Neurological Disorders

Historically, policy makers and researchers have used mortality statistics as the principal measure of the seriousness of diseases, based on which countries and organizations have launched disease control programs. Mortality statistics alone, however, underestimate the suffering caused by diseases that may be nonfatal but cause substantial disability. Many neurological and psychiatric conditions belong in this category. The absence of some neurological disorders from lists of leading causes of death has contributed to their long-term neglect. When the relative seriousness of diseases is assessed by time lived with disability rather than by mortality, several neurological disorders appear as leading causes of suffering worldwide. World Health Organization data suggest that neurological and psychiatric disorders are an important and growing cause of morbidity. The magnitude and burden of mental, neurological, and behavioral disorders is huge, affecting more than 450 million people globally. According to the Global Burden of Disease Report, 33 percent of years lived with disability and 13 percent of disability-adjusted life years (DALYs) are due to neurological and psychiatric disorders, which account for four out of the six leading causes of years lived with disability (Mathers and others 2003). Unfortunately, the burden of these disorders in developing countries remains largely unrecognized. Moreover, the burden imposed by such chronic neurological conditions in general can be expected to be particularly devastating in poor populations. Primary manifestations of the impact on the poor— including the loss of gainful employment, with the attendant loss of family income; the requirement for caregiving, with further potential loss of wages; the cost of medications; and the need for other medical services—can be expected to be particularly devastating among those with limited resources. In addition to health costs, those suffering from these conditions are also frequently victims of human rights violations, stigmatization, and discrimination. Stigmatization and discrimination further limit patients’ access to treatment. These disorders, therefore, require special attention in developing countries. This chapter addresses Alzheimer’s disease (AD) and other dementias, epilepsy, Parkinson’s disease (PD), and acute ischemic stroke. These conditions are current or emerging public health problems in developing countries, as assessed by high prevalence, large numbers of people who are untreated, and availability of inexpensive but effective interventions that could be applied on a large scale through primary care. Unfortunately, reliable population-based data from developing countries on the epidemiology of these and other neurological disorders are extremely limited. Some other important neurological conditions that cause high morbidity, such as headache, are not covered because of difficulties in recommending evidence-based interventions in developing countries.