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Twenty years ago, the Canadian province of Ontario launched an aggressive campaign to tackle stroke from all angles: it focused on prevention and awareness; strengthened its acute care practices and response times; and increased access to stroke rehabilitation.
It worked. Stroke rates have fallen 32% in a decade. But that was not all. Dementia rates have also fallen – by around 7% – confirming what Dr Vladimir Hachinski, a pioneering researcher in the field, already suspected: preventing stroke helps prevent dementia.
Now Canada is exploring how to apply this lesson nationally. And Hachinski, the neuroscientist leading the effort, has an even broader vision. He wants the whole world to focus on not just preventing strokes and dementia, but everything that can go wrong with the brain – and how to make things right.
“You need your brain to be healthy,†Hachinski said. “There is no health without brain health.”
The idea begins to gain ground.
“The World Health Organization recognizes brain health as a major problem,†said Dr. Victor Dzau, president of the United States National Academy of Medicine and a member of a loose coalition of medical experts from leading role in pushing governments and research institutes to make it a global priority. “People are getting very excited about this.”
“Every year there are more strokes, more heart attacks, more dementias,†said Hachinski, who helped form the World Brain Alliance, a coalition of nine of the world’s largest organizations focused on brain. “The more we can delay or prevent this, the better we can cope, otherwise all health systems around the world will be overwhelmed. “
Along with Dzau and others, Hachinski raised the issues in October at the G20 summit, an intergovernmental forum of the world’s 20 largest economies. They plan to do it again at the G7 meeting in June in Germany.
Brain health “isn’t getting the attention it deserves, given the scale of the problem,” Dzau said. Neurological disorders are one of the leading causes of disability and death worldwide.
Dzau co-chairs the Healthy Brains Global Initiative, which seeks to raise $ 10 billion over the next 30 years to transform what he sees as a fragmented and underfunded ‘research ecosystem’ into a collaborative, interdisciplinary model focused on research. better brain health throughout life.
“Whether we’re talking about Alzheimer’s disease or schizophrenia, you have to understand how the brain works and when it becomes dysfunctional and why,†Dzau said. “Brain health is the general umbrella. “
At the center of this movement is the connection between healthy brains and healthy bodies – now firmly established by decades of research, particularly around the link between heart and brain health. Heart disease and stroke share many of the same risk factors as dementia, such as high blood pressure, high blood sugar, and lack of physical activity. Research also shows that good psychological health can improve cardiovascular health, while poor mental health can adversely affect it.
Cardiologist Dzau and neurologist Hachinski want the world to stop thinking about brain health in terms of the individual disorders that develop later in life and to start thinking about how to promote good brain health from birth. .
“People with dementia watch one thing and strokes watch another and no one looks at the big picture,†said Hachinski, who has helped develop a new definition of brain health that goes beyond. beyond disease or its absence to encompass neurological, mental and physical health. well-being and how the three interact.
Currently, most research is focused on the diseased brain, rather than on ways to preserve and promote optimal brain health, Hachinski and others wrote in an August 2021 article in the journal Alzheimer’s & Dementia. The authors call for transdisciplinary collaboration between neurologists, psychiatrists, psychologists, neurobehavioural and socio-behavioral, policy makers and others around the world. A priority, they say, should be to find out why some countries have been successful in reducing stroke and dementia when others have not, and to apply those lessons globally.
The Canadian Initiative on Dementia Prevention and Brain Health is a first step in this direction. It will map regions of good and bad brain health, dementia, stroke and heart disease by tracking demographic, environmental, socio-economic and individual risk factors, as well as factors that protect brain health. And it won’t stop at Canada’s borders. The effort involves researchers from the United States, United Kingdom, and New Zealand to identify cost-effective ways to reduce dementia.
Meanwhile, the Healthy Brains Global Initiative will begin work focusing on anxiety and depression in people under the age of 30, based on research showing that three-quarters of mental health issues and neurological disorders take root in adolescence and early adulthood.
But that’s just the start, said Dzau, who said he saw “a huge need for more impactful research. We need breakthroughs and studies that examine community implementation of solutions.”
Research – and its implementation – must also be more equitable and inclusive, he said. “Small clinical trials in white populations are insufficient. We need to build more diverse living cohorts globally. At least that’s the vision of what we’re trying to do.”
Even when countries have the knowledge and technology to improve brain health, translating them into positive outcomes fairly can be a problem, he said. This is either because countries have too little money to do it, or because they have poorly structured health systems that cannot do the job. The United States is an example, he said.
“We’re pioneers in technology, science and research,†said Dzau, “but as far as implementation goes, because our system is so fragmented, it’s more difficult. “
For example, despite large increases in the use of life-saving stroke treatments, studies show that black and low-income adults are less likely to receive them. And black men in the United States are 70% more likely to die from a stroke than their white counterparts.
Solving problems like these on a global scale is the goal of this movement, Dzau said. But it won’t happen overnight. “We don’t have the solutions yet, but we have the ambition.”
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