Dementia & Alzheimer's

Normal ageing causes slower recall — you might take longer to remember a name but it comes back. Dementia is different in kind, not degree: forgetting recently learned information and not recovering it later, asking the same question repeatedly within minutes, getting lost on familiar routes, difficulty completing familiar tasks (cooking a known recipe, managing finances), confusion about dates and time, poor judgement (being deceived by scammers, making unsafe decisions), withdrawal from social activities, and significant personality or mood changes. The key distinction: normal ageing causes occasional lapses that don't disrupt daily life. Dementia causes progressive, cumulative decline that increasingly interferes with independence. If you are noticing these changes in a family member, a memory assessment is warranted.

Alzheimer's disease is a specific cause of dementia — the most common one, accounting for 60-70% of cases. Dementia is the broader syndrome (symptoms of cognitive decline). Other causes include vascular dementia (from strokes or blood vessel disease), Lewy body dementia (with hallucinations and Parkinson-like movement symptoms), frontotemporal dementia (prominent personality and language changes, often younger onset), and mixed dementia (Alzheimer's plus vascular). The distinction matters because the progression pattern, associated symptoms, and some treatment considerations differ. In practice, many older adults have mixed pathology. A geriatrician or neurologist uses clinical examination, neuropsychological testing, brain imaging, and blood tests to determine the most likely cause.

Until recently, available medications only managed symptoms without slowing the disease. Two new anti-amyloid antibodies — lecanemab and donanemab — have shown modest but statistically significant slowing of decline in early-stage Alzheimer's in clinical trials. They are approved in the US (2023-24) and under regulatory review elsewhere. They carry risks (brain swelling and microbleeds requiring MRI monitoring) and are suitable only for early-stage disease. Older symptomatic medications (donepezil, rivastigmine, memantine) improve day-to-day memory and behaviour for some patients without altering the underlying disease. Non-pharmacological measures — cognitive stimulation, physical activity, social engagement, good sleep, cardiovascular risk control — have the strongest evidence for both prevention and slowing progression.

Most dementia care in India happens at home, provided by family — usually daughters or daughters-in-law — without formal training or respite. Key practical steps: establish daily routines (dementia patients function better with predictability), simplify the home environment (remove trip hazards, label rooms and drawers), ensure identification on the person at all times (ID bracelet or card — wandering is a significant risk), manage medications with a pill organiser and supervision, address sleep disturbance early (sleep disruption is a major caregiver stress point), and plan for financial and legal matters (power of attorney) while the person can still participate. The Alzheimer's and Related Disorders Society of India (ARDSI) provides caregiver training, support groups, and a helpline — a valuable resource for Indian families.

There is no guaranteed prevention but strong evidence supports reducing modifiable risk factors. The Lancet Commission identifies 12 risk factors responsible for up to 40% of dementia cases: low education (early life), hearing loss, hypertension, obesity, smoking, depression, physical inactivity, diabetes, excessive alcohol, traumatic brain injury, air pollution, and social isolation. Controlling blood pressure from midlife is the single most impactful modifiable factor. Regular physical exercise (150 minutes per week) has the strongest evidence across all risk factors. Good quality sleep, a Mediterranean-style diet, staying socially and cognitively active, and treating depression all contribute. Controlling cardiovascular risk factors doesn't just prevent heart disease — it is one of the most evidence-backed dementia prevention strategies available.