Pak-AGE: Pakistan Longitudinal Study of Healthy Brain Ageing

Recently appointed MICRA Co-Director, Prof Tarani Chandola was part of a team led by Prof Iracema Leroi that was successful in obtaining pump-priming funds to develop a Longitudinal Study of Healthy Brain Aging in Pakistan (‘Pak-AGE’). The team (chaired by Prof Neil Pendleton) are in the process of developing a feasibility study for a representative sample of 1,000 older adults living in different regions of Pakistan.

Until recently, Pakistan, with its demographic ‘youth bulge’, has had a low average life expectancy. Thus, the proportion of people with age-related chronic conditions was small compared to maternal and child health issues and infectious disease. However, lifespan is now increasing and is predicted to exceed age 70 by 2023, with nearly 20% of the population over age 60 by 2030.

One of the commonest conditions of older age is dementia; in South Asia, the number of people with dementia is likely to exceed 9 million by 2030. In Pakistan, it is estimated that over 2.5 million people already live with the condition (based on population prevalences in other countries). Thus, brain health and the prevention of dementia needs to be a national priority.

In Pakistan, stigma and poor health literacy regarding dementia is widespread, and health and social care services to support people with dementia and their families are rare. Family members, usually women, or informal and untrained carers, are on the front-line of delivering dementia care in the home setting, which often has negative health, social and economic implications.

While age is the most important risk factor for dementia, there is now strong evidence for other risk factors across the lifespan, which, if addressed may prevent over 1/3 of all dementias. Unfortunately, Pakistan has rapidly increasing population rates of each of the following risk factors:

• hypertension (33% in >45’s),
• obesity (20%),
• hearing impairment (onset about 10 years earlier in South Asian compared to high-income countries),
• late-life depression (5%); smoking (32% of men),
• sedentary behaviour (highly prevalent after age 40),
• loneliness.

Diabetes, another key risk factor, is rapidly increasing, with up to 16% of the population being affected in urban areas, putting Pakistan on track to have 13 million diabetics by 2030. Furthermore, education below 12 years is a significant risk factor, applying to 92% of the population. Considering the relative youth of the Pakistan population, there is now a small window of opportunity to address these factors and potentially avoid up to 33% of all dementias.

Thus, there is a pressing need for policy, practice, and research to focus more on the needs of the newly-ageing population. This can only be achieved through obtaining meaningful data specific to Pakistan, so that risk profiles for accelerated brain ageing and dementia can be identified, and modification plans instigated. For this, a longitudinal dataset of ageing brain health, such as Pak-AGE, is needed.

Through a UK-supported project of a longitudinal cohort study in Pakistan, the team will create the infrastructure to conduct clinical brain health research, thereby establishing ways to improve the lives of ageing people and people already with dementia in Pakistan. This award will directly contribute to our vision of a thriving dementia clinical research network between the UK, Europe, the USA and Pakistan, capable of undertaking large scale clinical trials in dementia in the future.

If any MICRA members would like to contribute or request further information on this study, you can contact Professor Chandola directly: tarani.chandola@manchester.ac.uk