Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services—part 4 of 6
Abstract Although prevention of dementia and late-life cognitive decline is a major public health priority, there are currently no generally established prevention strategies or operational models for implementing such strategies into practice. This article is a narrative review of available evidenc...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | Alzheimer’s Research & Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13195-021-00875-8 |
| _version_ | 1819109144836177920 |
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| author | Alina Solomon Ruth Stephen Daniele Altomare Emmanuel Carrera Giovanni B. Frisoni Jenni Kulmala José Luis Molinuevo Peter Nilsson Tiia Ngandu Federica Ribaldi Bruno Vellas Philip Scheltens Miia Kivipelto on behalf of the European Task Force for Brain Health Services |
| author_facet | Alina Solomon Ruth Stephen Daniele Altomare Emmanuel Carrera Giovanni B. Frisoni Jenni Kulmala José Luis Molinuevo Peter Nilsson Tiia Ngandu Federica Ribaldi Bruno Vellas Philip Scheltens Miia Kivipelto on behalf of the European Task Force for Brain Health Services |
| author_sort | Alina Solomon |
| collection | DOAJ |
| description | Abstract Although prevention of dementia and late-life cognitive decline is a major public health priority, there are currently no generally established prevention strategies or operational models for implementing such strategies into practice. This article is a narrative review of available evidence from multidomain dementia prevention trials targeting several risk factors and disease mechanisms simultaneously, in individuals without dementia at baseline. Based on the findings, we formulate recommendations for implementing precision risk reduction strategies into new services called Brain Health Services. A literature search was conducted using medical databases (MEDLINE via PubMed and SCOPUS) to select relevant studies: non-pharmacological multidomain interventions (i.e., combining two or more intervention domains), target population including individuals without dementia, and primary outcomes including cognitive/functional performance changes and/or incident cognitive impairment or dementia. Further literature searches covered the following topics: sub-group analyses assessing potential modifiers for the intervention effect on cognition in the multidomain prevention trials, dementia risk scores used as surrogate outcomes in multidomain prevention trials, dementia risk scores in relation to brain pathology markers, and cardiovascular risk scores in relation to dementia. Multidomain intervention studies conducted so far appear to have mixed results and substantial variability in target populations, format and intensity of interventions, choice of control conditions, and outcome measures. Most trials were conducted in high-income countries. The differences in design between the larger, longer-term trials that met vs. did not meet their primary outcomes suggest that multidomain intervention effectiveness may be dependent on a precision prevention approach, i.e., successfully identifying the at-risk groups who are most likely to benefit. One such successful trial has already developed an operational model for implementing the intervention into practice. Evidence on the efficacy of risk reduction interventions is promising, but not yet conclusive. More long-term multidomain randomized controlled trials are needed to fill the current evidence gaps, especially concerning low- and middle-income countries and integration of dementia prevention with existing cerebrovascular prevention programs. A precision risk reduction approach may be most effective for dementia prevention. Such an approach could be implemented in Brain Health Services. |
| first_indexed | 2024-12-22T03:21:10Z |
| format | Article |
| id | doaj.art-8f03bdca0284472e89e5d7eb9cd03d91 |
| institution | Directory Open Access Journal |
| issn | 1758-9193 |
| language | English |
| last_indexed | 2024-12-22T03:21:10Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Alzheimer’s Research & Therapy |
