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Brain disorders contribute significantly to disability figures throughout the world, adding more Disability-Adjusted Life Years than HIV or ischaemic heart disease. Many of these disorders have a young age of onset leading to long periods of disability prior to death. Insurers see this reflected in the frequency of Income Protection claims. Gen Re’s Dread Disease surveys have consistently identified strokes, multiple sclerosis, Parkinson’s disease and benign brain tumours as principle contributors to Critical Illness claims across various markets.
When U.S. President George H.W. Bush launched the “Decade of the Brain” in 1990, it was hoped the initiative would dramatically improve the understanding and clinical management of all neurological disorders. However, apart from identifying the gene responsible for Huntington’s disease in 1993, the endeavour produced little else clinically relevant.
More recent developments in brain imaging, genetics, proteomics and therapeutics are beginning to transform clinical approaches. Already treatments for multiple sclerosis have changed the outlook significantly for many sufferers, and the prospects for other neurodegenerative diseases look similarly positive.1
Systematic management of the risk factors for cerebrovascular disease - for example, tobacco smoking or blood pressure control - has significantly reduced stroke incidence.2 Acute management algorithms minimise the numbers who experience profound, long-term disability. How clinical services for all brain disorders are organized has an impact, too; while it may be more inconvenient for patients to travel to a regional centre, the concentration of expertise on offer considerably improves long-term outcomes.3
Such advances bring into sharp focus two issues. One is as old as the hills: every neurology clinic has a proportion of patients whose symptoms cannot be explained within a purely medical model.4 Confusion over terminology and management is not just difficult for patients but also for insurers at both underwriting and claims.
The second issue is new. The number of brain investigations has risen as scanning becomes ubiquitous and cheap. With more patients expecting scans and most clinicians less confident about diagnosing without scanning, incidental findings of unknown significance, or entirely benign origin, are more frequently encountered.5
In the coming months, I will be looking at specific neurological disorders in addition to challenges, such as unexplained symptoms and diagnostic change.
