There will be close to 10 billion people in the world by 2050, and if the World Health Organization estimates are correct, as many as 22% of them – or 22 billion people – will be over 60.

A separate study by American doctors found that by that same year, the number of people living with dementia could be as high as 132 million – three times the current number.

The Organisation for Economic Co-operation and Development (OECD) estimates that impaired brain health drains as much as $8.5 trillion a year from the global economy in lost productivity. This number will increase as the population ages.

“We must better understand the brain and provide access to tools and information to help people nurture brain health as part of One Health in every community, country and health system,” according to the Davos Alzheimer’s Collaborative (DAC), a Swiss-based foundation and a US 501c3 initiated by The World Economic Forum (WEF) and The Global CEO Initiative on Alzheimer’s Disease (CEOi).

The DAC held a round-table discussion at Davos to discuss the need to prioritise brain health globally, especially given brain health’s impact on human and societal well-being, productivity, and resilience.

The discussion brought together leaders representing international organisations, scientists, experts from the healthcare industry, policymakers, and forward-thinking visionaries spanning both private and public sectors. Their collective aim was to delve into the significance of brain health as a crucial economic imperative, underscore the pressing requirement for ongoing global collaboration, and emphasise the essential role of fortifying health systems to ensure the well-being of populations with all levels of resources.

Moderated by George Vradenburg, founding chairman of the DAC, the discussion encompassed a range of critical topics, such as advancing the development of immunotherapies and vaccines, expediting interventions through the lens of patients’ groups, evaluating the effectiveness of public-private partnerships, intensifying efforts in risk reduction and prevention education, spotlighting the disproportionate impact on women, and emphasising the imperative for strengthened initiatives in data-sharing.

The event also kicked off a new network of global “Brain Health Ambassadors,” who will commit to promoting the inclusion of brain health at the primary care level and the international prevention of Alzheimer’s and related dementias. His Excellency Luis Gallegos, Chairman of the Board of UNITAR and former Minister of Foreign Affairs of Ecuador, became the first inaugural Brain Health Ambassador.

The Brain Health Imperative

“There is no question that we are all living longer, and that is good news,” Vradenburg said.

He emphasised that prolonged life spans contribute positively to society and the economy as individuals work for an extended period. Yet, he noted a potential oversight: “Rarely do you hear people talking about your brain span equaling your health span.”

Vradenburg expressed concern about the prevalence of individuals spending the last decade of their lives enduring some form of dementia.

“The prevalence of this disease is huge – nearly 50 million people around the world,” Vradenburg said. “But the disease starts 25 years or so before you get symptoms. So, this estimate of 50 million people diagnosed worldwide needs to be multiplied by a factor of eight to get the total number of people actually experiencing the disease.”

The silver lining is that today, doctors and scientists better understand what enables brain resilience and what can prevent Alzheimer’s, Vradenburg said. Moreover, as innovation accelerates and populations age, more countries and leaders see brain health as an economic, societal, and policy imperative.

“Governments, businesses, international organisations, and the scientific and advocacy communities everywhere are paying attention like never before. We have reached a critical inflexion point for action,” according to Vradenburg. He reminded that “2023 was a pretty good year” for people with Alzheimer’s, as the first disease-modifying drug was fully approved by the American Food and Drug Administration and covered by Medicare.

“For the patient community, this is excellent news,” he said. However, he admitted that the drug only has a moderate benefit – reducing the rate of decline by up to 27%, that it has side effects, and that it is expensive.

Prof Miia Kivipelto from the Karolinska Institute highlighted the current abundance of information regarding the factors influencing Alzheimer’s, particularly genetics, and the preventive measures available.

According to her, adopting a healthy lifestyle is pivotal, such as maintaining a balanced diet, participating in regular physical activity, practising relaxation techniques, effectively managing stress, and engaging in cognitive stimulation. She emphasized that the indicators for optimal cardiovascular health align with those crucial for maintaining brain health, including blood pressure regulation, cholesterol management, prevention of obesity, and controlling diabetes.

“What is good for the heart is good for the brain,” Kivipelto said.

Cognitive Reserve Strategies

Neuroplasticity is also crucial, noted Prof Murali Doraiswamy of Duke University.

“The important thing is that the brain is plastic throughout our lifetime,” he said.

Consider infants—they employ multiple senses, biting, smelling, and even testing the rebound of objects, Doraiswamy said. Participating in such multisensory activities is instrumental in shaping the networks within the brain. These networks, in turn, play a pivotal role in forming memories and experiences.

Doraiswamy highlighted the enduring presence of neuroplasticity even in the later stages of life and said researchers have explored various electrical and chemical stimuli in rodent models to augment neuroplasticity. While cautioning that these methods haven’t been applied to humans yet, he suggested the possibility of their future application.

Additionally, Doraiswamy introduced the concept of “cognitive reserve.”

“Cognitive reserve can simply be thought of as how many excess networks you have built up in your brain over a lifetime of experiences,” he said. “That reserve capacity is what protects you from decline if you suffer from a neurodegenerative disease. So, think of it as having access to cell phone towers and the more cell phone towers, you have a couple of get knocked out, you still have power.

“So it’s crucial for us to learn how to develop and monitor cognitive reserve.”

He said that physicians can evaluate an individual’s brain and cognitive reserve using state-of-the-art digital tools, including those accessible through smartphones.

“I think in addition to all of the pharmacotherapies that pioneers are developing, we need also to develop non-pharmacological ways,” Doraiswamy continued. “Now, with digital tools such as smartphone apps, it’s possible to create a closed-loop system where you can do cognitive self-testing at home in the comfort and convenience of your home. You can also send those reports to your doctor. And you can also decide to train what parts of your abilities are below normal for five minutes a day using these tools.”

Global Brain Health Initiatives

Drew Holzapfel, executive director of CEOi, said some programs are already underway and working. For example, this year, his organisation is collaborating with eight flagship sites in five countries to improve how Alzheimer’s disease is diagnosed. His organisation funded 19 programs in 12 countries in 2023.

“We’re trying to speed up the time from detection to diagnosis so that we can get care to the people who need it as fast as possible,” Holzapfel said.

His organisation’s second focus is creating collaborations to scale Alzheimer’s and brain health longitudinal clinical trial research. In India, for example, a group of high-volume clinics is looking at AI’s role in brain health. In another example, they work with ophthalmologists there to help detect cognitive impairment early and get those people into the health system.

The group has also started to look at how brain health and climate change are interconnected with partners in Kenya, Slovenia, and Chile.

Finally, he said, they are working on finding ways to engage governments.

“There have been a lot of governments and international organisations that have made commitments to Alzheimer’s. And so we’re committed to working with these governments to ensure we bring those commitments forward,” Holzapfel said.

Dr Noémie Le Pertel, a senior fellow and founding chair for the Economics of Well-being and Global Human Flourishing Working Group at the Human Flourishing Network, housed at Harvard University’s Institute for Quantitative Social Science, said her team is currently undertaking the world’s most comprehensive study on mental health, physical well-being, and various childhood predictors, encompassing the entire lifespan.

Le Pertel said: “The call to action that I wanted to put forward was really for leaders in the room who are working in organisations, what can we do and how can we join forces to seize the opportunity to work in the workforce to upskill people to understand the role of their brain health, and how it impacts not only organisation, society, the economy, but the future of our society?”

Image Credits: Courtesy of the Davos Alzheimer’s Collaborative, Courtesy of the Davos Alzheimer's Collaborative, Courtesy of the Davos Alzheimer's Collaborative.