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Epidemiology of Neurological Disorders. Dr. Yeşim YASİN Fall-2013. Outline :. Global burden of neurological disorders National burden of neurological disorders

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epidemiology of neurological disorders

Epidemiology of Neurological Disorders

Dr. Yeşim YASİN

Fall-2013

outline
Outline:
  • Global burden of neurologicaldisorders
  • Nationalburdenof neurologicaldisorders
  • Mostcommonlyseenneurologicaldisorders: a publichealthapproach
  • Prevention
global burden of disesase
Global burden of disesase
  • Neurologicaldiseasesarebecomingincreasinglyimportant in terms of publichealththroughouttheworldand in Turkey.
global burden of disesase1
Global burden of disesase
  • The Global Burden of Disease reportdrew the attention of the international health community tothe fact that the burden of mental and neurological disordershad been seriously underestimated by traditional epidemiologicalmethods that took into account only mortality, not disabilityrates.
global burden of disease
Global burden of disease
  • The Global Burden of Disease reportspecifically showed that while mentaland neurological disorders are responsible for about 1%of deaths, they account for almost 11% of disease burdenworldwide
slide6

Many conditions including neuropsychiatric disordersand injuries cause considerable ill-health but noor few direct deaths.

slide7

Neuropsychiatric disordersand injuries in particular were major causes of lost years of healthy life as measured by DALYs,

  • were significantly underestimated when measured by mortality alone
c ommon neurological disorders
Commonneurologicaldisorders
  • Stroke
  • Dementia
  • Epilepsy
  • parkinsonSdisease
  • Headeachedisorders
  • Multiplesclerosis
  • Neuroinfections
  • Neurologicaldisordersassociatedwithmalnutrition
  • Painassociatedwithneurologicaldisorders
  • Traumaticbraindisorder
slide10
Table 1. Number of DALYs for neurological disorders and as percentage of globalDALYs projected for 2015 and 2030

neuropsychiatric category

2%

4.3%

percentage of total dalys for selected diseases a and neurological disorders b
Percentage of total DALYsforselecteddiseasesaandneurologicaldisordersb

Neurologicaldisoerdersconstituteslightlyover 6% of total burden,

neurological disorders as percentage of total dalys for 2005 2015 and 2030 across income category
Neurologicaldisorders as percentage of total DALYsfor 2005, 2015 and 2030 acrossincomecategory

Neurological disorders contribute to 10.9%, 6.7%, 8.7% and 4.5% of the global burden ofdisease in high, upper middle, lower middle and low income countries, respectively, in 2005.

slide17

DeathsandDALYsfromselectedneurologicaldisorders as percentage of total neurologicaldisordres

DALYs

Deaths

slide18
Neurologicaldisorders as percentage of total deathsfor 2005, 2015 and 2030 acrossWorld Bank incomecategory

Neurologicaldisordersconstitute 16.8% of the total deaths in lower middle income countries compared with 13.2% of the total deaths in highincomecountries.

slide20

The number of YLDs per 100 000 populationassociated with neurological disorders and other diseases and injuries with neurological sequelaeis projected to decline from 1264 in 2005 to 1109 in 2030

YLDs per 100 000 population associated with neurological disorders andother diseases and injuries with neurological sequelae and as percentageof total YLDs projected for 2015 and 2030

slide21

YLDs per 100 000 population associated with neurological disorders andother diseases and injuries with neurological sequelae and as percentageof total YLDs projected for 2015 and 2030

YLDs associated with Alzheimer and otherdementias, however, are projected to increase by 38%.

top five causes of ylds among neurological disorders by income category
Top fivecauses of YLDsamongneurologicaldisorders, byincomecategory

YLDs per 100 000 population for neuroinfections, and the nutritionaldeficiencies and neuropathies category are highest for low income countries

neurologicalinjuries, epilepsy and migraine, they are highest in upper middle income countries

For Alzheimerand other dementias they are highest for high income countries

slide23

almost half of the burden in terms of YLDs attributable to neurological disorders is in low incomecountries followed by lower middle income countries

