World Alzheimer's Day 2024: Can we delay or prevent dementia in our society?
Under the aegis of Alzheimer’s Disease International (ADI), people coming together from all around the world celebrate the month of September as World Alzheimer’s Month and commemorates World Alzheimer's Day every year on September 21st. This campaign advocates for an International awareness-raising effort for Alzheimer’s disease (AD) and other dementias.
The theme for World Alzheimer’s Day 2024 is “Know Dementia, Know Alzheimer’s.” Considering the ‘human longevity revolution’ and the ‘human ageing time bomb’; the dementia crisis has been designated as the “the epidemic of our century”. It is estimated that more than 57 million people have dementia worldwide. More than two-thirds of them were in low-and middle income countries (LMICs). In India, data From the Longitudinal Aging Study in India (LASI) estimated that 8.8 million Indians older than 60 years live with dementia. The two most common causes of dementia are Alzheimer´s disease (AD) and vascular dementia. AD accounts for 50-70% of all cases of dementia, about 20-30% have either vascular dementia (VaD) or a combination of VaD and AD, the other dementia syndromes being Frontotemporal dementia (FTD and Dementia with Lewy Body (DLB).
Although ageing is one of the main risk factor for dementia, Dementia is not inevitable with ageing and is best depicted as a disorder on the “continuum of aging casualty”. We need to re- think dementia to be a "lifestyle disorder." Research has shown that AD develops in the life-course of 20-30 years on the background of ageing intricately and inexorably interacting with lifestyle risk factors (LSRFs), behavioural risk factors (BRFs), and Vascular Risk Factors (VRFs) along with other metabolic risk factors resulting in dementia.
The dementia process and brain pathology associated with dementia inexorably creeps in from early-life (20-40 years age group) to mid-life (40-59 years age group). AD is therefore a slow neurodegenerative neuropathological process resulting from cumulative brain pathology over a decades-long process, and is not an event that occurred de novo as a in late-life disorder. By the time AD manifest as symptomatic dementia, the brain neurodegeneration can no longer be prevented. Current treatment into AD is ‘too late’ and offers symptomatic treatment only.
Being a neurologist trained in Memory/Cognitive Disorders and Dementia, I am not being a therapeutic nihilist when much research is underway for novel anti-dementia, anti-amyloid and other drug targets are in the pipeline. However, I wish to reiterate that until such effective, curative or disease modifying drugs are available, both in the developed and developing countries easily/cheaply, preventive neurology strategies will remain the Holy Grail in addressing the dementia epidemic. I fervently believe that Epidemics can only be eradicated by prevention, not by therapy!
Optimism for a life-course perspective to dementia prevention stems from evidence in a recent study published in 2020 as the Lancet Commission Report on dementia prevention. Similar to the much practiced Preventive cardiology and the evidence from the Framingham Risk Score (FRS) that estimates a patient's 10-year risk of cardiovascular disease (CVD); there is now research evidence to similar riskometer tools in dementia. This includes Mid-Life Dementia Risk Score and Late-Life Dementia Risk Index, which can accurately predict the likelihood of older adults developing dementia in the future life-course. This novel approach for the prediction of dementia risk could help to identify individuals who might benefit from intensive brain healthy lifestyle interventions that could stave off dementia in the future.
The evidence from the 2020 Lancet Commission report lends credence that about 40% of dementia cases worldwide could theoretically be prevented or delayed by eliminating 14 modifiable risk factors during an individual's life course. Hence, it’s never too early or too late to act, to make such risk factor strategies at any stage during early or mid-life course. The 14 risk factors cited in the 2020 Lancet Commission report are low education, hearing loss, hypertension, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol consumption, traumatic brain injury (TBI), air pollution, social isolation, vision impairment, and high LDL cholesterol.
A life-span approach with a life-course approach focussing on Brain healthy Lifestyles, the promotion of Brain health and well-being, and healthy brain ageing (HBA) strategies would exert brain protection by preserving the brain’s cognitive reserve, brain neuroplasticity, brain resilience, and pave the route to a Dementia free life expectancy (DemFLE) operant on ‘The Scaffolding Theory of Aging and Cognition’ (STAC) conceptual model. The brain healthy lifestyles would mandate staying physically fit, adopting an active socially integrated lifestyle, (leisure activities, walking, bicycling, gardening ,playing musical instruments, social networking, visiting friends and relatives, going to movies, Hobbies) staying mentally and cognitively active( brain gym activities such as learning, reading, playing games, sudokos, puzzle games, meditation, yoga), being spiritually active, finding a ‘purpose in life’ (PIL or ‘Ikigai’) ensuring eudaimonic well-being (EWB), eating smart adhering to brain healthy diet (the Asian-Mediterranean diet, diets high in fish, fruit, and vegetables fruits), sleeping well, quitting tobacco and alcohol, and coping stress, depression and anxiety, and by promoting mental resilience for subjective psychological well-being.
