Speak, Memory

The alarm went off at 4PM, reminding Aditya (name changed) to collect his mother’s CT scan report on his way back from work. He swiped the alarm away, making a mental note of it. When his mother called at 7.40PM to ask if he had stopped by the hospital, he was almost home, having completely forgotten the task. He backtracked 8KM, feeling lost and inadequate. How could he forget a thing of such gravity, despite the timely reminder? A 32-year-old hardware engineer in Bengaluru, Aditya was diagnosed with ADHD in his late 20s. His phone keeps 15-20 alarms on any given day and holds over 200 voice notes he has recorded over the past year or so. Lately, he says, the lapses have begun to affect his work. “A colleague begins a sentence, and somewhere in the middle I find that the beginning has gone. In the kitchen, holding a spoon, I sometimes forget what I was going to eat.” The lapses began nearly two years ago and he has since “doubled down” on the problem, learning the Carnatic violin, keeping a journal, meditating and doing mental exercises on CogniFit, an online platform that pairs cognitive assessments with personalised games, targeting skills like memory and attention. CogniFit is one of the few new-age cognitive training apps that have peer-reviewed research behind them, including randomised trials. While there is evidence that the app can improve performance on some cognitive tests, it falls short of establishing that it prevents dementia or reliably improves everyday memory. And yet, neuroplasticity remains a thread the forgetful hang on to, the promise that the brain, like a river denied its course, will find another way to the sea.

“Memory loss doesn’t mean dementia automatically,” says Dr PT Sivakumar, professor of Psychiatry and Head of the Geriatric Psychiatry Unit at the National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru. Attention, depression, anxiety, stress, menopause, physical illness and nutritional deficiency can all wear at recall. Increasingly, young people are also linking lapses in memory with perimenopause, long Covid, postpartum brain fog and other conditions.

To improve cognitive function, many are learning a new language or taking up music or dance, teaching themselves maths or hobbies like quilting, and playing strategy games. For most of us, our phones have become the outer rooms of the mind, where we store the birthdays, the appointments and the people we can no longer keep in our heads. “It’s an adaptation of our brain function,” says Dr Sivakumar. “What we need is what we remember. Now we need to remember more passwords, for example. And when even that becomes a burden, we give the task over to a password manager.” We have outsourced memory so thoroughly that some of us even aspire to wear devices like Limitless, when clipped to a shirt or hung from a lanyard, records all of our conversations through the day and turns them into searchable transcripts—a private stenographer for a life too complicated to remember.

Even as the young fret over misplaced keys, the real forgetting is increasingly affecting the generation that raised them. LASI-DAD, the first nationally representative study of dementia in India published in 2023, estimated that 7.4 per cent of Indians over 60 (9.6 per cent for women and 6.3 per cent for men), or about 8.8 million people, were living with dementia, with higher prevalence in villages than in cities. Researchers project the number will reach 16.9 million by 2036. Worldwide, the World Health Organization counted 57 million people with dementia in 2021, more than 60 per cent of them in low and middle-income countries, with nearly 10 million new cases a year.

India has no national dementia plan. In October 2025, experts from the health ministry, writing in the Indian Journal of Public Health, called for one. Kerala, meanwhile, created a Department of Senior Citizens in May 2026 and plans annual cognitive screening for everyone over 60, with a state dementia registry, a screening tool to be validated at the Kerala University of Health Sciences, and Smruthipadham care centres. Universal screening is harder than it sounds. A cognitive test takes time, and in a crowded government outpatient clinic, Sivakumar says, “time is the biggest factor”. No country, he notes, routinely tests everyone. The alternative is to do a brief cognitive assessment as part of yearly health checks for seniors.

In many Indian homes, forgetting was not a symptom but a stage of life, like retirement, and it came with the expectation that one would stay indoors. This is slowly changing with greater awareness, medical camps and outreach programmes, and easier access to cognitive assessment at a growing number of memory clinics in urban multispecialty hospitals. “Many of the factors that contribute to dementia are lifestyle-related and symptoms can be delayed to a certain extent by keeping oneself physically and mentally active,” says Dr BN Gangadhar, former director of NIMHANS and former chairperson of the National Medical Commission. “In my opinion, physical exercise, yoga, social inclusion, and being mindful about everything from how much shampoo there is left in the bottle to whether a button on one’s shirt is loose, can help slow the progress of memory loss,” he says.

