Preventing dementia by preventing stroke: The Berlin Manifesto

Area of Science:

• Neurology and Public Health
• Global Health Epidemiology

Background:

• Neurological disorders, particularly stroke and dementia, are leading causes of global disability.
• Incidence trends for stroke and dementia are diverging, increasing in low- and middle-income countries while decreasing in high-income nations.
• Stroke and dementia share modifiable risk factors and stroke significantly increases dementia risk.

Purpose of the Study:

• To summarize evidence supporting the joint prevention of stroke and dementia.
• To highlight modifiable factors influencing global trends in stroke and dementia.
• To inform actionable strategies for reducing the burden of these neurological disorders.

Main Methods:

• Review of epidemiological data on stroke and dementia incidence trends.
• Analysis of shared and individual risk and protective factors.
• Examination of pathological and pathophysiological insights into cerebrovascular disease and neurodegeneration.
• Evaluation of clinical trial evidence for preventive interventions.

Main Results:

• Up to 90% of strokes and 35% of dementias are potentially preventable.
• Preventing stroke could prevent over a third of dementia cases.
• Interventions like anticoagulation for atrial fibrillation and blood pressure control show significant risk reduction.
• Population-level improvements in education and vascular risk factor management are associated with better cognitive health.

Conclusions:

• Joint prevention of stroke and dementia is feasible and recommended by global health organizations.
• Targeting modifiable risk factors at both population and individual levels is key.
• Understanding neurovascular unit interactions offers new therapeutic avenues.