India’s Dementia Dilemma: Neurologist Dr. Annu Aggarwal on Urgent Strategies for Prevention, Care, and Financing
By Arunima Rajan
In an interview with Arunima Rajan, Dr. Annu Aggarwal, neurologist at Kokilaben Dhirubhai Ambani Hospital, Mumbai outlines a roadmap to prioritise dementia prevention, improve diagnosis, and transform caregiving in India.
Dementia is declared a global emergency, yet in India it often ranks below infectious diseases in policy agendas. How should we integrate dementia prevention, diagnosis and care into flagship health schemes like Ayushman Bharat and the National Health Mission?
Despite dementia being declared a global health emergency, it continues to receive limited strategic focus in India, often overshadowed by infectious diseases. While communicable illnesses undeniably pose significant public health concerns, they are frequently acute and treatable. Dementia, by contrast, is a chronic and progressive condition, typically associated with ageing, and remains largely irreversible. India’s public health achievements in addressing HIV and tuberculosis through structured interventions demonstrate the nation’s capacity for wide-reaching healthcare responses. However, the unique challenge posed by dementia, coupled with increasing life expectancy and declining fertility, demands a long-term approach to support an ageing population. Projections indicating that dementia cases in China and India will double within the next 15 years further underscore the urgency.
To embed dementia-related services into flagship schemes like Ayushman Bharat and the National Health Mission (NHM), a multi-tiered and integrated strategy is essential. Dementia must first be elevated as a national health priority, positioned on equal footing with other non-communicable diseases (NCDs). Strengthening primary healthcare is central to early detection and care. Frontline workers such as ASHAs, ANMs, and primary care doctors need basic training to recognise early symptoms of dementia and perform cognitive screenings, integrated into existing NCD frameworks. Clear referral pathways must enable patients to move from primary to specialised centres. Given that risk factors like hypertension, diabetes, and obesity are already addressed by NCD programmes, dementia prevention strategies can be layered onto these initiatives.
Ayushman Bharat must expand its scope to encompass comprehensive dementia care. Insurance coverage should include diagnostics, long-term outpatient services, home-based care, and consultations with neurologists and geriatricians. Essential medications and future disease-modifying drugs must be added to the formulary. NHM should spearhead awareness campaigns promoting brain health through yoga, balanced diets, cognitive activity, and social engagement, and intensify efforts to control modifiable risk factors. Screening for vision and hearing loss among older adults should be routinely included in primary care. Specialised dementia units in tertiary hospitals staffed by multidisciplinary teams are essential. A national dementia registry must be created and integrated with existing health systems to guide policy and track outcomes.
With global care costs set to $2 trn by 2030 and the arrival of high-cost treatments such as lecanemab and donanemab, what innovative financing models, such as public insurance, social bonds or community cooperatives, can we pilot to ensure affordable, dignified dementia care alongside access to novel therapies?
With global dementia care costs expected to exceed $2 trillion by 2030 and the emergence of high-cost treatments like lecanemab and donanemab, innovative financing mechanisms are essential. Most individuals with dementia are elderly, retired, and often uninsured. An urgent need exists to extend public and private insurance to cover long-term, chronic conditions. Insurers should develop
long-term care policies covering outpatient care, home support, and residential facilities. For financially vulnerable groups, subsidised premiums or direct financial aid could be introduced. Including dementia care within Ayushman Bharat would mark a major insurance milestone.
Social bonds and impact investing can play a transformative role. Governments or institutions might issue 'Dementia Care Bonds', funding infrastructure, caregiver training, and research. Returns could be tied to improved access or outcomes. Social Impact Bonds (SIBs) could fund preventive strategies, with private investors reimbursed based on health improvements.
Community-based cooperatives, where families pool resources for elder care, can develop micro-insurance schemes and serve as caregiver training hubs. Mandatory long-term care savings schemes, akin to a provident fund, could be introduced. Government and corporate contributions would incentivise participation.
