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

Brain health services for the secondary prevention of cognitive impairment and dementia: Opportunities, challenges, and the business case for existing and future facilities

A European Task Force has recently developed and published the concept and protocols for the setup of the innovative health offer of Brain Health Services for the secondary prevention of dementia and cognitive impairment (dBHS). dBHS are outpatient health care facilities where adult persons can find an assessment of their risk of developing cognitive impairment and dementia, have their risk level and contributing factors communicated using appropriate language supported by adequate communication tools, can decide to participate to programs for personalized risk reduction if at higher risk, and benefit from cognitive enhancement interventions. This health offer is distinct from that of currently active memory clinics. The ultimate aim of dBHS is to extend healthy life, free from cognitive impairment. Here, we (i) discuss the pertinent opportunities and challenges for those persons who want to benefit from dBHS, professionals, and wider society, (ii) describe the concepts, protocols, organizational features, and patient journeys of some currently active dBHS in Europe, and (iii) argue in favor of the business case for dBHS in Europe.

Minoritised ethnic groups and modifiable dementia risk: a scoping review of UK-based evidence

BACKGROUND

People from minoritised ethnic groups are more likely to be impacted by dementia. In the general population, dementia may be prevented or delayed by up to 40% by reducing risk in 12 modifiable risk factors (MRF). However, minoritised ethnic groups are not systematically included.

OBJECTIVES

We conducted a scoping review following Joanna Briggs Institute guidance to map: (1) which minoritised ethnic groups have been included in UK research on dementia MRF, (2) for which MRF and (3) using which research methods.

ELIGIBILITY CRITERIA

Eligible studies analysed one or more of the 12 MRFs among minoritised ethnic groups.

EVIDENCE SOURCES

Medline, Embase Classic+Embase, PsycInfo, Web of Science, CINAHL and grey literature were searched.

CHARTING METHODS

Patient and public involvement with minoritised ethnic groups and professionals informed the data extraction tool. We use frequencies and graphs in data description.

RESULTS

We screened 7748 records, assessed 122 full text records and included 14 studies, which mostly used broad ethnic groups. Hypertension, diabetes and depression were studied as predictors of dementia in 10, eight and six studies, respectively, compared with low social contact and air pollution in just two each. Measures of MRF lacked consistency, and data per ethnic group were not reported in several studies. Research examining interactions in combinations of MRFs was lacking.

CONCLUSIONS

More research is needed with specific ethnic groups, consistent measures and focusing on discrimination and MRF interaction and severity. This will be key to personalised risk reduction with diverse communities.

The role of the hippocampus and SLC39A8 in chronic musculoskeletal pain-induced dementia: a Mendelian randomization study

Despite observational studies suggesting a link between chronic musculoskeletal pain (CMP) and increased risk of cognitive decline and dementia, the causal nature of this relationship remains uncertain due to potential confounding factors and reverse causality. We employed two-sample Mendelian Randomization (TSMR), bidirectional MR, mediation MR, drug-target MR, and colocalization analysis, along with gene set enrichment and protein-protein interaction (PPI) analyses. TSMR assessed the causal associations between CMP and the risk of dementia and its subtypes, including Alzheimer's disease (AD), vascular dementia (VaD), Lewy body dementia (LBD), frontotemporal dementia (FTD), and Parkinson's disease (PD). Bidirectional MR evaluated reverse causality, while mediation analyses identified potential mediators, focusing on neuroimaging and cognitive phenotypes. Drug-target MR investigated the role of the SLC39A8 gene, and colocalization analysis determined shared causal genetic variants. Gene set enrichment and PPI analyses elucidated the biological pathways implicated in the CMP-dementia relationship. Robust evidence established a causal relationship between chronic low back pain (LBP) and increased risk of PD, with knee osteoarthritis identified as a partial mediator, suggesting a pathway involving chronic inflammation. Bidirectional MR analysis revealed no evidence of reverse causality, further supporting the unidirectional causal link from LBP to PD. Colocalization analysis confirmed distinct genetic architectures for LBP and PD, while drug-target MR implicated the SLC39A8 gene as a potential mediator. Gene set enrichment and PPI analyses highlighted critical biological pathways, such as purine metabolism and glutamate receptor signaling. Suggestive evidence indicated potential causal links between limb pain and overall dementia, myalgia and VaD, as well as potential protective effects of Polymyalgia Rheumatica (PMR) against AD and rheumatism against PD. This study reveals a complex causal relationship between CMP and neurodegenerative diseases, particularly the robust link between LBP and PD. The findings underscore the need for further research to elucidate the underlying mechanisms and inform targeted prevention and treatment strategies.

