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

Alzheimer’s Research & Therapy

Cornelia van Duijn¹  David J. Llewellyn²  Philip Scheltens³  Eugene Tang⁴  on behalf of the European Task Force for Brain Health Services⁵  Janice M. Ranson⁵  Blossom C. M. Stephan⁶  Timothy Rittman⁶  Catherine J. Mummery⁶  Kaj Blennow⁷  Frank Jessen⁸  Shabina Hayat⁹  Carol Brayne⁹  Daniele Altomare^1,10  José Luis Molinuevo^1,11  Federica Ribaldi^1,11  Giovanni B. Frisoni^1,11  Frederik Barkhof^1,12 

[1] Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital;Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC;Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation;Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London;College of Medicine and Health, University of Exeter;Deep Dementia Phenotyping (DEMON) Network;Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden;Department of Psychiatry and Psychotherapy, Medical Faculty, University of Cologne;Department of Public Health and Primary Care, Cambridge Public Health, University of Cambridge;Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, Nottingham University;Laboratory of Neuroimaging of Aging (LANVIE), University of Geneva;Nuffield Department of Population Health, University of Oxford;

关键词: Alzheimer’s disease;    Dementia;    Aging;    Brain health services;    Risk factors;    Risk profiling;   

DOI  :  10.1186/s13195-021-00895-4

来源: DOAJ

【 摘 要 】

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.

【 授权许可】

Unknown