India’s Alzheimer’s bottleneck is diagnosis, not drug delivery

On World Alzheimer’s Day, neurosurgeon Dr. Mohana Rao Patibandla said India’s biggest Alzheimer’s gap is not access to newer anti-amyloid drugs, but access to early diagnosis. He said most Indian patients with dementia are never formally identified in time to benefit from emerging therapies.

Why it matters: - India is facing a fast-growing dementia burden, but many patients never reach a formal diagnosis. - That means newer Alzheimer’s therapies may have limited impact unless more families and primary care doctors recognize symptoms earlier. - Dr. Rao argues the bigger public health gap is not treatment delivery, but building a diagnostic pathway.

What happened: - On World Alzheimer’s Day, neurosurgeons in India highlighted the disconnect between advances in Alzheimer’s drug delivery in the U.S. and delayed diagnosis in India. - The discussion centered on lecanemab, the anti-amyloid Alzheimer’s drug marketed as Leqembi, which received U.S. FDA approval in 2025 in a subcutaneous autoinjector formulation. - A once-weekly starting-dose option for lecanemab is now under review. - Dr. Mohana Rao Patibandla, founder and director of Dr. Rao’s Hospital – International Institute of Neurosciences (IIN) in Guntur, said earlier detection is the missing piece in India.

The details: - Nationwide estimates published in Alzheimer's & Dementia put the number of Indians aged 60 and above living with dementia at 8.8 million. - Alzheimer’s disease accounts for roughly 70% to 75% of those cases. - India’s population of adults over 60 is currently around 138 million and is expected to nearly reach 194 million within five years. - World Health Organization estimates put the global dementia population at more than 55 million. - WHO projects that number will nearly double by 2050 as populations age. - Low- and middle-income countries, including India, are expected to carry a growing share of that burden. - Dr. Rao said anti-amyloid therapies like lecanemab work best in the earliest stages, before major cognitive decline. - He said families in India often dismiss memory loss in older adults as normal ageing instead of seeking medical evaluation. - Dr. Rao said many patients arrive only after the disease has moved beyond the stage where early intervention would matter most. - He said a weekly injection can be a meaningful convenience improvement in cities with memory clinics or neurologists. - He said the larger barrier for many people outside major cities is whether any diagnostic pathway exists at all. - Dr. Rao flagged warning signs that should prompt evaluation: trouble recalling recent conversations or events, repeated questions in a short span, disorientation in familiar places, and visible changes in judgment or personality. - He said those signs usually appear at home before anyone thinks to see a doctor.

Between the lines: - The issue is not only medical access. It is also awareness, geography and care pathways. - If India expands diagnosis and referral, more patients could become eligible for future disease-modifying Alzheimer’s treatments. - Without earlier recognition, even easier-to-administer drugs may reach too few patients to change outcomes at scale.

What’s next: - Dr. Rao said closing the recognition gap, not just improving the drugs, is what will matter most for Indian families. - IIN said its neuroscience program includes cognitive and neurological evaluation alongside its work in cerebrovascular, skull base, pediatric and oncologic neurosurgery. - Dr. Rao’s Hospital – International Institute of Neurosciences said it continues to offer minimally invasive skull base surgery, endovascular surgery, stereotactic radiosurgery, neuro-oncology and pediatric neurosurgery. - The institute said it also uses intraoperative neurophysiological monitoring, functional brain mapping, neuronavigation, a biplane catheterisation laboratory, a hybrid operation theatre and intraoperative CT imaging.

The bottom line: - India’s Alzheimer’s challenge is less about a lack of advanced drugs than a lack of timely diagnosis, especially outside major cities.