Alzheimer’s Disease in Nepal
Alzheimer’s disease is a degenerative brain disorder that is progressive and irreversible, and the leading cause of dementia worldwide. It slowly and progressively destroys memory (more pronouncedly, the recent memories than long-term memory in its initial phase), the ability to find words for fluent communication, confusion, reasoning, and thinking ability, changes in mood with often increased anxiety and irritability, and the capacity to perform even basic tasks. As the disease progresses, individuals may experience severe memory loss to the extent that they are not even able to recognize their loved ones.
According to the World Health Organization (WHO), dementia, including Alzheimer’s, is currently the seventh leading cause of death worldwide and one of the major causes of disability and dependency among older adults1. Although more commonly seen in older adults, Alzheimer’s is not a natural or inevitable part of aging. Instead, it is a distinct disease marked by abnormal changes in the brain, such as the build-up of harmful protein deposits, such as Tau tangles, and the accumulation of excessive amounts of beta-amyloid proteins. It can affect people mostly of older age (>65), but also people as young as their 40s and 50s.
The Centers for Disease Control and Prevention (CDC) highlights that Alzheimer’s disease is not a normal part of aging but a distinct medical condition that requires proper diagnosis and management2.
Globally, Alzheimer’s disease affects millions of people, and its prevalence is rising due to increased life expectancy. In Nepal, as in other low- and middle-income countries (LMIC), the condition is under-recognized, often misunderstood, and commonly mistaken as just “old age forgetfulness.” Lack of awareness, combined with cultural and societal factors, leads to late diagnosis, limited access to specialized care, and a considerable emotional and financial burden on families.
In the last couple of years, Nepal has seen a sharp rise in the life expectancies of people, and the growth rate of individuals over 60, considered old age in Nepal, is higher than the total population growth rate. There are 2.97 million older people in Nepal as of the 2021 census, which is a 38.2% increase compared to the previous census of 2011. The proportion of the older population reached 10.21% of the total population of Nepal3,4. In Nepal, where the senior population is steadily growing, Alzheimer’s disease presents a significant but largely overlooked public health challenge.
In most cases, the early cognitive decline is taken as a normal part of aging, without taking the person to a healthcare provider for a diagnosis, until the condition becomes severe. In a country like Nepal, recognizing early signs and seeking medical advice can significantly improve the quality of life for those affected.
Traditionally, caregiving responsibilities are borne by family members, which, in the absence of adequate resources and support, can become overwhelming. These challenges underscore the need for greater awareness, early intervention, and preventive measures to help address this condition effectively.
Early recognition of signs and symptoms of Alzheimer’s disease is crucial in Nepal to prevent early progression and implement measures that can slow down the progression of the illness. Advocacy to raise awareness, promote understanding, and provide practical guidance for recognizing, managing, and preventing this debilitating condition is the key in a country such as Nepal. Through better knowledge and proactive steps, individuals and families can identify and take concrete actions in the management of Alzheimer’s disease in Nepal.
The signs and symptoms of Alzheimer’s disease
It has been found that the two main causes so far identified that are behind Alzheimer’s disease, amyloid plaques and tau tangles, start at least a decade or more before the symptoms start appearing.
Gradually over the years, either the person himself or his close relatives start identifying that something is wrong. The first noticeable issues come in the form of memory loss, mainly memory of recently occurring events. loosing track of dates, loss of spontaneity in daily activities, taking longer time to complete tasks, and communication difficulties, mainly not finding the right word to complete the sentence, start appearing. These initial symptoms are termed Mild Cognitive Impairment (MCI).
Mild Cognitive Impairment (MCI) holds significant importance in the diagnosis and understanding of dementia, including Alzheimer’s disease. MCI is considered an intermediate stage between the normal cognitive decline associated with aging and more severe cognitive impairments such as dementia. This stage allows clinicians and researchers to identify individuals at a higher risk of progressing to dementia, particularly Alzheimer’s, offering a critical window for intervention. The early detection of MCI enables the development and application of preventive strategies, lifestyle modifications, and, when available, treatment options to potentially delay or mitigate the progression of cognitive decline. Additionally, studying MCI provides insights into the underlying mechanisms of Alzheimer’s disease, enhancing our understanding of its onset and progression. By recognizing MCI as a distinct clinical condition, healthcare professionals can promote better monitoring and management, paving the way for improved outcomes in dementia care and research.