| spelling | doaj.art-8f03bdca0284472e89e5d7eb9cd03d912022-12-21T18:40:44ZengBMCAlzheimer’s Research & Therapy1758-91932021-10-0113111510.1186/s13195-021-00875-8Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services—part 4 of 6Alina Solomon0Ruth Stephen1Daniele Altomare2Emmanuel Carrera3Giovanni B. Frisoni4Jenni Kulmala5José Luis Molinuevo6Peter Nilsson7Tiia Ngandu8Federica Ribaldi9Bruno Vellas10Philip Scheltens11Miia Kivipelto12on behalf of the European Task Force for Brain Health ServicesInstitute of Clinical Medicine, University of Eastern FinlandInstitute of Clinical Medicine, University of Eastern FinlandLaboratory of Neuroimaging of Aging (LANVIE), University of GenevaStroke Center, Department of Neurology, University Hospitals and University of GenevaLaboratory of Neuroimaging of Aging (LANVIE), University of GenevaDivision of Clinical Geriatrics, NVS, Karolinska InstitutetBarcelonaβeta Brain Research Center (BBRC), Pasqual Maragall FoundationDepartment of Clinical Sciences, Skåne University Hospital, Lund UniversityDivision of Clinical Geriatrics, NVS, Karolinska InstitutetLaboratory of Neuroimaging of Aging (LANVIE), University of GenevaGérontopole of Toulouse, University Hospital of Toulouse (CHU-Toulouse)Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCInstitute of Clinical Medicine, University of Eastern FinlandAbstract Although prevention of dementia and late-life cognitive decline is a major public health priority, there are currently no generally established prevention strategies or operational models for implementing such strategies into practice. This article is a narrative review of available evidence from multidomain dementia prevention trials targeting several risk factors and disease mechanisms simultaneously, in individuals without dementia at baseline. Based on the findings, we formulate recommendations for implementing precision risk reduction strategies into new services called Brain Health Services. A literature search was conducted using medical databases (MEDLINE via PubMed and SCOPUS) to select relevant studies: non-pharmacological multidomain interventions (i.e., combining two or more intervention domains), target population including individuals without dementia, and primary outcomes including cognitive/functional performance changes and/or incident cognitive impairment or dementia. Further literature searches covered the following topics: sub-group analyses assessing potential modifiers for the intervention effect on cognition in the multidomain prevention trials, dementia risk scores used as surrogate outcomes in multidomain prevention trials, dementia risk scores in relation to brain pathology markers, and cardiovascular risk scores in relation to dementia. Multidomain intervention studies conducted so far appear to have mixed results and substantial variability in target populations, format and intensity of interventions, choice of control conditions, and outcome measures. Most trials were conducted in high-income countries. The differences in design between the larger, longer-term trials that met vs. did not meet their primary outcomes suggest that multidomain intervention effectiveness may be dependent on a precision prevention approach, i.e., successfully identifying the at-risk groups who are most likely to benefit. One such successful trial has already developed an operational model for implementing the intervention into practice. Evidence on the efficacy of risk reduction interventions is promising, but not yet conclusive. More long-term multidomain randomized controlled trials are needed to fill the current evidence gaps, especially concerning low- and middle-income countries and integration of dementia prevention with existing cerebrovascular prevention programs. A precision risk reduction approach may be most effective for dementia prevention. Such an approach could be implemented in Brain Health Services.https://doi.org/10.1186/s13195-021-00875-8Brain Health ServicesDementiaAgingAlzheimer’s diseasePreventionDementia risk |
| spellingShingle | Alina Solomon Ruth Stephen Daniele Altomare Emmanuel Carrera Giovanni B. Frisoni Jenni Kulmala José Luis Molinuevo Peter Nilsson Tiia Ngandu Federica Ribaldi Bruno Vellas Philip Scheltens Miia Kivipelto on behalf of the European Task Force for Brain Health Services Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services—part 4 of 6 Alzheimer’s Research & Therapy Brain Health Services Dementia Aging Alzheimer’s disease Prevention Dementia risk |
| title | Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services—part 4 of 6 |
| title_full | Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services—part 4 of 6 |
| title_fullStr | Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services—part 4 of 6 |
| title_full_unstemmed | Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services—part 4 of 6 |
| title_short | Multidomain interventions: state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services—part 4 of 6 |
| title_sort | multidomain interventions state of the art and future directions for protocols to implement precision dementia risk reduction a user manual for brain health services part 4 of 6 |
| topic | Brain Health Services Dementia Aging Alzheimer’s disease Prevention Dementia risk |
| url | https://doi.org/10.1186/s13195-021-00875-8 |
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