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Preventing dementia by preventing stroke: The Berlin Manifesto
Hachinski V, Einhäupl K, Ganten D, Alladi S, Brayne C, Stephan BCM, Sweeney MD, Zlokovic B et al.. Alzheimer's & dementia : the journal of the Alzheimer's Association, 2019-07-01
Topic: Risk, prevention and care in population studies
The incidence of stroke and dementia are diverging across the world, rising for those in low- and middle-income countries and falling in those in high-income countries. This suggests that whatever factors cause these trends are potentially modifiable. At the population level, neurological disorders as a group account for the largest proportion of disability-adjusted life years globally (10%). Among neurological disorders, stroke (42%) and dementia (10%) dominate. Stroke and dementia confer risks for each other and share some of the same, largely modifiable, risk and protective factors. In principle, 90% of strokes and 35% of dementias have been estimated to be preventable. Because a stroke doubles the chance of developing dementia and stroke is more common than dementia, more than a third of dementias could be prevented by preventing stroke. Developments at the pathological, pathophysiological, and clinical level also point to new directions. Growing understanding of brain pathophysiology has unveiled the reciprocal interaction of cerebrovascular disease and neurodegeneration identifying new therapeutic targets to include protection of the endothelium, the blood-brain barrier, and other components of the neurovascular unit. In addition, targeting amyloid angiopathy aspects of inflammation and genetic manipulation hold new testable promise. In the meantime, accumulating evidence suggests that whole populations experiencing improved education, and lower vascular risk factor profiles (e.g., reduced prevalence of smoking) and vascular disease, including stroke, have better cognitive function and lower dementia rates. At the individual levels, trials have demonstrated that anticoagulation of atrial fibrillation can reduce the risk of dementia by 48% and that systolic blood pressure lower than 140 mmHg may be better for the brain. Based on these considerations, the World Stroke Organization has issued a proclamation, endorsed by all the major international organizations focused on global brain and cardiovascular health, calling for the joint prevention of stroke and dementia. This article summarizes the evidence for translation into action.
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
APA 7th
Hachinski, V., Einhäupl, K., Ganten, D., Alladi, S., Brayne, C., Stephan, B. C. M., et al. (2019). Preventing dementia by preventing stroke: The Berlin Manifesto. Alzheimer's & dementia : the journal of the Alzheimer's Association. https://doi.org/10.1016/j.jalz.2019.06.001
Vancouver
Hachinski V, Einhäupl K, Ganten D, Alladi S, Brayne C, Stephan BCM, et al. Preventing dementia by preventing stroke: The Berlin Manifesto. Alzheimer's & dementia : the journal of the Alzheimer's Association. 2019. doi:10.1016/j.jalz.2019.06.001. PMID: 31327392.
BibTeX
@article{hachinski2019-31327392,
author = {Hachinski, V. and Einhäupl, K. and Ganten, D. and Alladi, S. and Brayne, C. and Stephan, B. C. M. and Sweeney, M. D. and Zlokovic, B. and others},
title = {{Preventing dementia by preventing stroke: The Berlin Manifesto}},
journal = {Alzheimer's \& dementia : the journal of the Alzheimer's Association},
year = {2019},
doi = {10.1016/j.jalz.2019.06.001},
pmid = {31327392},
url = {https://doi.org/10.1016/j.jalz.2019.06.001}
}
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
Key findings
- This suggests that whatever factors cause these trends are potentially modifiable.
- In the meantime, accumulating evidence suggests that whole populations experiencing improved education, and lower vascular risk factor profiles (e.g., reduced prevalence of smoking) and vascular disease, including stroke, have better cognitive function and lower dementia rates.
- At the individual levels, trials have demonstrated that anticoagulation of atrial fibrillation can reduce the risk of dementia by 48% and that systolic blood pressure lower than 140 mmHg may be better for the brain.
Why it matters
This 2019 paper sets out the evidence behind a World Stroke Organization proclamation "calling for the joint prevention of stroke and dementia", arguing that the two conditions "confer risks for each other" and share "largely modifiable" risk factors. It reasons that because "a stroke doubles the chance of developing dementia", "more than a third of dementias could be prevented by preventing stroke"; this is an estimate, not a measured result. The paper reports no new data, and its figure, that anticoagulation for atrial fibrillation "can reduce the risk of dementia by 48%", concerns people with that heart rhythm condition and comes from trials the summary does not name.
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Study details
- Evidence strengthLow
How this study scored 56/100
Published in a leading specialty journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 9 / 10 | Tier 2 — leading specialty journal (Alzheimer's & dementia : the journal of the Alzheimer's Association) |
| Journal's citation record | 2 / 4 | Alzheimer s & Dementia: journal h-index 228 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 2 / 5 | 2019 — within 10 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 6 / 7 | Cited 314 times (OpenAlex, 2026-10-10) |
| Citations per year | 4 / 5 | 34.9 citations a year over 9 year(s) since 2019 |
| Impact for its field and year | 5 / 6 | Cited 29.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 4 / 6 | Cited by 33 other studies in this library |
| Still being cited | 3 / 4 | Cited 101 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Zaven S. Khachaturian: h-index 56 (OpenAlex, whole career) |
| Institution's track record | 2 / 3 | Massachusetts General Hospital: institution h-index 2,057 (OpenAlex) |
| Multi-centre collaboration | 3 / 3 | OpenAlex lists 32 institution(s) in 7 countries |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 31327392) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Total | 56 / 100 | — |
What each of these 20 components measures, and what this score is not →
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