Leif Østergaard

Preventing dementia by preventing stroke: The Berlin Manifesto

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaperReviewResearchpeer-review

  • Vladimir Hachinski, University of Western Ontario
  • ,
  • Karl Einhäupl, Charite - Universitatsmedizin Berlin
  • ,
  • Detlev Ganten, Charite - Universitatsmedizin Berlin
  • ,
  • Suvarna Alladi, National Institute of Mental Health and Neurosciences (NIMHANS)
  • ,
  • Carol Brayne, Cambridge University
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  • Blossom C.M. Stephan, University of Nottingham
  • ,
  • Melanie D. Sweeney, Keck School of Medicine of USC
  • ,
  • Berislav Zlokovic, Keck School of Medicine of USC
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  • Yasser Iturria-Medina, McGill University
  • ,
  • Costantino Iadecola, Weill Cornell Medicine Feil Family Brain & Mind Research Institute
  • ,
  • Nozomi Nishimura, Cornell University
  • ,
  • Chris B. Schaffer, Cornell University
  • ,
  • Shawn N. Whitehead, University of Western Ontario
  • ,
  • Sandra E. Black, University of Toronto
  • ,
  • Leif Østergaard
  • Joanna Wardlaw, Edinburgh University
  • ,
  • Steven Greenberg, Massachusetts General Hospital, Boston
  • ,
  • Leif Friberg, Karolinska Institutet
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  • Bo Norrving, Lunds Universitet
  • ,
  • Brian Rowe, University of Alberta
  • ,
  • Yves Joanette, Canadian Institute of Health and Research
  • ,
  • Werner Hacke, Universität Heidelberg
  • ,
  • Lewis Kuller, University of Pittsburgh
  • ,
  • Martin Dichgans, Klinikum Grosshaden, Munich Cluster for Systems Neurology (SyNergy), Molecular Neuropathology of Neurodegenerative Diseases
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  • Matthias Endres, Charite - Universitatsmedizin Berlin, Molecular Neuropathology of Neurodegenerative Diseases, University Heart Center Lübeck and the German Center for Cardiovascular Research (DZHK), Berlin Institute of Health (BIH)
  • ,
  • Zaven S. Khachaturian, Prevent Alzheimer Disease (PAD2020)

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.

Original languageEnglish
JournalAlzheimer's and Dementia
Volume15
Issue7
Pages (from-to)961-984
Number of pages24
ISSN1552-5260
DOIs
Publication statusPublished - 2019

    Research areas

  • Alzheimer's disease, Cognitive impairment, Dementia, Neurovascular unit, Policy, Prevention, Resilience, Risk factor reduction, Stroke, Treatment

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