Neurological Disorders

A neurological disorder is any disorder of the nervous system. Structural, biochemical or electrical abnormalities in the brain, spinal cord or other nerves can result in a range of symptoms. Examples of symptoms include paralysis, muscle weakness, poor coordination, loss of sensation, seizures, confusion, pain and altered levels of consciousness. There are many recognized neurological disorders, some relatively common, but many rare. They may be assessed by neurological examination, and studied and treated within the specialities of neurology and clinical neuropsychology.

Interventions for neurological disorders include preventive measures, lifestyle changes, physiotherapy or other therapy, neurorehabilitation, pain management, medication, operations performed by neurosurgeons or a specific diet. The World Health Organization estimated in 2006 that neurological disorders and their squeal (direct consequences) affect as many as one billion people worldwide, and identified health inequalities and social stigma/discrimination as major factors contributing to the associated disability and suffering.

eurological disorders pose a large burden on worldwide health. The most recent estimates show that the neurological disorders included in the Global Burden of Disease (GBD) Study Alzheimer’s and other dementias, Parkinson ’s disease, multiple sclerosis, epilepsy, and headache disorders migraine, tension-type headache [TTH] and medication-overuse headache [MOH] represent 3 percent of the worldwide burden of disease. Although this is a seemingly small overall percentage, dementia, epilepsy, migraine, and stroke rank in the top 50 causes of disability-adjusted life years

Detection and Diagnosis of Dementia

The evidence does not support dementia screening in the general population at present. Screening tools in primary health services may be used for those who report initial concerns about their cognitive function. Short versions of the Mini-Mental State Examination (Folstein, Folstein, and McHugh 1973) take as little as five minutes. However, unlike the Mini-Mental State Examination, which has been validated in several settings and languages, none of the short versions has been validated in LMICs, and their use is not recommended at present.

Diagnosis requires a clinical and informant interview and physical examination. Evidence from population-based studies, for example, the 10/66 culture-fair diagnostic algorithm (Prince and others 2003), suggests that diagnosis can be achieved using highly structured interviews and examinations conducted by trained community health workers. Adaptations for use in clinical practice are required, but the feasibility and cost-effectiveness of laboratory tests used in HICs to exclude treatable forms of dementia may limit their use in LMICs. Evidence from HICs indicates that the good practice of disclosure of the dementia diagnosis allows better planning and may limit distress; evidence from LMICs is lacking.

Appropriate adaptation to local culture, language, and beliefs should shape the design of programs and activities planned and implemented, and involve stakeholders, policy makers, the media, and local health care services. Health and social services should be enhanced to meet the projected increase in services.

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Regards,
Nancy EllaDual Diagnosis: Open Access
Email: dualdiagnosis@emedsci.com
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