4.6 Review

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

期刊

ALZHEIMERS RESEARCH & THERAPY
卷 13, 期 1, 页码 -

出版社

BMC
DOI: 10.1186/s13195-021-00895-4

关键词

Alzheimer's disease; Dementia; Aging; Brain health services; Risk factors; Risk profiling; Prevention; Public health

资金

  1. Swiss National Science Foundation [IZSEZ0_193593]
  2. Alzheimer's Research UK
  3. National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula
  4. National Health and Medical Research Council (NHMRC)
  5. JP Moulton Foundation
  6. National Institute on Aging/National Institutes of Health [RF1AG055654]
  7. Alan Turing Institute/Engineering and Physical Sciences Research Council [EP/N510129/1]
  8. National Institute for Health Research University College London Hospitals Biomedical Research Centre
  9. EU-EFPIA Innovative Medicines Initiatives 2 Joint Undertaking (IMI 2 JU) European Prevention of Alzheimer's Dementia consortium (EPAD) [115736]
  10. EU-EFPIA Innovative Medicines Initiatives 2 Joint Undertaking (IMI 2 JU) Amyloid Imaging to Prevent Alzheimer's Disease (AMYPAD) [115952]
  11. Swiss National Science Foundation: Brain connectivity and metacognition in persons with subjective cognitive decline (COSCODE): correlation with clinical features and in vivo neuropathology [320030_182772]
  12. Swedish Research Council [2017-00915]
  13. Swedish Alzheimer Foundation [AF-742881]
  14. Hjarnfonden, Sweden [FO2017-0243]
  15. Swedish government [ALFGBG-715986]
  16. CoSTREAM project (European Union's Horizon 2020 research and innovation program) [667375]
  17. National Institute for Health Research (NIHR) School for Primary Care Research
  18. Swiss National Science Foundation (SNF) [IZSEZ0_193593] Funding Source: Swiss National Science Foundation (SNF)
  19. H2020 Societal Challenges Programme [667375] Funding Source: H2020 Societal Challenges Programme

向作者/读者索取更多资源

The article discusses the development of new Brain Health Services for dementia prevention, emphasizing risk analysis and personalized risk reduction interventions. It suggests selecting appropriate risk assessment tools based on age and risk level, while considering modifiable risk factors.
We 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 e4 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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