According to a study published in the November 6, 2024, online issue of Neurology, the medical journal of the American Academy of Neurology, older people who are sleepy during the day or lose interest in activities due to sleep issues may be more likely to develop a syndrome that can lead to dementia.

People with the syndrome walk slowly and report memory problems, but they do not have a mobility handicap or dementia. Motoric cognitive risk syndrome is a condition that can develop before dementia.

What The Study Found?

The study found that people with excessive daytime sleepiness and a lack of enthusiasm to get things done were more likely to develop the syndrome than people without those sleep-related issues. The study does not prove that these sleep-related issues cause the syndrome, it only shows an association.

“Our findings emphasize the need for screening for sleep issues,” said study author Victoire Leroy, MD, PhD, of Albert Einstein College of Medicine in the Bronx, New York. “There’s potential that people could get help with their sleep issues and prevent cognitive decline later in life.”

How Was It Conducted?

The study included 445 participants, with an average age of 76, who did not have dementia. Participants completed sleep surveys at the beginning of the trial. They were queried about memory problems, and their walking pace was measured on a treadmill at the beginning of the study and then once a year for the next three years.

The sleep assessment included questions about how frequently people had difficulties sleeping because they woke up in the middle of the night, couldn't fall asleep within 30 minutes, or felt too hot or cold, as well as whether they used sleep aids. The question to assess excessive daytime drowsiness asks how frequently people have had problems remaining awake when driving, eating meals, or were engaged in any other activity.

The Findings

In total, 177 participants fit the category of bad sleepers, whereas 268 satisfied the definition of good sleepers.

At the outset of the trial, 42 participants had motoric cognitive risk syndrome. Throughout the trial, 36 more persons got the condition.

35.5% of patients who experienced extreme daytime sleepiness and a lack of enthusiasm developed the syndrome, compared to 6.7% who did not. After accounting for other factors that could influence the risk of the syndrome, such as age, depression, and other health conditions, researchers discovered that people with excessive daytime sleepiness and a lack of enthusiasm were more than three times more likely to develop the syndrome than those who did not have those sleep-related issues.

“More research needs to be done to look at the relationship between sleep issues and cognitive decline and the role played by motoric cognitive risk syndrome,” Leroy said. “We also need studies to explain the mechanisms that link these sleep disturbances to motoric cognitive risk syndrome and cognitive decline.”

A limitation of the study is that participants reported their own sleep information, so they may not have remembered everything accurately.

The study was supported by the National Institute on Aging.

An Alzheimer’s patient may vividly remember their wedding day from 40 years ago, remember the house they grew up in or sing a song they learned in childhood, but still struggle to remember what they ate for breakfast or a question they were asked just an hour ago.

So if Alzheimer’s is a memory loss disease, why do some old memories appear to remain intact while recent ones disappear so quickly?

According to leading experts, the answer lies in the way different memories are formed, stored and retrieved in the brain. It is also in the fact that Alzheimer’s does not damage every memory system at the same speed. This means that the ability to form and retain new memories can become impaired before older memories are affected.

“In Alzheimer’s, memory loss does not always happen evenly. The brain regions responsible for forming and storing new memories, particularly the hippocampus and surrounding areas, are often affected early,” Dr K K Jindal, Director, Neurology, CK Birla Hospital, Delhi, told HealthandMe.

Recent Memories Disappear First

A person with Alzheimer's disease may remember a marriage, childhood home or an event from 40 years ago, but not remember a meal or conversation from an hour earlier. To understand this, it helps to look at what happens when a new memory is formed.

Dr Praveen Gupta, Chairman, Marengo Asia International Institute for Neuro and Spine, Marengo Asia Hospitals, Gurugram, told HealthandMe, “The memories that Alzheimer’s erodes do not deteriorate at equal rates. One of the first brain functions to be compromised is the creation of new memories. This is because the older memories have enough time to spread their representations in the brain while the newer memories rely on memory circuitry that is very vulnerable.”

Dr Saurav Aggarwal, Consultant, Neurology, Fortis Hospital, Ludhiana, explained the process to HealthandMe through the concept of memory consolidation. He said when a person experiences something new, the memory initially depends heavily on the hippocampal network.

