Brain Health and Future Dilemma

By Matthew J. Ashley, M.D., J.D.

I recently revisited an American Heart Association press release regarding heart and brain health with great interest. The announcement highlights the incredible impact that diseases leading to cognitive impairments, including stroke and dementia, have on Americans’ lives in the current era. In the article, it is noted that estimates of U.S. spending on dementias alone have more than doubled from 1996 to 2016, from $38.6 billion to $79 billion – placing dementias among the top 10 most costly conditions in the U.S. in 2016. This figure does not include the enormous impact of impairment from various other brain health conditions. Among them, stroke, already well-recognized as a leading cause of disability in the U.S., couple these findings with the anticipated aging population of the U.S., the declining birth rates in the country, and the rising costs of caregiver support, and it seems like a recipe for a severe dilemma.

The World Health Organization estimates that by 2050, the world’s population aged 60 and older will double, and the population aged 80 and older will triple. And this is a U.S. issue as well. Exact figures are not attainable, but it is clear that the U.S. is also poised to see a dramatic rise in the elderly population. With stroke and dementia being highly correlated with health outcomes related to atherosclerotic disease as we age, it seems clear that drastic action is needed to address the pending problem. Without a concerted effort to prepare, the burden of disease of stroke and dementia seems probable to emerge as the pre-eminent social, economic, and moral issue of the future. Dr. Mitchell S.V. Elkind aptly points out in the American Heart Association press release that brain disease is outpacing heart disease globally, and we ought to prepare ourselves.

Fortunately, on the individual level, patients and care providers have tools to leverage to prevent stroke and vascular dementias. The same preventative interventions useful in preventing heart disease and other cardiovascular diseases have been shown to similarly impact brain health. If we wish to maintain a healthy aging population, significant work is needed to modify preventable risk factors, including hypertension, hyperlipidemia, obesity, diabetes, tobacco use, alcohol use, etc.

What is not as fortunate, however, or as clear about how to proceed, is how to manage the forthcoming need for caregiver support across the globe. Here is where declining births begin to contribute to the concerns. According to the National Health Statistics Report from January 10, 2023, from 2015-2019, women ages 15-49 reported a mean number of births of 1.3. Across the same timeframe, 56.7% of women in this age group reported having a biological child. This heralds a significant future decline in the number of young, healthy individuals who will be available to provide caregiver support for the aging population – highlighting further the importance of maintaining people’s health as they age to maintain their independence.

References

1. “Ageing and Health.” World Health Organization, 1 Oct. 2022, www.who.int/news-room/fact-sheets/detail/ageing-and-health.
2. Martinez, Gladys M., and Kimberly Daniels. “National Health Statistics Reports – Centers for Disease Control And …” Fertility of Men and Women Aged 15–49 in the United States: National Survey of Family Growth, 2015–2019, 10 Jan. 2023, www.cdc.gov/nchs/data/nhsr/nhsr179.pdf.
3. “What’s Good for the Heart Is Good for the Brain.” American Heart Association, 26 Jan. 2022, newsroom.heart.org/news/whats-good-for-the-heart-is-good-for-the-brain.