In its 2024 report, the Lancet Commission on dementia prevention set out 14 potentially modifiable risk factors across the life course: less education in early life; hearing loss, high LDL cholesterol, depression, head injury, inactivity, smoking, diabetes, hypertension, obesity and excessive alcohol use in midlife; and social isolation, air pollution and untreated vision loss in later life. Taken together, the commission estimated, these factors account for 45.3 per cent of dementia cases worldwide. And yet, someone who does everything right might still develop dementia.

Genes could load the dice even if they may not throw them. Sivakumar puts familial dementias, in which a child of an affected parent carries roughly a one-in-two risk and where symptoms start to show in the 40s or 50s, at “less than 2 per cent” of cases. The rest of the genetically influenced dementias are sporadic: many genes, the best known of them APOE4, act with the environment to cause memory loss. A parent with Alzheimer’s raises one’s own risk “several fold” he says, but nothing like the coin toss of the inherited forms. “Like diabetes, hypertension and cancer, dementia also has a familial contribution.”

In filmmaker Blessy’s Thanmathra (2005), based on Padmarajan’s short story ‘Orma (Memory)’, Mohanlal plays Ramesan Nair, a middle-aged government official whose one dream is that his son clear the IAS examination. By the time the boy passes the exam, Alzheimer’s has taken so much of the father’s mind that he cannot fathom the significance of the achievement. The film ran 150 days in Kerala and gave a face to a disease few families then knew.

For Kuldeep (name changed), memory loss began in his teens. He is 17 and homeschooled in Hyderabad, a promising student until ordinary nouns like tray, plate, scissors became “that thing” and “this thing”. He takes medication for depression, says his father, an engineer who asked not to be named. Kuldeep’s memory is uneven rather than empty. The boy plays chess, and even wins on some days. “Sometimes he remembers everything even from the distant past, but on other occasions, he has problems remembering what he had just read,” his father says, wishing there was more research into memory loss in the young.

Depression, Sivakumar says, is among the most common treatable causes of cognitive trouble even in older people, and among the most often missed, because often, doctors and families decide a patient has dementia and that nothing more can be done. Medicines are another culprit—high doses of drugs that are not needed, which he sees often. Withdraw them and the patient improves. “There will be treatable components even in a person with degenerative disorder.”

If the diagnosis is Alzheimer’s—the most common cause of memory loss in seniors, although Sivakumar says vascular disorders are high in India compared to the global average—the conventional medicines are symptomatic. Cholinesterase inhibitors such as donepezil, rivastigmine and galantamine, and memantine in later stages, can ease symptoms for a time. Alongside them doctors often prescribe cognitive stimulation, structured routines, hearing correction, treatment of depression and training for the family.

Two anti-amyloid drugs are now available in India for early symptomatic Alzheimer’s disease: donanemab, approved in November 2025 and launched in May 2026, and lecanemab, launched in August. They are for eligible patients with mild cognitive impairment due to Alzheimer’s or mild Alzheimer’s dementia, after Alzheimer’s pathology is confirmed. They can slow decline but do not reverse memory loss or restore lost function. Both reduce amyloid plaques and require careful patient selection and MRI monitoring for ARIA, which can include brain swelling or bleeding. In lecanemab’s main trial, ARIA occurred in 12.6 per cent of patients, compared with 1.7 per cent on placebo. A 350mg vial of donanemab costs about `91,000, but that is only the first dose. The dose rises over treatment, which can continue for up to 18 months. Amyloid confirmation requires PET scans or spinal-fluid tests, although pTau217 blood tests are now being offered in India. Overall, the need for early diagnosis, monitoring and repeated tests, besides the prohibitive cost, may limit access to these drugs in India. Researchers are now hoping that AI can help track the causes of dementia using large datasets. In April this year, the Centre for Brain Research at the Indian Institute of Science invited researchers from institutions across the country to develop predictive models using large-scale brain aging datasets.

