A neurology revival in Latin America

Abstract

From Oct 31 to Nov 5, 2015, the neurological community will meet in Santiago, Chile, for the World Congress of Neurology (WCN 2015), the biennial event organised by the World Federation of Neurology (WFN). In the apt words of the Congress President, Renato Verdugo, “it is the right time to have a World Congress of Neurology in Chile.” In upper middle-income and high-income countries of Latin America, such as Argentina, Brazil, and Chile, public and academic interest in neurological care and research are thriving, particularly in the fields of dementia and stroke. It is hence also the right time for international funders and the Pan American Health Organization, Regional Office of WHO (PAHO/WHO) to strengthen links with the WFN to build momentum, and deepen their support for the Latin American neurology community. Demographic characteristics have changed substantially in Latin America over the past 25 years, and ageing of the population is catching-up with that of North America and other wealthy regions. For instance, in Southern Latin America, life expectancy in women was 76·39 years (95% uncertainty interval 76·26–76·51) in 1990, but that had increased to 80·20 (79·73–80·71) by 2013—a figure fairly similar to that of women in the USA (81·42 [80·58–82·16]). Unsurprisingly, the burden of disease has also evolved, and Alzheimer's disease and stroke are now among the most common causes of years lost because of disability. This change is affecting Latin American societies as a whole and particularly their outdated health systems, which have traditionally attended to acute patients but now have to cope with the complex, multidisciplinary needs of people with chronic neurological conditions. These challenges are most likely driving the high interest in neurological practice and research. America is now the first region worldwide to adopt a Regional Plan of Action on Dementia, which was announced on Oct 2, 2015, after a resolution was passed unanimously by all PAHO/WHO Member States (including Latin American and Caribbean countries, the USA, and Canada). The prevalence of severe disabilities, such as cognitive impairment, in people aged 60 years or older is estimated to increase by 20% in North America from 2000 to 2020, but the increase could be a staggering 47% in Latin American and Caribbean countries (with the highest dementia prevalence worldwide, at an estimated 7·6 million cases in 2020). Understandably, such estimates are urging policy makers to take action, and the Regional Plan will provide the strategic route to achieve quality care for patients with dementia and to tackle risk factors (many of them common to stroke and cardiovascular diseases) in these populations. Every country is expected to put its own National Dementia Plan in place by 2020, following the lead of Argentina, Costa Rica, Mexico, and the USA, where plans have already been devised. A plan is under public consultation in Chile, and is expected to be approved by the government soon. Improving dementia research and surveillance capacity—a key strategic line of action of the Regional Plan—will be crucial to monitor progress, promote evidence-based neurological practice, and guide decision-making at the national level. Latin America already has the research infrastructure and resources to perform high-quality epidemiological studies but, at present, only about a third of memory clinics have the capacity to implement clinical trials. Even so, more than 80 clinical trials (mostly funded by the pharmaceutical industry) in patients with dementia are taking place in in Argentina, Brazil, and Chile. In Colombia, a landmark trial in preclinical Alzheimer's disease is ongoing. Remarkably, retention rates in clinical trials are consistently higher than in other regions (≥85% after 1 year of intervention is common whereas, for example, in North America rates ≥60% are difficult to achieve). To seize momentum, PAHO/WHO must strengthen its collaboration with the WFN to train young neurologists in clinical research and to promote international collaborations. Only in this way will the success of the Regional Plan by 2020 be possible. “Changing neurology worldwide” is the suitable motto of WCN 2015. Latin America has a long history of excellence in neurology (the first neurology ward was established in Buenos Aires, Argentina, in 1885), but over the past half century political and economic constraints have led to emigration of many brilliant specialists and to poor resourcing of academic institutions. In parallel with the ageing of Latin American societies, and at a time of more stable political and economic regimes, interest in the specialty is now being revived. WCN 2015 attendees will be able to sense that revival in Santiago. The huge burden of dementia in Latin AmericaAs mentioned in your Editorial,1 dementia is having a huge social and economic effect in Latin American countries. The prevalence of dementia in people aged 65 years and older is about 7·1%.2 As the population continues to age, about 7·6 million people in Latin America and the Caribbean are estimated to develop dementia by 2030.3 Latin America faces the same challenges in dealing with dementia as rich countries do, but with a much lower level of preparedness and relatively little awareness. For example, we have reported4 that, even among neurologists, a substantial number of practicing physicians that diagnose dementia will do so without providing a specific diagnosis of the dementia type. Full-Text PDF