A point-based cognitive impairment scoring system for southeast Asian adults

BACKGROUND

Cognitive impairment is a growing concern in Southeast Asian populations, where the burden of cerebrovascular disease (CeVD) is high. Currently, there is no point-based scoring system for identifying cognitive impairment in these populations.

OBJECTIVE

To develop and validate a simple point-based Cognitive Impairment Scoring System (CISS) for identifying individuals with cognitive impairment no dementia (CIND) and concomitant CeVD in Southeast Asian populations.

DESIGN

A cross-sectional study using data from two population-based studies.

SETTING

Community-based setting in Southeast Asia.

PARTICIPANTS

1,511 Southeast Asian adults (664 with CIND, 44.0 %).

MEASURES

Two CISS measures were developed: a basic measure including 11 easily assessable risk factors, and an extended measure incorporating seven additional neuroimaging markers. Performance was evaluated using receiver operating characteristic analysis (AUC) and calibration plots.

RESULTS

The AUC for CISS-basic and CISS-extended were 0.81 (95 %CI, 0.76-0.86) and 0.85 (95 %CI, 0.81-0.89), respectively. Calibration plots indicated satisfactory fit for both the basic measure (p=0.82) and the extended measure (p=0.17). The basic measure included age, gender, ethnicity, education, systolic blood pressure, BMI, smoking history, diabetes, hyperlipidemia, stroke history, and mild/moderate depression. The extended measure added neuroimaging markers of CeVD and brain atrophy.

CONCLUSION

The CISS provides a quick, objective, and clinically relevant tool for assessing cognitive impairment risk in Southeast Asian populations. The basic measure is suitable for initial community-based screenings, while the extended measure offers higher specificity for probable diagnosis. This point-based system enables rapid estimation of cognitive status without requiring complex calculations, potentially improving early detection and management of cognitive impairment in clinical practice.

Incremental Value of Multidomain Risk Factors for Dementia Prediction: A Machine Learning Approach

OBJECTIVE

The current evidence regarding how different predictor domains contributes to predicting incident dementia remains unclear. This study aims to assess the incremental value of five predictor domains when added to a simple dementia risk prediction model (DRPM) for predicting incident dementia in older adults.

DESIGN

Population-based, prospective cohort study.

SETTING

UK Biobank study.

PARTICIPANTS

Individuals aged 60 or older without dementia.

MEASUREMENTS

Fifty-five dementia-related predictors were gathered and categorized into clinical and medical history, questionnaire, cognition, polygenetic risk, and neuroimaging domains. Incident dementia (all-cause) and the subtypes, Alzheimer's disease (AD) and vascular dementia (VaD), were determined through hospital and death registries. Ensemble machine learning (ML) DRPMs were employed for prediction. The incremental values of risk predictors were assessed using the percent change in Area Under the Curve (∆AUC%) and the net reclassification index (NRI).

RESULTS

The simple DRPM which included age, body mass index, sex, education, diabetes, hyperlipidaemia, hypertension, depression, smoking, and alcohol consumption yielded an AUC of 0.711 (± 0.008 SD). The five predictor domains exhibited varying levels of incremental value over the basic model when predicting all-cause dementia and the two subtypes. Neuroimaging markers provided the highest incremental value in predicting all-cause dementia (∆AUC% +9.6%) and AD (∆AUC% +16.5%) while clinical and medical history data performed the best at predicting VaD (∆AUC% +12.2%). Combining clinical and medical history, and questionnaire data synergistically enhanced ML DRPM performance.

CONCLUSION

Combining predictors from different domains generally results in better predictive performance. Selecting predictors involves trade-offs, and while neuroimaging markers can significantly enhance predictive accuracy, they may pose challenges in terms of cost or accessibility.

