Alzheimer’s disease is a pressing concern in India. In 2019, India ranked fourth globally in dementia cases, including Alzheimer’s. By 2050, it’s expected to become the second-highest, surpassing Japan and the United States. This rapid increase in Alzheimer’s cases demands urgent attention and innovative solutions.
Current treatments, including cholinesterase inhibitors like donepezil and memantine, alleviate symptoms but do not halt the disease’s progression. However, researchers are exploring new and potentially more effective treatment approaches.
1. Anti-amyloid therapies: Some drugs target amyloid plaques, a hallmark of Alzheimer’s. The advantage of this approach is the potential to slow disease progression by reducing plaques in the brain. However, there are challenges, including mixed results in clinical trials and potential side effects.
2. Anti-tau therapies: Another approach involves reducing tau protein tangles in the brain, another hallmark of Alzheimer’s. While this approach offers the advantage of targeting another disease mechanism, it has faced limited success in trials.
3. Immunotherapy: Vaccines or antibodies are designed to stimulate the immune system to target amyloid plaques. While this is a novel approach, there could be potential side effects.
4. Lifestyle interventions: Diet, exercise, and cognitive stimulation are being studied as possible interventions. While they may prevent the early onset of Alzheimer’s, research is still ongoing to understand how lifestyle interventions can help.
5. Precision medicine: Tailoring treatments to individuals’ genetic and molecular profiles may become more common as research progresses. However, there could be challenges related to high costs and limited availability.
Innovative medications
In recent years, several innovative medications have shown promise in the treatment of Alzheimer’s:
- Aducanumab (Aduhelm): Developed by Biogen, this anti-amyloid antibody gained FDA approval in 2021. It offers hope for slowing disease progression in some patients.
- Lecanemab (formerly BAN2401): Developed by Eisai and Biogen, it was in clinical trials and has shown potential in reducing amyloid plaques.
- Donanemab (LY3002813): Developed by Eli Lilly, it was in late-stage clinical trials and also targets amyloid plaques.
- Aduhelm (generic version): Generic versions may offer more affordable options over time, potentially improving access to the medication.
However, the availability and affordability of these medications vary by region and healthcare system. Rural Alzheimer’s patients face unique challenges, including limited awareness, inadequate infrastructure, prejudices, and financial constraints.
Challenges faced by patients
Alzheimer’s patients in rural India face unique challenges that can delay diagnosis and access to care. These challenges include:
1. Limited awareness: There is often limited awareness about Alzheimer’s disease in rural areas. Many people attribute memory problems to normal aging, superstitions, or other causes, delaying diagnosis.
2. Inadequate healthcare infrastructure: Rural areas typically have inadequate healthcare infrastructure, with only a few healthcare facilities equipped to diagnose and manage Alzheimer’s. This makes it difficult for patients to access specialized care.
3. Prejudices and stigma: There are also many prejudices associated with cognitive disorders in rural communities. Misunderstandings and misconceptions about the disease can lead to isolation and discrimination.
4. Financial constraints: Alzheimer’s care can be expensive, and families in rural areas may struggle to afford medical expenses, caregiving support, and specialized facilities. There are often few support services, such as caregiver support groups and respite care, which are essential for families coping with Alzheimer’s.
Efforts to improve awareness, provide training to healthcare workers, and establish support networks in rural communities are essential to address these challenges and ensure better care for Alzheimer’s patients in rural India. Public health campaigns, telemedicine, and community-based outreach programs can play a significant role in raising awareness and providing support to affected individuals and their families.
Government’s role
The Indian government, both at the central and state levels, has taken several initiatives to address the challenges related to accessibility to Alzheimer’s diagnosis and treatment. These initiatives are aimed at improving awareness, infrastructure, and support for Alzheimer’s patients and their families.
1. National Dementia Strategy: The Indian government, through the Ministry of Health and Family Welfare, initiated the development of a national dementia strategy. This strategy aimed to address the growing burden of dementia, including Alzheimer’s disease. It aimed to improve awareness, early diagnosis, and access to care and support services.
2. Training healthcare workers: The government, in collaboration with organizations like the Alzheimer’s and Related Disorders Society of India (ARDSI), provides training programs for healthcare professionals, including doctors, nurses, and community health workers. These are aimed at enhancing their understanding of Alzheimer’s and dementia care, especially in rural areas.
3. National Program for the Health Care of the Elderly (NPHCE): The NPHCE, launched by the Ministry of Health and Family Welfare, includes provisions for promoting the mental health of the elderly population, which includes those with Alzheimer’s and dementia. It focuses on establishing geriatric clinics and services at the district level.
4. Community outreach and awareness programs: Various state governments have launched awareness campaigns and community outreach programs in collaboration with NGOs to educate people about Alzheimer’s disease and provide support to affected individuals and their families.
5. Telemedicine and telehealth initiatives: Some states have explored telemedicine and telehealth services to connect rural populations with healthcare professionals, including specialists in neurology and geriatrics, for consultations and advice on Alzheimer’s care.
6. Research initiatives: Government agencies such as the Indian Council of Medical Research (ICMR) have funded research projects related to Alzheimer’s disease and dementia, contributing to the understanding of these conditions and potential treatments.
There are several strategic ways in which the government can address the challenges surrounding Alzheimer’s diagnosis, treatment, and care accessibility in India. At the outset, there is a need to increase public awareness through nationwide campaigns to help reduce stigma and encourage early detection. Simultaneously, specialized training programs should be introduced for healthcare professionals to enhance their understanding of Alzheimer’s and dementia care, with a focus on rural healthcare providers.
It is important to establish memory clinics and dementia centers at district and sub-district levels to provide essential diagnostic and support services. This can help bridge the urban-rural healthcare gap and ensure that individuals in remote areas have access to timely care.
Telehealth and telemedicine services should be promoted and expanded, particularly in underserved regions, enabling remote consultations with specialists and improving access to expert advice and treatment options. Additionally, caregiver support programs, respite care services, and training for caregivers should be prioritized. Caring for Alzheimer’s patients is physically and emotionally demanding, and supporting caregivers is essential for both patient and caregiver well-being.
Research funding and collaboration with research institutions and pharmaceutical companies should be encouraged to advance understanding and treatment options for Alzheimer’s. Additionally, comprehensive policies and legislation specific to dementia care should be developed, addressing issues such as guardianship and legal protections for patients.
Last but not the least, community-based initiatives, support groups, and intergenerational programs should be facilitated to provide social and emotional support and engage young people in dementia awareness. Regular monitoring and evaluation mechanisms should be established to assess the effectiveness of these initiatives and ensure continuous improvement.
About the author: Dr Vishal Sehgal is the President of Portea Medical.
Disclaimer: The views and opinions expressed in this article are those of the author only and do not necessarily represent the official policy or position of Healthcare Radius.