CSR efforts could support dementia services, training, and research. All care providers must be regulated to ensure safety and facilitate insurance reimbursements. For expensive novel therapies, the government should negotiate bulk procurement and offer subsidies or free distribution to low-income patients.
Nearly 45 percent of dementia cases are linked to modifiable factors, including hearing and vision loss, air pollution, smoking, obesity and high blood-sugar. Which of these interventions can be most rapidly slotted into India’s existing primary-care and NCD programmes, and how?
Given that nearly 45 percent of dementia cases are linked to modifiable factors, several interventions can be swiftly integrated into India’s existing primary-care and Non-Communicable Disease (NCD) programmes, leveraging their established infrastructure and cultural resonance.
Firstly, cardiovascular health management, encompassing hypertension, diabetes, and obesity, presents a crucial and readily integrable area. These conditions are already core components of India’s NCD programmes, such as those under the National Health Mission and Ayushman Bharat Health and Wellness Centres. The integration here should focus on enhancing and standardising opportunistic screening for hypertension, diabetes, and obesity during every primary care visit, at health camps, and during community outreach initiatives. Furthermore, patient education on the critical link between uncontrolled NCDs and dementia risk must be significantly emphasised, coupled with robust counselling to ensure strict adherence to medication and comprehensive lifestyle modifications encompassing both diet and exercise. Promoting healthy, traditional Indian diets while actively discouraging processed foods and sugary drinks through public awareness campaigns is vital, alongside mandating clear calorie and constituent labelling on packaged and restaurant foods. This intervention can be rapidly slotted as the fundamental framework for NCD management is already in place, primarily requiring a sharpened focus and specific dementia-related messaging.
Secondly, addressing sensory loss, specifically hearing and vision impairments, offers another readily implementable intervention. This involves integrating routine vision and hearing screening for all older adults into existing annual health check-up programmes at Primary Health Centres, district hospitals, and corporate health initiatives. Alongside this, there should be a concerted effort to promote awareness about corrective measures, such as spectacles and hearing aids. Leveraging existing government schemes and NGO initiatives, like Rotary clubs sponsoring hearing aids, to extend their reach to the elderly, while publicising affordable options, will also be key. These screenings are relatively straightforward, non-invasive, and can be performed by trained primary healthcare workers, and corrective measures are often readily available and can have a significant positive impact.
Thirdly, the promotion of physical activity, particularly by leveraging the widespread acceptance of yoga, offers a culturally resonant and easily integrated pathway. Building upon yoga’s existing popularity, specific modules involving gentle movements, breathing exercises, and meditation, tailored for older adults, should be designed. These modules would explicitly emphasise the benefits for cognitive health, stress reduction, and overall well-being. They can be integrated into community centres, senior citizen clubs, and even popular televised programmes, making them highly accessible. Community mobilisation, encouraging Resident Welfare Associations and local bodies to organise free or subsidised exercise groups for elders, would further accelerate adoption. This can be rapidly slotted as yoga is culturally embedded and perceived positively, requiring minimal additional infrastructure and capable of dissemination through existing community networks.
Fourthly, alcohol and smoking cessation campaigns can be swiftly augmented. This involves reinforcing brief counselling on the harms of alcohol and smoking, including their direct link to dementia, by primary care providers during routine visits. Targeted public health campaigns, particularly for youth and young adults, should use persuasive messaging about long-term brain health impacts. Facilitating the establishment of community-based support groups for cessation would also be beneficial. Existing anti-smoking and alcohol awareness campaigns can be quickly augmented with dementia-specific messaging.
Fifthly, promoting education and cognitive stimulation through the concept of lifelong learning is a vital, albeit broad, intervention. This entails building on the protective effect of education by advocating for continued mental engagement throughout life. Community centres can be encouraged to organise activities such as reading clubs, board games, puzzles, and discussion groups that stimulate cognitive function for older adults. Promoting digital literacy among elders can also facilitate access to online educational resources and foster social connections. These initiatives primarily require advocacy and community organisation rather than extensive medical infrastructure, allowing for rapid implementation.