Dr Aggarwal said, “Old memories go through consolidation, where the brain spreads a memory across the cortex, its outer layer, including the temporal and frontal lobes. Years of retelling strengthen those links.”

By contrast, new memories remain heavily dependent on the hippocampal network. “Alzheimer's damages the hippocampus first, so the brain fails to consolidate new information, such as a memory from the morning or a few hours ago, causing it to fade” Dr Aggarwal says.

Older memories have therefore had years, sometimes decades, to become more represented and strengthened through repetition and recall. New memories do not have that advantage.

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The Hippocampus Is More Than The Brain's Memory Bank

The hippocampus is not just a storage box for memories. It plays a crucial role in organising and absorbing new experiences. Dr Aggarwal describes it as a “sorting desk”.

He says, “The hippocampus works like a sorting desk. It takes in new experiences, a step called encoding, and passes them to the cortex for storage, meaning that proper memories cannot be formed if the hippocampus is damaged.”

The hippocampus is particularly vulnerable in Alzheimer’s disease. According to Dr Aggarwal, two abnormal proteins are central to the disease process.

“Two abnormal proteins drive this damage. Amyloid forms plaques between neurons, and tau twists into tangles inside them,” Dr Aggarwal says. “Tangles appear first in the entorhinal cortex, the hippocampus's gateway. They spread inward and, with amyloid plaques, damage the connections between neurons (synapses).”

Dr Steve Paul Manjaly, Geriatric Medicine, Apollo Hospitals, Bangalore, told HealthandMe that the hippocampus has a high level of synaptic transmission, which makes it particularly vulnerable to toxic processes linked with Alzheimer’s disease.

He explains, “The hippocampus is the seat of memory and has high synaptic transmissions, making it prone to toxicity,” he says. “Also the pathology is such that the affect the networking pathways that affect the hippocampus majorly.”

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All Memories Are Different

One important misconception about Alzheimer’s is that there is one single type of memory that simply gets weaker over time. In reality, the brain uses several memory systems, and they can be affected at different stages.

“There is no single memory system; the three different types of memory systems are episodic memory, semantic memory, and procedural memory,” says Dr Gupta.

Episodic memory refers to personal experiences. For example, what happened yesterday, where a person went, or what they discussed during a particular conversation. This is affected earlier.

Semantic memory involves facts, information, words and their meanings. “Semantic memory is about names. E.g Delhi is the capital of India. This is affected much later in Alz,” Dr Manjaly explains.

Procedural memory is the memory of how to perform learned skills. “Procedural memory is about how something was learned. E. G driving a cycle etc. This is affected later in the disease,” he says. This is why someone with Alzheimer’s may forget what they had for lunch but still be able to tie their shoelaces or perform a familiar skill.

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Why Can A Patient Sing An Old Song But Forget A Person's Name?

One of the most striking and fascinating examples of preserved memory in Alzheimer’s is music. Families of people with dementia often notice that a loved one who struggles to remember names or recent conversations may still be able to sing an old song almost perfectly.

Songs are encoded through more than their words. Rhythm, melody, repetition, emotion and long-established associations all contribute to how they are represented in the brain.

“The various types of memories involve different neural networks,” says Dr Gupta. “Songs we know are not just about words; songs have associations with rhythm, emotions, repetition, and neural links that have been created since ages.”

Dr Aggarwal notes that procedural skills involve structures such as the basal ganglia and cerebellum, which tend to be affected later in Alzheimer’s disease.

Musical processing also involves several networks beyond the hippocampus, some of which may remain relatively preserved. This helps explain why familiar routines, songs and well-practised skills can sometimes survive long after the ability to form new memories has deteriorated.

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When Is Forgetfulness More Than Normal Ageing?

Forgetting sometimes is not, by itself, evidence of Alzheimer’s disease. With normal ageing, people may take longer to retrieve a name, need more time to learn something new or occasionally forget something, and remember it later. The more important warning signs are progression, frequency and impact on everyday functioning.

Dr. Gupta explains, “What matters most is not that they are forgetting but the frequency with which it occurs, that it is becoming progressively more problematic, and that it starts to interfere with daily functioning.”

