Forgetting a name. Losing track of a familiar road. Repeating the same question. Struggling with tasks that once required no thought at all.
For families, dementia often arrives quietly, disguised at first as ordinary forgetfulness. But across Jammu and Kashmir, the numbers suggest that what may look like an individual problem is becoming a population-level challenge.
About one in nine people aged 60 and above in J&K are estimated to be living with dementia – a prevalence among the highest reported in India.
The figure becomes more consequential when viewed against another demographic shift: the population itself is ageing.
The share of people aged 60 and above in J&K rose to 11.9 percent in 2023-24, from 9.5 percent in 2019-21, according to NFHS-6. As the proportion of older residents grows, so too does the population potentially vulnerable to cognitive decline.
And behind the dementia numbers lies another set of statistics that doctors say deserves greater attention: tobacco use, high blood pressure, diabetes, physical inactivity and air pollution.
The World Health Organization’s updated dementia guidance, released in July 2026, highlighted several modifiable risk factors associated with dementia. The organisation estimates that as much as 45 percent of dementia risk globally can be attributed to factors that can potentially be modified.
That does not mean dementia is simply a consequence of lifestyle choices. Age, genetics and other factors also play important roles. But it does mean that some of the forces shaping the future burden are not beyond intervention.
In J&K, smoking may be one of the most important.
“Every puff narrows the blood vessels to your brain,” said Dr Sheikh Hilal Ahmed, Assistant Professor in the Department of Neurology at GMC Srinagar, describing cigarette use as an important risk factor for vascular dementia.
He compared the effect to starving memories of the oxygen they need to survive.
The metaphor captures a medical concern that is becoming increasingly relevant as the region ages: the health of the brain is inseparable from the health of the blood vessels that supply it.
A study published in Alzheimer’s and Dementia estimated that 11.04 percent of people aged 60 and above in J&K were living with dementia.
The corresponding estimate elsewhere nationally was 7.43 percent.
The study drew on India’s Longitudinal Aging Study and its dementia assessment component, which used detailed neuropsychological testing and interviews with informants to model dementia prevalence.
Its estimate put the number of people aged 60 and above living with dementia in J&K at about 1.16 lakh roughly a decade ago.
That number is difficult to consider in isolation.
If prevalence were to remain unchanged, population ageing alone could push the number to around 2.53 lakh by 2036, based on population projection estimates.
In other words, even without an increase in the underlying prevalence, the number of people living with dementia could more than double simply because more people are reaching older age.
That is the demographic arithmetic confronting the health system.
And it comes at a time when J&K is also carrying a substantial burden of cardiovascular and metabolic disease.
Few risk factors are as culturally visible – or as difficult to disentangle from everyday life – as tobacco.
NFHS-5 found that 31.6 percent of men aged 15 to 49 in J&K used some form of tobacco. Cigarette smoking alone was reported by 26.6 percent.
J&K has repeatedly featured among regions with high levels of tobacco use, and doctors say that exposure matters not only for lung and heart disease but also for the brain.
For Dr Ahmed, the connection is particularly important in understanding vascular dementia.
Vascular dementia occurs when damage to the brain’s blood supply contributes to cognitive impairment. The damage can result from strokes, small-vessel disease, and other vascular problems.
Smoking can damage blood vessels and contribute to cardiovascular disease, making it one piece of a larger chain of risk.
The danger is therefore not necessarily a cigarette directly causing a memory problem years later. It is the cumulative damage to the vascular system – damage that can affect the brain along with the heart and other organs.
“When the blood vessels are compromised, the brain pays a price,” is the underlying concern behind the vascular pathway doctors describe.
And smoking rarely exists alone.
A person who smokes may also have high blood pressure, diabetes, unhealthy cholesterol levels, physical inactivity or other risk factors. Together, those conditions can amplify vascular damage.
The relationship between dementia and vascular health may deserve particular scrutiny in J&K.
A study involving 600 patients with hypertension across six rural districts of J&K found that 63.5 percent of those who had been diagnosed and advised treatment had uncontrolled blood pressure.
Smoking, diabetes and dyslipidemia – commonly described as abnormal or unhealthy blood-fat levels – were among factors significantly associated with uncontrolled hypertension.
For dementia researchers and clinicians, that is an important piece of the puzzle.
High blood pressure does not simply threaten the heart. Over years, elevated pressure can damage blood vessels throughout the body, including the small vessels supplying the brain.
Repeated vascular injury can affect cognitive function.
