Identifying dementia risk factors and implementing a culturally grounded risk‐reduction intervention in urban and regional Aboriginal Australian communities

The first WHO guidelines for risk reduction of cognitive decline and dementia marked an important milestone in the field of dementia prevention. In this paper, we discuss the evidence reviewed as part of the guidelines development and present the main themes emerged from its synthesis, to inform future research and policies on dementia risk reduction. The role of intervention effect-size; the mismatch between observational and intervention-based evidence; the heterogeneity of evidence among intervention trials; the importance of intervention duration; the role of timing of exposure to a certain risk factor and interventions; the relationship between intervention intensity and response; the link between individual risk factors and specific dementia pathologies; and the need for tailored interventions emerged as the main themes. The interaction and clustering of individual risk factors, including genetics, was identified as the overarching theme. The evidence collected indicates that multidomain approaches targeting simultaneously multiple risk factors and tailored at both individual and population level, are likely to be most effective and feasible in dementia risk reduction. The current status of multidomain intervention trials aimed to cognitive impairment/dementia prevention was also briefly reviewed. Primary results were presented focusing on methodological differences and the potential of design harmonization for improving evidence quality. Since multidomain intervention trials address a condition with slow clinical manifestation—like dementia—in a relatively short time frame, the need for surrogate outcomes was also discussed, with a specific focus on the potential utility of dementia risk scores. Finally, we considered how multidomain intervention could be most effectively implemented in a public health context and the implications world-wide for other non-communicable diseases targeting common risk factors, taking into account the limited evidence in low-middle income countries. In conclusion, the evidence from the first WHO guidelines for risk reduction of cognitive decline and dementia indicated that “one size does not fit all,” and multidomain approaches adaptable to different populations and individuals are likely to be the most effective. Harmonization in trial design, the use of appropriate outcome measures, and sustainability in large at-risk populations in the context of other chronic disorders also emerged as key elements.

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Future Directions for Dementia Risk Reduction and Prevention Research: An International Research Network on Dementia Prevention Consensus

Journal of Alzheimer s Disease ◽

10.3233/jad-200674 ◽

2020 ◽

Vol 78 (1) ◽

pp. 3-12

Author(s):

Kaarin J. Anstey ◽

Ruth Peters ◽

Lidan Zheng ◽

Deborah E. Barnes ◽

Carol Brayne ◽

...

Keyword(s):

Risk Factors ◽

Risk Reduction ◽

International Research ◽

Large Body ◽

Geographical Location ◽

Evidence Base ◽

Research Network ◽

Future Research ◽

Dementia Risk ◽

Dementia Prevention

In the past decade a large body of evidence has accumulated on risk factors for dementia, primarily from Europe and North America. Drawing on recent integrative reviews and a consensus workshop, the International Research Network on Dementia Prevention developed a consensus statement on priorities for future research. Significant gaps in geographical location, representativeness, diversity, duration, mechanisms, and research on combinations of risk factors were identified. Future research to inform dementia risk reduction should fill gaps in the evidence base, take a life-course, multi-domain approach, and inform population health approaches that improve the brain-health of whole communities.

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Awareness of Dementia Risk Reduction Among Current and Future Healthcare Professionals: A Survey Study

Journal of Public Health Research ◽

10.4081/jphr.2021.1961 ◽

2021 ◽

Author(s):

Femke De Krom ◽

Sangavi Sivananthan ◽

Farah Alkhotany ◽

Martijn Celen ◽

Indy Ezra Hol ◽

...

Keyword(s):

Risk Factors ◽

Protective Factors ◽

Risk Reduction ◽

Online Survey ◽

Essential Role ◽

Healthcare Professionals ◽

Risk And Protective Factors ◽

Survey Study ◽

Dementia Risk ◽

The Relationship

Background: The total number of people affected by dementia worldwide is increasing rapidly. Recent studies provided evidence for the contribution of modifiable risk and protective factors to dementia risk. Although healthcare professionals could play an essential role in informing the general public about the relationship between lifestyle and dementia, it is unclear what they know about this relationship. Therefore, this study assesses the awareness of dementia risk reduction among current and future healthcare professionals. Methods: An online survey was carried out among 182 healthcare students from Maastricht University and 20 general practitioners (GPs) and practice nurses in Limburg, The Netherlands. The survey assessed the knowledge about risk and protective factors of dementia and identified needs, wishes and barriers concerning dementia risk reduction strategies. Results: The majority of current (75.0%) and future (81.9%) healthcare professionals indicated that dementia risk reduction is possible. Among students, awareness of cardiovascular risk factors of dementia (e.g. coronary heart disease (44.5%), hypertension (53.8%)) was low. Most participants (>70.0%) would like to receive more information about dementia risk reduction. Conclusions: The majority of current and future healthcare professionals were aware of the relationship between lifestyle and dementia risk. However, there are still substantial gaps in knowledge regarding individual dementia risk factors. Given the essential role of healthcare professionals in providing lifestyle advice, there is a need to increase awareness by providing educational programs focused on dementia risk reduction.