According to the experts, warning signs may include:

• Repeatedly asking the same question within a short period
• Forgetting conversations or events that happened recently
• Getting disoriented in familiar places
• Misplacing objects and not being able to retrace one's steps
• Struggling with familiar recipes
• Having difficulty managing finances or medications
• Developing problems with words or understanding conversations
• Showing poorer judgement or decision-making
• Becoming increasingly dependent on family members for tasks previously handled independently

How Do Doctors Determine Whether Memory Loss Is Due To Alzheimer’s?

According to the doctors, Alzheimer’s diagnosis begins with a detailed history, including when the symptoms started, how they have progressed and how they affect daily functioning.

Information from family members can be particularly important because a person experiencing memory impairment may not recognise the extent of the changes.

“Now, the diagnosis of Alzheimer's is not just about memory tests,” says Dr Gupta. “We utilize a comprehensive assessment along with high-tech investigation methods like serum markers and PET scanning to find out the presence of biological markers of Alzheimer's disease.”

Besides memory loss, several medical conditions can produce symptoms that resemble dementia. Vitamin B12 deficiency and thyroid disorders can contribute to cognitive problems and need to be considered.

Experts say that blood tests can help identify such reversible contributors, while an MRI can look for strokes and patterns of brain shrinkage.

“MRI scans and pet scans can help narrow it down further and help sometimes in ruling out other causes of cognitive impairment,” Dr Manjaly says. “Thyroid and vitamin b12 deficiencies are also conditions that may mimic dementia.”

Modern diagnosis can also go beyond symptoms and structural imaging. Dr Aggarwal says amyloid PET imaging and cerebrospinal fluid testing can provide additional evidence of Alzheimer’s pathology by detecting abnormal protein changes associated with the disease. The exact combination of tests depends on the individual patient and overall clinical situation.

Unlike most serious medical conditions, where outcomes depend almost entirely on what happens inside a hospital, cardiac arrest is different in one important respect: the person with the greatest power to change what happens next is almost never a doctor. It is whoever is standing closest. The heart can be restarted. Brain damage can be prevented.

India records more than 700,000 cardiac arrest deaths each year. Across South Asia alone, an estimated 5.5 million cardiac arrests occur annually. What separates a death from a recovery is not the sophistication of the care that eventually arrives. It is what any individual knows to do in the minutes before it does.

Not a Heart Attack. Something Faster

Sudden cardiac arrest is frequently confused with a heart attack, but the two are different events. A heart attack occurs when a blocked artery cuts off blood supply to the heart muscle. Cardiac arrest is categorically different: the heart stops beating entirely, and with it, all circulation to the brain and body ceases. A person can have a heart attack and still have a pulse.

In cardiac arrest, there is none. Every minute without CPR or defibrillation reduces the chance of survival by roughly 10 to 12 percent. In India's major cities, an ambulance takes between 15 and 20 minutes to arrive; in rural areas, over 60 minutes. These numbers place the first line of response where it has always been: with whoever is already in the room.

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India's Distinct Risk Profile

The epidemiological picture in India has a distinctly local character. Data from South India show that the average cardiac arrest victim is 48 years old, predominantly male, and often without any prior diagnosis of heart disease. Lifestyle factors including physical inactivity, smoking, and alcohol consumption are consistent contributors, particularly among younger patients.

Perhaps most significant, 41 percent of autopsied patients with confirmed cardiac muscle damage showed no severe arterial blockage. Standard cardiovascular risk screening, designed primarily to detect blocked arteries, may therefore be missing a meaningful portion of those most at risk in India's population.

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The Most Solvable Gap

The most immediate opportunity lies not inside the hospital but in the space between a collapse and an ambulance. Only 1.3 to 9.8 percent of bystanders in India attempt CPR during a cardiac emergency, and fewer than 15 percent of urban Indians have received any formal training. These figures are the primary reason India's survival rate for out-of-hospital cardiac arrest sits below 2 to 3 percent.

CPR requires no equipment and no medical degree. Steady chest compressions from anyone nearby can sustain blood flow to the brain until professional help arrives. Schools, workplaces, residential societies, and places of worship each represent a real and scalable training opportunity.

