the Coming Wave of Brain Diseases

What does it take for society to identify a crisis and act? How do we prioritize the threats we face? When do we decide a problem is worth our collective attention?

Well, the pandemic gave us some answers. It took a few more months than it should have but nations around the world were able to recognize the threat and take action. However Covid-19 was an acute hit, a quickly spreading disease with a clear target. What happens when the threat has many contributing factors and comes on gradually?

A good example of that is climate change. It took us decades to realize something was wrong and even longer to start mounting a response. But at least we have figured out ways to measure it and some of its effects, allowing us to come to a broad consensus on the problem and begin concerted efforts to try and prevent the worst of it. But what about threats that aren’t as apparent, ones we can’t even properly measure or detect yet?

That is what makes brain diseases so insidious. They usually take decades to develop and they do so in silence. However, they are just as dire a cause as either the pandemic or climate change. It is time we started treating them as such.

The Problem

According to the WHO, neurological disorders are the leading cause of disability in the world and have the highest economic and social impact of all diseases. Brain Canada research shows that “1 in 3 Canadians are directly impacted…the burden on the Canadian economy every year is more than the cost of cancer and cardiovascular disease combined.”

To make matters worse, the number of people diagnosed is expected to grow rapidly in the decades to come. Age is the single biggest risk factor for many of these diseases and by 2050 there will be roughly a billion more people 60 or older than there are today.

The pandemic will further compound this crisis. Not only because of the enormous mental toll prolonged lockdowns, isolation, and economic uncertainty are placing on so many, but the virus itself may be a catalyst. There is a growing body of literature pointing to an association between coronavirus infections and neurological disorder. According to a research study (preprint mind you) released just two days ago looking at 236,379 Covid-19 survivors, “the estimated incidence of neurological or psychiatric sequelae at 6 months was 33.6%, with 12.8% receiving their first such diagnosis.”

If even a tiny fraction of those who got Covid-19 go on to develop some form of brain disorder, the impact it will have on society may be catastrophic. As it is we don’t have the resources or therapies needed to properly treat the patients we have, how will we manage the flood of patients to come? What kinds of research programs and public resources do we need to start investing in to mitigate the problem and help as many people as possible?

The Solution

To begin, we need to prioritize building better care centers. At the moment, people with these conditions do not have access to the resources needed to properly manage and live well with their conditions. We need interdisciplinary care centers accessible to as many people as possible, and we’ll need to train armies of nurse practitioners, physiotherapists, rehab specialists, social workers, occupational therapists and more to staff them.

Next, we need to set up as many longitudinal cohort studies as possible. While our knowledge of the brain has grown exponentially since the turn of the century, that has yet to translate to improved therapies for most brain diseases. When it comes down to it, despite all the bold claims made in most popular neuroscience books out there, we simply do not know how or why many of these diseases develop. According to a report sponsored by the Bill & Melinda Gates Foundation, “The 84 risks quantified in GBD (Global Burden of Disease) explain less than 10% of neurological disorder DALY burdens.” What that translates to is a lack of disease modifying therapies. For neurodegenerative diseases in particular, there isn’t a single treatment yet proven to slow, let alone stop the degenerative process.

To get there we’ll need many more studies like the newly launched Framingham Heart Study Brain Aging Program or the Cincinnati Cohort Biomarker Program (full disclosure, I am part of the team behind this program) so we can track and monitor hundreds of thousands of individuals to better understand the reasons why neurological diseases develop. This should be coupled with major investments in basic science to give us the tools and knowledge needed to measure how these diseases unfold over time.

But to do any of these things we need society to recognize the problem for what it is. The irony there is that the way our brains work is part of the problem. We have massive visual and sensory cortices that are readily wired to produce a response to threats we can see and feel quickly, less so for threats that come on slowly and require a little more abstraction and cognitive processing. Seeing very much is believing. We can see videos of hospitals rapidly filling up with Covid-19 patients or wildfires burning, we can’t really see the rampant levels of inflammation or degeneration happening in people’s heads.

Thankfully, we have tools to overcome this deficiency. Language, communication and education. Mental health and a basic understanding of the brain needs to become a central part of our education systems, as well as news and social media platforms. It is a great failing of our schools that we come out of 12 years of education knowing next to nothing about our brains. In addition, news outlets and social media need to do their part by more regularly including substantive information and stories about the brain and mental health into all their platforms.

And we have to be clear. Brain diseases and mental health issues are a destabilizing force on society that we are not properly addressing. To stem the rising tide and help those currently in need we need to elevate brain health to a global priority and give it the urgency and backing that it demands. Our brains are everything we are. Every thought we’ve ever had, every person we’ve ever loved, every memory we’ve ever made, and everything we could ever be, all of it is contained within our brains. It is time we give it the attention it deserves and do what needs to be done to stem the wave of diseases coming for us all.