Finally, implementing basic head injury prevention measures can be rapidly integrated. This involves intensifying existing road safety campaigns that advocate for compulsory helmet use for two-wheeler riders and seatbelt use for all vehicle occupants (both front and rear seats), specifically emphasising brain injury prevention. These are existing public safety initiatives that can be immediately linked to dementia prevention. While comprehensive air pollution control is a long-term goal, public awareness regarding the link between air pollution (including microplastics) and brain health can be rapidly initiated. Similarly, efforts to combat social isolation can be promoted through community organisations, NGOs, and local government bodies.
In most Indian households, family caregivers bear the brunt; burnout and skill gaps are real. How can we formalise dementia caregiving through accredited training, certification and incentives to create a scalable, professional workforce?
In most Indian homes, dementia caregiving falls informally to family members, often resulting in emotional and physical burnout. There is a pressing need to formalise and professionalise caregiving through structured training and accreditation. A national curriculum must be established to standardise caregiver education, covering the full spectrum from basic care and behavioural management to palliative and end-of-life care. Tiered certifications should accommodate family caregivers, professional home aides, and advanced specialists. National accrediting bodies, possibly under the Ministry of Health or the National Skill Development Corporation, should oversee training quality and certification, in coordination with medical and nursing councils. Training-of-Trainers programmes are vital to scaling reach across states and languages.
Training infrastructure should utilise existing nursing colleges, vocational institutes, and community colleges. Digital platforms and multilingual e-learning modules would broaden access, particularly in remote areas. Partnerships with NGOs and community groups would ensure grassroots outreach.
To professionalise the field, caregiver certification should become mandatory for employment in formal care settings. Financial incentives such as scholarships and training subsidies can encourage uptake. Career progression paths must be created, offering better wages and working conditions. Public and private insurers, including Ayushman Bharat, must formally recognise certified caregiver services, helping make professional support more accessible for families. Families should also be offered respite care support through subsidies or vouchers to reduce burnout.
Regulating dementia care providers is equally essential. Licensing requirements, oversight mechanisms, and performance evaluations must ensure patient safety, adequate staffing, and quality care. Public rating systems for facilities would build transparency and trust. Finally, public-private partnerships, including CSR investments by hospitals and pharma companies, should be encouraged to fund training, infrastructure, and service delivery. Collaboration with experienced organisations such as Dementia India Alliance and ARDSI would further strengthen training and advocacy efforts.
Healthy diets, regular exercise and cognitive stimulation delay onset, but Western models don’t always fit. What community-based, culturally sensitive programmes, such as yoga for cognition or local dietary guidelines, can we design to reach rural and urban elders alike?
Western models for dementia prevention though well-researched are not always well-suited to India’s diverse sociocultural contexts. Culturally adapted, community-driven programmes are therefore critical to engage both rural and urban populations. Promoting traditional practices such as yoga, traditional diets, and indigenous games offers a culturally relevant and effective approach. Yoga routines tailored to elders, along with dietary advice promoting fresh, seasonal foods while discouraging fast food, can be widely adopted. Creating region-specific nutritional guidelines and reviving games like carrom, chess, or chaupar can support mental agility in familiar, enjoyable ways. Local competitions or group activities could further encourage participation.
Strengthening community engagement through day centres and senior clubs is vital to reducing social isolation. These spaces can host regular cognitive, physical, and recreational activities. Intergenerational programmes where students and young people interact with elders through storytelling, crafts, or teaching digital skills help build social bonds and stimulate cognitive health. Informal initiatives like laughter clubs can also play a role.
Health promotion must be linguistically and culturally tailored. Materials in local languages, endorsements by respected community figures, and dissemination through folk media like street plays and storytelling can make messages more relatable and far-reaching.
For rural areas, mobile health units could offer cognitive screenings, exercise demonstrations, and awareness sessions. These must be accessible at times convenient to older adults and caregivers. Finally, equipping families with practical guidance such as home-based brain games and tips for preparing nutritious meals will ensure the sustainability of these interventions at the household level.
