Dementia as big a risk in rural India

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Rural Indians have less cardiovascular risk factors like diabetes, hypertension and obesity as compared to their urban counterparts but are similar to urban Indians when it comes to dementia, according to preliminary findings of the country’s largest dementia study conducted by the Centre for Brain Research, Indian Institute of Science, Bengaluru. This is the first of its kind study on ageing in rural India that aims to understand risk factors for dementia and develop preventive strategies.

According to Dr Jonas S Sundarakumar, Assistant Professor at Centre for Brain Research, Indian Institute of Science, Bengaluru and Co-principal investigator, “Our preliminary findings based on baseline assessment data show that rural Indians have less cardiovascular risk factors like diabetes, hypertension and obesity than urban Indians. But they have the same risk of dementia. We are now exploring the possible reasons for these interesting findings. We need to keep in mind that these are preliminary results based on baseline assessment data. The real strength of this study will emerge when we follow up these participants periodically to observe how different persons age differently and what the potential reasons for this are. We are now exploring to see if household air pollution in rural homes (due to use of solid fuels) may be causing reduced lung function (which can affect oxygen supply to the brain). Also, could the recent dietary changes in rural Indians (whole grains and millets to white rice and refined carbohydrates) play a role? These are some of the factors that we are currently investigating.”

Dr Sundarakumar argues for the need for increasing awareness in India on the magnitude of what is becoming a public health problem. “Our efforts need to address preventing dementia rather than trying to find a cure for dementia. The good news is that we are now getting to know several of its risk factors that can be addressed or ‘modified.’ In our recent paper, published in Nature Reviews Neurology, we have highlighted the important role of cardiovascular risk factors for dementia – which is diabetes, hypertension, obesity, high cholesterol, physical inactivity, smoking, In India, we are seeing an alarming rise in these conditions, potentially due to the recent lifestyle changes. Hence, lifestyle-based interventions, such as healthy diet and lifestyle, good physical and mental activity, would be cost-effective, community-level strategies. However, all these interventions must be tailored to the Indian culture to be acceptable and implementable. Additionally, control of diabetes, hypertension, through appropriate medication and monitoring are extremely important. These strategies will not only help in reducing the burden of dementia but also promote healthy ageing and improved quality of life of our senior citizens.”

Dementia is a general term for a group of progressive, neuro-degenerative brain disorders that occur in older age. Alzheimer’s disease is one specific cause of dementia. The symptoms of dementia include impairment of mental processes, such as memory, thinking, reasoning and judgement, and thus seriously impairs a person’s ability to perform functions of daily living. According to estimates in 2020, 5.3 million Indians aged above 60 years had dementia; but this is likely to be a conservative estimate. However, what is alarming is that this number is expected to triple in the next 30 years. Moreover, India’s older population is growing rapidly, and nearly one-fifth of its total population would be over 60 years old by 2050. So, this gives an idea of the health and socio-economic burden that our nation is anticipated to face.

The Centre for Brain Research (CBR) ,an autonomous centre of Indian Institute of Science, Bengaluru, is conducting the Srinivaspura Ageing, Neuro Senescence and COGnition (SANSCOG) study – a first-of-its-kind, large-scale, community-based, cohort study on ageing in rural India. The founding-director of CBR and Emeritus principal investigator of the dementia study is Prof Vijayalakshmi Ravindranath and its main aim is to carry out research on “how we can preserve cognitive functions during ageing and reduce the burden of dementia through diagnosis and innovative interventions.” The study will be spread across a projected sample size of 10,000 – predominantly marginalised older adults in rural areas for a minimum period of 10 years.

With this knowledge, dementia prevention and postponement strategies can then be developed for community-level implementation. This approach is the most effective way forward since decades of searching for a cure for dementia have failed. “The study started recruitment in 2018 and has made substantial progress till now. As we continue ramping up our baseline assessments, we are also getting a good response for our follow-up assessments,” adds Dr Sundarakumar.





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