Acting early can reduce risk of brain disease before symptoms appear

Think Brain Health – a policy, clinical and research challenge, a virtual meeting featuring expert speakers in the field of neurodegenerative diseases, addressed current and future opportunities to help everyone achieve good brain health.

Chair, Dr Alastair Noyce, Reader in Neurology and Neuroepidemiology at Queen Mary University of London stated that “brain health is a choice that we make in life and … dementia and related disorders are not an inevitable consequence of ageing.”

The global burden of brain diseases, such as Alzheimer’s disease and Parkinson’s disease, is increasing as people live longer. Worldwide, dementia (mostly Alzheimer’s disease) affects about 50 million people and Parkinson’s disease affects more than 6 million. Left uncontrolled, brain diseases will impose an ever-growing socioeconomic and individual burden. However, many cases of dementia can be avoided or delayed. Therefore, maintaining brain health can help to reduce this enormous burden and provide large financial savings to overstretched healthcare systems.

Think Brain Health is calling for increased focus on acting early to reduce the risk of brain disease before symptoms appear.

Simple lifestyle changes, such as improving patters of nutrition and increasing levels of physical activity and social engagement, can lower risk of dementia, the most feared illness in people over the age of 50.

Dr Naaheed Mukadam (UCL, London) showed that in the UK alone, a combination of preventing diabetes, reducing hypertension, supporting smoking cessation and correcting hearing loss could save the UK around £1.86 billion per year and reduce the prevalence of dementia by 8.5%.

Accurately assessing an individual’s risk of brain disease through an understanding of the interplay between modifiable environmental and molecular/genetic factors will help clinicians optimize long-term care. Overall, developing brain health services based on principles of individualized risk scores will help people live better as well as longer through early action to promote wellness and delay or prevent symptoms of brain disease.

As Dr Charles Alessi, Public Health England lead for preventable dementia highlighted, although “longevity is extremely important … what we’ve really got to look to is productive healthy aging rather than morbidity, with people being as active and contributing to society [as much] as possible.” Primary care professionals can play a key role in promoting health across the lifespan that is independent of “medicine by body part.”

Professor Philip Scheltens (University Medical Centers, Amsterdam), co-chair, stated that “making sure that the brain is healthier than it was before is of evident importance for clinical practice for the future.”

Early recognition of brain health risk requires awareness in the “silent period” before symptoms appear, as described by Professor Craig Ritchie (Edinburgh, Scotland), Director of Brain Health Scotland, currently the UK’s most forward-looking brain health service. To allow better “listening” in this silent period, it is essential to have proven systems to identify lifestyle and biological risk factors for dementia, as well as “understanding when the brain is working well,” as described by Professor Wiesje van der Flier (University Medical Centers, Amsterdam).

Think Brain Health – a policy, clinical and research challenge was held virtually over two sessions on Tuesday 24 and Wednesday 25 November 2020. All presentations are available to view on the Think Brain Health website:


http://www.

events

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Notes to editor

The Chair of Session 1, Dr Alastair Noyce, is a Reader in Neurology and Neuroepidemiology at Queen Mary University of London and a Consultant Neurologist at Barts Health NHS Trust. His main research interest is on the determinants of Parkinson’s disease and other brain diseases.

The Chair of Session 2, Professor Philip Scheltens, a leading expert in Alzheimer’s disease and Co-chair of the report, is based at the Alzheimer Center Amsterdam, Amsterdam University Medical Centers, Netherlands.

The conference programme and video recordings of each presentation are available at

http://www.

About Think Brain Health

The Think Brain Health initiative has been developed to promote understanding that brain health can be maintained, prepare healthcare professionals to support individuals concerned about or at risk of symptoms, and prioritize research to help build and fund health infrastructure.

The Think Brain Health website is available at

http://www.

org

and features materials from the Think Brain Health – a policy, clinical and research challenge meeting as well as the report Time matters: a call to prioritize brain health. The web site is run by the Oxford Health Policy Forum CIC, a not-for-profit community interest company registered in England and Wales (Registration number: 10475240).