Longitudinal dementia data are thin in India, and the absence of a unified registry hinders trial enrolment for emerging Alzheimer’s drugs. What role should ICMR, Alzheimer’s India and academic
centres play in establishing a national dementia registry that also facilitates patient recruitment into both observational cohorts and clinical trials?
India’s lack of robust longitudinal data on dementia remains a major obstacle to accurate forecasting, effective policymaking, and participation in clinical trials for new treatments. A unified national dementia registry is therefore essential to guide evidence-based decisions, allocate resources appropriately, and advance critical research. This requires the collaborative involvement of the Indian Council of Medical Research (ICMR), Alzheimer’s and Related Disorders Society of India (ARDSI)/Dementia India Alliance (DIA), and leading academic institutions.
ICMR should act as the primary coordinator and funding agency for the registry, ensuring scientific integrity and ethical compliance. It must lead the creation and implementation of standardised case definitions, diagnostic protocols, and data collection frameworks including demographic, clinical, neuroimaging, and genetic information for all participating centres. This will ensure consistency and interoperability across regions. ICMR should also oversee the development of a secure, user-friendly digital platform, ensuring data privacy and integration with national health systems such as the Ayushman Bharat Digital Health Mission. By doing so, it can support the creation of large, well-characterised observational cohorts to monitor disease progression and outcomes within India’s unique population. Continued investment in regional epidemiological studies will be vital to capture the diversity of dementia profiles across geographies.
ARDSI and DIA are uniquely placed to promote the registry’s relevance at the grassroots. They should raise awareness among patients, caregivers, and the public about the registry’s purpose and value. Their advocacy is essential in ensuring caregiver experiences including burnout, resource needs, and access to support are included in the data, informing effective policy and support systems. These organisations can also assist researchers with community engagement, particularly for clinical trial recruitment, and provide valuable cultural insights to make data collection more inclusive and acceptable. In partnership with ICMR, they should contribute to the development and dissemination of care guidelines informed by registry data.
Academic centres especially those with established departments in neurology, geriatrics, and psychiatry are vital to data collection and research. Their diagnostic expertise ensures data accuracy, while their infrastructure makes them ideal hubs for clinical trials. The registry will also enable these institutions to identify Indian-specific risk factors, subtypes, and treatment outcomes. Academic centres will play a key role in training professionals in data standards and diagnostic procedures. Additionally, they must help develop and validate culturally appropriate neurocognitive tools, building on initiatives like the ICMR Neurocognitive Toolbox.
A phased implementation approach is recommended, beginning with pilot projects in leading academic centres before expanding nationwide. Strong data governance, privacy safeguards, and community involvement will be fundamental to its success. Ultimately, the registry should be integrated with the Ayushman Bharat Digital Health Mission to create a unified health record system and support more coordinated, long-term care.
Tackling air pollution, NCDs and sensory loss requires more than the health ministry. Which cross-sector collaborations in environment, education and urban planning should be prioritised now to bend India’s dementia curve before it steepens?
Reducing India’s dementia burden requires cross-sectoral collaboration beyond the health sector. Key areas include environmental policy, education, and urban planning all of which impact cognitive health.
The environment sector, particularly the Ministry of Environment, Forest and Climate Change and local authorities, must enforce air quality standards, especially in high-risk urban and industrial areas. Investments in clean public transport, promotion of electric vehicles, and stricter control of industrial emissions are critical. Public access to real-time air quality data will further enable informed action. National campaigns must also address plastic pollution focusing not just on waste disposal, but also raising awareness of the neurological risks associated with microplastic exposure. Safe drinking water provision is essential to limit infections that could compromise overall health. Moreover, expanding and maintaining urban green spaces will support both cleaner air and opportunities for physical and social activity.
The education sector, including the Ministry of Education, UGC, and NCERT, should incorporate dementia prevention messaging into school and university curricula. Education is a proven protective factor for cognitive decline, and literacy on risk factors such as NCDs, unhealthy diets, and sensory loss should be built into classroom health education and materials. Collaborating with institutions to embed wellness programmes in workplaces will further promote long-term health in adults.
