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In Kolar, a farming district two hours drive from India’s IT hub Bangalore, researchers are enlisting 10,000 residents for a groundbreaking, 10-year study on dementia in rural Indians.
The investigation will track participants’ health and mental acuity for a decade, probing the relationship between physical wellbeing and dementia. The study aims to identify the factors that both raise and lower risk of developing dementia. Led by Vijayalakshmi Ravindranath, chair of the Indian Institute of Science’s Centre for Neuroscience, it will be the first probe of its kind in south Asia.
“Dementia starts two to three decades before the actual presentation of symptoms. We also believe lifestyle factors contribute to dementia,” says Prof Ravindranath.
“I want it to be the Framingham of India,” she adds, referring to the landmark cardiovascular study of residents of the US town of Framingham, which has provided many modern insights into heart disease and its prevention.
There has been little research on dementia in the developing world, where public health concerns typically focus on infectious diseases or reducing infant and maternal mortality.
That constitutes an imbalance that many scientists and public health experts are trying to correct. Two thirds of the world’s dementia sufferers actually reside in low and middle-income countries, according to Alzheimer’s Disease International, a global research and advocacy group. It has set up an international research collective called 10/66 Dementia Research Group. Its name refers to the 66 per cent of dementia sufferers who live in those low and middle income countries and the 10 per cent, or less, of population-based research that has been carried out in those regions.
“We require research to find out the extent of dementia and the care arrangements,” says Dr Amit Dias, a professor at Goa Medical College, and India co-ordinator for the 10/66 Dementia Research Group.
Philanthropic funding for scientific research into the disease itself is also growing in India, where concerns about geriatric care are mounting.
“We never worried about ageing before,” says Prof Ravindranath, but she points out that fewer elderly people live with their adult children. “Because of the joint [or extended] family system, people were shielded from this. But with the social order breaking down, people are thinking about it a lot more.”
In 2014, Kris Gopalakrishnan, one of the co-founders of the Indian IT giant Infoysys, donated $35m to establishment of a new Centre for Brain Research at the IIS in Bangalore. The centre is collaborating with the National Institute of Mental Health and Sciences on the Kolar study. Prof Ravindranath has also received a $11m grant from the Tata Trusts for research into Alzheimer’s disease, particularly to focus on early detection — before obvious symptoms emerge.
Working with mice, her team has already identified one potential bio-marker for early detection of Alzheimer’s. Their findings were published in the Journal of Neuroscience, a peer reviewed journal, in December. They are now planning a study of 600 upper-middle class professionals in Bangalore as part of the project.
Besides studying the progress of the disease, many believe India’s traditional medical system, Ayurveda, might provide clues for how to slow, stop or even reverse Alzheimer’s progress — a goal that has so far eluded Western pharmaceutical companies, despite spending billions of dollars. “If you look at the Alzheimer’s situation, it’s very bleak,” Prof Ravindranath says.
Ten years ago, she began testing traditional Ayurvedic memory-boosting formulas on mice, with no success at first. But then she isolated the root of a plant called Withania somnifera, or Ashwaghandha in Sanskrit.
It turned out that mice treated for 30 days with oral doses of purified Ashwaghandha root showed a sharp reduction in the brain of the amyloid plaque and amyloid protein — conditions that have been strongly associated with Alzheimer’s — and showed improved mental performance.
“The mouse that was forgetting and had tons of amyloid — it completely reversed it,” the scientist says.
Taking that initial research forward has been challenging.
Prof Ravindranath has worked to purify a large batch of the plant for toxicology tests, but her institute lacks the experience or financial muscle for serious drug development. However, she says she will keep pushing her research forward.
“We need to partner with somebody now,” she says. “When we are at the stage that nothing that we think will work has worked, we should explore new avenues. And one of those is leveraging ancient knowledge. But unless we base it on strong scientific foundations, it won’t gain acceptability.”