Headed For A Neuro Nightmare

A new study reveals that 35 lakh Indians will suffer from some form of brain disability every year. Are families equipped to deal with them?

There is a silent epidemic sweeping through India, and our society is ill prepared to deal with it. A recent study has estimated that every year about 35 lakh persons will get afflicted by ‘neurological’ disabilities, that is, physical damage of the brain causing loss of normal functioning. This does not include those born with congenital defects of the brain. 
    
Three major contributing factors creating this epidemic are dementia, stroke and traffic accidents, according to a study done by Abhijit Das and his colleagues at the Kessler Foundation Research Center, US, and K Radhakrishnan of the SCT Institute for Medical Sciences and Technology, Thiruvananthapuram. The study was published in the medical journal Neurology. 
    
Currently, it is estimated that about 37 lakh people suffer from dementia in India, and about 3-5 lakh are being added every year. Women, because of their higher life expectancy, feature in this statistic more than men. There are about 7.6 crore Indians over the age of 60 at present, that is, 7 per cent of the country’s population. This number is going to shoot up to 30 crore (17 per cent of the population) by 2051 as modern medicine increases life expectancy. Das and his colleagues estimate that by that year, the number of patients will triple with 16 lakh dementia patients added every year. 
    
The annual incidence of stroke in India is about 145 per 100,000 people with about 15 lakh new cases reported in 2010. The rate has increased 10-fold since 1969-70. Das estimates that in 30-40 per cent cases, long -term disability occurs. So, about 4.5 to 6 lakh people will be added to those with neurological disabilities every year due to stroke. “Stroke cases are increasing because of higher risk factors like hypertension and diabetes, linked to changes of lifestyle,” Das told TOI. 
    
Brain injuries caused by road traffic accidents are increasing at break neck speed. In 2011, the National Crime Records Bureau reported 136,834 deaths due to road traffic accidents, up by a staggering 70 per cent since just a decade ago. Das says that in the absence of head counts, the calculation of traumatic brain injuries resulting from road accidents can only be an estimate, that too on the lower side. He computes that 15-17 lakh people with long-term brain disability from traffic accidents are added every year in India. 
    
Putting all this together, we get a chilling statistic of 35 lakh people with brain disability added to the population every year — about 11,000 per day. 
    
Two types of brain-related disabilities have been deliberately left out by Das and his colleagues. One is epilepsy, which afflicts a staggering 1-1.2 crore according to estimates. Three quarters of these are “not getting suitable treatment” according to Das. They suffer from varying degrees of neurologic disability which may aggravate with lack of treatment. 
    
The other is psychiatric disorders. “I believe the demarcation between psychiatric and neurologic becomes arbitrary when you come to disabilities. Depression is seen in up to 40-60 per cent of people suffering from stroke or traumatic brain injury and is equally harmful. Psychological issues are very common in dementia as well (anxiety, psychosis, hallucination) and can be very disruptive for the family,” explains Das. 
    
India has very limited numbers of neurological and mental health facilities (1 bed per 40,000) and a dearth of mental health professionals (fewer than 3 psychiatrists/neurologists per million). So provision of neurologic and mental health care is very limited. Care-givers and attendants are also not trained to deal with such patients. 
    
But the biggest challenge is the family. Most neurological disability patients will finally come home. They may need help with their daily functions, they may suffer from psychological distress like hallucinations or memory loss, and in most cases they are aware of the degeneration or loss of control, at least in the initial stages. Families are not equipped to deal with all this — they may try to behave as if nothing is wrong, or they may treat the brain’s impairment as a fault of the patient. In poorer families, care giving may become minimal as the family has to pay attention to earning. 
    
And the neurologically impaired person will, because of age, depression or medication, develop other diseases or suffer falls, hugely increasing distress. 
    
This epidemic calls for making neurologic disability a public health priority in India and mandates urgent changes in national health policy, says Das. 

Fall Proof 
Tips to prevent falls in the elderly, a big cause of brain injury and fractures:

Physical activity | Lack of regular exercise results in poor muscle tone, decreased strength, and loss of bone mass and flexibility. All contribute to falls and increase severity of injury. So elderly should do more physical activity. 

Be safe | Reach and bend properly, take time to recover balance when getting up, learn the proper way to fall, and learn how to recover after fall. Also, wear proper fitting shoes with low heels or rubber soles. 

Vision correction | Get regular checkups to detect age-related eye diseases like cataract and glaucoma. 

Environmental modification | At least one-third of all falls in the elderly involve environmental hazards in the home, like tripping over objects left on the floor, slippery floors, lack of grab bars for holding etc. 

Medications | Some medications commonly used in elderly (for hypertension, antidepressants etc) can cause dizziness and increase fall risk. Family and doctors should be aware of this symptom and change medicines if necessary. 

Head Count
DEMENTIA | A gradual decline of brain functions like memory, learning, language, comprehension and judgment due to physical changes in the brain in older people. After the age of 65, prevalence doubles every five years. Alzheimer’s is a type of dementia, accounting for up to 75 per cent of dementia cases. 3-5 lakh new patients every year; 16 lakh by 2051 

STROKE | Loss of brain function when blood flow to any part of the brain is stopped by blood clot(s) or a bursting of blood vessels. The patient can suffer from paralysis of one or more body parts, loss of speech and memory, bladder and bowel control problems. 4.5 to 6 lakh cases every year lead to brain disabilities 

ACCIDENT VICTIMS | 70 per cent of road accidents lead to traumatic brain injury, with long term disability in most cases. 15-17 lakh accident victims every year are left with brain disabilities