Urban planning, led by the Ministry of Housing and Urban Affairs and supported by Smart Cities initiatives, must create age- and dementia-friendly spaces. This includes designing accessible pedestrian walkways, public parks, and transport systems that support mobility and safety for older adults. Public infrastructure must accommodate individuals with cognitive impairments, and community hubs should foster social engagement to reduce isolation. Planning measures to ease traffic congestion and improve road safety like better crossings and noise reduction—will also protect brain health. Mixed-use zoning and integrated social spaces can encourage physical activity and intergenerational contact.
Among these efforts, the fastest results can be achieved by embedding dementia-related messaging into existing NCD and environmental campaigns. Teaching schoolchildren about the brain effects of pollution or promoting brain-friendly diets within existing food programmes can yield early gains. Strengthening enforcement of air and waste regulations, along with designing walkable green neighbourhoods, will produce long-term benefits. These collaborative efforts will require sustained political commitment but are critical to addressing dementia as a whole-of-society challenge.
The Lancet Public Health study projects global dementia cases will treble to 152.8 million by 2050, yet uneven data quality and varying definitions hamper accurate forecasts. What steps should India take to standardise case definitions and strengthen surveillance at the state and district levels?
India’s inconsistent definitions and uneven dementia data present major barriers to accurate disease monitoring and service delivery. To correct this, the country must urgently standardise diagnostic criteria and strengthen surveillance at state and district levels.
National consensus on dementia case definitions is essential. ICMR, in partnership with national and global experts, must lead the process of adapting international diagnostic frameworks such as DSM-5, ICD-11, and NIA-AA criteria to the Indian context. These must reflect India’s wide linguistic, cultural, and educational variations. Moreover, tiered diagnostic tools must be developed to suit different levels of care: simplified screening tools for ASHA workers and primary care providers; more detailed clinical tools for district-level physicians; and advanced neuroimaging, biomarker, and neurocognitive assessments for tertiary centres.
Surveillance must be integrated within existing NCD data frameworks particularly the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke leveraging existing structures rather than building parallel systems. A national network of sentinel surveillance sites, spanning PHCs, district hospitals, and teaching hospitals across varied regions, should collect standardised data on prevalence, risk factors, and care patterns.
Training healthcare workers across all levels in consistent diagnostic methods, high-quality data entry, and ethical data management will be vital. These must be reinforced through periodic audits, quality checks, and feedback mechanisms.
Digital tools are indispensable. Secure, user-friendly platforms with full interoperability with Ayushman Bharat Digital Health Mission are needed to ensure data is accessible and useful across the system. Nationally representative surveys expanding upon efforts like the Longitudinal Ageing Study in India must be conducted regularly, using standardised dementia modules.
To improve diagnostic accuracy and research, academic institutions should be encouraged to facilitate brain donation programmes and post-mortem studies. These will yield important insights into disease pathology in Indian populations and support research into early detection and prevention strategies.
ICMR must continue to fund foundational research, develop data standards, and oversee national repositories. Academic centres will implement pilot projects, generate research, and train the workforce. ARDSI/DIA can support data collection by engaging caregivers and mobilising community support for surveillance, ensuring the entire effort remains people-centred.
That same study finds risk-factor improvements could prevent 6.2 million cases globally, yet rising obesity, smoking and hypertension add 6.8 million more. How must India calibrate its public-health priorities to ensure net reductions in dementia driven by education, cardiovascular health and lifestyle change?
Findings from the Lancet highlight a stark reality: while millions of dementia cases can be prevented, emerging risk factors like obesity, smoking, and hypertension are driving numbers upward. India must recalibrate its public health agenda to achieve a net decline in dementia by combining disease prevention with brain health promotion.