Blood DNA methylation signature for incident dementia: Evidence from longitudinal cohorts

INTRODUCTION

Distinguishing between molecular changes that precede dementia onset and those resulting from the disease is challenging with cross-sectional studies.

METHODS

We studied blood DNA methylation (DNAm) differences and incident dementia in two large longitudinal cohorts: the Offspring cohort of the Framingham Heart Study (FHS) and the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. We analyzed blood DNAm samples from > 1000 cognitively unimpaired subjects.

RESULTS

Meta-analysis identified 44 CpGs and 44 differentially methylated regions consistently associated with time to dementia in both cohorts. Our integrative analysis identified early processes in dementia, such as immune responses and metabolic dysfunction. Furthermore, we developed a methylation-based risk score, which successfully predicted future cognitive decline in an independent validation set, even after accounting for age, sex, apolipoprotein E ε4, years of education, baseline diagnosis, and baseline Mini-Mental State Examination score.

DISCUSSION

DNAm offers a promising source as a biomarker for dementia risk assessment.

HIGHLIGHTS

Blood DNA methylation (DNAm) differences at individual CpGs and differentially methylated regions are significantly associated with incident dementia. Pathway analysis revealed DNAm differences associated with incident dementia are significantly enriched in biological pathways involved in immune responses and metabolic processes. Out-of-sample validation analysis demonstrated that a methylation-based risk score successfully predicted future cognitive decline in an independent dataset, even after accounting for age, sex, apolipoprotein E ε4, years of education, baseline diagnosis, and baseline Mini-Mental State Examination score.

Exploring brain health awareness and dementia risk in young adults: A focus group study

OBJECTIVE

The topic of brain health across the life-course is currently receiving exponential attention. Alongside this, exposure to lifestyle-related risk factors for Alzheimer's disease and related dementias accumulates across the life-course. This study aimed to explore young adults' (18-39 years) perceptions and understanding of brain health and dementia risk.

STUDY DESIGN

This study employed a phenomenological descriptive qualitative methodology to examine the lived experiences and perceptions of participants.

METHODS

Focus groups were conducted with 39 young adults (18 female, 2 non-binary) from North America (n = 20) and Europe (n = 19), conducted via video conference.

RESULTS

Participants' awareness and understanding of brain health and dementia risk factors varied, influenced by factors such as general health, family history of dementia, and personal experiences with brain health issues (e.g., traumatic brain injury). The data revealed rich insights into how participants connected (or did not connect) lifestyle factors to brain health and dementia risk.

CONCLUSION

This study is among the first to explore young adults' perceptions of brain health across diverse populations. While participants demonstrated moderate awareness of factors affecting brain health, they often struggled to link these factors directly to dementia risk or protective measures.

Repetitive Transcranial Magnetic Stimulation-Mediated Neuroprotection in the 5xFAD Mouse Model of Alzheimer's Disease Through GABRG2 and SNAP25 Modulation

Alzheimer's disease (AD) is a leading neurodegenerative disorder with substantial impacts on cognition and behavior. Repetitive transcranial magnetic stimulation (rTMS), a non-invasive neuromodulation technique, has been used to treat various neuropsychiatric disorders, but its efficacy in AD has not been thoroughly investigated. This study examines the neuroprotective effects of rTMS in the 5xFAD mouse model of AD, with a particular focus on its modulation of GABAergic neuronal activity via the GABRG2 and SNAP25 proteins. Transcriptomic sequencing of rTMS-treated 5xFAD mice revealed 32 genes influenced by the treatment, among which GABRG2 was identified as a critical modulatory target. Electrophysiological assessments, including whole-cell patch clamp recordings from frontal cortex neurons, demonstrated significant alterations in inhibitory synaptic currents following rTMS. Subsequent experiments involved sh-GABRG2 transduction combined with rTMS treatment (20Hz, 14 days), examining behavioral responses, GABAergic neuron functionality, cortical GABA expression, cerebrospinal fluid GABA concentrations, β-amyloid accumulation, and pro-inflammatory cytokine levels. The results indicated notable improvements in behavioral performance, enhanced functionality of GABAergic neurons, and reductions in β-amyloid deposition and neuroinflammation after rTMS treatment. Further analysis revealed that SNAP25 overexpression could counteract the negative effects of GABRG2 silencing, highlighting the crucial role of SNAP25 downstream of GABRG2 in mediating rTMS's therapeutic effects in AD. This research highlights rTMS's potential to modulate synaptic and vesicular transport mechanisms, offering a promising avenue for ameliorating symptoms of AD through neuroprotective pathways.

