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.

Breast cancer is generally considered to be a problem of old age. In India, however, breast cancer is usually diagnosed in women who are in their 40s and 50s, a decade before the average age group in several other parts of the world. While this difference has clinical significance, the reasons behind it are varied and cannot be pinned down to any one biological or genetic cause.

Reproductive and lifestyle differences

Age, hormones, heredity, reproductive history and environment play roles in determining the risk of breast cancer. Historically, differences in age at first birth, number of pregnancies and breastfeeding period could have been responsible for the variance seen in risk levels across populations. Presently, the changing pattern of reproduction, late age of first pregnancy, lower number of births and less breastfeeding among certain groups of Indians could affect the risk of breast cancer.

Other changes include dietary, physical activity and body weight trends due to urbanization. Being overweight, especially postmenopausal, and excessive alcohol intake are known risk factors for breast cancer. But this alone does not account for the difference in age profile of breast cancer in India.

Genetic susceptibility is another factor which needs to be taken into account. Mutations in the inherited genes, including BRCA1 and BRCA2, may lead to the increased risk of development of breast cancer in young women. Nonetheless, there is no sufficient information to suggest that a particular genetic background specific for the Indian population contributes to this difference. More research in the field of genomics is needed.

Another thing to take into account is that the young age of the patients does not mean that the breast cancer occurs more frequently in India compared to other countries. Higher age-standardized incidence rates have been observed in Western countries due to reproductive behaviors, lifestyles, and screenings. Younger age of Indian patients may also be explained by demographic factors, as well as the difference in screenings and diagnoses.

Also read: Breast Cancer: Know the Risks, Recognise the Signs & Get Checked

Do young Indian women tend to develop aggressive cancers?

Indian cancer centers report significant shares of hormone receptor-negative, HER2-positive, and triple-negative breast cancers, as well as a more advanced stage of the disease at the time of diagnosis. Aggressive biological types among these subgroups might require aggressive therapy.

Nonetheless, it is critical not to generalize this information and apply it to all Indian women and breast cancers developed at a younger age. It may be questioned whether hospital-based studies reflect the whole population, as there is variation in tumour subtypes within the population.

Late diagnosis is one of the main problems. Poor awareness, fear and stigma, family obligations, financial constraints and delayed health-care visitation result in growth and spread of tumours before starting treatment. Young women may ignore a breast lump because they think that being young prevents them from developing breast cancer. It may be dangerous.

Should breast cancer screening start early in India?

The issue requires clarification between awareness, diagnosis and screening.

Breast awareness should start in early adulthood. Women should be aware of their normal breast condition and have an immediate medical check up if they find any changes such as a breast lump, nipple retraction, bleeding nipple discharge, skin dimpling and others, regardless of age. Suspicious change requires diagnosis rather than waiting until next screening examination.

In asymptomatic women, it is necessary to determine the ideal age and screening method according to Indian conditions. Mammography is well-known screening tool, ultrasound could assist in evaluating dense breast tissue in younger women. Both should not be over-used without proper medical evaluation. Women who have a robust family history or those carrying high-risk genes should have an earlier and more rigorous surveillance program.

What India requires is a systematic and risk-appropriate early detection program that includes public awareness, medical evaluation, screening, and treatment.

The bottom line is that breast cancer does not occur only among older patients. Early detection of symptoms and changes can make a difference in saving lives.

By Dr Sewanti Limaye, Director of Medical & Precision Oncology, Sir H. N. Reliance Foundation Hospital, Mumbai

Menopause typically occurs between the ages of 45 and 55. However, the hormonal changes leading up to it can begin earlier, with some women reporting symptoms in their 30s.

A 2025 study published in NPJ Women's Health examined 4,400 American women aged 30 and older. It found that roughly 55% of women aged 30-35 reported moderate or severe symptoms on the Menopause Rating Scale. The proportion rose to just over 64% among women aged 36-40. Despite these symptoms, most women did not seek treatment until they were 56 or older.

Speaking to HealthandMe, Dr. Kajal Parikh is an Obstetrician and a Gynecologist based in Mumbai, explained how hormonal changes can begin in the mid-to-late 30s, the signs women should watch for, and why monitoring symptoms and maintaining healthy habits matter during this transition.

Perimenopause Can Begin In Your Mid-To-Late 30s

From the first menstrual period to menopause, the body undergoes significant hormonal changes. Estrogen and progesterone are among the hormones involved in this process.

“These hormones don't exit overnight. The exit starts much earlier. Starting mid-30s to late 30s, the hormone levels start depleting. Now, when that level starts depleting, you're going to see signals.”

According to Dr Parikh, changes in menstrual cycles can be among the first signs. Periods may become heavier or lighter, while cycles may become shorter or longer.

Being mindful of these changes can help women identify patterns and discuss persistent or concerning symptoms with a healthcare professional. However, these symptoms alone do not confirm that a woman is in perimenopause.

Also read: Menopause Abruptly Shifts Bones, Liver And Blood Fats, Study Finds

Brain Fog, Sleep Problems And Other Signs To Watch For

Perimenopause symptoms can extend beyond menstrual changes. Women may notice dry skin, pigmentation, hair thinning, increased hair fall, low energy, brain fog and disturbed sleep.

Some women who previously slept well may begin waking up at 3 or 4 a.m. and find it difficult to return to sleep, Dr Parikh told HealthandMe.

“That's your body asking for some help, or rather the body signaling that we are going through some crisis, see how we can fix it.”

