Neurology Central

Early brain development and cognitive aging – a global challenge

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The global dementia epidemic
The number of people living with dementia worldwide is currently estimated at 47 million and this number is predicted to triple by 2050 [1]. Importantly, nearly 60% of people with dementia live in low- and middle-income countries (LMICs). There is currently no disease-modifying treatment for diseases that cause dementia, and dementia related care is costly and complex; some of the main challenges associated with dementia include its economic impact on families, caregivers and communities, and the associated stigma and social exclusion [2].

What can be done?

Understanding the life-course determinants of resilience to brain aging could significantly reduce the burden of cognitive impairment and dementia on individuals and societies at large through prevention. The concept of cognitive resilience is relatively new [3] and proposes that cognitive functions are maintained or recovered in face of an adversity [4]. Cognitive reserve (CR) is a specific type of cognitive resilience whereby the underlying adversity is organic in nature. The CR concept accounts for phenomenon that some individuals are able to remain cognitively healthy despite the accumulation of neuropathology. One review has estimated that 10–40% of individuals with Alzheimer’s disease (AD)-like brain pathology had no signs of cognitive impairment during life [5]. This suggests that there are moderating factors which allow one to preserve cognitive functions despite the underlying brain disease [6]. Identifying practical and modifiable sources of CR would inform the design of effective and scalable interventions that prevent dementia. Social, cultural, environmental and lifestyle factors may be as effective as a new drug, which is especially relevant in the context of LMICs that have a particular requirement for cost-effective strategies.

The key – understanding the early-life origins of cognitive aging

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