Development and internal validation of a risk prediction model for dementia in a rural older population in China

INTRODUCTION

We sought to develop a practical tool for predicting dementia risk among rural-dwelling Chinese older adults.

METHODS

This cohort study included 2220 rural older adults (age ≥ 65 years) who were dementia-free at baseline (2014) and were followed in 2018. Dementia was diagnosed following the DSM-IV criteria. The prediction model was constructed using Cox models. We used C-index and calibration plots to assess model performance, and the decision curve analysis (DCA) to assess clinical usefulness.

RESULTS

During the 4-year follow-up, 134 individuals were diagnosed with dementia. We identified age, education, self-rated AD8 score, marital status, and stroke for the prediction model, with the C-index being 0.79 (95% confidence interval = 0.75-0.83) and the corrected C-index for internal validation being 0.79. Calibration plots showed good performance in predicting up to 4-year dementia risk and DCA indicated good clinical usefulness.

DISCUSSION

The 4-year dementia risk can be accurately predicted using five easily available predictors in a rural Chinese older population.

HIGHLIGHTS

We developed and internally validated a practical tool for dementia risk prediction among a rural older population in China. The prediction tool showed good discrimination and excellent calibration for predicting up to 4-year risk of dementia. The prediction tool can be used to identify individuals at a high risk for dementia for early preventive interventions.

Association between Age-Related Macular Degeneration with Visual Disability and Risk of Dementia: A Nationwide Cohort Study

OBJECTIVES

To investigate the prospective association between the risk of dementia and age-related macular degeneration (AMD) in patients with related visual disability (VD).

DESIGN

A nationwide population-based cohort study used authorized data provided by the Korean National Health Insurance Service.

SETTING AND PARTICIPANTS

A total of 1,788,457 individuals aged >50 years who participated in the Korean National Health Screening Program were enrolled.

METHODS

From January 2009 to December 2019, participants were tracked for a diagnosis of dementia using registered diagnostic codes from claims data. Participants with VD were defined as those registered in a national disability registration established by the Korean government. The prospective association of AMD and related VD with new-onset dementia was investigated using a multivariate-adjusted Cox proportional hazard model adjusted for age, sex, body mass index, income level, systemic comorbidities, psychiatric diseases, and behavioral factors.

RESULTS

During the average follow-up period of 9.7 ± 2.16 years, 4260 of 21,384 participants in the AMD cohort and 137,166 of 1,662,319 participants in the control cohort were newly diagnosed with dementia, respectively. Participants diagnosed with AMD showed a higher risk of new-onset dementia than those in the control group in the fully adjusted model [hazard ratio (HR) 1.11, 95% CI 1.07-1.14]. The risk of dementia was higher in participants diagnosed with AMD and associated VD (HR 1.28, 95% CI 1.15-1.43) compared to those without VD (HR 1.09, 95% CI 1.06-1.13).

CONCLUSIONS AND IMPLICATIONS

A diagnosis of AMD was associated with an increased risk of all-cause dementia and its major subtypes. Close monitoring of cognitive function in patients with AMD, especially those with VD, may help in early detection of all-cause dementia, which could reduce the socioeconomic burden and improve the quality of life of patients.