Open has reported before on remedies pushed by other streams of medicine, Ayurveda among them, few of them tested to the standard the antibodies were. One of the more intriguing bets comes from Cuba, which has long spent state money on biotechnology. NeuroEPO, sold as NeuralCIM, is a nasal spray developed by a team led by physician and biotechnologist Teresita Rodríguez Obaya. Her reason was her mother Amelia Luisa Codorniu, a sociologist, who had danced, played the piano and filled rooms with friends for decades before Alzheimer’s took over. Near the end of her life, her daughter began giving her the drug, believed she saw improvement, and pushed for trials. The documentary Teresita’s Dream: Cuba’s Battle against Alzheimer’s, directed by Daniel Montero for the media collective Belly of the Beast, sets photographs of the mother before the illness against video from after. In the phase 2-3 ATHENEA trial in Havana, 174 people with mild to moderate Alzheimer’s took the spray or a placebo three times a week for 48 weeks. On a standard cognitive scale, the treated groups improved slightly while the placebo group declined, a gap of seven to eight points, reported in Alzheimer’s Research & Therapy in 2023.

There are meanwhile findings from Indian researchers that warrant public health policy changes. For instance, in a 2025 study from rural Karnataka including 4,145 people aged 45 and older, researchers found that participants using polluting cooking fuels had poorer cognitive test performance than those using clean fuels. Among women, exposure was also associated with lower hippocampal volume.

A 2025 study of 157 first-year medical students in central India reported an association between self-reported stress, poor sleep and everyday memory complaints. In the villages of Srinivaspurataluk in Kolar district, the Centre for Brain Research at the Indian Institute of Science has been following cognitively healthy adults since January 2018, aiming for 10,000 participants, with brain scans at the institute’s MRI centre. A parallel study follows city dwellers. Between them, the two cohorts are working out which risks matter for Indian brains, rather than borrowing answers from global studies.

A NIMHANS-led preliminary study has developed a programme of culturally adapted cognitive tasks delivered at home by caregivers. In its main phase, 32 patient-caregiver pairs were divided between the programme and usual treatment. The authors reported improvements in attention, working memory, fluency and memory, and in daily activities and quality of life. The sample was small, however. An earlier randomised study in Indian homes for the elderly tested yoga—daily sessions for a month, then weekly sessions and practice at home. At six months the yoga group did better on several cognitive tests.

Others have had results playing retro platform games like Mario for cognitive retraining, says Dr Sydney Moirangathem, consultant psychiatrist, Central Queensland Hospital and Health Services, and Gladstone Hospital, and former Additional Professor of Psychiatry at NIMHANS, Bengaluru. “Devices are double-edged swords. Screen addiction shares the same pathway as that of substance addiction in the brain, eventually affecting memory and attention. For older people, even routine repetitive exercises like grain separation—separating rice and dal mixed together—can aid attention and concentration pathways,” he says, stressing that behavioural techniques are not cures.

“Our focus on the elderly is still in a very primitive stage,” Sivakumar points out. There are gaps right from prevention to rehabilitation, with awareness confined mostly to educated city families and somewhat better in the south where mental health NGOs are active. Screening is still to be built into the Ayushman Arogya Mandirs, India’s primary health and wellness centres. There is no training or support structure for the families who do the caring—no day care and no affordable residential care for poor and rural households.

In Karnataka, a state-government and NIMHANS initiative reports 32 district-level Brain Health Clinics, which cover dementia among other neurological conditions. A recent review of rehabilitation in India’s public system found major workforce shortages at community health centres and district hospitals. Neuropsychiatrists, who treat the behavioural changes that follow strokes and dementia, are scarce. Neurorehabilitation centres built mostly for stroke and paralysis are now adding clinical psychologists who set tasks, design programmes and teach families to cope.

The POINTER trial in America, published in 2025, followed 2,111 older adults at risk of cognitive decline for two years. One group received a structured programme of exercise, a Mediterranean-Intervention for Neurodegenerative Delay (MIND)-style diet, cognitive challenge, social engagement and cardiovascular monitoring. The other was given a self-guided version with similar goals. Cognitive scores rose in both groups, and somewhat more in the structured one. The result supports sustained, organised help with healthy routines. It does not show that any single activity prevents dementia. Researchers say more work is needed on daily functioning and on whether the improvements last.

A 2024 analysis pooled 37 randomised trials of computerised cognitive training involving 1,489 people with mild cognitive impairment and 371 with dementia. Among those with MCI, verbal, visual and working memory scores improved. For people with dementia the evidence was thinner, with improvements in verbal memory only. Most studies measured performance soon after training. None of them establishes that brain games alone prevent dementia or restore independence.