Other possible symptoms include breast tenderness, worsening premenstrual symptoms, headaches, migraines, and bone and joint pain. Vaginal dryness, changes in urinary habits and reduced libido may also occur.

Symptoms vary considerably between individuals, and many of these changes can have causes other than perimenopause, the expert said,

When Should Women Seek Medical Advice?

Read More: ‘I Was Vocal About Cancer But Silent About Menopause Out Of Shame’, Says Actress Lisa Ray

Dr Parikh recommended annual gynecological visits to monitor changes over time. She also advised women to track their symptoms and seek medical advice if they worsen or do not improve with treatment.

Although menstrual changes may become noticeable in the late 30s and early 40s, the timing of the menopausal transition varies. Some women experience menopause earlier than expected, while others continue menstruating into their 50s.

For women without symptoms, Dr Parikh identified 40 as an appropriate age to begin regular monitoring and annual screening.

“40 is that golden age when you start monitoring, when you start getting your annual screenings done.”

The need for specific tests depends on a woman's age, symptoms and medical history. Women experiencing menstrual changes or possible menopausal symptoms at a younger age should consult a healthcare professional rather than waiting until 40.

What Tests And Lifestyle Changes Can Help?

Dr Parikh said doctors may assess iron levels, thyroid function, blood sugar and lipid levels while reviewing a woman's diet, nutrition and exercise habits. These assessments can help identify other conditions that may contribute to symptoms.

She also emphasised the importance of sleep, nutrition and exercise during the menopausal transition.

“The only thing that will save you from this transition are your three strong pillars, which is your sleep, your nutrition, and your exercise regimen.”

Treatment depends on the symptoms and individual health needs. After assessing symptoms and ruling out other possible causes, doctors can discuss appropriate options, including hormone therapy when indicated.

READ: Can Menopause Be Delayed? What Science Says About Slowing Ovarian Aging

Can Genetics Influence Menopause Timing?

Dr Parikh said genetics can play a role in determining when menopause occurs. A family history of early menopause, including in a woman's mother or grandmother, may be relevant when discussing her own reproductive health.

She also raised concerns about potential environmental exposures, including endocrine-disrupting chemicals found in some products and packaging. However, their individual contribution to the timing of menopause is difficult to establish, and these exposures should not be presented as proven causes of early menopause.

Maintaining a balanced diet, exercising regularly and prioritising sleep can support overall health during the menopausal transition.

For a patient with advanced heart failure, there comes a point when medicines, devices and repeated hospitalisations can no longer control the disease. For some, a heart transplant may offer the only realistic path to long-term survival. Yet in India, the challenge often begins much earlier than the waiting list: many patients who could potentially benefit from transplantation never reach an advanced heart-failure or transplant centre for evaluation.

The scale of the problem is enormous. A recent study found that 83,000 heart transplantations were required annually in India in 2021, although only a very small proportion of that need was met. In comparison, according to the National Organ and Tissue Transplant Organisation (NOTTO), 221 heart transplants were performed in 2023.

Why Patients With Advanced Heart Failure Miss Out

The first issue is delayed referral. Patients with advanced heart failure may continue to be treated repeatedly for breathlessness, fluid retention or hospital admissions without being assessed early for advanced therapies.

A transplant evaluation is not a last-minute decision. It requires time to assess the patient's medical condition, other organs, infection risk, nutrition, psychosocial circumstances and ability to undergo lifelong follow-up.

The second challenge is the limited availability of donor hearts. Heart transplantation depends almost entirely on deceased organ donation. India has made substantial progress in transplantation overall, but the national deceased organ donation rate remains less than one donor per million population.

How Geography And Cost Affect Access To Transplants

Geography and affordability also matter. Advanced heart-failure programmes and transplant centres are concentrated in selected regions, meaning that patients from smaller cities and rural areas may face substantial travel, financial and logistical barriers.

The cost of evaluation, repeated hospitalisations, mechanical circulatory support and post-transplant medicines can further influence whether a patient can realistically pursue transplantation.

Also read: “You’ve Got A Pig’s Heart!” Genetically Modified Pigs with Human-like Organs Transforming Organ Donation; Details Inside

When Should Patients Be Referred To A Transplant Centre?

We therefore need to change the way advanced heart failure is recognised. A patient with recurrent hospitalisations, persistent symptoms despite optimal therapy, progressive kidney or liver dysfunction, low blood pressure limiting medications, or dependence on intravenous therapies should trigger consideration of referral to an advanced heart-failure centre.

Early referral gives specialists more time to evaluate the patient, assess treatment options and determine whether transplantation or another advanced therapy is appropriate.

Heart Transplant Is Not The Only Advanced Treatment

Importantly, transplantation is not the only advanced therapy. Left ventricular assist devices (LVADs) can serve as a bridge to transplantation or, in selected patients, as long-term therapy.

These devices can help support the heart's pumping function in patients with advanced heart failure who meet the criteria for their use. The appropriate option depends on the patient's condition, overall health and treatment goals.

India has demonstrated that transplantation can grow rapidly when infrastructure, coordination and public awareness improve. The next step is to ensure that patients are identified early enough to be evaluated, and that a shortage of donor organs does not remain the only reason they never get the opportunity to reach the transplant list.

By Dr. Pravin Kulkarni, MBBS, MS (General Surgery), MCh (Cardiovascular and Thoracic Surgery), Fellowship in CTS, Director, Advanced Cardiac Surgery and Heart and Lung Transplant Program