22 July: World Brain Day 2016 devoted to the ageing brain

One in three individuals over the age of 80 suffers from at least one neurological disease

London (ptp017/20.07.2016/10:00) "It is becoming increasingly clear that neurological disorders, such as stroke and dementia but to name a few, are projected to rise at a rate that could overwhelm our healthcare systems," Prof Raad Shakir, London, President of the World Federation of Neurology (WFN) warned on the occasion of this year's World Brain Day on 22 July. Although experts have long been voicing this warning, the public is not sufficiently aware of the subject and healthcare policy in many places does not include it to a sufficient degree. Prof Shakir went on to say this: "The ageing population has major social, health, and economic consequences. Brain health will be among the most important determinants of social and economic well-being of older persons in the future."

For this reason, the World Federation of Neurology has decided to devote this year's Brain Day to the subject of "Brain Health and the Ageing Population - The Ageing Brain". According to Prof Shakir, the goal is "to increase global awareness on the management and prevention of all brain and neuromuscular diseases affecting the elderly and on concepts and means of promoting the prevention of brain diseases."

The prevalence of a number of neurological conditions increases with age, including stroke, dementia, and Parkinson's, the most common brain diseases affecting an ageing population. Experts assume that ten to 20 per cent of all 60 to 80 year-olds suffer from at least one of these disorders. Among those over the age of 80, nearly one and three is affected. And this age group is growing - worldwide. Today, people over the age of 60 number 800 million and account for 12 per cent of the world population. By 2050, demographers assume that 21 per cent will have reached that age and will number more than two billion. The number of neurological patients will rise continuously as a result.

Push prevention

"It is time to act!" This is the appeal of the chairman of the WFN Public Awareness Committee, Prof Mohammad Wasay, Karachi. "Diseases affecting the brain are the most frequent causes of handicaps today throughout the world. A good share of the disease burden would be avoidable if we were more devoted to prevention."

Age and genetic predisposition may remain the biggest risk factors for strokes and dementias but there are also factors that everyone can influence. For instance, high blood pressure and high blood sugar levels already occurring in middle age increase the risk of later contracting Alzheimer's by two to three times. Prof Wasay: "Treating risk factors of this kind in a timely manner therefore presumably reduces the risk not only of strokes but also of dementia. A balanced diet with a lot of leafy vegetables, fruits and fish keeps cholesterol values low, thereby helping to minimize risks. Giving up nicotine is sensible in any event - even though the specific influence of smoking on the development of dementia has not yet been totally clarified."

Along with a healthy diet and sufficient physical exercise, experts say it is vital to keep the brain fit by constantly exposing it to new stimuli. According to a study published in the New England Journal of Medicine, the risk of contracting dementia is 74 per cent lower in people who frequently play board games, 35 per cent lower in those who read intensively, 69 per cent lower in those who play a musical instrument and 41 per cent lower in those who work crossword puzzles. So Prof Wasay's advice is this: "Remain mentally active by staying curious and involved and by committing to lifelong learning: Read, write, work puzzles, attend plays or lectures, play games, garden, or pursue memory exercises. Remain socially active, engage in social and leisure activities by volunteering, traveling, or joining social clubs."

Controlled intervention studies such as FINGER (Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability) show that an active lifestyle can not only prevent but also help to slow down the unfolding of cognitive disorders. Multimodal interventions consisting of diet recommendations, regular exercise, cognitive training and close-knit monitoring of vascular risk factors proved in this study to be effective ways of maintaining or improving cognitive functions in people at risk of contracting dementia.

Strengthening healthcare structures

WFN Secretary General Prof Wolfgang Grisold, Vienna, emphasized the significance of expanding suitable neurological healthcare structures. "Modern neurology can offer much for managing the consequences of demographic developments. Healthcare policymakers in all countries are therefore well-advised to invest in expanding neurological care instead of perceiving old age as only a burden." He refuses to accept arguments of ever tighter healthcare budgets given reflexively in response to such demands: "A society simply has to afford the costs of treatment, therapy and care for our fellow human beings who are elderly. In this respects, we have to be our patients' advocates."

Besides a sufficient level of acute neurological care, the aim for ageing societies must be to further expand rehabilitation capacities and the possibilities of long-term care according to Prof Grisold. Palliative care will also take on an increasingly important role: "Neurologically orientated palliative medicine can cushion the effects of an incurable disease for various lengths of time. This improves the quality of life a bit for severely ill people with no prospects for a cure."

