Aging, dementia, and care models: Global perspectives with insights from India

Dementia is an escalating global public health challenge, with India poised to experience one of the largest absolute increases in cases due to rapid demographic aging, lifestyle transitions, and health system constraints. This review critically examines the epidemiology, barriers to diagnosis and care, economic and social impacts, and proposes an integrated dementia care framework for India. While dementia has traditionally been viewed through a social and clinical lens, emerging evidence highlights the biological complexity underlying its onset and progression. The interplay of hallmark mechanisms of aging-including amyloid-β and tau pathology, mitochondrial dysfunction, neuroinflammation, and loss of proteostasis-forms the foundation of dementia pathogenesis. Additionally, systemic factors such as metabolic dysregulation, gut-brain axis disruption, and chronic inflammation further amplify neurodegeneration. Sleep deprivation, a modifiable risk factor, accelerates amyloid deposition, brain atrophy, and cognitive decline, while comorbid conditions like diabetes, cardiovascular disease, and depression compound vulnerability. Lifestyle interventions, including physical activity, healthy diet and sleep optimization, alongside novel therapeutic avenues such as psychedelic-assisted interventions, offer promising strategies for prevention and care. Drawing insights from global models, we propose a tiered network of dementia centers in India, integrating mechanistic knowledge with community-based care, early detection, caregiver support, and culturally tailored interventions. Further, it is an opportunity for private Indian Hospitals such as Apollo Research Academy and others to develop Dementia Centers in India. These approaches emphasize the prevention across the life course, equity in access, and sustainability in implementation. A dementia-inclusive strategy for India must align biological insights with policy innovation to mitigate the impending burden and safeguard cognitive health in an aging population.