The weekend version of this is everywhere in urban India—from puzzle clubs, digital detoxes and meet-ups over lectures to picking up woodworking and pottery. A more useful evidence of neuroplasticity comes from rehabilitation, where the aim is not to sharpen a healthy brain but to help an injured or a failing one find another way. At NIMHANS in Bengaluru, a published case report describes a person with traumatic brain injury whose programme combined paper-and-pencil and computer tasks with music, dance choreography, social media and family therapy. A familiar song whose lyrics had been lost eventually helped the patient recover verbal memory. Music and movement were used to reach autobiographical memory. The case shows what a personalised approach can achieve.

Music has a record of weathering memory loss. British musician Clive Wearing, who was left with a memory span of seconds after contracting encephalitis, could still play complex pieces on the piano and conduct.

In February 2025, when Vishvaa Rajakumar, a 20-year-old engineering student in Puducherry, won the online Memory League World Championship by memorising 80 random digits in 13.5 seconds, he told the New York Times that hydration matters because memorisers subvocalise. The 2021 Indian Memory Championship, held online, drew 1,256 participants from across the world, from schoolchildren to retirees. In memory clubs, organised through forums and meet-up sites, participants practise the method of loci: walking an imagined house and leaving a number on each chair.

One of the most revealing accounts of what forgetting feels like comes from a video game that takes about an hour to play. In Before I Forget, released in 2020 by 3-Fold Games, the player wakes in a London flat painted like a shifting watercolour. Post-it notes cover the surfaces with instructions for ordinary tasks. A calendar on the wall is two years out of date. The woman whose eyes the player looks through is Sunita Appleby, an award-winning cosmologist who learned to love the stars from her Leela Auntie, married to a pianist named Dylan. The rooms begin almost without colour. Each object she picks up returns a fragment of her life, and a little warmth seeps back into the walls. The game began as a prototype at a 2016 game jam for women developers in Bristol and took its two makers, Chella Ramanan and Claire Morwood, almost four more years to finish, with advice from clinicians. Their stated aim was to show Sunita’s life beyond the disease without hiding the disease.

The war against memory is fought in small skirmishes. An alarm set twice. A name quickly entered into the phone before it can vanish from the mind. The brief panic of opening a room or a browser tab and finding no trace of why one came there. “Forgetting is a normal process. Much of what we remember is chosen without our awareness: the brain marks what is new, emotional or important, and while we sleep it turns those marked moments into lasting traces called engrams. Deliberate attention can widen that gate and distraction can close it,” says Dr Jagdish Hiremath, a Bengaluru-based cardiologist. He adds that stress, which the post-millennial generation reports more of than any before it, is a known contributor to heart disease and a reliable thief of everyday memory, since the hormone cortisol acts directly on the hippocampus. Thankfully, what it does is at least partially reversible.

For people with dementia, however, memory loss is permanent, and it grows until it takes in the whole of a life. Forgetfulness is not always the first sign of dementia. Some forms first affect behaviour, language or judgement, while memory remains relatively preserved. Pune-based author and IT professional Natasha Sharma saw this in her mother, Harsh Mani Sharma, a history gold medallist and voracious reader who loved crosswords and sudoku. She grew unusually irritable and impatient, began using language her family had never heard from her, and became preoccupied with sweets. Only as the disease progressed did the family see its reach. She forgot she was speaking to her daughter and sometimes mistook her husband for someone else. She succumbed to behavioural variant frontotemporal dementia (bvFTD) a few months ago.

NRS Babu, the Thiruvananthapuram-based editor, educator and entrepreneur who died in June this year at 85, was revered for his sharp wit, literary skill and prodigious memory. As a journalist and editor, he filled his stories with anecdotes in which the date, the time and even the weather of the day were recalled with precision, not to talk of other minute details from conversations with politicians and celebrities. As a teacher, he narrated contemporary history with the exactness only a person with an elephantine memory could manage. Babu’s memory was part of Kerala’s journalism folklore. Yet towards the end of his life, dementia robbed him of it and he seemed to become someone else, much to the anguish of those who had known him. He recognised very few people, although he made an effort to pretend that he knew them. All that made interactions agonising for those who knew him well—and maybe for him too. When he died, someone said he had used so much of his memory power in the early years of his stellar career that he needed some rest in his last days.