India’s Aging Population – A Changing Demographic
The latest population of India is 1.46 billion. Nearly 13.8 million are people over the age of 60 years, which is expected to increase to 180 million in 2030. this is due to increase in life span which was about 40 years in 1960s and now is nearly 70 years
June is observed as Alzheimer disease awareness month. This is to create public awareness about this disease, educate them to identify the disease in the early stage, to update the recent happenings in the diagnosis, and management of this problem.
About 55 million people suffers from memory related brain disorder called dementia in the world. There are many types of dementia, the causes are different, some can be treated successfully, but majority can progress over time. The characteristic symptoms of dementia are, difficulties with memory, language, problem-solving and other thinking skills that affect a person's ability to perform everyday activities.
In India about 8.8% of people aged over 60 years suffers from dementia.
5.5M(according to Fogarty international centre,2023, and Longitudinal aging study in India) and projected to increase to152 M in 2050
Alzheimer, s type of dementia amounts to about 70-75 % of all dementias. Alzheimer’s disease is an irreversible, progressive brain disorder that slowly destroys memory and thinking skills and, eventually, the ability to carry out the simplest tasks.
The vast majority of people who develop Alzheimer’s dementia are age 65 or older
Even though Alzheimer’s disease was described as early as 1906 by German doctor Alois Alzheimer, till date there are no definitive methods to prevent it, or permanent cure
Symptoms to Watch For
Symptoms occur because nerve cells (neurons) in parts of the brain involved in thinking, learning and memory (cognitive function) have been damaged or destroyed. Eventually, neurons in parts of the brain that enable a person to carry out basic bodily functions, such as walking and swallowing, are affected
The accumulation of the protein fragment beta-amyloid into clumps (called beta-amyloid plaques) outside neurons(nerve cells) and the accumulation of an abnormal form of the protein tau (called tau tangles) inside neurons are two of several brain changes associated with Alzheimer’s. tau tangles block the transport of nutrients and other molecules essential for normal function and neuron’s survival.
The apolipoprotein E (APOE) gene is involved in late-onset Alzheimer’s. This gene has several forms. One of them, APOE e4, which increases a person’s risk of developing the disease and is also associated with an earlier age of disease onset. However, carrying the APOE e4 form of the gene does not mean that a person will definitely develop Alzheimer’s disease.
Usually, progression of this disease is classified as early, middle and later stages
In the early stage-mild mood changes, or behavioral changes which are not normally seen in healthy individuals, along with mild memory impairment mostly for recent events(may keep forgetting the things kept in an place, things to do, difficulty remembering the events).
In the middle stage- memory symptoms worsen to the extent of difficulty to remember familiar names, sometimes not able to recognize the relatives and friends. Difficulty finding the way back when going out etc. Other symptoms like depression, anxiety, agitation, hallucination sleep disturbances are common. His daily activities are significantly affected at this stage
In the late stages, the affected person cannot even recognize his own family members, total loss of insight, loss of bowel and bladder control, Death usually occurs due to multiple systemic causes, like infection, pneumonia etc.
High blood pressure, Diabetes, obesity, chronic alcohol consumption, chronic smoking, depression, social isolation etc. are supposed to increase chances of Alzheimer’s. Managing these factors from early ages may help prevent developing dementia at the latter age
Normally doctors investigate these patients to find out if there are any treatable causes, the important investigations are a few blood tests, a brain scan (PET scan), CSF examination .
The management of Alzheimer’s disease may involve multiple specialties like Neurologists, psychiatrists, and general physicians
As of now there are no medications to cure this disease, few of medications available for many years are given to slow down the progression of memory impairment (like donepezil, memantine, rivastigmine etc.) other medications are used depending on the symptoms
Of late, two drugs have been approved by FDA-USA which has brought lots of hope for the Alzheimer disease sufferers. These are 1. Aducanumab and 2.lecanemab. Both of these are supposed to be helping if given in early stage.
An early diagnosis also helps families plan for the future. They can take care of financial and legal matters, address potential safety issues, learn about living arrangements, and develop support networks
The cost of care is not only financial. Families, friends, and caregivers struggle with great emotional and physical stress as they cope with the physical and mental changes in their loved ones
patients and their relatives should consult medical professionals at the early stages of the disorder when they notice that any person above the age of 60 years has developed progressive memory impairment and behavioural changes. This helps in getting timely guidance about how to take care of these people over time and to initiate the available medications.
There are governmental and non-governmental organisations from where guidance and help can be sought both at state level and national levels.