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OVERSIMPLIFICATION OF DEMENTIA RISK REDUCTION MESSAGING IS A THREAT TO KNOWLEDGE TRANSLATION IN DEMENTIA PREVENTION RESEARCH

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2017.27 ◽

2017 ◽

pp. 1-3

Author(s):

K.J. Anstey ◽

R. Peters

Keyword(s):

Risk Factors ◽

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Risk Factor ◽

Knowledge Translation ◽

Risk Reduction ◽

Assessment Tools ◽

Prevention Research ◽

Dementia Risk ◽

Dementia Prevention

The evidence for specific risk factors for Alzheimer’s disease, vascular dementia and all cause dementia is increasing rapidly in quantity and quality. This has enabled the compilation of risk assessment tools for Alzheimer’s disease (1), and their validation (2). It has also supported the promulgation of public health messaging about dementia risk reduction or dementia prevention. In general these developments are strong advances in the field of dementia prevention. However, the oversimplification of the findings and possible over-or mis-interpretation of their meaning, poses risks to accurate and effective knowledge translation in this field. Lack of balance in the interpretation of evidence on risk factors for dementia may lead to trials of interventions for dementia prevention that are ineffective. This will waste resources and create pessimism about dementia prevention research. Two potential problems that may occur when translating evidence from observational research into prescriptions for prevention are identified here. The first is the generalisation of specific findings about risk factors either to multiple types of dementia or to multiple populations, when the evidence is in fact relevant to specific populations or outcomes. The second is the inference that reversal of a risk factor will lead to prevention, without knowledge of the threshold at which a factor becomes a ‘risk’, or evidence that reversal of the risk factor also reverses neuropathological processes instigated or caused by the risk factor.

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Dementia Risk Reduction in Practice: The Knowledge, Opinions and Perspectives of Australian Healthcare Providers

10.1101/2020.07.01.20144550 ◽

2020 ◽

Author(s):

Lidan Zheng ◽

Kali Godbee ◽

Genevieve Z. Steiner ◽

Gail Daylight ◽

Carolyn Ee ◽

...

Keyword(s):

Risk Factors ◽

Risk Reduction ◽

Primary Healthcare ◽

Online Survey ◽

Healthcare Providers ◽

Cognitive Stimulation ◽

System Level ◽

Free Text ◽

Dementia Risk ◽

Primary Healthcare Providers

AbstractIntroductionThe aim of this paper was to assess Australian primary healthcare providers’ perspectives and knowledge about dementia risk factors and risk reduction.MethodsPrimary healthcare providers were recruited through Primary Health Networks across Australia (N = 51). Participants completed an online survey that consisted of fixed-response and free-text components to assess their knowledge, attitudes and current practices relating to dementia risk factors and risk reduction techniques.ResultsThe survey results showed that over 85% of participants agree that quitting smoking, increasing physical activity, increasing social activity, and treating diabetes can help to reduce the risk of developing dementia. The top suggestions for dementia risk reduction by Australian primary healthcare providers included living a healthy lifestyle (36%), managing cardiovascular risk (17%), and cognitive stimulation (14%). The primary barriers identified for working with patients to reduce dementia risk included low patient motivation and healthcare system level limitations. The most common recommendations were increasing resources and improving dementia awareness and messaging.ConclusionsCollaborative efforts between researchers, media, clinicians, and policy makers are likely needed to support the uptake of risk reduction activities into primary care settings.

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Dementia risk reduction in practice: the knowledge, opinions and perspectives of Australian healthcare providers

Australian Journal of Primary Health ◽

10.1071/py20189 ◽

2021 ◽

Vol 27 (2) ◽

pp. 136

Author(s):

Lidan Zheng ◽

Kali Godbee ◽

Genevieve Z. Steiner ◽

Gail Daylight ◽

Carolyn Ee ◽

...

