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Dementia In India

How many people have dementia in India ?

India is the country with the second largest aged population in the world.
Statistics show that by 2020, 1 out of 11 persons will be aged over 60 years. 
After the age of 60, the incidence of dementia doubles with every five years of age.
There are approximately over 3.2 million people affected by Dementia in India today.

The state of West Bengal has an estimated 40 lakhs of elderly population over the age of 65 of which 80,000 suffers from Dementia. The city of Calcutta has about 2.3 lakhs of elderly over the age of 65 of which nearly 46,000 are victims of this dreaded disease.  

And 18 million people are affected all over the world. 
As far as is known the disease occurs equally across all groups in society.

What is the prevalence of dementia?

Age                Prevalence

40-65                   1 out of 1,000

65-70                   1 in 50

70-80                   1 in 20

80+                      1 in 5

The number of families affected in India increase at a faster rate. The available data shows that by 2020, India will be the most affected country in the world with a vast number of persons with dementia.

However, at present there is limited awareness of dementia , Inadequate training for formal carers and a lack of support for informal carers, Inadequate human and financial resources and limited policy on dementia care.

Although there is currently no cure, there are ways to reduce risk factors, treat and manage the behavioural and psychological signs and symptoms of dementia and improve quality of life for the individual and family carer, through:

      Promoting an understanding of what is quality dementia care is,

      Prevention and early diagnosis/intervention;

       Guidance to use of medications (pharmaceutical and natural) to treat cognitive decline and memory loss;

       Psychosocial approaches including support, counselling, education and memory loss programs for people with dementia and informal families/carers;

The practical implications of the Dementia population for India are far-reaching. The numbers are increasing, the resources are limited and perceived social priorities lie elsewhere. Hence, the response to such demands has to be well orchestrated and based on systematic planning. ARDSI Calcutta has taken the first step in this regard in the Eastern region of India and expect your help as they move ahead to continue providing quality care to Dementia population.

10 Warning Signs of Alzheimer’s

To help you know what warning signs to look for here is a checklist to review. See a physician for complete examination if you make several checkmarks.

•Recent memory loss: It is normal to occasionally forget assignments, colleague’s names, telephone no. and then remember them later. Those with the disease will forget these things more often and will not remember them later.

•Difficulty performing familiar task: Busy people can be distracted time to time that they may leave the soup on the stove and forget to serve only to remember it at the end of the meal. People with Alzheimer’s could prepare a meal and not only forget to serve it, but also forget they made it.

•Problems with language: Everyone has trouble finding the right word sometimes, but this victim may for get simple words or substitute inappropriate words making his/her sentences incomprehensible.

•Disorientation of time/place: It is normal to forget the day of the week or your destination for a moment. But people with Alzheimer’s can become lost on their own street not knowing where they are, how they got there or how to get back home.

•Poor or Decreased judgment: People can become so immersed in an activity that they temporarily forget the child they are watching. People with Alzheimer’s could forget entirely the child under their care. They may also dress inappropriately wearing several shirts or blouses.

•Problems with abstract thinking: Balancing a checkbook may be disconcerting when the task is more complicated than usual. Someone with Alzheimer’s disease could forget completely what the numbers are and what needs to be done with them.

•Misplacing things: Anyone can temporarily misplace a wallet or keys. A person with Alzheimer’s may put things in inappropriate places: an iron in a freezer or a wristwatch in a sugar bowl.

•Changes in mood or behavior: Everyone becomes sad or moody from time to time. Someone with Alzheimer’s can exhibit rapid mood swings from calm to tears to anger for no apparent reason.

•Changes in personality: People’s personalities change somewhat with age. But a person with Alzheimer’s can change drastically becoming extremely confused, suspicious or fearful.

•Loss of initiative: It is normal to be tired of housework, buisness activities or social obligations but most people will regain their initiative later. The person with Alzheimer’s may become very passive and require cues and prompting to become involved.

THE CHALLENGE OF DEMENTIA & ARDSI CALCUTTA TOGETHER CAN MAKE A DIFFERENCE

Dementia epidemic: Dementia, a predominantly old-age debilitating neuro-psychiatric disease, is the biggest irony of living long and constitutes the flip side of the tremendous advancement in the medical sciences and health care which has pushed up life expectancy. As the world demography undergoes a definite change in the age profile, with the number and the ratio of old people (60+) in the total population constantly rising, dementia is fast approaching to hit the world in a proportion of epidemic. Every seven seconds one new incidence of dementia is taking place in some part of the globe. It has been projected that the Asia Pacific region will be the hardest hit region in this imminent epidemic. China will be the worst hit country. India will earn the dubious distinction of emerging second, next only to China, in the dementia map.

Year 2050

Region/ Prevalence Incidence Projection  

World        30              4.6           100

AsiaPacific 14              4.3            65 

China         5.5            1.7            27 

India         3.5             1.0            16.5 

Notes: All figures are in million. Prevalence is the estimated current total number of people inflicted by dementia and Incidence is the current rate of rise of dementia population per year. Ref: ADI, Access Economics study (2006)

According to a study by the Indian Council for Medical Research, there is an estimated 40 lakh elderly population in West Bengal, out of which 80,000 are having dementia. The figures for the city Kolkata are 2.3 lakh and 46,000, respectively. Age is the single most important risk factor for dementia. The probability of having dementia increases steeply with the increase in age. Those aged over 60 in the Asia Pacific will increase from under 10 per cent now to 25 per cent of the total population by 2050, and those over 80 years will increase five times - from 1 per cent to 5 per cent. So dementia epidemic is a certainty.

