Preventing dementia by preventing stroke: The Berlin Manifesto

Research output: Contribution to journalReview article

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 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.

Details

Authors
  • Vladimir Hachinski
  • Karl Einhäupl
  • Detlev Ganten
  • Suvarna Alladi
  • Carol Brayne
  • Blossom C.M. Stephan
  • Melanie D. Sweeney
  • Berislav Zlokovic
  • Yasser Iturria-Medina
  • Costantino Iadecola
  • Nozomi Nishimura
  • Chris B. Schaffer
  • Shawn N. Whitehead
  • Sandra E. Black
  • Leif Østergaard
  • Joanna Wardlaw
  • Steven Greenberg
  • Leif Friberg
  • Brian Rowe
  • Yves Joanette
  • Werner Hacke
  • Lewis Kuller
  • Martin Dichgans
  • Matthias Endres
  • Zaven S. Khachaturian
Organisations
External organisations
  • University of Western Ontario
  • Charité Universitätsmedizin Berlin
  • National Institute of Mental Health and Neurosciences, Bangalore
  • University of Cambridge
  • University of Nottingham
  • University of Southern California
  • McGill University
  • Cornell University
  • University of Toronto
  • Aarhus University
  • Aarhus University Hospital
  • University of Edinburgh
  • Massachusetts General Hospital
  • Karolinska Institutet
  • University of Alberta
  • Heidelberg University
  • University of Pittsburgh
  • German Center for Neurodegenerative Diseases (DZNE), Bonn
  • German Centre for Cardiovascular Research
  • Weill Cornell Medical College
  • Canadian Institutes of Health and Research
  • Ludwig-Maximilian University of Munich
  • Munich Cluster for Systems Neurology
  • Berlin Institute of Health (BIH)
  • The Campaign To Prevent Alzheimer's Disease
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Geriatrics

Keywords

  • Alzheimer's disease, Cognitive impairment, Dementia, Neurovascular unit, Policy, Prevention, Resilience, Risk factor reduction, Stroke, Treatment
Original languageEnglish
Pages (from-to)961-984
Number of pages24
JournalAlzheimer's and Dementia
Volume15
Issue number7
Publication statusPublished - 2019 Jul
Publication categoryResearch
Peer-reviewedYes