The role of population-level preventive care for brain health in ageing

Abstract

Over the past several decades, a worldwide demographic transition has led to an increasing number of older adults with chronic neurological conditions. These conditions, which have a profound effect on the cognitive function and physical ability of older adults, also have a long preclinical phase. This feature provides a unique opportunity to implement preventive measures for high-risk groups and the population as a whole, and therefore to reduce the burden of neurological diseases. The concept of brain health has emerged as the overarching theme to define overall brain function independently of underlying pathophysiological processes. We review the concept of brain health from the ageing and preventive care perspectives, discuss the mechanisms underpinning ageing and brain ageing, highlight the interplay of various forces resulting in deviation from brain health towards brain disease, and provide an overview of strategies to promote brain health with a life-course approach.

Figure 1.

Trajectories of accelerated versus delayed brain ageing in relationship with chronological age and brain health. Accelerated brain ageing due to accumulation of damage, in the absence or failure of compensatory mechanisms, results in impaired brain functional and structural integrity. This impairment, when surpasses a certain threshold, can manifest with decrease in cognitive function and neurologic diseases.

Figure 2.

The ABC framework for systematic risk exposure evaluation. This proposed systematic approach proposes addessing and monitoring the following items in middle age and young adult individuals in order to decrease the damge load to the brain and modifying the trajectory of brain ageing at an individual level: Awareness (education about factors that can affect brain function and structure and paying attention to early signs of neurological diseases), Blood Pressure (early diagnosis and treatment of hypertension), Community engagement (increase the sense of belonging and participating in meaningful social activities), Drugs and smokings (avoiding and cessation of recreational drugs, alcohol and tobacco), Enviromental hazards (avoiding chemical exposures and air and water polutant), Food (balanced diet with low sodium and sugar and enriched with fruits and vegtables), Glyecmic control (early diagnosis and treatment of diabetes), Hyperlipdemia (early diagnosis and treatment of hyperlipidemia), Inactivity/Insomnia (physical activity and mobility with focus on aerobic excercises and walking/improving regular and adequate sleep and early diagnosis of sleep disorders such as sleep apnea). The figure was created by BioRender.

Figure 3.

The brain connectivity as a proxy for brain resilence. Adverse events in early life, lack of formal education and deprevied living enviroment and exposure to cerebrovascular risk factors can prevent the brain from reaching its maximum network capacity. Addressing those factors will boost the brain connectome and changes the baseline functional levels and the slope of decline overtime. The figure was created by BioRender.