Brain Injury and Dementia in Pakistan: Current Perspectives

Abstract

Alzheimer's disease (AD) is the most common form of dementia, accounting for 50-75% of all cases, with a greater proportion of individuals affected at older age range. A single moderate or severe traumatic brain injury (TBI) is associated with accelerated aging and increased risk for dementia. The fastest growth in the elderly population is taking place in China, Pakistan, and their south Asian neighbors. Current clinical assessments are based on data collected from Caucasian populations from wealthy backgrounds giving rise to a "diversity" crisis in brain research. Pakistan is a lower-middle income country (LMIC) with an estimated one million people living with dementia. Pakistan also has an amalgamation of risk factors that lead to brain injuries such as lack of road legislations, terrorism, political instability, and domestic and sexual violence. Here, we provide an initial and current assessment of the incidence and management of dementia and TBI in Pakistan. Our review demonstrates the lack of resources in terms of speciality trained clinician staff, medical equipment, research capabilities, educational endeavors, and general awareness in the fields of dementia and TBI. Pakistan also lacks state-of-the-art assessment of dementia and its risk factors, such as neuroimaging of brain injury and aging. We provide recommendations for improvement in this arena that include the recent creation of Pakistan Brain Injury Consortium (PBIC). This consortium will enhance international collaborative efforts leading to capacity building for innovative research, clinician and research training and developing databases to bring Pakistan into the international platform for dementia and TBI research.

Keywords: Alzheimer's disease; Pakistan; TBI; aging; dementia; road traffic accidents; violence.

Figure 1

Number of injuries and deaths due to Road Traffic Incidents (RTI) in Pakistan (35). Date represents information taken from: http://www.pbs.gov.pk/sites/default/files/tables/Traffic%20Accidents%20%28YEARLY%29.pdf.

Figure 2

Road Traffic Mortalities (RTM) rates and Out-of-pocket Expenditure across South Asia. OOP, Out-Of-Pocket (OOP) expenditure, as % of the health expenditure; RTM, Road Traffic Mortality rate (per 100,000 population). Data reported from Pakistan is from 2012 and for the rest of the countries is from 2016 [Data Source: World Health Organization (WHO)] (44).

Figure 3

Road Traffic Accident Mortality Rates Across South Asia. Road Traffic Mortality rate (RTM) per 100,000 population (44) (Map Template Courtesy: Bing).