Complex interactions and composite burden of risk factors in vascular cognitive impairment

Vascular cognitive impairment (VCI) stresses the vascular contributions to cognitive decline, ranging from mild to major forms. Except for symptomatic treatment for relevant vascular diseases, the other recommended strategy is to intervene in key vascular risk factors (VRFs) as early as possible. A considerable amount of previous research delineated the association of a specific factor with dementia, involving each risk factor discussed in the present review. However, due to the heterogeneity and complexity of VCI, managing a single factor is insufficient to reduce its incidence and prevalence. Ongoing studies suggest differences in the impact of various combinations of risk factors on dementia. Here in this review, we aimed to provide an updated overview of clinical evidence and implications of complex interactions among various risk factors of VCI, including common VRFs and modifiable dementia-related risk factors. Understating the effect of comorbid risk factors on VCI and underlying mechanisms of them during VCI progression is essential for identifying high-risk population and developing preventive strategies. Furthermore, we summarized common composite risk scores and models used for risk evaluation and prediction of VCI, involving conventional risk scores, subclinical vascular composites, and novel risk models driven by intelligent algorithms. Lastly, we discussed potential gaps and research directions on searching specific clinical risk profiles, constructing effective risk scores, and implementing targeted risk interventions.

Daily-life walking speed, running duration and bedtime from wrist-worn sensors predict incident dementia: A watch walk - UK biobank study

OBJECTIVE

To determine if wrist-worn sensor parameters can predict incident dementia in individuals aged 60 + years and to compare prediction with other tools.

DESIGN

Observational cohort study.

SETTING

Community PARTICIPANTS: The cohort comprised 47,371 participants without dementia, aged 60 + years, who participated in the UK Biobank study (mean age=67 ± 4 years; 52 % female).

MEASUREMENTS

Nineteen digital biomarkers were extracted from up-to-7-day wrist-worn sensor accelerometry data at baseline. Univariable and multivariable Cox proportional hazard models examined associations between sensor parameters and prospectively diagnosed dementia.

RESULTS

Median follow-up was 7.5 years (interquartile range: 7.0 to 9.0 years), during this time 387 participants (0.8 %) were diagnosed with dementia. Among the gait parameters, slower maximal walking speed had the strongest association with incident dementia (32 % decrease in hazard for each standard deviation increase) followed by lower daily step counts (30 % decrease) and increased step-time variability (17 % increase). While adjusting for age and sex, running duration, maximal walking speed and early bedtime were identified as independent and significant predictors of dementia. The multivariable prediction model performed comparably to the ANU-ADRI and UKB-Dementia Risk Score models in the UK Biobank cohort.

CONCLUSIONS

The study findings indicate that remotely acquired parameters from wrist-worn sensors can predict incident dementia. Since wrist-worn sensors are highly acceptable for long-term use, wrist-worn sensor parameters have the potential to be incorporated into dementia screening programs.

Walking time and genetic predisposition for Alzheimer's disease: Results from the HELIAD study

Objective: Our study aimed to explore whether physical condition might affect the association between genetic predisposition for Alzheimer's Disease (AD) and AD incidence. Methods: The sample of participants consisted of 561 community-dwelling adults over 64 years old, without baseline dementia (508 cognitively normal and 53 with mild cognitive impairment), deriving from the HELIAD, an ongoing longitudinal study with follow-up evaluations every 3 years. Physical condition was assessed at baseline through walking time (WT), while a Polygenic Risk Score for late onset AD (PRS-AD) was used to estimate genetic predisposition. The association between WT and PRS-AD with AD incidence was evaluated with Cox proportional hazard models adjusted for age, sex, education years, global cognition score and APOE ε-4 genotype. Then, the association between WT and AD incidence was investigated after stratifying participants by low and high PRS-AD. Finally, we examined the association between PRS-AD and AD incidence after stratifying participants by WT. Results: Both WT and PRS-AD were connected with increased AD incidence (p < 0.05), after adjustments. In stratified analyses, in the slow WT group participants with a greater genetic risk had a 2.5-fold higher risk of developing AD compared to participants with lower genetic risk (p = 0.047). No association was observed in the fast WT group or when participants were stratified based on PRS-AD. Conclusions: Genetic predisposition for AD is more closely related to AD incidence in the group of older adults with slow WT. Hence, physical condition might be a modifier in the relationship of genetic predisposition with AD incidence.

Association of mid-life cardiovascular risk with biomarkers of Alzheimer's disease, neurodegeneration, and white matter hyperintensities: Heart SCORE brain study

Background

Atherosclerotic cardiovascular disease (ASCVD) risk factors in mid-life are associated with cognitive decline and late-life dementia. However, the role of these risk factors in Alzheimer's disease (AD) pathology remains elusive.