That makes blood-pressure control part of a much broader strategy for protecting brain health.
Yet uncontrolled hypertension can remain invisible for years.
Unlike a broken bone or an acute infection, high blood pressure often produces no obvious symptoms. A person can feel well while vascular damage accumulates silently.
By the time memory problems become apparent, some of that damage may already have occurred.
The other half of the equation is age.
Dementia is strongly associated with ageing, and longer life expectancy means more people are reaching the ages at which cognitive disorders become more common.
J&K is moving through that demographic transition.
NFHS-6’s estimate that people aged 60 and above represented 11.9 percent of the population in 2023-24, compared with 9.5 percent in 2019-21, illustrates the speed of the change.
That rise may appear modest as a percentage. In health-system terms, however, it represents a substantial increase in the population that may require geriatric, neurological, psychiatric and social-care services.
Dr Ahmed points to changing lifestyles and eating habits as additional factors associated with dementia risk.
Smaller families and loneliness may also matter.
In earlier generations, older people in Kashmir often lived within large households spanning several generations. Changing family structures can mean that an older person has fewer people around them to notice subtle cognitive changes, assist with daily activities, or provide long-term care.
Loneliness itself is increasingly considered relevant to cognitive health.
And as families become smaller, the burden of dementia care can become concentrated on fewer relatives.
The question, therefore, is not only how many people develop dementia. It is who will care for them.
Dementia rarely affects only the person diagnosed. It changes the routines of households.
A family member may have to accompany an older person to appointments, supervise medication, manage finances or eventually provide assistance with basic daily activities.
In Kashmir, where family remains a central component of social care, the consequences of a growing dementia burden could therefore extend well beyond hospitals and clinics.
The condition can also remain under-recognised.
Early cognitive changes are sometimes dismissed as normal ageing. Families may adapt to the behaviour without seeking medical advice, particularly when symptoms develop gradually.
That can delay diagnosis and make it harder to address potentially modifiable risk factors.
A diagnosis does not necessarily mean that progression can be stopped. But identifying dementia early can help families understand what is happening, plan care and manage associated medical conditions.
It can also create an opportunity to address the vascular and lifestyle factors that may be worsening cognitive decline.
The WHO’s estimate that 45 percent of dementia risk globally may be attributable to modifiable factors offers both a warning and a measure of hope.
The warning is obvious: a substantial part of the future burden may be linked to factors that health systems and individuals can influence.
The hope is more subtle. Not every case of dementia can be prevented.
Age remains the strongest known risk factor for many forms of dementia. Genetics and other biological processes matter. Even people who live healthy lives can develop the condition.
But population health does not require eliminating every case to make a difference.
Reducing smoking, controlling blood pressure, preventing and managing diabetes, encouraging physical activity and reducing exposure to air pollution could potentially reduce the overall burden of cognitive disease while also preventing heart attacks, strokes and other illnesses.
In that sense, dementia prevention may begin long before anyone notices a memory problem.
It may begin with a blood-pressure check.
With quitting cigarettes. With controlling blood sugar. With a walk. With better management of cholesterol. And with recognising that what protects the heart may also protect the brain.
For J&K, the convergence of these trends creates an uncomfortable forecast. The population is ageing. The estimated prevalence of dementia is high. Smoking remains widespread. Hypertension is frequently uncontrolled. Diabetes and abnormal lipid levels add to the vascular burden. And social structures are changing.
If the current prevalence estimate holds, demographic ageing alone could substantially increase the number of people living with dementia over the next decade.
That makes dementia not simply a neurological issue but a public-health question.
It touches tobacco control, primary healthcare, cardiovascular prevention, diabetes management, urban air quality, physical activity and the social wellbeing of older people.
The most important intervention may therefore occur years before the first memory disappears.
For Kashmir, the question is no longer whether dementia is an emerging problem. The available estimates suggest that it is already here.
The more difficult question is how much of what comes next can still be prevented.
And perhaps that is where the cigarette becomes more than a cigarette.
Every puff may not erase a memory. But over a lifetime, the damage to the vessels that nourish the brain can help determine how well those memories survive.
In a region growing older by the year, protecting memory may increasingly mean protecting the blood vessels that carry it.
The future of Kashmir’s ageing population may depend not only on how medicine treats dementia after it appears, but on how seriously the health system addresses the risks that begin decades before it does.
About the Author
Amir Yaseen is a Srinagar-based journalist interested in Kashmir, policy, progress, and the human stories shaping everyday life.
