Under 50 and at Risk: Why Alzheimer’s should be on Your Radar Now!
Plus, India’s first blood test to estimate your biological age is here. Read all about it now.
Alzheimer’s is more than ‘just old age’| Creative by Anjul D.
Just getting older puts you at risk for Alzheimer’s!
As lifespan increases, so does the risk of developing the debilitating brain disease that robs people of their memories, language, family ties and sense of self.
Here are 5 reasons why you must worry about Alzheimer’s
Risk increases as lifespan increases: 8.8 million Indians over 60 years are currently living with Dementia. Alzheimer’s, a form of Dementia, accounts for 60-80% of the cases. 16.9 million Indians could have Dementia by 2036 (if prevalence stays at 7.4% of population).
Younger Indians are getting an Alzheimer’s diagnosis: Indians are being diagnosed with neurological diseases like Dementia, Alzheimer’s and Depression as young as 41-44 years, according to this study.
Alzheimer’s is expensive, for the family and the country: In 2013, it cost ₹2,02,450 lakh annually to care for an Alzheimer’s patient in urban India. And that is a broad estimate.
A Lancet paper recently estimated the economic cost of Alzheimer’s in India
Individual or per capita cost would work out to an average INT$* 299
From 2020-2050, Alzheimer’s care could cost the Indian economy around INT$ 4,60,270 million -this includes expense on care and medication plus the economic toll from the impact on the workforce.
That amounts to 0.141% of the GDP. *(in international dollars – value equal to US$1 in the year 2020)
A vast majority of cases in India go undiagnosed: It is dismissed as old age, there is stigma associated with mental health and tests are not available in all languages yet. Typically, more women than men develop Alzheimer’s which also impacts access to care.
Diabetes and Hypertension increase risk of developing Alzheimer’s. This is apart from other factors like age, family history, brain injury and genetics.
In fact, states with larger senior populations like Kerala, Goa, Andhra Pradesh, Tamil Nadu and Himachal Pradesh currently have the maximum number of Alzheimer’s patients. Meaning: as India ages, which is happening, the number of cases could only increase.
Reason enough to read on? I thought so! So now that you are here, let’s address the basics one by one.
What is Alzheimer’s disease?
It is a brain disorder which slowly destroys memory, thinking skills and functioning to the extent that patients find it difficult to carry out basic, everyday tasks. While scientists are still investigating what causes Alzheimer’s, where it begins and how it progresses, they do know that it involves two toxic proteins –
Beta amyloid that forms plaques in spaces between nerve cells, and
Tau or twisted protein fibres that form tangles inside brain cells.
Over time, these plaques and tangles spread through the brain, damaging and killing nerve cells and causing brain tissue to shrink.
Another feature is the loss of connections between neurons in brains of Alzheimer’s patients.
All these changes typically start a decade or so before a person starts showing symptoms of Alzheimer’s. This is why most research now is also focused on biomarkers that could indicate early changes in the brain.
What are the symptoms of Alzheimer’s disease?
Alzheimer’s disease is a condition that progresses slowly and the person’s symptoms worsen over years.
In the early stages, people experience loss of memory and other cognitive changes. This ranges from wandering, getting lost and forgetting why or where they are going. They may also have difficulty handling money, completing daily tasks or holding conversations. One might also see changes in personality or behaviour e.g. aggression. This is when most people get diagnosed.
As the disease progresses, it damages areas of the brain that deals with language, reasoning, conscious thought and processing sounds and smells. This is when patients may not recognise family and friends, have difficulty dressing themselves and are unable to learn new things or cope in new situations. They may also have delusions and hallucinations.
As it becomes severe and brain tissue shrinks significantly, Alzheimer’s patients have difficulty speaking, swallowing and walking; are moody, disoriented, distrustful of family and friends and suffer serious memory loss.
How is Alzheimer’s different from normal ageing?
As we age, it is normal to forget, to look for words while speaking or get lost, momentarily. This is one of the reasons Alzheimer’s is often dismissed as ‘old age’.
But, as Dr Prem Narasimhan, geriatric medicine consultant at Mumbai’s Jaslok Hospital explains, there are some critical differences.
“So, in the case of normal ageing, even if you forget, activities of daily living, like bathing, dressing oneself, are never going to get affected. But in Alzheimer's, it worsens more and more.
And what really hits the caregiver is that it can alter the personality of the patient. The person you know is there behind the disease, but you are not able to recognize that person anymore,” he says.
Another key difference: People who age normally also forget, but recall what they forgot later. They also recognize that they had forgotten something. With Alzheimer’s:
Patients forget, but do not realise it
Get lost in familiar places and don’t realise it
Are confused and disoriented in new places
Language and sense of expression also gets affected
Can Alzheimer’s be cured or its damages reversed?
“Unfortunately there is no complete reversibility yet. You can only manage the disease, care for the person. There is no real complete cure,” says Dr Prem. However, he points out that even while scientists are looking for a cure, non-medical interventions are holding out hope.