Objective

We investigated the association of mid-life 10-year ASCVD risk with late-life amyloid, tau, neurodegeneration [AT(N)] measures and white matter hyperintensities (WMHs).

Methods

Participants enrolled in the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study between 2003-2005 (mid-life) and underwent brain MRI and PET scans in 2018-2022 (age >65 years, late-life) to detect and quantify amyloid (A, PiB-PET) and tau (T, Flortaucipir (FTP) PET) deposition, cortical thickness (N) and WMHs. Mid-life ASCVD risk was categorized as; borderline (5%-7.4%), intermediate (7.5%-<15%), or high (≥15%). Association of mid-life ASCVD risk HR (95% CI) was assessed using logistic and linear regressions with A, T, or N and chi square beta coefficients for WMH in late life.

Results

Over a ∼16 years follow up, in 135 participants (mean age 73 years), mid-life ASCVD risk categories had a graded association with neurodegeneration (ORASCVD high vs low risk% 6.98 [2.44-19.95]; p < 0.05) driven primarily by self-identified Black race and age, while none with A and T. ASCVD risk score was also associated with WMHs ((β=0.42 ± 0.22; p = 0.05).

Conclusions

In this asymptomatic, diverse cohort, 10-year ASCVD risk was predictive of late-life neurodegeneration and WMHs but not amyloid or tau. Further mechanistic studies can elucidate whether midlife ASCVD risk factors associated neurodegeneration initiates brain vulnerability leading to AD in late life.

Sociodemographic and health predictors of adherence to self-administered computerized cognitive assessment

Introduction

Cognitive assessment is essential to detect early cognitive decline and guide interventions. Self-administered computerized assessment is a promising option for periodic cognitive screening in the general population. One of the most critical challenges to implementing cognitive screening in at risk populations is participants' adherence. However, there is insufficient evidence to determine which factors are essential for adherence to long-term digital cognitive screening.

Aims

This study aims to investigate potential sociodemographic and health predictors of adherence to a self-administered web-based cognitive monitoring, the Brain on Track (BoT), in the general population.

Methods

Participants (n = 347) were recruited from the general community. The participants were asked to perform one BoT test every 3 months for cognitive screening and were followed at two time points, namely, 1-year and 3- to 6-year follow-up. Regression models were used to investigate sociodemographic and health predictors of adherence to BoT use at 1 year and up to 6 years.

Results

Being older positively affects adherence to periodic cognitive screening for both follow-up periods. Being a female, having more years of formal education, presenting more BoT baseline correct answers and fewer BoT baseline incorrect answers, and reporting memory complaints positively affect adherence to periodic screening at 3 to 6 years of follow-up but not at 1-year follow-up.

Discussion

The identified determinants of adherence can be considered when planning long-term cognitive screening protocols to increase adherence. Specific strategies could be helpful to improve the adherence of participants who adhere less.

Perceptions of brain health and aging among middle-aged latinos: A qualitative paper

OBJECTIVES

Latinos living in the US are disproportionately impacted by Alzheimer's disease and related dementias (ADRD). To develop culturally-informed interventions, a first step is engaging with key stakeholders. The present study aimed to explore perspectives on brain health and aging among middle-aged Latinos living in Chicago, IL.

METHODS

Individual, semi-structured interviews were conducted with 30 English- or Spanish-speaking Latinos between 35 to 64 years old. Questions from a previously used interview guide were leveraged and addressed knowledge about the brain, perceptions of healthy and unhealthy aging, ideas of how to care for the brain, where knowledge was acquired, and suggestions for disseminating brain health education. Responses were analyzed using thematic analysis.

RESULTS

The following themes were identified: (1) Understanding of the brain is varied (including cognitive, behavioral, anatomical, and psychological descriptions); (2) Perceptions surrounding healthy aging are broad and demonstrate a depth of understanding (e.g., physical and cognitive abilities, independence, positive emotions, and sociability), yet understanding of signs of an unhealthy brain is somewhat limited (e.g., focus on memory); (3) Brain health promotion is largely viewed as actionable (spanning physical health, cognitively stimulating activities, emotional wellbeing, medical self-management, and social connectedness); (4) Suggestions for disseminating education included media, clinics, churches, libraries, and community centers, with consideration of possible barriers and facilitators to behavior change (e.g., finances, prioritizing family).