YLDsassociated

withneurological

disorders by income

category

burden attributable to seven basic risk factors
BURDEN ATTRIBUTABLE TO SEVEN BASIC RISK FACTORS
  • Highcolesterol
  • Smoking
  • High body massindex
  • Highbloodpressure
  • Alcoholuse
  • Insufficientconsumption of fruitsandvegetables
  • Physicalinactivity
hypertension as a common risk factor
Hypertension as a common risk factor

number of deaths attributed to hypertension, which refers to the fact that they could beprevented by keeping hypertension under control is 39.731 for cerebrovasculardiseases

slide33

alcohol consumption-attributeddeaths are mostly the

consequences ischemic heart

diseases and hemorragic stroke.

2088 deaths caused byhemorrhagic stroke couldbe prevented by prevention

of alcohol consumption

slide35

high cholesterol is among major risk factors of ischemic heart diseases and ischemicstroke.

Prevention of high cholesterol could prevent 7.802 deaths caused by ischemic stroke

slide36

Sufficient amount of physical activity could prevent 10.269 deaths caused by ischemic stroke.

As for burden of disease which is preventable, physical activity could

prevent 101.578 DALY in ischemic stroke.

prevention
Prevention
  • Many neurological disorders can be prevented!
prevention1
Prevention
  • Primaryprevention
  • Secondaryprevention
  • Tertiaryprevention
primary prevention
Primaryprevention
  • High risk approach (individualapproach)
  • Populationbasedapproach
prevention high risk strategy
Prevention- high risk strategy
  • Elimination of themajor risk factors.
    • Controllinghighbloodpressure
    • Loweringthelevel of bloodcholesterol
    • Quittingtobaccouse
    • Controllingdiabetes
    • Maintaininga healthyweight, body massindex
    • Diet
    • Exercisingregularly
    • Preventionandtreatment of coronaryhearthdiseases
prevention population based strategy
Prevention- populationbasedstrategy
  • Raisingawareness of healthpersonnelabouttreatmentandprevention of neurologicaldiseases

A comprehensive

national strategy; community-based health promotion and accessto treatment can substantially decrease the burden associated with cerebrovasculardiseases (stroke)

prevention population based strategy1
Prevention-populationbasedstrategy
  • Healthpromotionprogrammestoprevent risk factors.
    • Smokefreeairspace
    • Diabetcontrolprogrammes
    • Promotingandcreatingbuiltornaturalenvironmentsthatencourageandsupportphysicalactivity.
prevention population based strategy2
Prevention- populationbasedstrategy
  • immunization programme forthe prevention of neuroinfections (poliomyelitis, neurologicalconsequences of infections)
  • Road safety – prevention of traumaticbraininjury

Traumatic brain injury is the leading cause of

death and disability in children and young adults

tertiary prevention
Tertiaryprevention

ASPIRIN In cases of acute stroke, aspirin is given as soon as CT or MRI has excluded intracranialhaemorrhage.

  • Usingmedication
  • Rehabilitation

Immediate aspirin treatment slightly lowers the risk of early recurrent stroke andincreases the chances of survival free of disability

about one fewer patient dies or is left dependentper 100 treated. However, because aspirin is applicable to so many stroke patients, it hasthe potential to have a substantial public health effect.

who recommendations
WHO recommendations
  • Gaincommitmentfromdecision-makers
  • Increase public and professional awareness
  • Minimize stigmaanderadicatediscrimination
  • Strengthen neurological care within the existing health systems
  • Incorporate rehabilitation into the key strategies
  • Establish links to other sectors
  • Define priorities for research
conclusions
Conclusions
  • Estimating the burden of diseases is difficult due to
    • imperfect medical registration,
    • variations in structure of patient referral and influence of secondary diagnoses.
    • Taking into account the current aging of the population, the prevalence of some neurological diseases, such as CVA, Parkinson's disease and dementia will rise.
    • Priority setting for care and treatment is hampered by differences in burden of illness on the individual and on the community level