter really because from a socio economic and care-giving point of
view,
all of
them would require a similar disease management protocol.
Different
levels of education led to differences in various dementia risk factors across
states,
such as
under-nutrition, uncontrolled cardiovascular disease and exposure to indoor air
pollution.
If prevalence stays the same, the number of people with dementia is projected
to
reach
16.9 million in 2036 due to an increase in our older population.
What were
the other important findings?
The
cross-state variation in dementia prevalence was found to be considerable, with
the
lowest
prevalence in Delhi at 4.5 per cent and the highest in Jammu and Kashmir at 11
per
cent.
According to the research, there were wide variations across gender and
geographical
locations.
What are
the differences between rural and urban areas?
The study
showed dementia is much higher in rural areas, possibly because of low levels
of
education
and awareness. And since the burden of dementia cases is unevenly distributed
across
states and sub-populations, control protocols might, therefore, require
different levels
of local
planning and support.
What was
the reason behind the higher prevalence rate in Jammu and Kashmir? Could
posttraumatic stress disorder (PTSD) be the cause?
The
Sher-e-Kashmir Institute of Medical Sciences was gathering samples but we are
yet to
find out
the reasons behind the higher prevalence rate in Jammu and Kashmir. We will
find
answers
during phase two of our study. But what I can tell you is that dementia is
correlated
with
hypertension, hearing loss, visual impairment and nutritional deficiencies.
Why Dr
Dey?
Are
high-fibre carbs key for reversing diabetes?
Dr A B
Dey is Professor and Head, Department of Geriatric Medicine, former Dean
(Research),
Nodal Officer, National Centre for Ageing, AIIMS. He has authored many
research
papers and has been instrumental in establishing Geriatric Medicine as a
subspeciality
in India.
His findings have been the basis and evidence for policy formulation and
action.
He has had a role in the development of the National Programme for Health Care
of
older
people. He has been Chairman of the committee to develop ICE material for the
National
Programme for Health Care of the Elderly, Ministry of Health and Family
Welfare,
GoI.
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