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Overview of Brain Disorders: Research Across the Lifespan

January / February 2014 | Volume 13, Issue 1

In Bhutan, one older woman and one younger woman with young child strapped to back, another young child held on hip by person of
Photo by Curt Carnemark/World Bank

Fogarty began its Brain Disorders: Research across
the Lifespan program a decade ago to expand research
capacity for dozens of conditions in developing
countries.

Difficult births, poor nutrition and exposure to infectious diseases and toxins mean many children in poor countries lose cognitive function early in their lives and are prevented from achieving their full potential. Others go on to develop epilepsy, causing them to be feared and shunned. For those who manage to survive to old age, they may become afflicted with premature dementia but lack access to diagnosis or treatment. The same conditions can initiate or exacerbate neuropsychiatric disorders, which are often stigmatized and poorly treated, leading to more disability and worse outcomes.

These and other brain disorders that develop across the lifespan are heartbreaking wherever they occur, but pose an enormous burden in low- and middle-income countries (LMICs) where resources are lacking. The physician-to-patient ratio can be as low as one for every 20,000 people, with even fewer psychiatrists and neurologists.

That's why Fogarty began its Brain Disorders in the Developing World: Research across the Lifespan program a decade ago, designed to expand research capacity for dozens of conditions in developing countries. The initiative supports activities that address neurodevelopmental disorders - such as autism, fetal alcohol syndrome and learning disabilities - as well as neurodegenerative diseases including Alzheimer's and Parkinson's diseases, addiction, seizure disorders, neuropsychiatric conditions such as depression and schizophrenia, posttraumatic stress and other disorders. In all, the program has awarded more than 150 grants totaling about $85 million - mostly from NIH partner Institutes and Centers.

"Many people in developing countries suffer from conditions that affect their brains and devastate their lives, but we don't have much data documenting the underlying causes of the disorders and interventions that might be effective," said Fogarty Director Dr. Roger I. Glass. "By supporting research and training in countries where resources are limited, we hope to generate research capacity that could ultimately improve the lives of those suffering from the burden of these neurologic diseases."

Mental and behavioral disorders are the largest global contributors to Disability Adjusted Life Years (DALYs), according to the Global Burden of Disease Study 2010 from the University of Washington's Institute for Health Metrics and Evaluation (IHME).

During the past several decades, global improvements in health care have permitted more children to survive to adulthood, even as they bear the lasting effects of early disease and malnutrition. These can include lower cognitive ability and the development of chronic neurodegenerative disorders. Many causes of developmental disabilities, such as genes, nutrition, infectious diseases, environmental toxins and trauma, are particularly common in resource-poor countries. Sub-Saharan Africa, for instance, carries a especially heavy burden of infectious and parasitic diseases, including HIV, tuberculosis, meningitis and malaria. In many of these countries, very little data exist on the epidemiology, natural history and pathogenesis of neurological problems while at the same time, there exists a lack of care.

Fogarty's initiative specifically aims to support teams of researchers from both low- and high-resource institutions as they study brain disorders relevant to developing countries that occur at any stage of life. The projects are intended to provide scientific evidence and also help build the skills needed to research the nervous system and what can undermine it.

To date, research findings have led to publication of 435 peer-reviewed articles and 14 books or book chapters, and the projects have facilitated long-term training of at least 138 scientists.

Over the years, Fogarty has partnered with other NIH Institutes and Centers in a number of its initiatives but the brain disorders program has generated the most trans-NIH support. The eight NIH partners are: the National Institute on Aging (NIA), National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institute of Child Health and Human Development (NICHD), National Institute on Drug Abuse (NIDA), National Institute of Environmental Health Sciences (NIEHS), National Institute of Mental Health (NIMH), National Institute of Neurological Disorders and Stroke (NINDS) and Office of Dietary Supplements. Non-NIH partners include the Institute of Neurosciences, Mental Health and Addiction of the Canadian Institutes of Health Research and Mexico's Consejo Nacional de Ciencia y Tecnologia.

Fogarty's Brain Disorders in the Developing World: Research across the Lifespan program is designed to increase research capacity in low-resource countries and help improve neurological health for millions around the globe.

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