The number of people with dementia is expected to triple worldwide by 2050, and poor and developing nations will be hit hardest. Could better public health stem the tide? Recent epidemiological and trial data hint as much, but putting health and lifestyle interventions into practice at a population level requires massive investments. Enter the Atlantic Philanthropies, a private foundation that supports health and education programs for disadvantaged groups around the world. Today, the University of California, San Francisco, and Trinity College Dublin announced that Atlantic has donated $177 million to establish the Global Brain Health Institute (GBHI). This is the largest single award by the charitable organization, founded by 84-year-old businessman Charles “Chuck” Feeney, and one of the last before the foundation concludes operations in 2016. The GBHI, which officially begins operations November 17, will train people from around the world in dementia care and prevention, and support them in establishing programs in their native countries.
“Dementia is the looming problem that’s going to cripple our health services, yet a trivial amount of research funding goes into it compared to cancer and heart disease,” noted Ian Robertson at Trinity, who co-leads the institute along with Bruce Miller at UCSF. Robertson said the GBHI wants to change a pessimistic public mindset about dementia and stimulate more interest in preventive programs. “We think the best way to do that is to train brilliant leaders across the world, who will go on to implement policies that may affect thousands or even millions of people,” Robertson said.
The need for new ideas to combat dementia is great. Demographers project 130 million cases worldwide by 2050, with two-thirds expected to occur in the rapidly aging populations of low- to middle-income countries (see May 2012 news; Jun 2013 news; Aug 2015 news). These countries are poorly equipped to deal with the crisis, as they lack dementia experts or social programs.
A glimmer of hope comes from accumulating evidence that lifestyle changes and public health interventions can cut the number of new dementia cases. Several studies have suggested that better cardiovascular care and other public health changes underlie falling dementia rates in the United States and Europe (see May 2013 news; Jul 2013 conference news; Jul 2014 conference news). Researchers led by Kristine Yaffe and Deborah Barnes at UCSF calculated that up to 10 percent of dementia cases worldwide could be prevented by modest drops in a handful of risk factors, including hypertension, diabetes, smoking, and inactivity (see Jul 2011 news; Sep 2014 news). These reports inspired creation of the GBHI, said Yaffe, who will lead some training programs at the institute.
Institute leaders plan to train 600 people over 15 years. Initially, this will take place at UCSF and Trinity, but the GBHI will partner with other institutions over time, Robertson said. The institute has two programs, one for scholars and one for fellows. The Scholars Program will accept 32 applicants per year, who will come for one to 12 months and receive living expenses, but no salary. They will represent a diverse group with different goals. Besides doctors, scientists, and economists, they might include journalists or filmmakers who want to increase public awareness about dementia, Robertson said.
The Fellows Program will take eight applicants each year from medicine, research, psychology, social science, economics, and public policy, and train them for two years under a full scholarship and salary. The fellows will take classes ranging from neuroscience and geriatrics to health law, policy, and communications. They will interact directly with dementia patients and their families. Applications come through the GBHI website.
“We are looking for fellows who have a program they want to implement in their home country or community,” Robertson told Alzforum. GBHI will provide fellows with seed money but expect them to obtain additional funds from national and international organizations.
The institute will not fund basic research, instead focusing on practical aspects such as ways of improving dementia care, markers for early diagnosis, or reducing the stigma associated with dementia. It hopes to target a multi-domain intervention trial to caregivers, who themselves are at high risk of cognitive decline.
Recent findings support a lifestyle approach. Three large trials of health and lifestyle interventions in Europe have recently finished collecting data. Each multi-domain approach included rigorous cardiovascular care, along with guidance on exercise, nutrition, and social and cognitive activities, in people at risk of cognitive decline (see Sep 2012 news). At the 8th Clinical Trials in Alzheimer’s Disease conference, held in Barcelona, Spain, November 5-7, leaders of the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) and the Multi-Domain Alzheimer’s Prevention Trial (MAPT) reported that participants in the intervention groups stayed mentally sharper than controls (see upcoming story). The third study, Prevention of Dementia by Intensive Vascular Care (PreDIVA), will report findings within weeks.
“These trials show that multi-domain interventions can work. The data make me optimistic,” Yaffe said. Robertson noted that results from these trials will inform the design of future GBHI projects. —Madolyn Bowman Rogers
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