Explained: What the largest study on dementia hopes to achieve

Dementia: Burden of the disease

Dementia is a general term to describe a group of symptoms which occurs due to the damage and death of brain cells. According to the World Health Organisation, dementia is a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities. Worldwide, around 50 million people have dementia, and there are nearly 10 million new cases every year — implying one new case every 3.2 seconds. It is estimated that 5.3 million people above the age of 60 have dementia in India in 2020. This equals to one in 27 people, according to the Dementia in India 2020 report. Alzheimer’s dementia is the most common type of dementia.

Dementia robs the person not only his memories and personality but often his dignity as well. Stigmatisation, lack of adequate services, barriers to access available services all worsen the physical, psychological and financial hardships of the families, according to Dementia in India report 2020. 📣 Express Explained is now on Telegram

The SANSCOG study

A complete understanding about the cause of dementia remains elusive. It commonly occurs after middle age as a result of neurodegenerative and cerebrovascular processes beginning earlier in the life course. Hence , Srinivaspura Ageing, Neuro Senescence and Cognition (SANSCOG), a first-of-its-kind study in 10,000 rural Indians in Srinivaspura, Kolar district, Karnataka aims to understand risk and protective factors associated with normal ageing, dementia and related disorders. The study is being carried out by the Centre for Brain Research, Indian Institute of Science, Bangalore, India, in collaboration with the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore and Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER), Kolar.

“We are conducting detailed, multimodal assessments that include clinical, neurocognitive and biochemical, genetic and brain imaging measurements on 10,000 residents of Srinivaspura, aged 45 years and above, and following them up over a long period of time,” says Dr Vijayalakshmi Ravindranath, Director, Centre for Brain Research. The study is planned as a longitudinal study where participants will be periodically followed-up over a long period of time (at least 10 years).

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Study could give vital clues on new strategies

Data from the developing world, especially India, is sparse in the field of dementia research and such comprehensive, longitudinal evaluations spanning genotype to phenotype would help to better understand gene-environment interactions, which in turn could provide vital clues to initiate strategies targeted at prevention of cognitive decline and dementia, says Dr Jonas Sundarakumar, scientific officer, Grade 1 at the Centre for Brain Research. The recruitment started in 2018 and there are around 2,200 participants so far. Over 1,850 participants have completed comprehensive, baseline, clinical, cognitive and biochemical assessments, and follow-up assessments have recently started.

Differences in cardiovascular risk factors

Preliminary unpublished data from the SANSCOG study, when compared with data from the parallelly-running, urban study (Tata Longitudinal Study of Ageing) shows that there are significant differences in the cardiovascular risk factors such as hypertension, diabetes, hypercholesterolemia and obesity between the rural and urban population, with the urban population having a much higher prevalence of these vascular risk factors. How these differences in cardiovascular risk factors play out in the differential risk for developing dementia and related disorders remains to be seen, as we regularly follow-up these ageing cohorts, the study researchers said.

Top challenges in dementia care

Lack of awareness is a major concern, Dr Sridhar Vaitheswaran, Assistant Director & Consultant Psychiatrist, Dementia Care in SCARF – Schizophrenia Research Foundation (SCARF) India said. Other challenges include lack of manpower and day centres.

Multi-country study underway on Cognitive Simulation Therapy

Like diabetes has no cure but can be controlled, there are interventions that can control dementia, Dr Sridhar said. A multi-country study on Cognitive Simulation Therapy (CST) for Dementia is underway in India- Brazil- Tanzania. CST is a brief group-based pyschosocial intervention for people living with mild to moderate dementia. There is consistent evidence for the effectiveness of CST but less is known about its implementation to routine clinical care and the multi country study aims to create an ongoing sustainable CST implementation programme to increase quality of life and cognition for people with dementia, said Dr Sridhar, one of the co-investigators of the UK Medical Research Council and Indian Council of Medical Research-funded study.