New strategies are needed to deal with the growing number of cerebral diseases. A program was recently presented at the 5th European Academy of Neurology Congress in Oslo, Norway.
According to data from the Global Burden of Disease Study 2017, brain diseases alone now account for 10% of the global burden of diseases (source 1). As life expectancy increases, so does the number of people living (longer) with neurological diseases. Dementia, one of the most common cerebral disorders, affects about 50 million people worldwide, with 10 million new cases every year, of which 60-70% are due to Alzheimer's dementia. It is estimated that the number will rise to 82 million by 2030 and to 152 million by 2050 (source 2).
From June 29th to July 2nd, 2019, the 5th EAN (European Academy of Neurology) Congress took place in the Norwegian capital Oslo. There, Prof. Anne Hege Aamodt, President of the Norwegian Neurological Association, presented a concept called "The Norwegian Brain Health Strategy 2018-2024" (source 3). It includes four overarching objectives:
Prof. Aamodt said: "The prevention of cerebral diseases, the provision of consistent therapy, aftercare, and rehabilitation, as well as increased research and expertise, are absolutely essential to optimize outcomes for patients. The program is designed to help implement this for a wide range of conditions, including dementia, multiple sclerosis, Parkinson's disease, and apoplexy.
The Norwegian Society of Neurology and the Norwegian Directorate of Health (in Norwegian: Helsedirektoratet) are working to achieve the objectives of the program, which could serve as a model for other countries, as Norway is the first country in Europe to launch such an initiative.
This includes raising €20 million for a national clinical research center dedicated to the clinical treatment of serious diseases such as MS, dementia or amyotrophic lateral sclerosis (ALS). The Norwegian Research Council will also receive an additional €5 million to expand research and innovation in neurological diseases.
Prof. Aamodt says: "We believe that this national approach should be replicated and implemented in other European countries, tailored to each country. The continent will undergo major societal changes - such as population aging - which will have an impact on cerebral diseases, and health systems must adapt to these changes.
Following the launch of the Norwegian Brain Health Strategy, EAN and EFNA (European Federation of Neurological Associations) are calling for a Europe-wide program to raise public awareness of cerebral diseases, influence governments and apply the latest science to improve outcomes for patients and society.
An important topic at the congress was the burden of disease caused by apoplexy and dementia. Stroke specialist Prof. Vladimir Hachinski, whose work is recognized worldwide, emphasized that strokes account for 42% of neurological diseases (as compared to 10% for dementia) and that many cases of dementia can be prevented by preventing strokes.
According to a recent Lancet study, about one in five develops dementia in the first 5 years after a transient ischemic attack (TIA) or apoplexy. Prof. Hachinski says: "Neurological diseases are the leading cause of Disability-adjusted life years (DALYs). [...] The good news is that 90% of strokes are potentially preventable by controlling the risk factors." Apoplexy and dementia have many treatable factors in common, including exercise, active lifestyle, healthy diet, normotensive blood pressure, etc.
The search for a cure for Alzheimer's has been focused on the amyloid/tau hypothesis for the last 40 years, but this "single-track" approach has so far failed to produce even one disease-modifying agent, according to Hachinski (source 3).
Studies presented at the plenary symposium of the EAN Congress also underline that the majority of neurological diseases are associated with neuroinflammation, including those previously considered non-inflammatory, such as Alzheimer's, ALS, motor disorders, apoplexy, migraine, and epilepsy. EAN is cooperating with the journal Nature, which has published a special issue of articles on neuroinflammation written by various speakers after the congress has ended.
Sources:
1. James, S. L. et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet 392, 1789-1858 (2018).
2. World Health Organization, Dementia. Available at: https://www.who.int/news-room/fact-sheets/detail/dementia. (Accessed: 23rd July 2019)
Third Press Room. Available at: https://www.ean.org/oslo2019/Press-Room.2661.0.html. (Accessed: 23rd July 2019)