The number of people living with or dying from neurological conditions such as stroke, dementia, Alzheimer’s disease and meningitis has risen sharply — by 18 per cent — over the last 30 years, according to a new analysis from the Global Burden of Disease, Injuries and Risk Factors Study (GBD) 2021.
Published in The Lancet Neurology journal, this finding is significant because the health burden of neurological conditions seems to be far greater than previously thought. Also, stroke, migraine and diabetic neuropathy feature high on the disease spectrum.
What the study says
The study says that in 2021, at least 3.4 billion people experienced a nervous system condition. The overall amount of disability, illness and premature death — a measurement known as disability-adjusted life years (DALYs) — caused by neurological conditions increased by 18 per cent in three decades. The top ten among them are strokes, neonatal encephalopathy (newborn babies with deranged brain function), migraine, Alzheimer’s Disease and dementia, diabetic neuropathy (nerve damage caused by high blood sugar), meningitis, epilepsy, neurological complications from preterm birth, autism spectrum disorder and nervous system cancers.
This is the first time that neonatal encephalopathy, diabetic neuropathy, pre-term birth complications and autism have moved up to the top 10 worrisome conditions. The most prevalent neurological disorders in 2021 were tension-induced headaches (around two billion cases) and migraines (about 1.1 billion cases).
In India, the rate of DALYs and deaths were more than 5,000 and 113 per 100,000 people in 2021.
What does the study mean for India?
Prof K Srinath Reddy, distinguished honorary professor at Public Health Foundation of India, (not attached to the present study) points out that Indians need to be vigilant about diabetic neuropathy and strokes. More so given our ageing population, increase in risk factors and co-morbidities, health system deficiencies in early detection and delayed treatment.
As diabetic neuropathy has more than tripled globally since 1990, in line with the increase in the prevalence of diabetes, India is at a tipping point. “With an already great burden of diabetes, India needs a primary healthcare system which can ensure that Type 2 diabetes is not only detected early but addressed, too. Remember nerve damage cannot be reversed,” says Dr Reddy.
Although the study does not list specific data on strokes in India, Dr Reddy says they are the major cause of death and disability. Recently, a new study in Scientific Reports said that the prevalence of stroke had increased by 50 per cent over the last 17 years in India and at present one in four people are at risk of getting a stroke in their lifetime. The chance of stroke occurring at age 55 and above is one in five for women and one in six for men.
“This study highlights the need to look at risk factors. Hypertension needs to be adequately controlled and diagnosed early. Diabetes, air pollution, smoking (active and passive), heat effects of climate change and stressful living conditions are triggers too,” says Dr Reddy. “Often strokes are preceding warning signs (transient ischaemic attacks). If detected and treated at this stage, major strokes can be prevented. This too requires an efficient primary healthcare system so that it can respond fast and prevent irreversible neurological damage,” he adds.
The study itself suggests modifying 18 risk factors over a person’s lifetime. It singled out how controlling high systolic blood pressure could prevent 84 per cent of global DALYs from stroke.
Alzheimer’s and Dementia
The report highlights the need to minimise deaths from Alzheimer’s and dementia with better management strategies and support systems for individuals with cognitive impairment. Dementia care requires comprehensive healthcare services. “However, in India, given the stigma around mental health, there is a lack of specialised care services and limited caregiver
education and support programmes. We need specialised dementia and stroke centres in neurological departments across the country,” says Dr Shivraj Hunge, consultant neurologist with Jupiter Hospital, Pune.
Encephalitis in children
Encephalitis, although accounting for a smaller proportion of deaths compared to stroke and dementia, remains a concern due to its potential for outbreaks and high mortality rates, particularly among children. “Prevention strategies such as vaccination campaigns, vector control measures and improved sanitation infrastructure are crucial. Additionally, strengthening healthcare facilities, enhancing surveillance systems and increasing public awareness about symptoms and prevention are essential for timely diagnosis and treatment,” says Dr Hunge.
The study says that in 2021, at least 3.4 billion people experienced a nervous system condition. (Representational) 
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