Vladimir Hachinski is a Canadian neurologist, clinical neuroscientist and Distinguished University Professor in the Department of Clinical Neurological Sciences at the Schulich School of Medicine and Dentistry at Western University. He is also a Senior Scientist at London's Robarts Research Institute. His research pertains in the greatest part to stroke and dementia, their interactions, and their joint prevention through integral brain health promotion. He and John W. Norris helped to establish the world's first successful acute stroke unit at Sunnybrook Hospital in Toronto, and, by extension, helped establish stroke units as the standard of care for stroke patients worldwide. He discovered that the control of the heart by the brain is asymmetric, the fight/flight (sympathetic) response being controlled by the right hemisphere and the rest and digest (parasympathetic) response being controlled by the left hemisphere and damage to one key component (the insula) can lead to heart rhythm irregularities and sudden death. This discovery has added fundamental knowledge to how the brain controls the heart and how to prevent sudden death.
Hachinski has held many prominent positions in the global neurology community, including editor-in-chief of the journal Stroke (the leading publication in the field), president of the World Federation of Neurology, and founder of World Brain Alliance. He is a Fellow of the Royal Society of Canada (FRSC) and the Canadian Academy of Health Sciences (FCAHS), a Member of the Orders of Ontario and Canada, the Medical Hall of Fame and the recipient of several national and international awards and recognitions for his research, mentorship, and advocacy in stroke, dementia, public health and healthy aging.
Early life, education, and early career Hachinski was born in Zhytomyr, Ukraine, the eldest of three children. He moved with his family first to Germany and then to Caripito, Venezuela as a child. The family moved to Port Perry, Ontario, Canada thereafter. He graduated from Port Perry High School a year later at the top of his class.
Hachinski received his MD in 1966 from the University of Toronto,Canadian who's who. Volume XXIV, 1989, Simpson, Kieran (ed.); University of Toronto Press, 1988 and completed his residency in internal medicine and neurology in Toronto and Montreal, followed by a neurophysiology fellowship in Toronto. He received his formal accreditation in neurology as a Fellow of the Royal College of Physicians and Surgeons of Canada (FRCPC) in 1972. From 1973-74, a research fellowship with the Ontario Department of Health brought him to a cerebrovascular laboratory at the National Hospital for Nervous Diseases in London, England, and then to the Department of Clinical Physiology at Bispebjerg Hospital in Copenhagen, Denmark.
Following this, he returned to Toronto to take a staff position in the Department of Neurosciences at Sunnybrook Medical Centre, where he and Dr. John W. Norris established the MacLachlan Stroke Unit, Canada's first acute stroke unit. Hachinski remained at Sunnybrook until 1980, when he moved to London, Ontario to act as a neurology consultant for its major health centres: University Hospital, Victoria Hospital, St. Joseph's Hospital, and the London Psychiatric Hospital. He was hired concurrently as a professor at Western University (then called the University of Western Ontario). During this time (and until 1990), he also acted as Director of the Investigative Stroke Unit at London's University Hospital.
In 1987, he earned a Master of Science degree from McMaster University in Hamilton, Ontario, studying in the Department of Epidemiology and Biostatistics with a focus on design, measurement, and evaluation. The University of London's highest earned degree, Doctor of Science (in Hachinski's case, in medicine), was conferred upon him in 1988 for his "contributions to migraine, stroke, and dementia."
Research
Vascular cognitive impairment At the beginning of Hachinski's career, the view prevailed that most dementias were caused by hardening of brain arteries (cerebral atherosclerosis). The hypothesis was that a slow strangulation of the brain's blood supply leads to neuronal death and dementia. Hachinski showed in 1975 that, when the dementia was through brain artery disease, most were from "multi-infarct dementias" (his concept) — caused by multiple, small, often symptomless strokes. His term "vascular cognitive impairment" would later be widely adopted to describe the vascular component that occurs in most major dementias. This is an important concept since stroke doubles the risk of dementia and strokes are treatable and preventable. Some dementias are as well. He has offered an explanation for the origin of some of these lesions and associated symptoms through his concept of the ambibaric brain. He postulates that the brain has two complementary blood pressure systems, one high and one low and disturbances in each lead to different types of preventable lesions.
The hardening of the arteries explanation spawned a whole industry of brain vessel "vasodilators". He showed that "vasodilators" were not only expensive but useless. He also developed the "Hachinski Ischemic Score" that continues to be widely used to identify the vascular cognitive impairment, a treatable and preventable component of dementia. Identifying the vascular component is tremendously important for patient prognosis, as treating the vascular causes of dementias can mitigate their effects. The score is cited in the medical literature about once every ten days, and has been validated and optimized for use in clinical practice.
