NIMHANS' Department of Health and Family Welfare and the Dementia India Alliance came up with draft action plan for the state.
Karnataka Health Minister Dinesh Gundu Rao announced Dementia as priority disease and said it will be part of screening programme under 'Griha Arogya' in Karnataka. (Supplied)
The Karnataka government on Thursday, 21 September, announced that it would include dementia screening as part of the “Gruha Arogya” scheme.
Unveiling a Draft State Action Plan for Dementia on World Alzheimer’s Day, the state’s Health Minister Dinesh Gundurao declared the condition a public health priority.
He also announced that screening for dementia cases would be taken up on priority in the eight districts that have been listed for the screening of non-communicable diseases as part of the Gruha Arogya scheme.
Health Minister Dinesh Gundu Rao speaking to caregivers of Dementia patients. (Supplied)
With lakhs of individuals currently living with dementia in Karnataka and the number expected to double by 2036, the National Institute of Mental Health and Neuro Sciences (NIMHANS) and the Dementia India Alliance (DIA) joined hands with the state’s Department of Health and Family Welfare to declare dementia a public health priority.
“This initiative will be a trend for not just Karnataka but other states as well. We will soon train our healthcare workers covering eight districts of Karnataka — Ramanagara, Tumakuru, Belagavi, Gadag, Mysuru, Chikkamagaluru, Ballari, and Yadgir — to ask the relevant questions to screen and identify dementia patients,” said the health minister.
Explaining the seriousness of dementia, Dr PT Sivakumar, a consultant in the geriatric psychiatry unit under the Department of Psychiatry at NIMHANS in Bengaluru said, “There are many life-threatening diseases in the world, like cancer and HIV, from which people have recovered, and then told us how bad they had it. However, there is only one disease from which no single person has recovered from it to talk about how difficult and bad it was, and that is dementia.”
It may be noted that dementia is not a specific disease but rather a general term describing a decline in a person’s cognitive abilities that is severe enough to interfere with their daily life.
It is a prevalent and complex medical condition that affects millions of individuals globally. It involves a variety of symptoms related to memory, communication, problem-solving, and other cognitive functions. These symptoms can gradually worsen over time, significantly affecting an individual’s quality of life.
Gundu Rao explained: “With an ageing population, understanding dementia is of the utmost importance to provide appropriate care and support to those affected and their families.”
Dr Radha Murthy, who has been working in the field of dementia care for the last 20 years and is the president of the Dementia India Alliance, said the estimated dementia prevalence for people above the age of 60 was 7.4 percent, with nearly 90 lakh Indians currently living with dementia.
She added that this number was expected to rise to nearly 1.7 crore by 2036.
In Karnataka, there are more than 5 lakh people diagnosed with dementia, and this is only the tip of the iceberg.
Nearly 90 percent of dementia cases were going diagnosed due to lack of awareness, the stigma attached to the disease, lack of memory clinics to diagnose the condition, and not enough experts working in this field, explained Murthy.
“It is a growing public health concern, as dementia also carries substantial psychological, social, and economic costs for not just the family members but society as a whole,” she said.
Having had the opportunity to work closely with almost 30,000 families over the last two decades, Murhty said it provided her invaluable insights into their realities and needs.
“The needs of families of patients with dementia encompass not only the person who’s directly impacted but also the caregivers. In many households, I’ve witnessed strained relationships between spouses when dealing with a family member suffering from dementia. There’s a lack of accessible services, insufficient information, and a pervasive lack of awareness about where to seek help, all accompanied by a heavy burden of stigma,” she said.
The challenges we face are multi-faceted: Low awareness, societal misconceptions, and a scarcity of memory clinics for proper diagnosis. “Additionally, there’s a dearth of experts, with a staggering 90 percent of cases still undiagnosed,” Murthy added.
Although Karnataka boasts a considerable number of daycare centres and residential homes for dementia patients, they remain scattered and often come with exorbitant costs. This situation forces individuals to sacrifice their professional commitments to look after their loved ones with dementia.
Dr Suvarna Alladi, a professor of neurology at NIMHANS, said that World Health Organisation in all its wisdom has said every nation should have a global action plan for dementia.
“With experience, professionals, caregivers, families, and based on research that all of us have engaged with on what will really work, hours of discussion, and years of thought, we have come up with a draft action plan for people with dementia for people living in Karnataka with dementia,” she said.
Explaining what the draft action plan looked like and what the state government was expected to do, NIMHANS Director Dr Prathima Murthy said the Karnataka government needed to first look at dementia as a public health priority because the risk of dementia increases as people age.
Therefore, it becomes important to first of all acknowledge dementia in the public health space, she said.
Dementia action plan for state unveiled at NIMHANS (Supplied)
A Karnataka Brain Health Initiative survey showed that only 5 percent of people with dementia in the state were identified, so it becomes very important to improve the identification, said Dr Prathima Murhty.
“Only when we do early intervention can the best results be achieved,” she noted.
Recognising the urgency of this issue, the Karnataka government agreed to implement the comprehensive dementia action plan.
The Karnataka State Dementia Action Plan will reportedly focus on risk reduction strategies to delay and potentially prevent the onset of dementia, echoing this year’s World Alzheimer’s Month theme “Never too early, never too late”.
The state government’s action plan encompasses several areas. It includes:
Announcing dementia as a state health priority from Thursday, Health Minister Gundu Rao said, the Karnataka Health Department was prioritising early intervention by proposing the screening of individuals aged 60 and above, commencing with the eight districts.
In line with Dr Pratima Murthy’s recommendations, the minister affirmed that the state intended to identify individuals with NCDs such as diabetes, hypertension, cancer, respiratory diseases, mental health disorders, and substance abuse disorders, and those who are particularly susceptible to cognitive impairment. The focus is on proactive identification of cognitive impairment in this demographic.
Dr Pratima Murthy emphasised that by identifying risk factors, 40 percent of cases with potential progression to dementia could be prevented. Therefore, targeting high-risk groups was crucial.
She advocated for a unified screening approach encompassing mental, neurological, and substance use disorders.
This approach should be integrated into various healthcare programs, including district mental health programmes, home-based evaluations within NCD programmes, and the Brain Health Initiative.
The doctor also stressed the need for increased awareness regarding healthy ageing. While there is significant emphasis on diet, supplementation, and physical activities for young adults, attention often diminishes as people age. Nonetheless, mental stimulation is essential for healthy ageing.
To facilitate dementia diagnosis, online tools developed by Dr Radha Murthy and her team can be employed.
Overcoming the prevailing reluctance to spend money on treatment for the elderly is crucial, highlighting the importance of recognising the elderly as a valuable resource within the country. This would involve ensuring proper home care and palliative care.
However, capacity-building is required, necessitating the training of healthcare professionals, ASHA workers, and community workers.
Dr Pratima Murthy emphasised the need to raise awareness about various dementia support lines and advocated for the establishment of a statewide dementia registry.
Meanwhile, Dr Prabhachandra, a professor of psychiatry at NIMHANS, said that regional support and training in the local language, as well as locally available resources, were the absolute need of the hour.
Assuring that whatever had been proposed in the draft action plan could be accepted without any delay, Gundu Rao gave assurances that dementia would be considered a priority and that the action plan would be implemented.
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