WFN as an advocate

Given that about 80 per cent of the elderly population will live in less developed regions of the world in 2025, WFN is also advocating a more just distribution of global resources. Prof Grisold: "Although we have made great strides forward in the diagnosis and therapy of neurological diseases, appalling inequalities exist in the availability of treatment possibilities. Many people across the globe either have no access or insufficient access to neurological care." In wealthy countries, there are an average of three neurologists per 100,000 inhabitants whereas in low-income countries the figure is just 0.03.

Global efforts in the fight against Alzheimer's

The increasing number of dementia patients poses one of the really big challenges. In December 2013, the G8 leaders declared: "Our ambition is to identify a cure or a disease-modifying therapy for dementia by 2025 and to increase collectively and significantly the amount of funding for dementia research to reach that goal."

In 2015 there were still 47 million dementia patients to care for. Experts predict that this number will rise to 75 million by 2030 and to 131 million by 2050. This growth will have massive consequences, not the least of which will be economic. A study conducted in Great Britain, Sweden, Spain and the United States estimated that one dementia patient still capable of mastering everyday life relatively independently cost society about Eur 14,500 a year. For patients already requiring institutional care, this figure rises to Eur 72,500 a year. Together, dementia diseases in 2015 were already incurring enormous costs of US$ 818 billion worldwide.

Prof Gunhild Waldemar, Director of the Danish Dementia Research Centre, Copenhagen, makes the following demand: "All individuals with Alzheimer's Disease should have access to reliable and timely diagnosis and treatment, irrespective of social inequalities. This includes medication as well as the use of non-pharmacological interventions for which clear evidence of benefit already exists, such as psychosocial, behavioural, or environmental interventions."

Although biomedical research has provided insights into the fundamental causes and pathogenesis of Alzheimer's, Prof Waldemar noted that more is required for an actual breakthrough, namely: "We need an even better understanding of the neurodegenerative mechanisms of the disease." One thing is certain: dementia is not necessarily an age-related phenomenon. Half of all 90 year-olds have no memory impairments," Prof Waldemar said.

There has been major progress in recent years in care for dementia patients and for research on risk factors and prevention possibilities, Prof Waldemar reports. "Important steps forward have been made in the field of prognosis and early diagnosis; with respect to the huge potential of modern neuroimaging; and we have seen some promising results with immunisation strategies against AD. However, it is still impossible today to reverse or even stop Alzheimer's, by far the most frequent form of dementia."

Investments in the development of innovative, effective therapies would be essential. Prof Waldemar voiced this demand: "In view of the lack of progress in developing a cure for Alzheimer's Disease and the rapidly increasing costs of dementia, policymakers and governments have a powerful incentive to provide more resources for this important field. We clearly need breakthroughs concerning therapies that can halt or reverse the progress of AD; therapies tailored to the individual patient and approaches for a delay of the onset of dementia disorders."

The Danish expert would like to see a concerted international effort and suitable budget levels for conducting the further research still required. "Budgets for drug discovery, development, and clinical trials should be increased to allow international cohorts, ethical and regulatory frameworks and standardised methods to be established, which will facilitate clinical trials and accelerate progress."

Wakeup call on behalf of brain health

"Our initiative to stage a World Brain Day is also a wakeup call for political and policy decision-makers the world over. Regardless of the enormous burden that they cause, neurological diseases are not included to an adequate degree on the health policy agenda - neither at national level nor at international level. The burden of neurological disorders continues to be underestimated, under-recognised and under-funded," WFN President Shakir remarked. "The message we are conveying with World Brain Day is clear: The priorities in policy and funding must change. Brain health should be treated as one of the highest-level healthcare priorities. Neurologists are the advocates of brain health and need to take the leading role in advancing new approaches in stemming the scourge of neurological disease."

World Brain Day was launched by the WFN in 2014 and is dedicated to a different neurological disease or topic every year. The date for this awareness day was not chosen at random: The WFN was founded on 22 July 1957 in Brussels.

119 national societies and regional partners participating in the campaign

The 119 national member societies of WFN and important regional partners such as the European Academy of Neurology spread the message of World Brain Day at national, regional and international level by holding events and implementing educational and awareness activities. The WFN provides promotional and educational material such as posters, brochures and presentations. An important focus of the campaign is the use of social media.

Virtual press conference

Video statements from Prof Raad Shakir, Prof Mohammad Wasay, Prof Wolfgang Grisold and Prof Gunhild Waldemar are now available at: https://www.wfneurology.org/world-brain-day-2016

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