The current approach to brain care is largely reactive, considered only when patients or families raise concerns. This approach is not working. Brain diseases are a greater cause of disability than cardiovascular diseases or cancer, and their prevalence is projected to grow with lengthening life expectancy. Brain-related disability already affects one in four people worldwide and accounts for a third of the global burden of disease. Currently, greater health expenditure per capita results in more years of disability, rather than more years of healthy life. By 2030, brain-related disability will represent over half of the world-wide economic impact of disability. According to the World Health Organization, brain-related disabilities are the major threat to human society. Dementia is the #1 feared condition as we age, and a main lifelong cause of brain-related disability.
To address this major challenge, I propose a different approach, one focused on promoting brain health and resilience to prevent brain diseases, and in the presence of disease minimize the risk of disability and optimize function. This requires: (1) A focus on the whole person, rather than on the disease; (2) Regular check-ups for the brain, and the development of a ‘brain vital sign’ that can offer sensitive, personalized biomarkers of cognitive performance and behavior across the lifespan to empower individuals and allow for true precision health for the brain; (3) The prescription of lifestyle interventions that promote brain health as an integral part of lifelong brain care, leveraging technology to enable coaching and other aides to ensure adherence; (4) The use not simply of medications, but of non-invasive neuromodulation methods to characterize and modify brain alterations in activity (spatio-temporal signatures) that relate to individual disability and thus offer personalized and targeted therapeutic interventions.
Alvaro Pascual-Leone, MD, PhD, is a Professor of Neurology, Harvard Medical School, a Senior Scientist at the Hinda and Arthur Marcus Institute for Aging Research and Medical Director of the Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife in Boston, MA. He also serves as Scientific Director of the Barcelona Brain Health Initiative and is a co-founder of Linus Health and TI Solutions.
Dr. Pascual-Leone is considered a world leader in noninvasive brain stimulation technologies. His research combines brain imaging and stimulation techniques to examine causal relations between brain activity, cognitive processes, and behavior in health and disease. A major current focus is to characterize and sustain brain health across the lifespan. He is a member of the Spanish Royal Academy and been honored with many distinctions and awards. He has published more than 850 scientific peer-reviewed papers and his work is highly cited. He remains a practicing cognitive neurologist and dementia specialist.