Dementia in middle- and low-income nations: A public health priority

Sir,

Dementia refers to a syndrome, which is progressive in nature and leads to deterioration in cognitive function which eventually affects the memory, thinking, orientation, comprehension, learning capacity, judgment, behavior, ability to perform routine work, etc.[1] The global estimates suggest that in excess of 47 million people suffer from dementia, with close to 60% of them being from low- and middle-income nations.[2] In fact, around 7.7 million new individuals are diagnosed with dementia every year, and going by the current trend, it is anticipated that by the year 2050, if no effective actions are taken, the dementia cases can increase to almost 135 million (3 times of the current estimate).[2]

Even though dementia is commonly diagnosed among the elderly (viz out of every 100 people aged 60 and above, almost 5-8 people suffer from dementia), it is not a normal part of the ageing process.[2] Findings of studies have suggested a positive association between adoption of harmful lifestyles (viz smoking, physical inactivity, obesity, etc.) and early onset of dementia among the study participants.[3] In fact, Alzheimer's disease is one of the most common causes of dementia, accounting for almost 60-70% of dementia cases.[2]

Owing to the impact of dementia of different aspects of an individual's life, it has been acknowledged as one of the major causes of disability and dependency among the elderly.[4] In addition, people with dementia are often denied their basic rights which others can avail.[1] To further worsen the scenario, dementia not only compromises the life standards of the people who have it, but also even cast a significant impact on the physical, psychological, social and economical impact (in the form of direct medical or social costs, and the costs of informal care) on the caregivers, families and society as a whole.[2] However, most of these challenges to the family members result because of the minimal awareness among the general population about the disease, often resulting in stigmatization, barriers to diagnosis and care, and negative impact or stress on the caregivers/family members, especially in developing nations.[1,2,5]

In the absence of availability of an effective treatment to either cure or alter its course, the primary goal in dementia care is to enable early diagnosis, ensure optimization of physical health and well-being, identify and manage accompanying physical illness, facilitate effective treatment of behavioral and psychological symptoms and provide guidance to the caregivers.[1,4] As recommended by the World Health Organization, the need of the hour is that program managers from different nations should acknowledge dementia as a public health priority and thus involve all stakeholders (viz health, social, financial and legal sectors).[1,5]

In addition, efforts should be taken to raise awareness about dementia, both among the general population and the policy makers (so that they can understand their role and responsibility in responding to the challenge of dementia).[2,6] This will indirectly strengthen the public and private efforts to improve care and support for people with dementia and for their caregivers.[2,6] Further, adequate thrust should also be given to motivate people for lifestyle modifications (especially with regard to diet, exercise, smoking addiction, etc.).[3]

To conclude, dementia is a significant public health concern, especially in low- and middle-income nations, and hence it is high time that concerted efforts should be planned and implemented to effectively tackle the rising trend of the disease worldwide.

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Conflicts of interest

There are no conflicts of interest.