In 1986, the journal, Archives of Neurology published a series of papers by Hachinski, Harold Merskey and colleagues on the rarefaction (decreased density) of white matter in the brains of older adults. These papers were among the first to recognize the importance of white matter lesions as risks for stroke and dementia. Rarefaction of white matter in the brain had already been shown to be correlated with a wide variety of health problems, but these papers were groundbreaking for two reasons especially: First, they introduced the term, "leukoaraiosis," to warn that white matter changes can have multiple causes and second, they specifically highlighted a previously underappreciated relationship between hypertension and leukoaraiosis. By coining "leukoaraiosis," Hachinski drew medical practitioners' attention to these white matter hypodensities in the brains of patients affected by small strokes.
Hachinski continued to develop and promote his novel approach to dementia — viewing it as a product of preventable and treatable vascular problems, thus itself also amenable to prevention, delay, and mitigation — eventually coining it as the "vascular cognitive impairment approach" to dementias in 1994. This proactive and preventative, rather than solely retroactive and treatment-based approach included other novel coinages, such as "brain at risk," describing patients without cognitive impairment but with risk factors for it.
Even with these developments, available diagnostic criteria for dementias continued to present a challenge, as they were not able to capture the complex, interactive, and adaptive nature of brain pathologies leading to dementia. For this reason, in 2006, Hachinski decided to lead (with Gabrielle LeBlanc) the development of core common standards to describe the clinical, neuropsychological, imaging, genetic, and neuropathological features of cognitive impairment. This standardization has allowed for ongoing improvement of the diagnostic criteria with new knowledge, comparison of results from different studies, and analysis & meta-analysis using "big data" techniques.
Acute stroke The MacLachlan Stroke Unit at Sunnybrook, Canada's first stroke unit (est. 1975), was almost 20 years ahead of its time; stroke units have been considered the most effective treatment for stroke patients of all ages, severities, and types only since the 1990s. Hachinski and Norris' early work with that unit and others helped to cement the importance of dedicated wards for stroke patient monitoring and treatment, but his research over the next 17 years also shaped how those treatments and monitoring methods are executed.
In 1986, while he was Director of the Investigative Stroke Unit at University Hospital in London, he developed (with Robert Coté), the Canadian Neurological Scale – a simple but systematic tool, usable by non-physicians for evaluating and monitoring the neurological status of patients with acute stroke. It has been incorporated in the medical record of the province Quebec, Canada. Later, in 1992, he (with collaborators David Cechetto and Stephen Oppenheimer) began work to explore possible mechanisms for observed increases in catecholamines, cardiac enzymes, arrhythmias, and sudden death following acute stroke. This would eventually lead to the discovery that the insula of the brain is the mediator of these various cardiac complications. Knowing this alters doctors to monitor the heart closely, to prevent sudden death.
The scientific bases for preventing stroke and dementia together have been summarized by an international panel of experts.
Since stroke, heart disease and dementia represent risks for each other and share the same risk and protective factors, he advocates preventing this "Triple Threat" together.
He is a participant in an initiative to make brain health the top priority. He has offered a comprehensive and understandable definition of brain health. When thinking, feeling and connecting are the best that they can be in a safe, healthy, and supportive environment. He also designed a simple method to measure it (The Hachinski integral brain health index). He co-leads the development of implementation of integral brain health (cerebral, mental, and social) in the city of London, Canada.
Stroke prevention In addition to his interest in the mechanisms of stroke and best practices for treatment, Hachinski also has a keen research interest in stroke prevention. He acted as the principal neurological investigator of two seminal, multicentre studies, led by Henry JM Barnett. First the Extracranial/Intracranial Arterial Bypass Surgery trial (1983–87). It showed that the increasingly popular and very expensive EC/IC arterial bypass procedure did not significantly reduce the risk of ischemic stroke.
The second was the North American Symptomatic Carotid Endarterectomy Trial that showed that the operation helped prevent stroke in patients with symptoms from a narrowing in the carotid arteries.
Population health Hachinski's home province of Ontario, Canada introduced a formal Provincial Stroke System in 2000. Hachinski advocates a strategy of preventing some dementias through the prevention of stroke. With his colleagues, he showed, for the first time, a concomitant decrease in the incidence of stroke and dementia at a whole-population level. The total number of cases continues to rise, however, due to population aging. Stroke and dementia tend to occur together and share common risk factors. Regretfully, they are addressed separately, especially dementia.
Integral Brain Health Implementation Strategy CanDo