Disease burden: A comparison with the leading diseases in the Asia Pacific region reveals that dementia scores quite high in terms of 'burden of disease', a concept developed by Harvard School of Public Health in association with the World Bank and the World Health Organisation to assess the extent of loss of health, life and wellbeing due to mortality, morbidity and disability. Burden of Disease = Mortality Burden + Morbidity and Disability Burden. Nearly 100 million Daly's (One DALY - Disability -Adjusted Life Year - represents loss of one year of equivalent full health; Daly's for a disease are the sum of the years of life lost due to premature mortality in the population and the years of healthy life lost due to disability) are lost each year due to neuro-psychiatric conditions, which is the second highest source of disease burden after infectious and parasitic diseases, and higher than cardiovascular disease, injuries, prenatal disorders or cancer (neoplasm's). Within neuro-psychiatric conditions, at present depression ranks 1st (with 38.5% of disease burden, i.e., 38.5% of 100 million Daly's) and dementia comes 6th (with 5% disease burden). But dementia is fast racing to overtake depression as the leading source of disability by 2016. In the Asia Pacific, dementia accounts for a disease burden almost similar as that from all tropical diseases taken together, and higher than malaria, tetanus, breast cancer, drug abuse or war. The disease burden from dementia is projected to increase by over 76 per cent over the next quarter century. To get a complete assessment of loss of life, health and wellbeing due to dementia, we need to factor in the indirect disease burden generated by dementia in the form of acute stress, strain, trauma, depression and other diseases and disorders the family carers are so prone to develop. As dementia warrants 24x7 intensive care and negotiating various psychological and behavioural abnormalities, the individual, social, professional and economic life of the family care givers are shattered and they themselves tend to develop various psychological disorders and stress-related diseases.

Economic impact: The deflating impact of the high disease burden of dementia on the national production is easily comprehensible. However, we do not yet have any ready statistics about this and a comprehensive study in this regard should be commissioned. Dementia has the potential to have a devastating impact on the public health systems. This is not only because of the graying of the population but because dementia is among the most disabling chronic diseases. Quantification of costs in the public health care sector to be thrust upon by dementia epidemic varies widely with the country and various other factors like the level of health care a country enjoys at present, the mix of care, etc. However, costs will definitely rise relative to gross domestic product as prevalence increases. A study on the Asia Pacific has estimated the cost of dementia at $60.4 billion (in 2003 US dollar). More cost studies are required, specially for our country. As sensitivity to the impending dementia epidemic is at a pathetically low level in India, we cannot escape a high cost in tackling the menace. It is urgently needed that our nation becomes aware of the problem, specify the challenges, draw up a cost-effective prioritized action plan and start implementation without making any further delay. Since age is the single most important risk factor for dementia, and old people unfortunately constitute one of the weaker sections of the society, the problem gets obviously compounded. The present socio-economic and lifestyle realities and value systems like urbanisation, trends away from extended families and towards nuclear families and the increasing number of older people who thus live alone, labour and job mobility with increasing number of children staying away and abroad, a somewhat negative perception about spending in geriatric care that is prevalent at both individual and social levels, etc. create serious hurdles to tackling dementia and exacerbate the social and economic impact of dementia.

Challenges and roadmap for tackling dementia 

Leaving aside the most fundamental challenge of finding a cure therapy for dementia, the roadmap for tackling dementia and its progression towards an epidemic-like situation can be laid out as follows.

 Prevention: It has been seen that the most effective way to make savings on dementia costs would be if the onset of dementia could be delayed or incidence reduced through prevention approaches arising from new research. So people have to be made aware of the preventive measures. 

Early diagnosis: Early diagnosis and early intervention go a long way to slow down the process of degeneration and improve quality of life. Early diagnosis is thus a pre-requisite for better care and treatment. 

Appropriate care: Till date we do not have any cure drug for dementia. Treatment of the irreversible progressive degenerative diseases causing dementia essentially means trying to (i) slow down the pace of progression of the disease, (ii) give symptomatic relief and (iii) ensure wellness or quality of life as much and as long as possible. This is done through administration of medicine and provision of proper care. In the present state of affairs, where we do not yet have a cure drug for dementia, care assumes the most significant aspect of its treatment. For no other disease perhaps, care is as important as it is for dementia. Care here is not only a supportive aspect of the course of treatment, it constitutes the core. If dementia can be diagnosed early and in the early and middle stages of the disease, appropriate care contributes positively and in good amount towards retarding the deterioration and ensuring a better quality of life. So provision of quality specialised dementia care at affordable prices assumes a very special significance.

 Support for family care givers: Dementia care giving is a hard specialised 24x7 task. Family care givers are the main characters in the care chain. They need to be supported emotionally and technically. They need regular respite to rejuvenate their health and energy so as to enable them to give quality care over a long period and maintain their own physical health and mental fortitude. They also need time off caring task to meet their individual, social and professional obligations.

 

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