Epidemiology of Neurological Disorders

1. Epidemiology of Neurological Disorders Dr. Yeşim YASİN Fall-2013

2. Outline: • Global burden of neurologicaldisorders • Nationalburdenof neurologicaldisorders • Mostcommonlyseenneurologicaldisorders: a publichealthapproach • Prevention

3. Global burden of disesase • Neurologicaldiseasesarebecomingincreasinglyimportant in terms of publichealththroughouttheworldand in Turkey.

4. Global burden of disesase • The Global Burden of Disease reportdrew the attention of the international health community tothe fact that the burden of mental and neurological disordershad been seriously underestimated by traditional epidemiologicalmethods that took into account only mortality, not disabilityrates.

5. Global burden of disease • The Global Burden of Disease reportspecifically showed that while mentaland neurological disorders are responsible for about 1%of deaths, they account for almost 11% of disease burdenworldwide

6. Many conditions including neuropsychiatric disordersand injuries cause considerable ill-health but noor few direct deaths.

7. Neuropsychiatric disordersand injuries in particular were major causes of lost years of healthy life as measured by DALYs, • were significantly underestimated when measured by mortality alone

8. Commonneurologicaldisorders • Stroke • Dementia • Epilepsy • parkinsonSdisease • Headeachedisorders • Multiplesclerosis • Neuroinfections • Neurologicaldisordersassociatedwithmalnutrition • Painassociatedwithneurologicaldisorders • Traumaticbraindisorder

9. Estimates of disabilityadjusted life years (DALYs)

10. Table 1. Number of DALYs for neurological disorders and as percentage of globalDALYs projected for 2015 and 2030 neuropsychiatric category 2% 4.3%

11. Percentage of total DALYsforselecteddiseasesaandneurologicaldisordersb Neurologicaldisoerdersconstituteslightlyover 6% of total burden,

12. DALYsforindividualneurologicaldisorders as percentage of total neurologicaldisorders

13. Neurologicaldisorders as percentage of total DALYsfor 2005, 2015 and 2030 acrossincomecategory Neurological disorders contribute to 10.9%, 6.7%, 8.7% and 4.5% of the global burden ofdisease in high, upper middle, lower middle and low income countries, respectively, in 2005.

14. Estimates of deaths

15. Deathsattributabletoneurologicaldisorders as percentage of total deaths, 2005, 2015, 2030

16. Deathsfromselectedneurologicaldisorders as percentage of total neurologicaldisorders

17. DeathsandDALYsfromselectedneurologicaldisorders as percentage of total neurologicaldisordres DALYs Deaths

18. Neurologicaldisorders as percentage of total deathsfor 2005, 2015 and 2030 acrossWorld Bank incomecategory Neurologicaldisordersconstitute 16.8% of the total deaths in lower middle income countries compared with 13.2% of the total deaths in highincomecountries.

19. Estimates of years of healthy life lost as a resultof disability (YLDs)

20. The number of YLDs per 100 000 populationassociated with neurological disorders and other diseases and injuries with neurological sequelaeis projected to decline from 1264 in 2005 to 1109 in 2030 YLDs per 100 000 population associated with neurological disorders andother diseases and injuries with neurological sequelae and as percentageof total YLDs projected for 2015 and 2030

21. YLDs per 100 000 population associated with neurological disorders andother diseases and injuries with neurological sequelae and as percentageof total YLDs projected for 2015 and 2030 YLDs associated with Alzheimer and otherdementias, however, are projected to increase by 38%.

22. Top fivecauses of YLDsamongneurologicaldisorders, byincomecategory YLDs per 100 000 population for neuroinfections, and the nutritionaldeficiencies and neuropathies category are highest for low income countries neurologicalinjuries, epilepsy and migraine, they are highest in upper middle income countries For Alzheimerand other dementias they are highest for high income countries

23. almost half of the burden in terms of YLDs attributable to neurological disorders is in low incomecountries followed by lower middle income countries YLDsassociated withneurological disorders by income category

25. Turkey, Burden of Disease

26. Turkey, Burden of disease

31. BURDEN ATTRIBUTABLE TO SEVEN BASIC RISK FACTORS • Highcolesterol • Smoking • High body massindex • Highbloodpressure • Alcoholuse • Insufficientconsumption of fruitsandvegetables • Physicalinactivity

32. Hypertension as a common risk factor number of deaths attributed to hypertension, which refers to the fact that they could beprevented by keeping hypertension under control is 39.731 for cerebrovasculardiseases

33. alcohol consumption-attributeddeaths are mostly the consequences ischemic heart diseases and hemorragic stroke. 2088 deaths caused byhemorrhagic stroke couldbe prevented by prevention of alcohol consumption

34. 11109 deaths caused by ischemic stroke could be prevented byprevention of obesity

35. high cholesterol is among major risk factors of ischemic heart diseases and ischemicstroke. Prevention of high cholesterol could prevent 7.802 deaths caused by ischemic stroke

36. Sufficient amount of physical activity could prevent 10.269 deaths caused by ischemic stroke. As for burden of disease which is preventable, physical activity could prevent 101.578 DALY in ischemic stroke.

38. Prevention • Many neurological disorders can be prevented!

39. Prevention • Primaryprevention • Secondaryprevention • Tertiaryprevention

40. Primaryprevention • High risk approach (individualapproach) • Populationbasedapproach

41. Prevention- high risk strategy • Elimination of themajor risk factors. • Controllinghighbloodpressure • Loweringthelevel of bloodcholesterol • Quittingtobaccouse • Controllingdiabetes • Maintaininga healthyweight, body massindex • Diet • Exercisingregularly • Preventionandtreatment of coronaryhearthdiseases

42. Prevention- populationbasedstrategy • Raisingawareness of healthpersonnelabouttreatmentandprevention of neurologicaldiseases A comprehensive national strategy; community-based health promotion and accessto treatment can substantially decrease the burden associated with cerebrovasculardiseases (stroke)

43. Prevention-populationbasedstrategy • Healthpromotionprogrammestoprevent risk factors. • Smokefreeairspace • Diabetcontrolprogrammes • Promotingandcreatingbuiltornaturalenvironmentsthatencourageandsupportphysicalactivity.

44. Prevention- populationbasedstrategy • immunization programme forthe prevention of neuroinfections (poliomyelitis, neurologicalconsequences of infections) • Road safety – prevention of traumaticbraininjury Traumatic brain injury is the leading cause of death and disability in children and young adults

45. Tertiaryprevention ASPIRIN In cases of acute stroke, aspirin is given as soon as CT or MRI has excluded intracranialhaemorrhage. • Usingmedication • Rehabilitation Immediate aspirin treatment slightly lowers the risk of early recurrent stroke andincreases the chances of survival free of disability about one fewer patient dies or is left dependentper 100 treated. However, because aspirin is applicable to so many stroke patients, it hasthe potential to have a substantial public health effect.

46. WHO recommendations • Gaincommitmentfromdecision-makers • Increase public and professional awareness • Minimize stigmaanderadicatediscrimination • Strengthen neurological care within the existing health systems • Incorporate rehabilitation into the key strategies • Establish links to other sectors • Define priorities for research

47. Conclusions • Estimating the burden of diseases is difficult due to • imperfect medical registration, • variations in structure of patient referral and influence of secondary diagnoses. • Taking into account the current aging of the population, the prevalence of some neurological diseases, such as CVA, Parkinson's disease and dementia will rise. • Priority setting for care and treatment is hampered by differences in burden of illness on the individual and on the community level

48. THANK YOU!