Towards Earlier Diagnosis and Treatment of Disorders of the Brain

By Luca, Monica Di; Nutt, David et al. | Bulletin of the World Health Organization, May 2018 | Go to article overview

Towards Earlier Diagnosis and Treatment of Disorders of the Brain


Luca, Monica Di, Nutt, David, Oertel, Wolfgang, Boyer, Patrice, Jaarsma, Joke, Destrebecq, Frederic, Esposito, Giovanni, Quoidbach, Vinciane, Bulletin of the World Health Organization


The 2015 Global Burden of Disease study estimates that about a third of the population worldwide is affected by mental or neurological disorders across their lifespans. (1) This high burden (2,3) may be surprising as there is a general lack of awareness on the pervasiveness of disorders of the brain. Global data, but particularly those from European studies, indicate that these disorders are a major public health problem: disorders of the brain rank among the leading causes of ill-health and disability and account for 35% of Europe's total disease burden with a yearly cost of 800 billion euros, of which 60% are related to direct health care and non-medical costs. (4,5) The burden is growing due to the epidemiological transition from acute to chronic diseases and the increase in life expectancy, but also because of several socioeconomic, environmental and behavioural health determinants.

Mental and neurological disorders are complex and are linked to hundreds of specific diagnoses. (6,7) The causes of such disorders are heterogeneous, ranging from pathological protein aggregation leading to neurodegeneration or dysregulation of the immune process, to developmental and functional abnormalities. These disorders also frequently involve an intricate interplay between genetic and environmental factors. Needs for basic and clinical research, the provision of medicines and medical devices, and adeqiiate health-care systems and services are growing, but are increasingly unmet.

Discussions on health care focus too often on the increase of health-care cost rather than on the benefits of better health. Therefore, emphasizing on the need for more value-based and patient-centred care, and for the scaling-up of an integrated care model for mental and neurological disorders is important. An integrated care model encompasses the whole care process, from prodromal, early diagnosis to disease management and patient empowerment. (8)

The European Brain Council, an organization promoting research in Europe on health and disorders of the brain to improve the quality of life of those living with such disorders, initiated a two-year research project on the value of treatment.. The project included case studies on schizophrenia, Alzheimer disease, epilepsy, headache, normal pressure hydrocephalus, Parkinson disease, multiple sclerosis, restless legs syndrome and stroke. The study's research framework included the testing of an integrated model and the development of a series of qualitative and quantitative benchmarks to identify treatment gaps and causal factors along the continuum of care in a patient care pathway analysis. The study also estimated the socioeconomic impact and health gains from best practice health-care interventions with an economic evaluation. …

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