Features

doi:10.1038/nindia.2013.18 Published online 1 February 2013

Neurological disability: a brewing epidemic

Biplab Das

India might be on the brink of a new epidemic triggered by rising cases of neurological disability, a new study claims. The study has identified three neurological disabilities — traumatic brain injury from road traffic accidents, dementia and stroke, which affect millions of Indians.

"India is generating approximately 1.5–1.7 million neurologically disabled people every year due to traumatic brain injury (TBI) alone," says Abhijit Das, a co-author of the study. The study was undertaken by researchers from US-based Kessler Foundation Research Center, University of Medicine and Dentistry of New Jersey and Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India.

"Traumatic brain injuries are a big contributor to this predicted epidemic. India leads the world in road accident-related deaths," Das told Nature India.

The study claims that India has the highest mortality rates from RTA in the world – accounting for 161,736 RTA deaths in 2010. In the same year, 2.2 million people had TBI due to RTA alone. As RTAs contribute to 60%–70% of all TBIs, this might have led to 3–3.5 million TBI cases in 2010 in India.

TBI also increases the risks of neurological disorders such as Alzheimer's disease (AD). In a recent review, it has been shown that 30% of patients, who die of TBI, have plaques in brain, the telltale sign of AD.

"The second contributor to the emerging epidemic is dementia," Das says. The Indian population is ageing rapidly because of increased life expectancy and declining fertility rates. The proportion of older adults in India is predicted to increase dramatically from 76 million in 2001 to 301 million by 2051, he says.

"By 2050, the number of people with dementia is expected to triple in India, adding at least 1.6 million neurologically disabled persons due to dementia annually," Das warns.

Stroke is the third major contributor to the emerging epidemic. The incidence rate of stroke in India is 145 in 100,000 people with approximately 1.5 million new cases reported in 2010. Stroke results in long-term disability including paralysis, language problems, and other cognitive deficits. In diseases such as stroke, nerve cells are damaged and killed by excessive stimulation by neurotransmitters such as glutamate and similar substances.

The rising rates of TBI, dementia, and stroke will potentially add over 3.5 million people to the disabled population annually, almost equal to the population of a metropolitan city like Nagpur or Lucknow. This is a staggering number: every minute, 7 people will acquire a neurologic disability, amounting to nearly 11,000 every day.

But can India ward off the threat of such an epidemic? "Stroke can be averted provided Indians adopt healthy lifestyles – exercise, quit smoking, and treat hypertension," Das points out. It is also possible to keep dementia at bay. "Exercise is the only way which can protect older people from dementia (Alzheimer's type) as it promotes birth of nerve cells in hippocampus, the seat of memory," he says.

Anupam Gupta from the Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences, Bangalore says dementia and stroke are major contributors to neurological disability across the globe.

With no available drugs or other modalities to curb progressive illnesses such as dementia and post-stroke complications, rehabilitation of such patients is the only effective way to reduce disability and keep them functional, Gupta concludes.


References

  1. Das, A. et al. Neurologic Disability: A Hidden Epidemic for India. Neurology 79, 2146-2147 (2012) | Article | PubMed |
  2. Sivanandam, T. M. et al. Traumatic brain injury: A risk factor for Alzheimer's disease. Neurosci. Biobehav. Rev. 36, 1376-1381 (2012) | Article | PubMed |
  3. Mehta, A. et al. Excitotoxicity: bridge to various triggers in neurodegenerative disorders. Eur. J. Pharmacol. 698, 6-18 (2013) | Article | PubMed |