For many Indians, dementia remains a condition associated almost exclusively with old age. Memory problems are often dismissed as a normal part of getting older, while the years spent managing blood pressure, diabetes, cholesterol, inactivity or hearing problems are rarely viewed through the lens of future brain health.
That approach may need to change.
An estimated 8.8 million Indians aged 60 and above are living with dementia – around 7.4% of the country’s older population, according to estimates from the Longitudinal Ageing Study in India-Diagnostic Assessment of Dementia (LASI-DAD). At the same time, global evidence is increasingly pointing towards an important opportunity: the 2024 Lancet Commission estimated that up to 45% of dementia cases could potentially be prevented or delayed by addressing modifiable risk factors over the course of life.
With World Alzheimer’s Day observed on September 21, Dr Kunal Bahrani, chairman and group director – Neurology, Yatharth Hospitals, says the conversation needs to move beyond recognising memory loss to understanding what people can do much earlier.
“By the time a family notices significant memory problems, some of the factors influencing brain health may have been present for decades. We cannot change our age or genetics, but we can influence several of the conditions and habits that shape our long-term neurological health,” says Dr Kunal Bahrani.
India’s brain-health challenge starts well before old age
The concern becomes more relevant in a country where chronic conditions such as diabetes and hypertension are widespread. Research examining dementia risk in India has also highlighted factors including diabetes, physical inactivity, hearing loss and undernutrition as important areas for prevention.
The connection is easy to overlook. A person may think of uncontrolled blood sugar as a diabetes complication or high blood pressure as a heart problem. But the brain is affected by the same long-term vascular and metabolic stress.
“Brain health does not exist in isolation. The blood vessels, heart, metabolism and brain are closely connected. Years of poorly controlled diabetes or hypertension can have consequences for the brain even when a person feels completely well,” explains Dr Bahrani.
Why your 40s may matter more than you think
Dementia prevention is often framed as something to consider after retirement. Dr Bahrani believes this is one of the misconceptions that needs to change.
The habits and health conditions that accumulate through midlife can influence cognitive health much later. This makes the 40s and 50s an important period to take blood pressure, blood sugar, cholesterol, body weight, physical activity and smoking habits seriously.
“Someone in their 40s is unlikely to worry about Alzheimer’s disease. That is understandable. But prevention is precisely about acting before there is a problem. You do not wait for memory loss to begin exercising, controlling your blood pressure or stopping smoking,” he says.
It isn’t about finding a ‘brain food’
Dr Bahrani also cautions against the growing tendency to reduce brain health to a particular food, supplement or memory exercise.
There is no single food that can cancel out years of inactivity or uncontrolled metabolic disease. Instead, brain health is influenced by a collection of everyday behaviours—regular physical activity, a balanced diet, adequate sleep, social interaction, cognitive engagement and appropriate management of chronic health conditions.
Hearing and vision also deserve attention. Untreated sensory problems can make communication, social participation and everyday cognitive engagement more difficult, while potentially adding to long-term cognitive vulnerability.
“People sometimes spend a lot of time looking for a supplement for memory but ignore a hearing problem, remain sedentary all day or leave their diabetes poorly controlled. We need to look at the whole picture rather than searching for one solution,” says Dr Bahrani.
When should families pay attention?
Prevention does not mean that dementia is always avoidable. Ageing, genetics and several other factors continue to influence an individual’s risk. But dismissing persistent changes as “normal ageing” can delay evaluation.
Repeatedly struggling with familiar tasks, difficulty managing finances or medications, getting lost in familiar surroundings, noticeable changes in judgement or personality, or increasing difficulty finding words may warrant medical attention—particularly when these changes begin to interfere with everyday life.
“Forgetfulness from time to time is not automatically dementia. What matters is the pattern, progression and impact on daily functioning. If a change is persistent or noticeably different from a person’s usual behaviour, it deserves attention rather than dismissal,” Dr Bahrani adds.
The larger message, he says, is not one of fear but of timing.
“We often start protecting our health only after something goes wrong. Brain health gives us an opportunity to think differently. The earlier we control the risks we can control, the more we can potentially do to preserve cognitive health and independence later in life,” concludes Dr Kunal Bahrani, Chairman and Group Director – Neurology, Yatharth Hospitals.
