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Preventing dementia by preventing stroke : The Berlin Manifesto

Hachinski, Vladimir ; Einhäupl, Karl ; Ganten, Detlev ; Alladi, Suvarna ; Brayne, Carol ; Stephan, Blossom C.M. ; Sweeney, Melanie D. ; Zlokovic, Berislav ; Iturria-Medina, Yasser and Iadecola, Costantino , et al. (2019) In Alzheimer's and Dementia 15(7). p.961-984
Abstract

The incidence of stroke and dementia are diverging across the world, rising for those in low- and middle-income countries and falling in those in high-income countries. This suggests that whatever factors cause these trends are potentially modifiable. At the population level, neurological disorders as a group account for the largest proportion of disability-adjusted life years globally (10%). Among neurological disorders, stroke (42%) and dementia (10%) dominate. Stroke and dementia confer risks for each other and share some of the same, largely modifiable, risk and protective factors. In principle, 90% of strokes and 35% of dementias have been estimated to be preventable. Because a stroke doubles the chance of developing dementia and... (More)

The incidence of stroke and dementia are diverging across the world, rising for those in low- and middle-income countries and falling in those in high-income countries. This suggests that whatever factors cause these trends are potentially modifiable. At the population level, neurological disorders as a group account for the largest proportion of disability-adjusted life years globally (10%). Among neurological disorders, stroke (42%) and dementia (10%) dominate. Stroke and dementia confer risks for each other and share some of the same, largely modifiable, risk and protective factors. In principle, 90% of strokes and 35% of dementias have been estimated to be preventable. Because a stroke doubles the chance of developing dementia and stroke is more common than dementia, more than a third of dementias could be prevented by preventing stroke. Developments at the pathological, pathophysiological, and clinical level also point to new directions. Growing understanding of brain pathophysiology has unveiled the reciprocal interaction of cerebrovascular disease and neurodegeneration identifying new therapeutic targets to include protection of the endothelium, the blood-brain barrier, and other components of the neurovascular unit. In addition, targeting amyloid angiopathy aspects of inflammation and genetic manipulation hold new testable promise. In the meantime, accumulating evidence suggests that whole populations experiencing improved education, and lower vascular risk factor profiles (e.g., reduced prevalence of smoking) and vascular disease, including stroke, have better cognitive function and lower dementia rates. At the individual levels, trials have demonstrated that anticoagulation of atrial fibrillation can reduce the risk of dementia by 48% and that systolic blood pressure lower than 140 mmHg may be better for the brain. Based on these considerations, the World Stroke Organization has issued a proclamation, endorsed by all the major international organizations focused on global brain and cardiovascular health, calling for the joint prevention of stroke and dementia. This article summarizes the evidence for translation into action.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Alzheimer's disease, Cognitive impairment, Dementia, Neurovascular unit, Policy, Prevention, Resilience, Risk factor reduction, Stroke, Treatment
in
Alzheimer's and Dementia
volume
15
issue
7
pages
24 pages
publisher
Wiley
external identifiers
  • scopus:85069004242
  • pmid:31327392
ISSN
1552-5260
DOI
10.1016/j.jalz.2019.06.001
language
English
LU publication?
yes
id
6544b3e3-838b-483e-a37a-8c459930fae6
date added to LUP
2019-07-23 14:10:08
date last changed
2020-12-01 01:22:42
@article{6544b3e3-838b-483e-a37a-8c459930fae6,
  abstract     = {<p>The incidence of stroke and dementia are diverging across the world, rising for those in low- and middle-income countries and falling in those in high-income countries. This suggests that whatever factors cause these trends are potentially modifiable. At the population level, neurological disorders as a group account for the largest proportion of disability-adjusted life years globally (10%). Among neurological disorders, stroke (42%) and dementia (10%) dominate. Stroke and dementia confer risks for each other and share some of the same, largely modifiable, risk and protective factors. In principle, 90% of strokes and 35% of dementias have been estimated to be preventable. Because a stroke doubles the chance of developing dementia and stroke is more common than dementia, more than a third of dementias could be prevented by preventing stroke. Developments at the pathological, pathophysiological, and clinical level also point to new directions. Growing understanding of brain pathophysiology has unveiled the reciprocal interaction of cerebrovascular disease and neurodegeneration identifying new therapeutic targets to include protection of the endothelium, the blood-brain barrier, and other components of the neurovascular unit. In addition, targeting amyloid angiopathy aspects of inflammation and genetic manipulation hold new testable promise. In the meantime, accumulating evidence suggests that whole populations experiencing improved education, and lower vascular risk factor profiles (e.g., reduced prevalence of smoking) and vascular disease, including stroke, have better cognitive function and lower dementia rates. At the individual levels, trials have demonstrated that anticoagulation of atrial fibrillation can reduce the risk of dementia by 48% and that systolic blood pressure lower than 140 mmHg may be better for the brain. Based on these considerations, the World Stroke Organization has issued a proclamation, endorsed by all the major international organizations focused on global brain and cardiovascular health, calling for the joint prevention of stroke and dementia. This article summarizes the evidence for translation into action.</p>},
  author       = {Hachinski, Vladimir and Einhäupl, Karl and Ganten, Detlev and Alladi, Suvarna and Brayne, Carol and Stephan, Blossom C.M. and Sweeney, Melanie D. and Zlokovic, Berislav and Iturria-Medina, Yasser and Iadecola, Costantino and Nishimura, Nozomi and Schaffer, Chris B. and Whitehead, Shawn N. and Black, Sandra E. and Østergaard, Leif and Wardlaw, Joanna and Greenberg, Steven and Friberg, Leif and Norrving, Bo and Rowe, Brian and Joanette, Yves and Hacke, Werner and Kuller, Lewis and Dichgans, Martin and Endres, Matthias and Khachaturian, Zaven S.},
  issn         = {1552-5260},
  language     = {eng},
  number       = {7},
  pages        = {961--984},
  publisher    = {Wiley},
  series       = {Alzheimer's and Dementia},
  title        = {Preventing dementia by preventing stroke : The Berlin Manifesto},
  url          = {http://dx.doi.org/10.1016/j.jalz.2019.06.001},
  doi          = {10.1016/j.jalz.2019.06.001},
  volume       = {15},
  year         = {2019},
}