Tuesday 22 January 2019

Dealing with dementia

As National Brain Awareness Week gets underway, Dr Ian Robertson reflects on the important work being done by the Global Brain Health Institute to tackle the disease

A third of all cases of dementia can be prevented
A third of all cases of dementia can be prevented

In the 1980s, when the Celtic Tiger was just a distant dream, arriving passengers in Dublin Airport walked under a large poster of a group of youngsters and the caption "Ireland's greatest natural resource - its people".

I thought that this was a bit rich at the time, given that in the departure passageways of the airport I could see similar young people streaming out en masse, work-seeking emigrants during that difficult decade. They may have been the country's greatest resource, but they were also its biggest export. But I was wrong and the surge of inward investment attracted by a well-educated, motivated and youthful workforce that partly fuelled the economic revival was evidence of my error.

It was, however, something particular about these youngsters that was Ireland's greatest natural resource more than simply their physical, youthful presence. It was their brains. Healthy, well-functioning brains whose billions of neurones had been enriched and connected up by a country that valued education and provided a high level - with many ghastly exceptions of course - a relatively secure family and social environment that built the confidence and emotional security, the essential bedrocks for healthy, high-performing brains.

A healthy brain leads to a high-performing mind, and across the world, economic development goes hand in hand with the accumulation of this mental capital. But not only are people with healthy brains a boon for the economy, they also stay physically healthier, live longer and are less vulnerable to a range of other mental health problems.

But there is one other stark threat to our wellbeing which makes brain health a matter of extreme urgency.

That threat is dementia.

We have lengthened the life of our bodies to an incredible degree - the average life expectancy of children born now in Ireland will be over 80 and huge numbers will live to 100 and more. Great news, except for one sobering fact. At the moment, at least half of people in their nineties have dementia. Our success in extending physical life has not, unfortunately, been matched with equivalent success in extending our brain life.

Dementia care costs more than cancer, heart disease and stroke together. Dementia rates in Ireland and in other developed countries will double over the next few decades. Our health and social services are already under severe pressure - without some urgent action, they may collapse under the weight of an epidemic of this most-feared affliction. So, this is yet another first world problem like obesity or diabetes? No - it will be far worse for low-income countries. At the moment, there are roughly equal numbers of people with dementia in high and low-income countries. But by 2050, there will be roughly four times as many people with dementia in low-income countries than in high income countries - a staggering 100 million people across the world. If high-income health and social services have difficulty coping, there is no chance in poorly-resourced low-income countries.

But there is hope. We managed to halve the rate of heart disease in the last 40 years, and we can do the same for dementia by building brain health. At least a third of all cases of dementia can be prevented by the sorts of lifestyle changes - exercise, diet, blood pressure control, stopping smoking - that worked for heart health. But there are additional measures that are needed for brain health, including education, mental challenge, stress control and correcting hearing loss. A brain that is strengthened by these measures can cope much better with diseases such as Alzheimer's Disease. But most people haven't adopted the concept of brain health. Nor do most governments yet have policies to put into the effect the current knowledge we have in order to prevent of dementia across the world.

The Irish-American Philanthropist Chuck Feeney established the Atlantic Philanthropies which, in 2015, made the largest ever philanthropic award in the history of the Irish State to Trinity College Dublin to establish, jointly with University of California at San Francisco, the Global Brain Health Institute (gbhi.org).

GBHI will train 600 leaders from across the world to implement into policy the knowledge we have about how to prevent dementia. In a joint transatlantic programme, these Atlantic Fellows (atlanticfellows.org/atlantic-institute/) come from around the globe and from a range of backgrounds - medical doctors, social scientists, artists, journalists, lawyers, psychologists - all trained to be leaders in building public awareness about brain health. When that happens, our greatest national resource will be our old as well as our young people. A public health approach to dementia could prevent a significant number of new dementia cases - perhaps by as much as 30pc. A comprehensive vision for research and groundbreaking models of prevention, care and treatment are required to address this expanding epidemic. A new cadre of leaders, sharing skills and knowledge, and working together to develop and implement interventions and inform public policy, can fundamentally change the trajectory of dementia, locally and globally.

The new Global Brain Health Institute (GBHI) will train international health providers as leaders, advocates and key stakeholders in the shared fight against dementia. The programme will graduate Fellows who will return to their home regions as exceptional and empowered 'change agents', with career-duration mentoring, access to pilot funds, and an international network of colleagues collaborating to drive a common mission.

An innovative Scholars programme will focus on providing brain health experiences to a broad array of promising leaders from several environments. Trainees will have opportunities to work at UCSF, TCD, or both, or at emerging GBHI hubs around the world. At least one-half of Scholars and Fellows will come from outside the US and Ireland, with initial emphasis on Latin America and the southern Mediterranean.

These individuals will experience personalised training in brain protection, dementia prevention, and public policy directed toward changing outcomes for underserved older people. GBHI seeks allies to share in this mission. The unique GBHI training programme is dependent on identifying outstanding individuals who possess the drive and skills to change their environments around brain health and dementia prevention. At least eight new Fellows will be sought annually for two-year training.

The ultimate success of GBHI lies in the dynamic and diverse opportunities to engage the most talented trainees and provide the type of career-long support needed for continued development of leadership. We wish to partner with inspiring individuals and forward-thinking institutions around the world that can help us deliver this intensive training. In the long term, we seek to nurture regional centres that will share and perpetuate our mission.

■ National Brain Awareness Week begins today. For more information go to nai.ie

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