Brain disorders research: a decade of progress

March / April 2015 | Volume 14, Issue 2

​Opinion by Fogarty Director Dr Roger I Glass

The breadth and complexity of brain disorders make them some of the most difficult conditions to diagnose and treat, especially in the developing world, where there may only be one psychiatrist or neurologist in an entire country. These disorders occur throughout the lifespan - from infants starved of oxygen during difficult births, to children whose development is stunted due to malnutrition or exposure to infections or toxins, to adults who develop depression or dementia. Such mental and behavioral issues cause the world's largest burden of disability, according to the Institute of Health Metrics and Evaluation.

That's why Fogarty has been working with its NIH partners for more than a decade through the Brain Disorders in the Developing World: Research Across the Lifespan Program to catalyze this field of research and develop badly needed expertise in low- and middle income countries (LMICs). As we celebrate this milestone, it's important that we stop to review our progress and consider how best to move forward. I'm pleased to report we recently completed an evaluation of the program, which highlighted some important accomplishments and provided useful guidance for its next iteration.

With a total investment of about $84 million awarded through more than 150 grants, investigators have generated discoveries detailed in 435 peer-reviewed articles and 14 books or book chapters. Scientists developed clinical assessment tools designed for low resource settings, produced and tested novel interventions, and identified new approaches that show promise. To help sustain this significant momentum, the funding enabled long-term training of at least 138 scientists.

As we and our partners consider the program's next phase, the evaluation suggests we enhance collaboration and networking to more firmly establish a community of practice, strengthen our focus on implementation science and develop a systematic approach to measuring capacity building. For more details of the evaluation, please see the related article, Brain program catalyzes research, builds capacity.

One of the most heartbreaking and costly brain disorders is Alzheimer's Disease. By 2050, the number of people living with dementia around the world is expected to triple, reaching 135 million. Nearly three-quarters of them will reside in developing countries, which are least equipped to bear this burden.

Despite these distressing predictions, I was encouraged by some favorable news presented at the recent NIH Alzheimer's Disease Summit. Age-specific risk is declining in high-income countries, likely due to rising levels of educational attainment. This is a welcome development since literacy levels are climbing in LMICs - even among women and girls. With the increasingly wired world and growing libraries of free online learning tools, this trend should continue. Researchers believe other modifiable risk factors are also likely to curb dementia, especially diabetes, smoking, depression and physical activity.

To learn more about this important meeting, please see the related article, NIH meeting advances Alzheimer’s research agenda. It is vital that countries monitor the dementia epidemic closely so scientists can study changes in prevalence and relate those to differences in exposure to risk factors. By pooling this type of data and working together as a global community, we might someday be able to prevent and treat this dreadful disease.

Finally, in March, I had the great pleasure to travel to a scientific meeting hosted by our grantees at the Center for Cysticercosis Elimination in Tumbes, Peru. The Center's dedicated team - including a significant number of scientists trained with Fogarty support - has made great strides in studying how to diagnose and treat cysticercosis, a parasitic infection that often infects the brain and is a major cause of adult-onset seizures. They have also made significant progress toward their long-term goal of eliminating the disease altogether by vaccinating pigs, which spread the disease. You can read more about this incredible success story in the related article, Scientists work to eliminate disease carried by pigs.

By continuing to build the human scientific capacity that is so badly needed in low-resource settings, we can begin to make real progress against the full scope of brain disorders, which are the cause of so much global suffering.

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