Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6
Abstract 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 interve...
| Main Authors: | , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2021-10-01
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| Series: | Alzheimer’s Research & Therapy |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13195-021-00895-4 |
| _version_ | 1819289841601347584 |
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| author | Janice M. Ranson Timothy Rittman Shabina Hayat Carol Brayne Frank Jessen Kaj Blennow Cornelia van Duijn Frederik Barkhof Eugene Tang Catherine J. Mummery Blossom C. M. Stephan Daniele Altomare Giovanni B. Frisoni Federica Ribaldi José Luis Molinuevo Philip Scheltens David J. Llewellyn on behalf of the European Task Force for Brain Health Services |
| author_facet | Janice M. Ranson Timothy Rittman Shabina Hayat Carol Brayne Frank Jessen Kaj Blennow Cornelia van Duijn Frederik Barkhof Eugene Tang Catherine J. Mummery Blossom C. M. Stephan Daniele Altomare Giovanni B. Frisoni Federica Ribaldi José Luis Molinuevo Philip Scheltens David J. Llewellyn on behalf of the European Task Force for Brain Health Services |
| author_sort | Janice M. Ranson |
| collection | DOAJ |
| description | Abstract 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 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. |
| first_indexed | 2024-12-24T03:13:16Z |
| format | Article |
| id | doaj.art-b32cfaafd9ce4f9999e42323b5763f5f |
| institution | Directory Open Access Journal |
| issn | 1758-9193 |
| language | English |
| last_indexed | 2024-12-24T03:13:16Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Alzheimer’s Research & Therapy |
| spelling | doaj.art-b32cfaafd9ce4f9999e42323b5763f5f2022-12-21T17:17:43ZengBMCAlzheimer’s Research & Therapy1758-91932021-10-0113111210.1186/s13195-021-00895-4Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6Janice M. Ranson0Timothy Rittman1Shabina Hayat2Carol Brayne3Frank Jessen4Kaj Blennow5Cornelia van Duijn6Frederik Barkhof7Eugene Tang8Catherine J. Mummery9Blossom C. M. Stephan10Daniele Altomare11Giovanni B. Frisoni12Federica Ribaldi13José Luis Molinuevo14Philip Scheltens15David J. Llewellyn16on behalf of the European Task Force for Brain Health ServicesCollege of Medicine and Health, University of ExeterDeep Dementia Phenotyping (DEMON) NetworkDepartment of Public Health and Primary Care, Cambridge Public Health, University of CambridgeDepartment of Public Health and Primary Care, Cambridge Public Health, University of CambridgeDepartment of Psychiatry and Psychotherapy, Medical Faculty, University of CologneDepartment of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University HospitalNuffield Department of Population Health, University of OxfordCentre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College LondonDeep Dementia Phenotyping (DEMON) NetworkDeep Dementia Phenotyping (DEMON) NetworkInstitute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, Nottingham UniversityLaboratory of Neuroimaging of Aging (LANVIE), University of GenevaLaboratory of Neuroimaging of Aging (LANVIE), University of GenevaLaboratory of Neuroimaging of Aging (LANVIE), University of GenevaBarcelonaβeta Brain Research Center (BBRC), Pasqual Maragall FoundationAlzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMCCollege of Medicine and Health, University of ExeterAbstract 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 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.https://doi.org/10.1186/s13195-021-00895-4Alzheimer’s diseaseDementiaAgingBrain health servicesRisk factorsRisk profiling |
| spellingShingle | Janice M. Ranson Timothy Rittman Shabina Hayat Carol Brayne Frank Jessen Kaj Blennow Cornelia van Duijn Frederik Barkhof Eugene Tang Catherine J. Mummery Blossom C. M. Stephan Daniele Altomare Giovanni B. Frisoni Federica Ribaldi José Luis Molinuevo Philip Scheltens David J. Llewellyn on behalf of the European Task Force for Brain Health Services Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6 Alzheimer’s Research & Therapy Alzheimer’s disease Dementia Aging Brain health services Risk factors Risk profiling |
| title | Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6 |
| title_full | Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6 |
| title_fullStr | Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6 |
| title_full_unstemmed | Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6 |
| title_short | Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6 |
| title_sort | modifiable risk factors for dementia and dementia risk profiling a user manual for brain health services part 2 of 6 |
| topic | Alzheimer’s disease Dementia Aging Brain health services Risk factors Risk profiling |
| url | https://doi.org/10.1186/s13195-021-00895-4 |
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