Leif Østergaard

Special topic section: linkages among cerebrovascular, cardiovascular, and cognitive disorders: Preventing dementia by preventing stroke: The Berlin Manifesto

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

DOI

  • Vladimir Hachinski, Robarts Research Institute and Department of Clinical Neurological Sciences, University of Western Ontario, London, ON, Canada.
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  • Karl Einhäupl, Center for Stroke Research Berlin & Department of Neurology, Charité - Universitätsmedizin Berlin, Germany.
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  • Detlev Ganten, Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany; Institute of Public Health, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany.
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  • Suvarna Alladi, Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
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  • Carol Brayne, The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
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  • Blossom C M Stephan, Division of Psychiatry and Applied Psychology, School of Medicine & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan & NIHR MindTech Health Care Technology Cooperative, Institute of Mental Health, University of Nottingham, Nottingham, UK.
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  • Melanie D Sweeney, Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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  • Berislav Zlokovic, Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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  • Yasser Iturria-Medina, Department of Neurology and Neurosurgery, Montreal Neurological Hospital and Institute, McGill University, Montreal, Québec, Canada H3G 1A4.
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  • Costantino Iadecola, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA.
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  • Nozomi Nishimura, The Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
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  • Chris B Schaffer, The Nancy E. and Peter C. Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
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  • Shawn N Whitehead, Department of Anatomy and Cell Biology, Western University, Ontario, Canada.
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  • Sandra E Black, Department of Medicine (Neurology), Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
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  • Leif Østergaard
  • Joanna Wardlaw, Centre for Clinical Brain Sciences, Edinburgh Imaging, UK Dementia Research Institute, University of Edinburgh, Scotland, UK.
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  • Steven Greenberg, Department of Neurosurgery, Neuro-oncology Research Group, Cancer Center Amsterdam, VU University Medical Center, 1007 MB Amsterdam, the Netherlands; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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  • Leif Friberg, Faculty of Health Sciences, Clinical Institute, University of Southern Denmark, Odense, Denmark; Department of Pelvic Cancer, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
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  • Bo Norrving, Department of Clinical Sciences (Neurology), Department of Neurology and Rehabilitation Medicine, Skane University Hospital, Lund University, Lund, Sweden.
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  • Brian Rowe, Department of Emergency Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
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  • Yves Joanette, Canadian Institute of Health and Research, Ottawa, Canada.
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  • Werner Hacke, Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Heidelberg, Germany.
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  • Lewis Kuller, Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA.
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  • Martin Dichgans, Bioprocess Engineering Department, Institute of Industrial and Environmental Biotechnology, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran; Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany.; Department of Translational Neurodegeneration, German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.
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  • Matthias Endres, Department of Cardiology, Charité Universitätsmedizin Berlin (CBF); Berlin Institute of Health (BIH); German Center of Cardiovascular Research (DZHK), Berlin, Germany.
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  • Zaven S Khachaturian, Prevent Alzheimer Disease (PAD2020), Potamac, MD, USA.

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. © 2019 the Alzheimer's Association and the World Stroke Organisation. Published by Elsevier Inc. All rights reserved.

Original languageEnglish
JournalInternational Journal of Stroke
Pages (from-to)1747493019871915
Number of pages25
ISSN1747-4930
DOIs
Publication statusE-pub ahead of print - 22 Sep 2019

    Research areas

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

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