Description

Preventive Neurology Ninety percent of adult neurological disability relates to stroke and neurodegenerative diseases such as Parkinson’s disease and motor neurone disease. As life-expectancy increases, the number of people disabled by these conditions is expected to double by 2050. These are all common conditions of the ageing nervous system. Loss of neurones cannot yet be reversed, but delaying the onset of disease and slowing its progression are realistic goals. Our main aim is to use our purpose-built research infrastructure and our well-established cohorts of patients to try and predict on an individual level who will develop these diseases, which will allow us to intervene earlier and reduce the impact of these diseases. These are difficult diseases to model, with a huge amount of variation that’s not well understood. It is often not easy to predict how people are going to progress. That is why our cohorts of patients are vital in helping us to understand the clinical variations and the biological basis for them, as well as being able to predict which patients will fare better than others. This will then inform how acute hospitals might deploy their resources to better care for people with chronic neurological conditions, as well as adopting a more individualised approach to patient care. With the rapid aging of populations, neurologic disorders have become among the leading causes of disability and mortality worldwide. Most neurologic conditions have a prolonged prodromal phase-even if they tend to manifest with an acute syndrome such as stroke-and can lead to a relentless, often deleterious course creating a major burden on patients, caregivers, and society. This unique nature of neurologic diseases signifies the strong need for equally effective primary and secondary prevention strategies and focus on brain health before brain diseases ensue. The field of preventive neurology applies both universal and selective primary prevention strategies to promote brain health both at the public and personal levels. The preventive neurology approach aims to identify and target high-risk individuals and protect them from reaching a critical point where overt clinical symptoms are present and disease progression is irreversible. Universal and selective prevention training, along with dovetailed clinical and public health research, are 3 essential pillars of preventive neurology. The burgeoning field of preventive neurology aims to assess neurologic care needs in a society, promote the participation of neurologists in restructuring of the health care policies to promote brain health, and identify medium- and high-risk individuals to prevent or delay future neurologic events. Hypertension occurs in approximately 30% of patients with type 1 diabetes and from 50 to 80% of patients with type 2 diabetes. Although the pathogenesis of hypertension is distinct in each type, hypertension markedly enhances the already high risk of cardiovascular and renal disease in types 1 and 2 and implications for treatment are similar in both. The threshold for blood pressure treatment in diabetic patients is generally agreed to be 140/90 mm/hg with a target BP of < 130/80. So-called "lifestyle modifications" play an important role in therapy, particularly in type 2 patients, by decreasing blood pressure and improving other risk factors for cardiovascular disease. Indeed non-pharmacologic interventions have been demonstrated to prevent the development of type 2 diabetes in patients at high risk to develop the disease. Aggressive anti-hypertensive drug treatment is warranted given the high risk associated with the combination of diabetes and hypertension and the demonstrated effectiveness of anti-hypertensive treatment in reducing cardiovascular morbidity and mortality in this group of patients. ACE inhibitors and ARBs are the cornerstones of pharmacologic management, in no small part because of the renoprotective effects of these agents in antagonizing the development and progression of diabetic renal disease. Multiple agents, including diuretics, will usually be required to attain target blood pressure levels.

Key Specification Preventive

Neurology

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