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Alzheimer s & Dementia
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Other literature type . 2019
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Preventing dementia by preventing stroke: The Berlin Manifesto

Authors: Vladimir Hachinski; Karl M. Einhäupl; Detlev Ganten; Suvarna Alladi; Carol Brayne; Blossom C. M. Stephan; Melanie D. Sweeney; +19 Authors

Preventing dementia by preventing stroke: The Berlin Manifesto

Abstract

AbstractThe 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.

Country
Germany
Subjects by Vocabulary

Microsoft Academic Graph classification: Stroke Geriatrics Incidence (epidemiology) Atrial fibrillation Alzheimer's disease medicine.medical_specialty medicine Dementia Intensive care medicine Vascular disease business.industry medicine.disease Blood pressure business

Dewey Decimal Classification: ddc:610

Keywords

Epidemiology, physiopathology [Brain], Risk factor reduction, Global Health, Atrial Fibrillation, drug therapy [Atrial Fibrillation], Incidence, Health Policy, Brain, Alzheimer's disease, prevention & control [Dementia], drug therapy [Hypertension], Berlin, Stroke, Psychiatry and Mental health, Cognitive impairment, Policy, Blood-Brain Barrier, Hypertension, Neurovascular unit, diagnosis [Hypertension], epidemiology [Stroke], prevention & control [Stroke], epidemiology [Dementia], Article, Cellular and Molecular Neuroscience, Developmental Neuroscience, Humans, Resilience, Prevention, diagnosis [Atrial Fibrillation], physiopathology [Cerebrovascular Disorders], Treatment, Cerebrovascular Disorders, Dementia, Neurology (clinical), Geriatrics and Gerontology

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    This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    205
    popularity
    This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
    Top 0.1%
    influence
    This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
    Top 10%
    impulse
    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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visibility
citations
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
views
OpenAIRE UsageCountsViews provided by UsageCounts
205
Top 0.1%
Top 10%
Top 0.1%
6
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bronze