A dual strategy is needed. The first element is risk mitigation: intensifying control of NCDs through routine screening for hypertension, diabetes, and obesity across all healthcare levels, coupled with early treatment and adherence support. This must be accompanied by sustained campaigns promoting healthy, home-cooked diets, reducing sugars and processed foods, and encouraging physical activity such as walking and yoga. Existing tobacco and alcohol regulations must be strictly enforced, supported by widespread public education about their link to cognitive decline and accessible cessation services. Tackling air pollution and ensuring safe drinking water are equally critical. In addition, vision and hearing care services should be made universally affordable, with awareness campaigns encouraging routine checks especially as sensory loss is now a recognised risk factor.
The second element is brain health promotion. This starts with strong investment in education across all life stages building cognitive reserve and resilience. Public health messaging should promote continuous mental engagement, active social participation, and lifelong learning. Equally important is recognising the role of sleep and stress; campaigns should promote healthy sleep hygiene and teach stress management through mindfulness and meditation.
India’s approach must be life-course based, targeting both the current adult population and the next generation. Preventing early onset of risk factors in children and young adults such as poor diets, lack of physical activity, and early tobacco use is as important as reducing existing risks in older adults. Specific messages and interventions must be tailored to each age group.
Crucially, this cannot be achieved by the health sector alone. Environmental, educational, and infrastructural policies all play a role in shaping cognitive outcomes. Therefore, intersectoral collaboration, as outlined earlier, is essential. Data from the proposed National Dementia Registry and large-scale studies must guide the targeting of resources towards the most impactful interventions, ensuring every rupee is used effectively.
Ultimately, dementia prevention should be embedded into India’s broader NCD and wellness strategies, ensuring that population brain health becomes a central tenet of national public health planning.
No country has yet devised a sustainable way to pay for and deliver 24-hour dementia care for the projected 152 million sufferers by 2050. What long-term workforce development and infrastructure strategies should India adopt now to prepare for this demographic tsunami?
With dementia projected to affect 152 million people globally by 2050 and no nation yet offering a sustainable model for continuous care India must act urgently to build a long-term strategy that is both preventative and care-focused.
Workforce development is critical. India must establish a formal caregiver profession, starting with a national dementia care curriculum and certification framework. This will create a clear career path and attract individuals to the field. A multi-tiered approach is needed—training everyone from home carers and certified dementia care assistants to geriatric nurses, occupational therapists, psychologists, and specialist doctors. Programmes like Skill India and the National Skill Development Mission should be leveraged to scale up training. Training-of-Trainers models will help reach remote regions. Caregivers must receive fair wages, social security benefits, and opportunities for progression. Public campaigns must help change perceptions, recognising dementia carers as essential health professionals. The existing health workforce such as ASHAs and ANMs should receive basic dementia care training to enhance early support and referral. In parallel, carers should be equipped with digital skills for teleconsultation and patient monitoring, especially in rural settings.
On infrastructure, a tiered system of care centres must be built. Community-based day care centres should be set up in each urban ward and rural cluster, providing cognitive stimulation and respite for families. Additionally, affordable and quality-assured residential care facilities—spanning assisted living, nursing homes, and dedicated dementia units—must be developed. These should serve a range of income groups and offer round-the-clock support for advanced cases. Formalising and regulating home-based care services is equally important, allowing tailored, flexible care to be delivered in patients’ homes. Urban planning must incorporate dementia-friendly features—safe footpaths, accessible signage, public transport, and community gardens—to improve patient mobility and wellbeing. Families should be supported to make home environments dementia-friendly through practical guidance.
Public-Private Partnerships (PPPs) will be crucial to building this infrastructure. Government could provide land and policy support, while the private sector invests in construction and operations. CSR funds should also be directed towards dementia care. Technology will further transform delivery. Expanding telemedicine services for diagnosis, caregiver support, and remote monitoring will extend specialist access to underserved areas. Wearable sensors and smart home systems can enhance patient safety and provide real-time alerts.
Finally, India must invest in innovation and research hubs to create affordable, culturally relevant care models and technologies. A proactive and preventative strategy focusing on modifiable risk reduction alongside scalable care models will allow India to manage the coming demographic shift with dignity, affordability, and care excellence.
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