Where public health frameworks establish the groundwork, private sector partners have the infrastructure to extend that reach across the country. This is precisely the kind of challenge that structured public-private collaboration is designed to meet.

The Opportunity Ahead

Cardiac arrest incidence in India is projected to rise by 30 percent over the next decade as diabetes and hypertension rates continue to climb. That is a known trajectory, which means it is also a manageable one. AI tools now predict cardiac arrest up to 24 hours in advance using routine ECG data, and these technologies are already being developed with India's specific healthcare constraints in mind. What those tools ultimately do, however, is buy time.

The biological window of the first few minutes will always depend on whoever first responds to the patient. The country's greatest lever is not a device or a drug. It is an informed bystander who takes immediate action.

The word dialysis can stir up anxiety and fear for many. It's often seen as a sign of life never being the same again or it's considered a "last resort. I see many patients every day who assume that dialysis is their only choice. In fact, dialysis is a life saving therapy which takes over some of the functions of the kidneys which are unable to perform them properly. Knowing about the dialysis that it will require in the future, how dialysis works, and whether it can be delayed or avoided will help you avoid unnecessary anxiety and make informed decisions.

The kidneys are incredible organs that constantly filter out excessive fluid, toxins and waste products from the blood and help to keep the body's electrolyte balance, blood pressure and red blood cell production in check. As kidney function decreases substantially, these functions are disturbed and allow the build-up of harmful substances in the body. Dialysis mimics some of these filtering functions, and works to keep a patient healthy when their kidneys no longer do so.

Dialysis is not started just because of a laboratory value as is often thought. Many people think that dialysis is meant as a next step when kidney function drops below a certain percentage. But it depends on the results of kidney function tests, symptoms, and fluid overload, as well as electrolyte problems and patient clinical condition. Some people with an advanced stage of CKD may be able to do just fine and have no indication of needing dialysis for months; others might need urgent dialysis in case their kidneys are failing very quickly or they develop very serious complications that put their life at risk.

The most frequent indications for initiation of dialysis are: very high potassium levels, symptoms of fluid overload such as breathlessness, nausea and vomiting caused by accumulation of toxins, confusion, extreme tiredness, loss of appetite or condition where the dialysis cannot be managed with medication alone. In these cases, dialysis is not a choice but a lifesaver.

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How The Two Main Types Of Dialysis Work?

There are two types of dialysis: In hemodialysis, the blood is pumped through a dialysis machine that removes waste products and excess fluid from the blood and returns the cleaned blood to the body. It's typically done three times a week in a dialysis center, but a few patients have home dialysis as an option. The process is usually a four hour per session process.

Another option is peritoneal dialysis, which involves using the patient's own abdominal lining to filter the blood. The abdominal cavity is filled with a cleansing solution, waste products and excess fluid are carried in to the solution through a permanent catheter, and the solution is drained. This treatment is often available at home and can provide a patient with more flexibility and independence. Medical suitability, lifestyle, home support and patient preference will all influence the decision on whether to undergo hemodialysis or PD.

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Can Kidney Disease Be Slowed Or Dialysis Delayed?

A major concern patients have is if they can avoid dialysis altogether. The answer is dependent on the cause of kidney disease and the timeliness of diagnosis. However, in many cases, the kidney disease is a progressive condition over many years and there is a chance to slow the progression of the disease with appropriate medical treatment and lifestyle changes. Well managed diabetes and hypertension, avoiding unnecessary pain killers like non-steroidal anti-inflammatory drugs (NSAIDs), healthy weight, salt reduction in the diet, smoking cessation and frequent visits to a nephrologist can have a huge impact on slowing the deterioration of the kidneys.

An early diagnosis is very important. Sadly, a major drawback about chronic kidney disease is that most of the time, people don't have any symptoms in the initial stages of the disease. People are often diagnosed when they have significant kidney damage already. Routine screening is particularly important for those with diabetes, hypertension, cardiovascular disease, obesity and a family history of kidney disease. A number of simple blood and urine tests can detect kidney disease before symptoms occur.

Acute Kidney Injury And Chronic Kidney Disease Are Different

It is also crucial to differentiate acute kidney injury from chronic kidney disease. Acute kidney injury can occur if the kidneys become severely dehydrated, if the body be