Education

GBHI Neurologists Call for Action as Health and Socioeconomic Disparities Compromise Brain Health

By Camellia Rodriguez-SackByrne

Socioeconomic and health disparities compromise a person’s well-being, with specific risks for their brain health, writes Elisa de Paula França Resende, MD, Jorge Jesus Llibre Guerra, MD, MS and Bruce Miller, MD, of the Global Brain Health Institute (GBHI). In a recent article in Jama Neurology, the authors emphasize how these disparities influence dementia prevalence in communities across the globe.

“A reasonable proportion of risks are attributable to conditions that can be changed across an individual’s life span,” the authors say.

Can is the operative word. With risk factors for dementia such as access to quality education, healthy diet, treatments for ongoing health conditions, and protection against head injuries not equally available across countries, widespread and timely access to these basic resources is crucial. Access also requires will – both political and economic – to create change.

The statistics they cite are sobering. Dementia is more prevalent and occurs 10 years earlier in low- and middle-income countries than in high-income countries. Further, low educational attainment is associated with higher risk of developing symptoms and earlier symptom onset. Equally concerning is the limited access to affordable and healthy food as well as the increased cognitive risk of highly stressful situations on vulnerable individuals.

The authors make recommendations on how to advance equity:

  1. Increase funding for research on dementia prevention.

  2. Advance policies that address socioeconomic and health inequities related to dementia and having dementia plans prioritize actions to reduce inequities in prevention and care.

  3. Seek additional measures to define neurogenerative disease internationally since biomarkers are not accessible in many parts of the world.

  4. Increase widespread awareness of health and socioeconomic inequities that put people at risk for dementia.

Two of the authors, Resende and Llibre Guerra, are Senior Fellows from the Atlantic Fellows for Equity in Brain Health program at GBHI, a training program based at University of California, San Francisco and Trinity College Dublin that aims to address inequities in brain health.

“The rigorous training of new leaders in brain health around the world gives societies everywhere a chance to transform how they view and care for their elders,” says Miller, co-director of GBHI.

The authors also highlight the important role of nonprofit organizations such as Alzheimer’s Disease International and the Alzheimer’s Association. With partnerships on the ground, these groups generate information such as comprehensive global dementia reports and provide funding for training programs and research.

Since the article’s publication, the authors have received positive feedback.

“My colleagues from Brazil thank me for addressing such an important issue for our country and for the world,” says Resende. “This Viewpoint article allowed us to spread worldwide the GBHI core message: we need to address inequities if we want a world without dementia and brain diseases in the future.”  

Their call to action is timely, with the prevalence of dementia expected to increase in the years ahead and the sharpest increases expected in the low- and middle-income countries.

The neurologist trio strikes a chord of hope as representatives of a larger global network of seven Atlantic Fellows programs. The Atlantic Fellows program at GBHI and its sister programs work to advance fairer, healthier, more inclusive societies. With a cadre of leaders completing intensive training and gaining connections with peers around the globe, fellows return to their communities upon completion of their training to use newly-honed skills to be change makers and champions for equity.

“I am excited about the Atlantic Fellows program,” says Llibre Guerra. “It’s unique in our focus on equity, vulnerable populations, a global approach, and a powerful mix of disciplines. As a result, the Atlantic Fellows will help to translate research evidence and innovation into more informed and effective policies targeting vulnerable populations and shaping a recipe for global equity.”

GBHI Gathers Brain Health Specialists to Focus on Dementia in Latin America and Beyond

Scientists, clinicians and health professionals convene to consider the latest research and ideas in dementia.

By Niall Kavanagh

“Brain health is embedded in equity,” said Victor Valcour, MD, professor of neurology and executive director of Global Brain Health Institute (GBHI), to open the Alzheimer’s Association International Conference (AAIC) Satellite Symposium in Sao Paulo, Brazil, on April 10. “Risk factors for dementia are rooted in health disparities.”

It’s no surprise, then, that Brazil and, more broadly, Latin America—where a third of the population lives in poverty with limited access to health care, combined with one of the world’s fastest growing elderly populations—are experiencing growing rates of dementia faster than most of the world.

Such was the setting for this global gathering of about 600 scientists, clinicians and health professionals, co-hosted by UC San Francisco and Trinity College Dublin’s collaborative GBHI.

A GROWING PROBLEM

In Brazil, about 1.7 million people live with dementia, and three quarters of them are undiagnosed. Across Latin America, roughly 4.6 million people have dementia, and two-thirds of them have Alzheimer’s disease. Like much of the world, dementia cases in Latin America are expected to triple by 2050.

“With this will come great challenges in dementia care, diagnosis, and prevention,” said Valcour.

The prevalence of dementia is higher in Latin America than much of the world, including North America and Europe, in part due to the aging population, but also because of health disparities. Dementia symptoms tend to emerge earlier in Latin American populations than others, likely due to low literacy rates, few years of formal education, high rates of poverty, and limited access to health care.

Together, these attributes reduce “cognitive reserve”—or the brain’s ability to adapt—which may protect against dementia symptoms. Further, many Latin Americans have high blood pressure and diabetes—known risk factors for dementia—compared to people in high-income countries.

There is no cure for dementia, but drug and behavioral interventions—such as healthy diet, regular exercise, and controlling blood pressure—are thought to delay onset of symptoms, and thus prevent disease.

THINKING LOCALLY, ACTING GLOBALLY

The aim of the symposium was to consider the latest research in dementia science and the need to create a National Dementia Plan for Brazil, part of the WHO’s 2017 goal to make dementia a public health priority.

The three-day meeting featured contributions from Atlantic Fellows for Equity in Brain Health at GBHI, including Maira Okada de Oliveira, who is working to improve diagnosis of dementia among illiterate groups in Brazil; Elisa Resende, MD, who is studying how teaching literacy to adults in Brazil has a high potential to lower their risk of dementia; and Barbara Costa Beber, PhD, who is increasing awareness of dementia among Brazil’s 40,000 speech and language therapists.

“From projects rooted in local communities, to national training initiatives and pan national networks, we want to equip leaders with tools to address dementia across Latin America and beyond,” said Lea Grinberg, MD, PhD, associate professor of neurology and GBHI executive committee member.

In addition to discussing the unique challenges dementia poses for Latin American countries, the AAIC Satellite Symposium considered a wide range of dementia-related topics, including sleep medicine, gender differences in dementia, and how to reduce stigma about dementia.

Atlantic Fellows Boon Lead Tee, MD, MSc and Yue Leng, PhD, MPhil—as well as Drs. Flavia Garcez and Ismael Calandri—won best posters for their respective projects, “Neurolinguistcs Presentation of Chinese Speaking Primary Progressive Aphasia Individuals” and “Sleep Medication Use and Risk of Dementia in a Biracial Cohort of Older Adults."

Brian Lawlor, MD, deputy director of GBHI director, said he is hopeful the gathering will emphasize the importance of a public health approach to dementia, and thus strengthen collaborations and innovations. “Together as an activated community, change can be delivered,” said Lawlor.

New initiative to help promote brain health among children launched

New initiative to help promote brain health among children launched

My Brain Robbie, a fantastic new initiative to promote brain health among school going children, has been launched through the Pilot Awards for Global Brain Health Leaders. The project includes an animated video of a little brain which helps children learn about the eight steps to keeping our brains healthy, along with free educational resources for parents and teachers.