The Think Brain Health initiative has been funded by grants from Biogen, F. Hoffmann-La Roche and UCB Biopharma SRL, all of whom had no influence over the content.

About neurodegenerative brain diseases

Neurodegeneration is a consequence of disease-related processes in the brain that result in impaired functioning of the nervous system.1 Neurodegenerative diseases are long-term progressive conditions that cause a decline in brain health, loss of independence and premature death. Age is the strongest risk factor for neurodegenerative diseases,2 and these diseases are becoming more common as people are living longer.

The two most common neurodegenerative diseases are Alzheimer’s disease and Parkinson’s disease. Some, but not all, neurodegenerative diseases are causes of dementia. Dementia is the fifth highest cause of death and the number of global deaths from dementia is predicted to double over the next 20 years.3

The financial cost of neurodegenerative disease to society is considerable. Direct (e.g. medical) and indirect (e.g. sick leave) healthcare costs the global costs of dementia have increased from US$604 billion in 2010 to US$818 billion in 2015.3,4 The World Health Organization (WHO) has estimated that, by 2030, Alzheimer’s disease and other dementias will be responsible for 1.2% of the total deterioration in health-related quality of life.5

Alzheimer’s disease (AD) is the most common neurodegenerative disease and the most common cause of dementia.6 It involves the progressive loss of specialized cells in the brain (neurons), which control behaviour, memory and cognition. Over time, this neuronal loss significantly and progressively impacts a person’s ability to maintain the activities of daily living.7,8 More than 520,000 people in the UK have dementia caused by AD; worldwide, dementia (mostly AD) affects about 50 million people.7,8

Parkinson’s disease (PD) is caused when brain cells die and stop producing ‘dopamine’, a chemical that controls movement.9 In the later stages it is characterized by balance problems, which often result in falls, as well as loss of independence and deterioration in cognition. The number of people diagnosed with PD in the UK is around 145,000; worldwide, PD affects more than 6 million people.10

1. Mattson MP, Magnus T. Ageing and neuronal vulnerability.
   
   Nat Rev Neurosci
   
   2006;7:278-94.
2. Livingston G, Sommerlad A, Orgeta V et al. Dementia prevention, intervention, and care.
   
   Lancet
   
   2017;390:2673-734.
3. Prince M, Wimo A, Guerchet M et al. World Alzheimer report 2015: the global impact of dementia, 2015.
   
   Available from:
   
   https:/

   /

   www.

   alz.

   co.

   uk/

   research/

   world-report-2015
   
   (Accessed 15 January 2019).

4. Wimo A, Guerchet M, Ali GC et al. The worldwide costs of dementia 2015 and comparisons with 2010.
   
   Alzheimers Dement
   
   2017;13:1-7.
5. World Health Organization. Neurological Disorders. Public health challenges Switzerland: WHO, 2006.
   
   Available from:
   
   https:/

   /

   www.

   who.

   int/

   mental_health/

   neurology/

   neurological_disorders_report_web.

   pdf
   
   (Accessed 15 January 2019).

6. Cummings JL, Cole G. Alzheimer disease.
   
   JAMA
   
   2002;287:2335-8.
7. World Health Organization. Dementia fact sheet, 2017.
   
   Available from:
   
   http://www.

   who.

   int/

   en/

   news-room/

   fact-sheets/

   detail/

   dementia
   
   (Accessed 6 February 2019).

8. Alzheimer’s Research UK. Dementia Attitudes Monitor – Wave 1 Report 2018, 2019.
   
   Available from:
   
   https:/

   /

   www.

   dementiastatistics.

   org/

   wp-content/

   uploads/

   2019/

   02/

   Dementia-Attitudes-Monitor-Wave-1-Report.

   pdf
   
   (Accessed 6 February 2019).

9. Sveinbjornsdottir S. The clinical symptoms of Parkinson’s disease.
   
   J Neurochem
   
   2016;139:318-24.
10. Dorsey ER, Elbaz A, Nichols E et al. Global, regional, and national burden of Parkinson’s disease, 1990-2016: a systematic analysis for the global burden of disease study 2016.
    
    Lancet Neurol
    
    2018;17:939-53.