LASI Data Put Dementia at 8.8 Million Older Indians as Geriatricians Push Early, Home-Based Care

The news

NEW DELHI. India is looking at an “old age pandemic” of cognitive decline, geriatrician Dr Prasun Chatterjee told The Indian Express in a health feature by Rinku Ghosh on 21 September, which argued that dementia care must begin with early detection and continue at home. Dr Chatterjee is a WHO Technical Advisory Group member for Healthy Ageing, president of the Indian Academy of Geriatrics and group clinical lead for geriatric medicine and longevity science at Apollo Hospital, Delhi. He explained that Alzheimer's disease is a neurodegenerative disorder in which abnormal protein clumps called amyloid plaques and tau tangles build up in the brain and destroy memory, thinking and the ability to carry out daily tasks. It is the most common cause of dementia, but the two terms are not interchangeable: dementia is a decline in memory, thinking, behaviour or other cognitive abilities severe enough to interfere with everyday life, while Alzheimer's is one specific disease that causes it. The Longitudinal Ageing Study in India, a nationally representative survey, estimated that about 7.4% of Indians aged 60 and above — roughly 8.8 million people — were living with dementia, based on data collected in 2017-2020. The more detailed LASI-DAD research estimated the prevalence of major neurocognitive disorder at 7.2% and mild neurocognitive disorder at 17.6%; among those aged 80 and above, major neurocognitive disorder was 15.2%. Mild cognitive impairment is a stage in which cognitive abilities have begun to decline but substantial independence is still preserved, and Dr Chatterjee said diagnosing it opens a window for intervention. One 78-year-old patient's cognitive test score rose from 67/100 to 87/100 after three months of cognitive training and family-led activities at home. His MISCI pilot trial at AIIMS, New Delhi, with 60 older adults with subjective cognitive impairment, found improvements in attention, concentration, recall and retention after six months, greatest in the group combining cognitive training with a Mediterranean-equivalent diet and exercise. Modifiable risk factors he listed include hypertension, diabetes, obesity, physical inactivity, lack of sleep, smoking, harmful alcohol use, hearing loss, depression and social isolation; he advised a cognitive assessment at 65 instead of 75. On new drugs, the feature noted that anti-amyloid therapies raise questions of equitable access: donanemab, introduced by Eli Lilly as Lormaizi, costs ₹91,688 per 350 mg vial in India. “India needs a system that begins before the patient reaches the neurologist,” Dr Chatterjee said. Syllabus link: health of the elderly, vulnerable sections and social sector services, GS1 and GS2.

Static syllabus linkage

1. LASI is India's official ageing survey. The Longitudinal Ageing Study in India is conducted by the Union Ministry of Health and Family Welfare through the International Institute for Population Sciences, Mumbai, with Harvard T.H. Chan School of Public Health and the University of Southern California. Wave 1 covered over 72,000 adults aged 45 and above and their spouses across all States and Union Territories, and was released in 2021. LASI-DAD, the Harmonized Diagnostic Assessment of Dementia, is a sub-study that gives clinically detailed dementia estimates.
2. The legal framework for older persons is split across laws. The Maintenance and Welfare of Parents and Senior Citizens Act, 2007 obliges children and relatives to maintain senior citizens and provides for tribunals and old-age homes. Article 41 directs the State to make effective provision for public assistance in old age, within its economic capacity. The Mental Healthcare Act, 2017 allows a person to make an advance directive and appoint a nominated representative, which is directly relevant to people who may later lose decision-making capacity.
3. National programmes exist but dementia is a small part. The National Programme for Health Care of the Elderly, launched in 2010, provides geriatric services at district hospitals and above, and regional geriatric centres in medical colleges. The WHO's Global Action Plan on the Public Health Response to Dementia 2017-2025 urged countries to adopt national dementia plans; India does not yet have a standalone national dementia policy. World Alzheimer's Day is observed on 21 September each year.
4. The new drugs target amyloid, with limits. Anti-amyloid monoclonal antibodies such as lecanemab and donanemab clear amyloid plaques and have been shown in trials to modestly slow decline in early Alzheimer's disease. They require confirmation of amyloid through scans or tests, regular infusions and MRI monitoring for brain swelling or bleeding. Their cost and infrastructure needs make them inaccessible to most patients in low- and middle-income countries.

Why UPSC loves this

1. Population ageing is a GS1 and GS2 theme. The syllabus includes population and associated issues and welfare schemes for vulnerable sections. UPSC has asked about India's demographic transition, the challenges of an ageing population and the adequacy of social security for the elderly. Dementia adds the dimension of long-term care, which is usually missing from answers.
2. The care economy is rising in importance. Questions on unpaid care work, mostly by women, and on the need for a care economy have appeared in GS1 and essays. Dementia care falling on families, as the feature notes, links health to gender and labour.

Analysis

1. The numbers point to a care problem, not only a medical one. 8.8 million people with dementia, and a much larger group with mild impairment, cannot be managed by specialists; India has few geriatricians and neurologists relative to that scale. The feature's emphasis on family-led cognitive activity is therefore not a soft alternative to medicine but the only model that can reach most patients. Policy should treat caregivers as part of the health system, with training, respite and support, rather than as a private matter.
2. Families carry the burden, and that burden is gendered. Dr Chatterjee notes that families provide most dementia care in India. In practice this falls largely on women — daughters, daughters-in-law and wives — often at the cost of paid work. The counter-view is that family care preserves dignity and familiarity, which the feature shows can help the patient. Both are true; the policy task is to support family care without assuming it is free.
3. Expensive new drugs will widen inequality unless policy is careful. At ₹91,688 per vial, anti-amyloid therapy is out of reach for almost everyone, and it also needs scans and monitoring available only in large cities. If it becomes the public image of dementia treatment, it could crowd out attention to cheap measures with broader benefit — controlling blood pressure, treating hearing loss, early screening. Public spending should favour the latter, while insurance and price negotiation address access to the former over time.
4. Prevention runs through the NCD programme India already has. Many risk factors listed — hypertension, diabetes, inactivity, smoking, alcohol — are exactly those targeted by the NCD programme. Adding a brief cognitive screen at 65 to the existing NCD screening at Ayushman Arogya Mandirs would be a low-cost way to catch mild impairment. The evidence from the MISCI pilot is small, 60 people, so claims should be modest, but early detection costs little and helps families plan.

Administrator's brainstorm