The Growing Burden Of Neurodegenerative Disorders

Neurodegenerative diseases affect millions of people worldwide. And with the world demographics getting older, it is apt to foretell that the burden of neurodegenerative disorders is expected to mount. With advances in medical technology, the life expectancy of people has drastically increased, reeling people to an age where neurodegenerative disorders are more prevalent. 

These diseases delineate an insidious degeneration or atrophy of the brain cells i.e., neurons thus destructuring and hampering the function of the central nervous system or peripheral nervous system. Under the umbrella of neurodegenerative diseases, take shelter a spectrum of disorders that can be serious and life-threatening. Some of the examples of neurodegenerative diseases include Parkinson’s disease, Huntington’s disease, Alzheimer’s disease, Spinal muscular atrophy, amyotrophic lateral sclerosis, Multiple sclerosis, frontotemporal dementia, and the spinocerebellar ataxias. Furthermore, as per the statistics presented by the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016, neurodegenerative disorders were the leading cause of disability-adjusted life-years (DALYs) and the second leading cause of deaths worldwide in 2016.

By the numbers, Alzheimer’s is the most commonly prevalent neurodegenerative disorder. Going by the numbers, at least 50 million people are living with Alzheimer’s disease or other forms of dementia. In the case of Parkinson’s, it is believed that over 10 million people worldwide are living with Parkinson’s disease, whereas an estimated 2,500,000 people in the world have multiple sclerosis. The numbers for each of the neurodegenerative disorders are expected to increase in the coming decades. 

How Neurodegenerative disorders are diagnoses? 

Early diagnosis is crucial to treat the disease and improve patient outcomes. In several other disorders, pathological analysis of the diseases is the cornerstone of the diagnosis; in the case of neurodegenerative diseases, it can not be applied. However, when it comes to Neurodegenerative diseases, the chances of misdiagnosis, as well as underdiagnosis, are way higher. Even so different neurodegenerative disorders have different etiologies, and their impact on the brain is different; the bedrock neurodegenerative mechanisms causing neurodegeneration such as protein accumulation, mitochondrial dysfunction, oxidative stress, inflammation, and finally, cell death, get easily overlapped. 

Sometimes, neurodegenerative diseases often get confused with psychiatric disorders (such as anxiety and depression) owing to behavioral symptoms such as social detachment. Other times, psychiatric disorders as comorbidities, which are pretty common in most neurodegenerative disorders, get easily missed. Further, due to overlapping symptoms, there is a risk of patients getting clinically misdiagnosed as another significant setback that hampers effective treatment of the neurodegenerative diseases. 

There was an era when the diagnosis of neurodegenerative disorders was purely decided on the basis of memory loss, totally ignoring the emotional and behavioral changes. With advances in research and better comprehension of such disorders, the importance of psychological etiologies behind the neurodegenerative disorders came into the spotlight. Fast forward to the present time, with a lot being achieved in psychopathology research and a lot more underway, the focus lies on studying the biological changes that take place in the brain to study the brain circuit and track the necessary changes. At present, an array of diagnostic tools and imaging techniques are used to detect the activity of the brain, location, and extent of the injury, if present. However, there are certain limitations and constraints such as these techniques will fail to help study changes in the social and emotional state of the person, which can only be studied by families, friends, or closed ones who are in close contact with the patient. 

Do we have a cure? 

Sadly, to date, there is no cure for neurodegenerative diseases and they continue to represent one of the biggest therapeutic challenges. However, in the past decades, considerable research has been done to address progressive neuronal death, which is a primary characteristic of neurodegenerative disorders. The present treatment approaches are palliative and address the different symptoms of the diseases. 

Some of the available treatment options to address symptoms include:

Cholinesterase inhibitors (also called acetylcholinesterase inhibitors) increases the level and duration of the neurotransmitter action, 

Antipsychotic drugs help regulate symptoms such as hallucinations, delusions, or mania symptoms,

Nonsteroidal anti-inflammatory drugs (NSAIDs) tackle inflammation, 

Analgesic drugs help to relieve pain, and 

Deep brain stimulation helps to control abnormal brain activity.

Although, over the years, the contributions in understanding the neurodegenerative disorders appear to be approaching the tipping point, however, the rate of progress is moving at a snail’s pace, and the demand for novel therapeutic agents appears prompt. Furthermore, besides treatment modalities, there are other special requirements that go beyond medical needs to help patients living with neurodegenerative disorders—for instance, rehabilitation. Access to rehabilitation services after the diagnosis helps in providing personal support and co-ordinated care. The cost incurred with both the medical treatment and rehabilitation provisions also needs attention. As per the report published in  Annals of Neurology in 2017, some of the most common neurological diseases, including Alzheimer’s disease, Parkinson’s, and SMA, cost up to USD 8 million in the US alone annually. Further, the costs are expected to rise significantly in the coming years. Stigma is also a discrediting aspect that reduces patients’ social status in society. Several times the fear of social exclusion erodes all the chances of patients or care-takers coming out and receive treatment. Myths, misconceptions, and false notions further fuel the perversing stigma associated with them. 

Thus, a higher level of neuroscience research and investment needs to be made so as to enable the society to reap the benefits in brain disorders research. Education and making people aware of the true situation of the neurodegenerative illnesses will also help in reaching the goal. Further, To fight the burden of neurodegenerative disorders, the UN General Assembly took a welcoming step by including the mental well-being in goal 3 of the 17 goals of the Sustainable Development Agenda 2030. Recognition of such disorders by international organizations help not only in creating awareness but also garner attention the patients living with these disorders deserve. With a lot of private pharma companies and academia collaborating to help support the patients living with such debilitating disorders, inertia seems to be stronger on the side of better outcomes in the foreseeable future. Because, brain health is the most important resource that needs a light full of compassion, empathy, and candor to blossom and prevail.