India

In clinical practice, a variety of cognitive tests are used, including the Mini-Mental State Examination (MMSE) and its indian adapted version The Hindi Mental State Examination, as well as the Montreal Cognitive Assessment (MoCA), the Kolkata cognitive screening, and the Addenbrooke’s cognitive examination-III. However, their effectiveness is frequently undermined by India’s vast linguistic, cultural, and educational heterogeneity. Many of these tests carry a significant educational bias, where performance is heavily influenced by literacy and formal schooling. These challenges have led to the Addenbrooke’s Cognitive Examination-III (ACE-III) being adapted and validated for use in seven major Indian languages. Additionally, the Indian Council of Medical Research has developed the Neurocognitive Toolbox (ICMR-NCTB), also known as the Multilingual Dementia Research and Assessment (MUDRA) Toolbox. The ICMR-NCTB has been standardised across 5 languages (Hindi, Bengali, Telugu, Kannada, and Malayalam).

Basic structural imaging, such as CT and MRI scans, is available in India. However, access is influenced by geographic and socioeconomic factors, with services more readily available in private hospitals and diagnostic centres in urban areas. The availability of more advanced imaging technologies like PET is almost limited to a handful of national research institutions, such as NIMHANS in Bangalore and AIIMS in Delhi, and a few private hospital chains. The MRI scans are also encouraged to get done from private set ups recommended by doctors and are affordable.

There is no provision for routine APOE testing within the public healthcare system, however, genetic testing is offered by private diagnostic laboratories and specialised genetic testing companies. The Society for Indian Academy of Medical Genetics has issued a position statement discouraging direct-to-consumer genetic testing for any medical purpose due to the serious risks involved, including the lack of professional guidance, questionable clinical validity of some tests, and the potential for causing immense psychological distress and anxiety when results are delivered without proper pre- and post-test genetic counseling.

CSF biomarker testing for Alzheimer’s disease is not a routine clinical procedure, but is available in research settings. Similarly, blood-based biomarker testing is currently conducted only in research contexts.

Government institutions like the National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru and the All India Institute of Medical Sciences (AIIMS) in Delhi operate specialised, multidisciplinary memory clinics. The government’s National Programme for Health Care of the Elderly aims to create a broader network by establishing geriatric units in district hospitals and weekly clinics at the primary care level. However, the effectiveness of this nationwide framework is severely hampered by a critical shortage of trained specialists, particularly geriatricians and neurologists.

Beyond these national institutes, memory clinics are beginning to emerge in the private sector and some regional hospitals. The state of Kerala has several such facilities. Private hospitals like PRS Hospital in Trivandrum, Rajagiri Hospital in Kochi, and KMC Hospital in Chengannur all run memory clinics, typically as a joint effort between their neurology and psychology departments.

A number of private companies have established high-quality, specialised dementia care homes, but these facilities are almost exclusively located in major metropolitan areas. Athulya Senior Care operates ten facilities across Chennai, Bengaluru, Kochi, Coimbatore, and Hyderabad. They offer dedicated Mind & Memory Care programs in dementia-friendly environments with trained staff, personalised care plans, and therapeutic activities. Jagruti Dementia Care Centre has centres in Mumbai (Malad), Pune, Navi Mumbai, Ahmedabad, Gurgaon, Delhi (Noida), and Chennai. They provide a spectrum of services including long-term residential care, day care, and respite care. Epoch Elder Care has facilities in Gurgaon, Delhi NCR, and Pune. They specialise in assisted living and palliative care for elders, including those with dementia. Heritage Eldercare provides assisted living facilities in Hyderabad and Chennai, offering specialised Alzheimer’s and dementia care, as well as day care services.

ARDSI is also running Full time Dementia Care homes and Dementia Day care Centers in Kerala and across the country through its chapters.

Formal financial safety nets offer very limited relief for the specific needs of dementia treatment. The government’s flagship health scheme, Ayushman Bharat (PM-JAY), is designed to cover hospitalisation costs and explicitly excludes outpatient care and long-term custodial services, which constitute the bulk of dementia-related expenses. While the scheme was recently expanded to include Alzheimer’s disease, this coverage applies to acute complications requiring hospitalisation, not the continuous care needed.

As part of the broader National Action Plan for Welfare of Senior Citizens, Integrated Programme for Senior Citizens provides crucial financial grants to NGOs and other implementing agencies to run and maintain Senior Citizens’ Homes. Rather than providing a direct insurance benefit to patients for their long-term care needs, the government subsidises the supply side – the care facilities run by NGOs. A family’s access to affordable, quality care is entirely dependent on the presence, capacity, and funding of such an NGO in their specific locality. The most effective form of government support for long-term Alzheimer’s disease care in India is therefore mostly indirect. Thus, the financial journey is overwhelmingly a private one, with the vast majority of costs falling directly on the individual and their family.

Direct financial aid from the central government is minimal and difficult to access. For example, the Indira Gandhi National Disability Pension Scheme offers 300-500 rupees per month but requires a disability certification of 80% or more and Below Poverty Line status, excluding most families. A pioneering initiative is the Karnataka state government’s Carer’s Allowance, which provides 1,000 rupees per month directly to caregivers, though dementia is not yet explicitly listed as a covered condition.

In the absence of a robust public system, non-governmental organisations provide national helplines, professional counseling, caregiver support groups, day care centres, and training programs for both family and professional caregivers.

In general, families have limited access to long-term care and psychosocial support services for people living with Alzheimer’s disease, mostly available in large cities and often requiring out-of-pocket payments. It is estimated that the care provided by family caregivers is nearly 10 times greater than that provided by healthcare personnel, such as nurses, social workers, physicians, and psychologists.

Despite the absence of a formal government strategy, the Alzheimer’s Disease and Related Disorders Society of India published a comprehensive Dementia India Strategy Report in 2018. This report serves as a detailed roadmap for a national policy, covering everything from awareness and early diagnosis to caregiver support and research. ARDSI and other advocacy groups are actively using this report to lobby the government for the adoption of a national dementia strategy, and these efforts have influenced some state-level initiatives and an increased focus on integrating dementia care into existing health frameworks.

Kerala was the first state to adopt a dementia state plan, followed by Karnataka. In Maharashtra, the government has introduced targeted services, with Memory Clinics established across six districts to strengthen diagnostic capacity. The State Dementia Action Plan in India Developed in collaboration with key stakeholders including the National Institute of Mental Health and Neurosciences (NIMHANS), the Dementia India Alliance, and the state’s Department of Health and Family Welfare, the plan focuses on early diagnosis, awareness campaigns, caregiver training, and community-based care.

All India Institute of Medical Sciences (AIIMS) researchers have developed an artificial intelligence (AI) learning model to predict the prevalence rate of dementia in India.

The Bose Institute, with support from the Department of Science and Technology (DST), is pioneering the scientific validation of traditional Ayurvedic medicine for Alzheimer’s disease. A key study focused on the Ayurvedic formulation Lasunadya Ghrita, demonstrating at a molecular level that its extract can inhibit the formation of toxic amyloid plaques and break down existing ones.