Even as dementia cases rise sharply across India’s ageing population, doctors say the country’s ability to diagnose and treat Alzheimer’s disease early and not the arrival of new drugs alone will determine whether patients actually benefit from recent medical advances.
An estimated 8.8 million Indians above 60 are currently living with dementia, with Alzheimer’s disease accounting for close to two-thirds of these cases. For nearly three decades, treatment options were limited to drugs that eased symptoms such as memory loss and behavioural changes without altering the underlying disease. That changed this year when lecanemab, sold as LEQEMBI, became India’s first approved disease-modifying therapy for Alzheimer’s, following clearance from the Central Drugs Standard Control Organisation. Unlike earlier drugs, it is designed to act on the biological process driving the disease rather than only its downstream symptoms.
Dr Madhukar Bharadwaj, Director & HOD Neurology, Aakash Healthcare said the approval has changed a conversation doctors have had with anxious families for years. “For years, families have asked us the same question — can we do anything to actually slow this down, not just manage it. Until now, our honest answer was limited. With lecanemab now available in India, that conversation is finally beginning to change, even if it is only for patients we catch early enough,” he said.
That caveat, doctors say, is central to how the drug can be used. Dr Bharadwaj adds, “Lecanemab is approved only for early-stage disease, that is, patients with mild cognitive impairment or mild dementia, and not for those further along. Before treatment can begin, doctors must confirm amyloid pathology through cerebrospinal fluid analysis or blood-based biomarker testing. This has effectively redefined what early diagnosis needs to mean in practice: a patient with mild forgetfulness can no longer be told to wait and watch, since timing now determines whether disease-modifying treatment remains an option at all.”
Doctors say this places new pressure on primary care referral systems, cognitive screening at the first point of contact, and closer coordination between general physicians, geriatricians and neurologists — coordination that most centres in India are not yet equipped to provide.
Dr Neha Kapoor, Associate Director and HOD Neurology, Asian Hospital which treats elderly patients from both urban and semi-urban areas, said access remains the bigger obstacle. “People generally assume slower memory is just old age, something to live with, not something to check. By the time they walk into a hospital, it has already progressed. The key lies in ensuring that there is medical help available in rural and semi-urban areas also for early detection and treatment,” Dr Kapoor said.
That access gap, doctors note, is largely a geographic one. Dr Rajas Deshpande, Consultant and Director – Neurology, Jupiter Hospital said, “The infrastructure required for lecanemab — CSF testing, PET imaging, MRI monitoring — currently exists in only a handful of Indian metros. In smaller towns, the nearest neurologist may be hours away, and early memory loss is frequently dismissed rather than investigated.”
Dr Deshpande described early intervention as a logistical challenge as much as a medical one. “We talk about early intervention as if it is purely a medical decision. In reality, it is a logistics problem first — can the patient reach diagnostic infrastructure before the disease moves past the stage where this treatment can help them.”
Doctors also flagged a broader pattern of ageing-related health concerns going unaddressed in isolation from one another. Dr Vineet Malhotra Senior Consultant- Urology & Andrology VNA Hopsital pointed to men’s sexual health as one such overlooked area. “Vascular health, hormonal balance, diabetes — these influence both brain function and sexual health in ageing men, yet patients almost never bring up the two together, and doctors don’t always ask. If we are serious about early-stage screening for conditions like Alzheimer’s, we also need men to feel comfortable raising every quiet symptom, not just the ones that feel socially acceptable to mention.”
Doctors broadly agreed that closing India’s diagnostic gap will require community-level cognitive screening, training for primary care teams to recognise early warning signs, and sustained public awareness campaigns in regional languages.