In a country where long working hours, urban stress, sedentary lifestyles and an increasing burden of hypertension and diabetes have become part of everyday life, it is easy to dismiss forgetfulness or poor concentration as simply the result of being “overworked”. Someone forgets a familiar name, struggles to find the right word, loses track of a date or becomes unusually irritable, and the immediate explanation is often stress or lack of sleep.
But the brain does not work in isolation. Its health is closely connected to how a person sleeps, eats, moves, manages stress and controls chronic diseases. When changes in memory, judgement, movement, mood or sleep become persistent or begin interfering with daily functioning, they should not simply be written off as ageing or mental fatigue.
Brain health is a dynamic state that allows a person to think, learn, remember, make decisions, regulate emotions, interact socially and professionally, and cope with the stresses of life. It encompasses much more than memory — attention, problem-solving, judgement, coordination, balance, movement and the ability to interpret sensory information are all part of it.
When ordinary forgetfulness becomes a warning
Occasional forgetfulness is common. What is concerning is a pattern that is progressive or begins to affect everyday independence.
Difficulty planning or solving problems, repeatedly struggling to find familiar words, replacing words or incorrectly naming objects can be early signs of cognitive dysfunction. A person may get lost in a place they know well or lose track of the date, season or time. Poor judgement may manifest as unusual decisions involving finances, safety or social situations.
The warning signs can also appear physically. Slowness, shuffling while walking, instability, frequent falls or repeatedly dropping objects may indicate problems with movement and coordination. Difficulty judging distances, recognising familiar people or objects, or becoming confused while driving can point towards visual and spatial difficulties.
Changes in personality should not be overlooked either. Sudden anxiety, depression, apathy, irritability or withdrawal from social and professional activities may accompany neurological dysfunction. Sleep disturbances, including insomnia, excessive daytime sleepiness or acting out dreams, can also be important clues.
The threshold for seeking medical attention is straightforward: if these changes interfere with daily life, worsen over time or begin worrying family members and colleagues, a neurological evaluation is warranted.
India has its own neurological vulnerabilities
The Indian context makes this conversation particularly important. Hypertension and diabetes are major contributors to stroke, vascular dementia and neuropathy. In some rural and economically disadvantaged communities, these conditions may remain undiagnosed or poorly controlled.
India also faces a significant burden of stroke among people below 50 years of age. Early-onset diabetes, tobacco use and genetic susceptibility are among the factors associated with this burden. This means that neurological health can no longer be viewed only through the lens of ageing.
Our changing lifestyles add another layer. Urbanisation and sedentary habits reduce physical activity, which can affect biological mechanisms involved in brain resilience. Dietary patterns are equally relevant. High-carbohydrate, low-protein diets and deficiencies of vitamin B12, vitamin D and iron — particularly among some vegetarian and elderly populations — can contribute to neuropathy, fatigue and cognitive impairment. Excess salt and trans fats further increase vascular risk.
Tobacco use, including chewing tobacco, increases the risk of stroke, vascular dementia and cognitive decline. Excessive alcohol consumption is associated with seizures, cerebellar atrophy and peripheral neuropathy. India also continues to encounter neurological infections such as tuberculous meningitis, neurocysticercosis and HIV-related neurological disorders.
There is another problem that receives less attention: access. The document highlights an urban-rural divide, limited access to advanced investigations such as MRI, CT and EEG, and an estimated neurologist availability of approximately one per 100,000 people. Mental-health stigma and limited awareness can further delay diagnosis.
The brain is not as fixed as we think
There is, however, an important reason for optimism. The brain has a remarkable ability called neuroplasticity — its capacity to reorganise itself, create new connections, strengthen existing ones and, in some circumstances, shift functions from damaged areas to healthier ones.
This has practical implications. Aerobic exercise can promote the formation of new synapses and increase brain-derived neurotrophic factor, or BDNF, which supports neuronal growth and plasticity. Learning new skills and engaging in cognitive exercises can encourage cortical rewiring. After a stroke or neurological injury, rehabilitation and physiotherapy can help the brain remap motor pathways. Meditation and mindfulness may support regions involved in attention and emotional control, while a healthy diet rich in anti-inflammatory foods, flavonoids and omega-3 fatty acids can support synaptic health.
The brain's different pathways are also influenced by everyday habits. Physical activity, adequate sleep, mental stimulation and stress management can support systems involved in memory, motivation, mood, focus and resilience. In practical terms, protecting brain health does not require waiting for a neurological diagnosis; it begins with the way we live every day.
India also has cultural practices that can potentially support brain health. Yoga and meditation may contribute to GABAergic and parasympathetic balance, while traditional diets containing turmeric, legumes and leafy greens provide compounds such as curcumin and flavonoids with potential neuroprotective properties. Strong family support systems can also play an important role in caring for people living with conditions such as dementia.
Ultimately, cognitive health is not simply about remembering names or where the keys were left. It is about preserving the ability to think, communicate, move, make decisions, work and remain independent.
In a country facing the combined pressures of chronic disease, lifestyle changes, nutritional deficiencies, neurological disorders and unequal access to specialist care, recognising the early signs becomes especially important. Forgetfulness may sometimes be harmless. But when a change is persistent, progressive and begins to alter everyday life, it is the brain asking to be heard.
The author is the head and senior consultant—Neurology, Manipal Hospital, Sarjapur Road.
The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.
