Preventing Neurological Disorders: Are We Being Far-Sighted Enough?

If we do not slow the pandemic of neurological disorders, we face an even greater pandemic driven by aging populations – but still too few health professionals deal in prevention.

Vladimir Hachinski and Ryosuke Takahashi

Ryosuke Takahashi

Vladimir Hachinski

Health professionals are trained to deal with diseases. Few engage in prevention, which remains underestimated, underfunded, and underused, but is pivotal in stemming the rising tide of neurological disorders. For dementia, billions spent on finding a drug to counter cognitive deterioration have yielded two drugs of efficacy still to be fully determined and unquestionable complications and high costs. Moreover, an effective drug to slow cognitive deterioration in symptomatic patients would only address the symptomatic late phase of the disease. It would do nothing to prevent increasing waves of cognitive impairment, driven by aging populations compounded by an open-scissors crisis of upward aging trends and downward birth rates.

In 1960, global life expectancy was 51 years; now it is 72 years. The global fertility rate was five births per woman; now it is 2.4. In Japan’s super-aged and declining birth rate society, life expectancy has changed from 68 years to 85 years, while the total fertility rate has declined from 2 to 1.3 per woman. This poses mounting social, economic, and health challenges.

One approach is keeping older adults healthy and working past their current retirement ages. Another is educating people to optimize their cerebral, mental, and social health so that they can contribute to the increasingly knowledge-based economy. Integral brain health is key to health, productivity, and well-being throughout life.

Promoting brain health includes preventing risk factors and enhancing protective factors. Neurological disorders inflict the largest proportion of disability adjusted life years. Stroke and dementia account for 62%. Stroke, ischemic heart disease, and most dementias share modifiable risks and protective factors, and also to a lesser degree, with Parkinson’s disease and bipolar disorders.

Risk factors differ in other neurological disorders, but promoting integral brain health might mitigate their consequences and prevent complications from the triple threat of stroke, ischemic heart disease, and dementia.

Integrating and scaling up prevention by promoting integral brain health through multiple approaches can promise a quantifiable difference. The World Health Organization is acting at the global level, and several countries have national brain health plans that must be complemented by community initiatives that can more easily integrate population-focused and individual approaches.

Integral Brain Health: An Urgent Action Plan

An abyss exists between what is done and what needs to be done. An abyss cannot be crossed in small steps, so we need an Integral Brain Health Urgent Action Plan to:

Consider integral brain health – cerebral, mental, and social – in all individual, community, and governmental decisions.

Create a compendium of actionable knowledge on what is known and what needs to be and can be known by experts and users, and strategies of motivation and implementation.

Fund new approaches to promoting and scaling up integral brain health in different-sized populations, with variable measures and reflecting different cultures.

Empower existing leaders, organizations, and communities to implement their highest impact measures based on cost effectiveness.

Create a new integral brain culture through public campaigns featuring highly accomplished brain users, such as sports champions, innovators, artists, writers, media personalities, scientists, and scholars.

One slogan could be “Integral brain health now.” The campaign could promote a basic ABC of “Activity and rest, Balanced diet, and Connecting with others” to help people think better, feel better, and perform better. It would emphasize the simplest, most effective individual actions. For example, walking 4,000 steps a day decreases mortality and provides significant health benefits. Doing it with someone else adds the benefit of socializing and doubles the chance that the person will continue to walk. Walking in greenery adds yet another benefit – long recognized in Japan as shinrin-yoku (forest bathing).

But how can health professionals expand their horizons when they are trained to focus on individual patients? The pandemic taught acute care doctors the importance of prevention so that they would not be overwhelmed by cases. It also fostered unprecedented collaboration between public health officers and acute care professionals. Similar cooperation is needed to prevent brain disorders before the painful lessons of the pandemic fade.

Integral brain health concerns everyone. Small efforts by many produce big changes overall. If about 10% of the population adopts a new view, change follows rapidly. The pandemic is still transforming lifestyles, work, and education – now is a propitious time to introduce fundamental changes.

Exhausted by the pandemic and crises, we may ask if this is the best time to ramp up prevention. But there seldom is an ideal time to innovate. If we do not begin to slow the pandemic of neurological disorders, we face an even greater, more relentless pandemic driven by aging populations. Infectious pandemics subside, aging epidemics do not. If we do not act now, then when? If not us, then who? It is for us, and it is now that we need to act. •

Vladimir Hachinski is a Distinguished University Professor in the Department of Clinical Neurological Sciences at the Robarts Research Institute of Canada’s Western University and former president of the World Federation of Neurology. He has made major contributions to the understanding, diagnosis, treatment, and prevention of stroke and dementia, and leads a dementia prevention/brain health initiative.

Ryosuke Takahashi is chair of the Department of Neurology at the Kyoto University Graduate School of Medicine. He is the past president of the Japanese Society of Neurology and the vice president of the Asian-Oceanian Association of Neurology. His major research interests are in the diagnosis and treatment of Parkinson’s disease and its related disorders.

Editors’ Note: This article was originally published in G7 Japan: The 2023 Hiroshima Summit, edited by John Kirton and Madeline Koch, published by GT Media. It is available at Reprinted with permission. This article represents the opinion of the authors and is not the official opinion of the WFN.