As an example, Dr Prem mentions one of his patients – “She is brilliant at cards. So much so that her relatives say when she's playing cards, we don't even feel she has an issue. But that's because she likes doing that and that's working for her. But if you go back to other things, she's actually forgetting, she even forgets names.”
Music therapy, art therapy, solving puzzles, singing, meditation all, he says, help improve the quality of life of older patients with Alzheimer's.
What can you do?
A lot, as it turns out. Here’s what Dr Prem Narasimhan recommends:
1. Test your cognitive ability: After the age of 50, ask your physician or a geriatrician to run cognitive tests. You should repeat these annually.
In your 30’s and 40’s, challenge your brain regularly. Play Sudoku or Scrabble, solve the crossword, do puzzles. There are mobile apps to improve cognition. Use those to test and challenge yourself.
2. Sleep for 6-8 hours, everyday: It helps your brain process new information and strengthens memory. It also helps protect the brain against cognitive disorders, including various types of dementia.
3. Learn and do new things: “The brain gets bored easily,” says Dr Prem. He advises scheduling ‘me-time’ everyday and using it to pick up and indulge in a hobby. like learning a new instrument, gardening, dancing, pottery, painting etc.
4. Make technology your helper: Before you use an app to make a to-do list, write it down. Once in a while, do the math in your head. Try to recall phone numbers and dial them. It’s good for your brain.
5. Socialise, in real life: Not on the phone. Building and maintaining social connections keeps the brain healthy.
And the rest of course, go without saying: Move more, eat healthy, manage your stress and stay away from smoking and alcohol. In Alzheimer’s especially, with no remedy available right now; prevention is literally the best medicine.
Talking about prevention, you might want to read this!
Now, in India, get a blood test to determine your biological age
Indian longevity research company Decode Age has developed a test to estimate your biological age – aka the pace at which your cells are ageing. And all they need is a blood sample.
I spoke with Darshit Patel, Founder and Chief Scientific officer of Decode Age to understand more. Edited excerpts:
How does the test work?
The Decode Age team took blood data that is easily accessible and tested often – like blood sugar, cholesterol, thyroid panel, hormone panels etc. Then they gave each blood marker a weightage based on the impact it had on ageing.
Using this data, Darshit explains, “we built an algorithm on these biomarkers to predict biological age. We tested it on about 15,000 patients or 15,000 real world data points and found a certain level of accuracy that is acceptable at a clinical level. So that's where BloodAge started.”
What will this test tell you?
The test report has two parts. One is the regular blood report with the levels for the different biomarkers: HBA1C, lipids, etc. that helps preventive care doctors and clinical doctors.
The BloodAge portion has a coloured scale with levels that show you how much each biomarker is contributing to ageing you.
As Darshit puts it, “For each and every parameter we give you this particular range, that is what is healthy, what is optimal, and what is really something to get concerned about.” The company also has an in-house functional medicine doctor to guide (and refer) persons in whom they have identified health issues.
How is it different from a regular blood panel or health check-up?
One is the price point. According to Darshit, the 71-marker blood panel currently costs about ₹7,500 in the market. “We charge you ₹8,000. We give you that extra layer of blood age, and we kind of give you what is an optimal and healthy range for your biomarkers,” he says.
The second differentiator is it helps a person gamify (set goals and achieve them) their health as well. How? Darshit explains: “This month I'm at 34 (years). Maybe I could reverse it more. Maybe I could push it more. What can I do? Maybe I should take this supplement. Maybe I should go for this workout. Maybe I should be dieting or something like that, and that it just gamifies. The patient gets more involved in their own health journey.”
How can you get the test?
The test is commercially available in India in partnership with the Tata 1mg platform, but bookings have to be done on the Decode Age website. It costs ₹8,000 per test and you get the results within a week.
What’s next?
The company is building a more comprehensive app (there is a basic one now) to help test-takers participate in their longevity journey. Also in the works, an ageing test based on the gut microbiome.
Is this India’s first biological age test?
No. BloodAge is India’s first blood-based biological ageing test. However, it is not the first to predict your biological age.
There are other tests available that calculate your biological age based on changes in your DNA called methylation or epigenetic ageing tests. Then you have some tests that compute biological age based on how fast the telomeres in your cells are shrinking.
In both cases, price for a test ranges from ₹15-45,000.
How do you use the test results?
According to Darshit, “for each age group, the goals are different…A tool like this would give a different set of answers.”
He explains: In the late 20’s-30’s group, a test like this would help them ‘move the (age) needle backwards.’ For those between 30-40 years, biological age testing works as a prevention tool and for the 40-50 years age group, it helps them manage their health better.
Also as Darshit himself pointed out, do not look at any one set of results in isolation. Every set of biomarkers – physical (VO2Max etc. that your wearable tracks), physiological or blood based like the BloodAge test, markers of the gut microbiome or genes – are equally important.
So, if you do get a biological age test done, use it to see how you can do better – via nutrition, exercise etc. – to optimise your healthspan.
Disclaimer: I have not taken the BloodAge test. The above excerpt is for your information only. Please do not consider it a recommendation. As always, do what’s best for you.
That’s it for this week. See you Monday.
Kavita Krishnan.