Mild cognitive impairments (MCIs) are followed by increased anxiety and irritability, mood changes, changes in dressing, and reduced daily self-care. Gradually, the person looks perplexed and confused, talks less, withdraws from social activities, has difficulty navigating which were familiar places, loosing track while speaking, and finds it difficult to continue the normal chain of thoughts, and may start appearing lost. The person may find difficulty recognizing familiar people or places by name. As the disease progresses, the person becomes unaware of time and place, expresses irritation and anger, and may show inappropriate behaviors such as undressing at inappropriate times or places, using vulgar language, wandering, and not finding how to return. At this stage, the person becomes more and more symptomatic and may require constant vigilance and care from another person.
Gradually, the person becomes completely isolated, unable to communicate, and without awareness of the surroundings. A lack of interest in eating, difficulty swallowing, and loss of bowel and bladder control lead to general health decline and being completely bedbound and unable to carry out anything without help.
A common reason for death in people with Alzheimer’s disease is aspiration pneumonia, which occurs because of the difficulty swallowing, and food and water end up going into the lungs.
Syndromes linked to Dementia and Alzheimer’s disease
Alzheimer’s disease can have various symptoms, including sundowning syndrome, which is a term in which individuals experience increased confusion, anxiety, and irritation at around the time the sun sets (late afternoon to evening). It is a common occurrence since, as the brightness decreases, the person finds it more difficult to be in control of the surroundings.
Another syndrome that is associated with dementia and Alzheimer’s disease is confabulation. It’s a phenomenon often observed in individuals with dementia or other memory-related conditions. Confabulation occurs when someone fills in gaps in their memory with fabricated, distorted, or misinterpreted information, often based on their real past experiences. These aren’t intentional lies but rather the brain’s attempt to make sense of incomplete memories. It’s a fascinating example of how the mind works to maintain coherence, even when the memory fails. This happens unconsciously and here is an example:
“An elderly woman with Alzheimer’s disease is asked what she had for breakfast earlier that day. She responds confidently, “I had pancakes and orange juice with my family at our old house.” In reality, she ate oatmeal alone at the care facility where she now resides.
The woman isn’t lying—her brain is filling in gaps in her memory with details from a cherished past experience. Her response blends fragments of her real memories and fabrications, creating a plausible but inaccurate narrative.”
Risk Factors
Alzheimer’s disease has no definitive cure. Early detection and management can lead to slower progression of the disease. There are, however, certain risk and preventive factors that are important to know. “Since no definitive cause has been identified yet, although genetic, lifestyle, and environmental factors are believed to play a role in the emergence of Alzheimer’s disease, ongoing research aims to better understand how these elements interact and contribute to its development, offering hope for improved prevention and treatment strategies in the future.
Alzheimer’s Disease International lists 14 modifiable risk/preventive factors on its website, an infographic from which is presented below5.
References
- World Health Organization. Dementia Fact Sheet. Available from: https://www.who.int/en/news-room/fact-sheets/detail/dementia
- Centers for Disease Control and Prevention. Alzheimer’s Disease and Dementia. Available from: Alzeimer’s Disease and Dementia
- Chalise, H. (2023) Aging Trend and Situation in Nepal. Advances in Aging Research, 12, 39-48. doi: 10.4236/aar.2023.123003.
- Chalise, H.N. and Brightman, J. (2006) Aging Trend: Population Aging in Nepal. Geriatrics & Gerontology International, 6, 199-204.
https://doi.org/10.1111/j.1447-0594.2006.00347.x - Alzheimer’s Disease International. Risk factors and risk reduction. Accessed on 27th April, 2025 from: Risk factors and risk reduction | Alzheimer’s Disease International (ADI)