This is Brain Awareness Week but we need better neurological care services, write Dr Ruth Loane, Dr Shaun O'Keeffeand Prof Desmond O'Neill
It is now almost two decades since former president George Bush snr declared the "Decade of the Brain". Many advances have occurred in our understanding of the brain and the illnesses that affect it. While the public has followed these advances with interest, unfortunately there has not been a similar development of services to ensure they can benefit from advances in the prevention and treatment of diseases of the brain and nervous system.
Those involved in providing this treatment - geriatricians, neurologists, old-age psychiatrists and rehabilitationists - are frustrated at the slow pace of development in services needed to support both patients and primary care services.
In the case of stroke and dementia (the two most expensive neurological illnesses), the promise of stroke units, memory clinics and other similar initiatives has not been realised in Ireland.
One of the functions of "Brain Awareness Week" (observed this week in 69 countries) is to inform Irish society of developments in neuroscience. It is, therefore, serendipitous that the World Health Organisation (WHO) has just released a major report* on the need to recognise neurological diseases as a public health problem, and the need to develop creative responses for their prevention and management in conjunction with primary care.
The emphasis of the report is on ageing and the developing world. This is apt as the majority of older people are in the developing world. As many neurological diseases are more common in later life, there is a unity of purpose between those involved in neurological diseases across the globe.
The good news is that preventive strategies, if promoted, are likely to have an impact on illnesses previously thought unpreventable. There has been a remarkable improvement in the health of older people in the developed world, with disability (much of which is neurologically based) falling among the over-80s at a rate of 1.5 per cent a year.
There has also been a sustained fall in stroke prevalence: a repeat study of stroke in Oxford, given the ageing population, expected a 28 per cent increase, but instead found a 29 per cent decrease.
Not only is there preliminary data suggestive of the declining prevalence of dementia, but there is interesting evidence of potential for preventive strategies. This ranges from blood-pressure control and Alzheimer's disease in humans, to a key study of mice with the Huntingdon's gene who had the onset of symptoms delayed by being in a more stimulating environment.
However, set against this is a worldwide lack of specialist services to provide direct care. The report points to the potential for a formal recognition of a coalition of specialities - geriatric medicine, neurology, old-age psychiatry and rehabilitation medicine - to provide secondary care but also academic development in tackling the neurological diseases. A good example of this in the WHO report demonstrates how three specialities provide care for older people with dementia in Brazil, a country with the world's 11th-largest population of older people.
We are fortunate in Ireland that this coalition of specialities works together in a setting of reduced resources, for example in the Council on Stroke of the Irish Heart Foundation, to promote a major development of resources for those with illnesses of the brain and nervous system. The Alzheimer Society of Ireland has also been supportive, paying particular tribute to the community assessment model of old-age psychiatry.
It must be hoped that the current review of services for people with neurological diseases by the Health Service Executive will follow the WHO report in looking to a broad coalition to respond to the challenges of neurological illnesses.
Unlocking the dynamism inherent in the joint working of these specialities must be a part of the solution of meeting the preventive, treatment and rehabilitation needs of those with neurological disease.
Dr Ruth Loane, chair, Irish Association of Consultants in Old Age Psychiatry; Dr Shaun O'Keeffe, chair, Irish Society of Physicians in Geriatric Medicine; and Prof Desmond O'Neill, secretary, Irish Gerontological Society.
*The WHO report is available at http://www.who.int/mental_health/neurology/neurological_disorders_report_web.pdf