In fact, the World Brain Day on July 22nd this year the German Society of Neurology and the German Brain Foundation lend some evidence that too much sugar can harm the brain and impact AD. We should also be ‘Heart Smart’ to be ‘Brain Smart’ by controlling high blood pressure, treating diabetes mellitus, and preventing obesity to maintain a healthy BMI. My advocacy underscores that by improving lifestyle choices apart from controlling the modifiable risk factors would indeed be a public health roadmap for preventing and staving off the risk for future dementia in the next generation, a promise for tomorrow’s generation for DemFLE
This article would not have a 360° perspective by not addressing a sustainable dementia education for our children, grandchildren and for the next generation. Dementia education in children, school professionals, teenagers, adults, and the elderly in our society is quintessential to ‘know dementia, know Alzheimer’s’ as a lifestyle disorder. Our communities and society should be made aware of the “cradle-to- grave’ life-course perspective in preserving brain health, and adopting proactive brain healthy lifestyles as a public health initiative to dementia prevention in India.
“When meditating over a disease, I never think of finding a remedy for it, but instead a means of preventing it”- Louis Pasteur; 1884
Prof Dr.B.P.Shelley, MBBS, MD, DM, FRCP
Fellowship in Behavioural Neurology, Institute of Neurology, London, UK
Fellowship in Cognitive Neurology, Addenbrooke’s Cambridge University Hospitals, UK
Professor and Head - Department of Neurology
Yenepoya Medical College
Yenepoya (Deemed to be University), Mangaluru, Karnataka
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AAP's Sanjay Singh alleges Centre 'relaxed' border security norms to help Adani set up energy park
New Delhi (PTI): Aam Aadmi Party leader Sanjay Singh on Wednesday alleged that the Centre "relaxed" border security norms to help Adani set up an energy park at the Pakistan border in Gujarat.
During discussion on the Immigration and Foreigners Bill, 2025 in the Rajya Sabha, Singh said that the Centre controls 50 kilometres of international border across states and still blames state governments for illegal immigrant entry from those borders.
He alleged that the government has "played" with the security of the country by "relaxing" security norms for setting up an energy park in Gujarat at the Pakistan border to benefit a "friend".
"To benefit Adani you have relaxed border security rules. How shameful it is! You compromise on the nation's security for a friend," Singh said.
He questioned the Border Security Force's (BSF) failure to check entry of illegal immigrants from Bangladesh border.
"50 km security is with the BSF in Bengal… You are unable to stop for 50 km. You are not able to speak about your failure. The responsibility of the border in Assam, Tripura, Bengal is with you and you have messed up with its security. You are blaming the state government for your fault," Singh said.
Singh also raised the issue of fugitives Mehul Choksi, Nirav Modi, Lalit Modi, Nitin Sandesara and Vijay Mallya.
"Dacoits of India, Mehul Choksi and Nirav Modi after looting Rs 20,000 crore are sitting outside the country. They are teasing this nation. Why have you not been able to catch those dacoits? Why didn't you freeze their passport?" Singh said.
He alleged that the ruling party members helped Lalit Modi escape from the country.
He said Vijay Mallya is "teasing" the government from overseas after looting Rs 9000 crore of Indian banks and the common man.
Minister of State Nityanand Rai wanted to intervene in the speech but Singh refused to yield. Singh said that TV channels ran news that Mallya would come to India, stay in Tihar barrack and he would be punished.
"They were also talking about bringing Vijay Mallya back. After Rs 9,000 crore loot, Vijay Mallya is teasing from overseas. Nitin Sandesara looted Rs 6,000 crore of India and is teasing you from overseas. I am a respected member of this House. I am a member of the country's highest House but with great pain and agony, I am sharing with you that these cheaters who have looted thousands of crores of India are being treated with luxury in foreign countries and my passport is seized," Singh said.
He said that if the government has a clear intent then it should seize passports of everyone who owes more than Rs 50 crore, so that no one is able to escape from India.
He asked the government to share the number of Bangladeshi illegal immigrants that have been deported from the country.
"You have had a government in the state for the last 11 years, a government in the Centre for the last 11 years and you are unable to tell the number of Bangladeshi intruders that you have chased them out of India...You do only politics. The Bengal election is coming up, politics have started. The Bihar election is coming up, politics have started. Move beyond this," Singh said.
CPI(M)'s V Sivadasan said that giving immigration officers to make final decisions on entry of foreigners means there will be no appeal and therefore it needs to be changed.
“People should have the right to be heard..This government had an infamous history of sending back academics and activists from foreign countries. They were given all permissions yet they were sent back from the airport in an extremely humiliating manner. They were speaking against the politics of hatred which the ruling classes are using to divide the people,” Sivadasan said.
He said that the Bill states any foreigner causing threat to India’s integrity will be denied entry into the country, however, there is a lack of clarity on the threat which the Bill refers to.
BJP member Ajeet Madhavrao Gopchade alleged that illegal Bangladeshi and Rohingya immigrants are in thousands. He alleged that illegal immigrants do "bogus voting" and are enjoying the benefits of India’s hospitals, schools, ration shops and government schemes for free.
YSR Congress Party's S Niranjan Reddy said that the Bill has stringent provision to curb mischief-mongers which are about 1-2 per cent and those provisions should not create inconvenience for the rest of 98 per cent.
He said that certain countries with whom India shares good relations can be exempted from some of the provisions in the Bill.
BJP members Shmabhu Sharan and Mahendra Bhatt, TDP member Masthan Rao Yadav Beedha and UPP (L) member Rwngwra Narzary also participated in the discussion.