Keyword(s):

Risk Factors ◽

Risk Reduction ◽

Primary Healthcare ◽

Online Survey ◽

Healthcare Providers ◽

System Level ◽

Free Text ◽

Health Networks ◽

Dementia Risk ◽

Primary Healthcare Providers

This study examined Australian primary healthcare providers’ knowledge about dementia risk factors and risk reduction and their perspectives on barriers and enablers to risk reduction in practice. Primary healthcare providers were recruited through Primary Health Networks across Australia (n=51). Participants completed an online survey that consisted of fixed-responses and free-text components to assess their knowledge, attitudes and current practices relating to dementia risk factors and risk reduction techniques. The results showed that Australian primary healthcare providers have good knowledge about the modifiable risk factors for dementia; however, face several barriers to working with patients to reduce dementia risk. Commonly reported barriers included low patient motivation and healthcare system level limitations. The most commonly reported recommendations to helping primary healthcare providers to work with patients to reduce dementia risk included increasing resources and improving dementia awareness and messaging. While the results need to be interpreted in the context of the limitations of this study, we conclude that collaborative efforts between researchers, clinicians, policy makers and the media are needed to support the uptake of risk reduction activities in primary care settings.

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Lifestyle Risk Factors and Cognitive Outcomes from the Multidomain Dementia Risk Reduction Randomized Controlled Trial, Body Brain Life for Cognitive Decline ( BBL‐CD )

Journal of the American Geriatrics Society ◽

10.1111/jgs.16762 ◽

2020 ◽

Vol 68 (11) ◽

pp. 2629-2637

Author(s):

Mitchell McMaster ◽

Sarang Kim ◽

Linda Clare ◽

Susan J. Torres ◽

Nicolas Cherbuin ◽

...

Keyword(s):

Risk Factors ◽

Randomized Controlled Trial ◽

Cognitive Decline ◽

Risk Reduction ◽

Controlled Trial ◽

Cognitive Outcomes ◽

Lifestyle Risk Factors ◽

Randomized Controlled ◽

Dementia Risk ◽

Lifestyle Risk

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Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6

Alzheimer s Research & Therapy ◽

10.1186/s13195-021-00895-4 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Janice M. Ranson ◽

Timothy Rittman ◽

Shabina Hayat ◽

Carol Brayne ◽

Frank Jessen ◽

...

Keyword(s):

Risk Factors ◽

Health Services ◽

Risk Reduction ◽

Initial Assessment ◽

Modifiable Risk Factors ◽

Brain Health ◽

Local Resources ◽

Risk Profiling ◽

Dementia Risk ◽

Personalized Risk

AbstractWe envisage the development of new Brain Health Services to achieve primary and secondary dementia prevention. These services will complement existing memory clinics by targeting cognitively unimpaired individuals, where the focus is on risk profiling and personalized risk reduction interventions rather than diagnosing and treating late-stage disease. In this article, we review key potentially modifiable risk factors and genetic risk factors and discuss assessment of risk factors as well as additional fluid and imaging biomarkers that may enhance risk profiling. We then outline multidomain measures and risk profiling and provide practical guidelines for Brain Health Services, with consideration of outstanding uncertainties and challenges. Users of Brain Health Services should undergo risk profiling tailored to their age, level of risk, and availability of local resources. Initial risk assessment should incorporate a multidomain risk profiling measure. For users aged 39–64, we recommend the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) Dementia Risk Score, whereas for users aged 65 and older, we recommend the Brief Dementia Screening Indicator (BDSI) and the Australian National University Alzheimer’s Disease Risk Index (ANU-ADRI). The initial assessment should also include potentially modifiable risk factors including sociodemographic, lifestyle, and health factors. If resources allow, apolipoprotein E ɛ4 status testing and structural magnetic resonance imaging should be conducted. If this initial assessment indicates a low dementia risk, then low intensity interventions can be implemented. If the user has a high dementia risk, additional investigations should be considered if local resources allow. Common variant polygenic risk of late-onset AD can be tested in middle-aged or older adults. Rare variants should only be investigated in users with a family history of early-onset dementia in a first degree relative. Advanced imaging with 18-fluorodeoxyglucose positron emission tomography (FDG-PET) or amyloid PET may be informative in high risk users to clarify the nature and burden of their underlying pathologies. Cerebrospinal fluid biomarkers are not recommended for this setting, and blood-based biomarkers need further validation before clinical use. As new technologies become available, advances in artificial intelligence are likely to improve our ability to combine diverse data to further enhance risk profiling. Ultimately, Brain Health Services have the potential to reduce the future burden of dementia through risk profiling, risk communication, personalized risk reduction, and cognitive enhancement interventions.

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