The comprehensive, customized, cost-effective approach (CCCAP) to prevention of dementia

Risk and sex-specific trends of dementia and stroke in Italy Compared to European and high-income countries and the world: global implications

BACKGROUND

Understanding the increasing trends in Italy may inform new prevention strategies and better treatments. We investigated trends and risk factors of dementia, stroke, and ischemic heart disease (IHD) in Italy with the second-oldest population globally, compared to European and high-income countries and the world.

METHODS

We analyzed the Global Burden of Disease Study (GBD) 2019 estimates on incidence and burden (i.e., disability and death combined) of the three conditions in both sexes. We also analyzed the burden attributable to 12 modifiable risk factors and their changes during 1990-2019.

RESULTS

In 2019, Italy had 186,108 new dementias (123,885 women) and 94,074 new strokes (53,572 women). Women had 98% higher crude dementia and 24% higher crude stroke burdens than men. The average age-standardized new dementia rate was 114.7 per 100,000 women and 88.4 per 100,000 men, both higher than Western Europe, the European Union, high-income countries, and the world. During 1990-2019, this rate increased in both sexes (4%), despite a decline in stroke (- 45%) and IHD (- 17%) in Italy. Dementia burden attributable to tobacco decreased in both sexes (- 12.7%) during 1990-2019, while high blood glucose and high body mass index combined burden increased (25.4%). Stroke and IHD had similar trends.

CONCLUSIONS

While decreases in new strokes and IHDs are encouraging, new approaches to their joint prevention are required to reverse the rising dementia trends, especially among women. Life course approaches to promoting holistic brain health should be implemented at the community, national, and international levels before the growing trends become overwhelming.

What will it take to achieve brain health globally?

Brain health initiatives and programs are gaining traction worldwide. Some are clinically based, others research based, and some are a combination of clinical and research action plans. Achievement of global brain health is a challenging endeavor with prerequisites including but not limited to multidisciplinary and multisectoral approaches, strengthening of neurologic policies at local and regional levels, global advocacy, leadership and collaboration amongst stakeholders, development of technical and guidance documents, and strengthening and interpretation of the relevant evidence. Over 1 billion persons worldwide are impacted by neurologic disorders, and brain health initiatives are needed to curb the human suffering and cost of these disorders. We provide a brief review of select brain health initiatives and programs and offer possible steps to achieve brain health globally.

What is brain health?

The call to optimize brain health is now a local, regional and global priority. Organizations such as the World Health Organization, Centers for Disease Control and Prevention and Alzheimer's Association, American Academy of Neurology, World Federation of Neurology, and others have developed recommendations for the maintenance of brain health. Brain health definitions range from broad to narrow in scope and may focus on cognition or encompass broader core components such as cerebral, mental and social domains. In this manuscript we will explore various definitions of brain health and its core components, the importance of cognitive and functional domains, and briefly introduce the concept of cognitive medicine in the context of brain health.

We are preventing some dementias now-But how? The Potamkin lecture

Most dementias are untreatable and their prevalence is increasing around the world. However, the incidence of dementia is declining in some countries. We need to find out urgently why and how and apply the lessons promptly and widely. Given the multiplicity and variability of environmental, socioeconomic, and individual risk and protective factors, the approach needs to be comprehensive, customized to work in a particular setting, and cost effective, to justify the needed funding. Stroke, heart disease, and dementia share the same major preventable risk and protective factors and pose risks for each other. Preventing them together might result in efficiencies and economies of scale. Prevention can best occur in existing actionable population health units through established leaders in government, non-governmental organizations, and the community, around a positive message of promoting brain health as the key to health, productivity, and well-being.

A Critical Study on the Impact of Dementia on Older People Undergoing Treatment in Care Homes

Maximum healthcare needs for older people are complex due to diseases, comorbidities, or disabilities, including long-term or mental and physical health issues. Various residential and nursing care homes help care for older people, especially those with special medical needs. Among these special medical needs, dementia is one medical condition requiring exceptional care for the affected to prevent adverse effects of the situation they usually encounter. Dementia is a health condition that involves impairments to memory and thinking due to any injury or disease-causing damage to the brain. Older people suffer from different diseases, which cause cognitive disability and long-term ailments and directly affect patients' quality of life. Given the cognitive impairment dementia causes to older people, it is difficult for the care providers to accurately assess the impact on every individual to formulate a person-centered care plan. During the COVID-19 pandemic, due to administrative restrictions on social distancing to prevent transmission of this disease, caregivers and elderly persons feel tremendous mental stress, further aggravating their problems because of loneliness. Thus, there is a requirement to do the study and analyze the effects on older people to provide quality and person-centered care. Due to the above factors as significant challenges in the current context, there is an ardent need for the results of variegated studies besides a thorough analysis of available literature analyzed to provide proper evidence to the care providers. It will pave the way for understanding the actual impact of the condition in its natural context. In this regard, a literature review and the results of the studies are discussed. This research brings into the limelight all those factors in the context of previous studies and data analysis of the current situation.

Global, regional, and national trends of dementia incidence and risk factors, 1990-2019: A Global Burden of Disease study

BACKGROUND

An ample literature documents the growing prevalence of dementia and associated costs. Less attention has been paid to decreased dementia incidence in some countries.

METHODS

We analyzed trends in age-standardized dementia, stroke, and ischemic heart disease (the triple threat) incidence rates and population attributable fraction of death and disability attributable to 12 risk factors in 204 countries and territories and 51 regions using Global Burden of Disease 2019 data.

RESULTS

During 1990 to 2019, dementia incidence declined in 71 countries; 18 showed statistically significant declines, ranging from -12.1% (95% uncertainty intervals -16.9 to -6.8) to -2.4% (-4.6 to -0.5). During 2010 to 2019, 16 countries showed non-significant declines. Globally, the burden of the triple threat attributable to air pollution, dietary risks, non-optimal temperature, lead exposure, and tobacco use decreased from 1990 to 2019.

CONCLUSION

The declining incidence of dementia in some countries, despite growing prevalence, is encouraging and urges further investigation.

The New Brain Age

The pandemic is transforming neurology. Long Covid will linger, neurological diseases will increase, and technology, artificial intelligence and new virtual worlds will usher a new age of the brain and new roles for neurologists.The pandemic has compelled international collaboration, greatly increased communications and accelerated drug and vaccines approvals. It also dramatized the close interconnection of cognitive, mental, and social health and their relevance to building back better health, education, work and leisure. Brain health is the key to health, productivity, and well-being.Neurologists are best placed to lead brain knowledge integration and application through the unifying theme of brain health by becoming advocates, healers, and guardians of the brain.