CONCLUSIONS

Results showed significant heterogeneity in understanding of the brain, albeit with promising attitudes that actions can be taken to protect one's brain from ADRD.

PRACTICE IMPLICATIONS

Takeaways include the need for increasing education on normative versus nonnormative memory loss and signs of ADRD beyond memory impairment. Messaging may benefit from utilizing analogies, considering familism and spirituality, and highlighting lifestyle changes that do not carry a financial burden or place blame on individuals.

The emerging field of non-invasive brain stimulation in Alzheimer's disease

Treating cognitive impairment is a holy grail of modern clinical neuroscience. In the past few years, non-invasive brain stimulation is increasingly emerging as a therapeutic approach to ameliorate performance in patients with cognitive impairment and as an augmentation approach in persons whose cognitive performance is within normal limits. In patients with Alzheimer's disease, better understanding of brain connectivity and function has allowed for the development of different non-invasive brain stimulation protocols. Recent studies have shown that transcranial stimulation methods enhancing brain plasticity with several modalities have beneficial effects on cognitive functions. Amelioration has been shown in preclinical studies on behaviour of transgenic mouse models for Alzheimer's pathology and in clinical studies with variable severity of cognitive impairment. While the field is still grappling with issues related to the standardization of target population, frequency, intensity, treatment duration and stimulated region, positive outcomes have been reported on cognitive functions and on markers of brain pathology. Here we review the most encouraging protocols based on repetitive transcranial magnetic stimulation, transcranial direct current stimulation, transcranial alternating current stimulation, visual-auditory stimulation, photobiomodulation and transcranial focused ultrasound, which have demonstrated efficacy to enhance cognitive functions or slow cognitive decline in patients with Alzheimer's disease. Beneficial non-invasive brain stimulation effects on cognitive functions are associated with the modulation of specific brain networks. The most promising results have been obtained targeting key hubs of higher-level cognitive networks, such as the frontal-parietal network and the default mode network. The personalization of stimulation parameters according to individual brain features sheds new light on optimizing non-invasive brain stimulation protocols for future applications.

Health and Lifestyle Factors and Dementia Risk Among Former Professional Soccer Players

Importance

Elite-level contact sport participation is associated with increased dementia risk, which may be attributable to sport-related traumatic brain injury and repetitive head impact exposure. However, the contribution of wider, potentially modifiable dementia risk factors remains uncertain.

Objective

To explore the association of potentially modifiable dementia risk factors with dementia risk among former professional soccer players.

Design, Setting, and Participants

This retrospective cohort study used electronic health record linkage to national electronic datasets of general and mental health hospital inpatient and day-case admissions, prescribing information, and death certification in Scotland for male former professional soccer players born between January 1, 1900, and December 31, 1990, who were aged 30 years or older on December 31, 2020, and general population control individuals matched by sex, year of birth, and area socioeconomic status. Database interrogation was performed on November 30, 2021, and data were analyzed between January 16, 2023, and July 8, 2024.

Exposures

History of smoking, depression, alcohol-related disorders, diabetes, hypertension, hearing loss, and obesity coded within electronic health records.

Main Outcomes and Measures

Prevalence of dementia risk factors and their association with incident dementia diagnoses were evaluated and compared between former soccer players and matched controls.

Results

The final cohort consisted of 11 984 male former professional soccer players and 35 952 matched controls. Over a median 21 years (IQR, 7-34 years) of follow-up from study entry at age 30 years or older, providing a total of 1 039 848 years of follow-up, 434 former soccer players (3.62%) and 453 matched population controls (1.26%) were identified with a dementia diagnosis (hazard ratio [HR], 3.02; 95% CI, 2.54-3.58; P < .001). Overall, rates of general health and lifestyle dementia risk factors were similar or lower among former soccer players compared with matched controls (eg, diabetes: 4.26% vs 6.35%). Dementia risk associated with these factors among soccer players was similar to or lower than among controls (eg, hypertension: HR, 4.62 [95% CI, 3.69-5.78] vs 6.96 [95% CI, 5.64-8.59]).

Conclusions and Relevance

This cohort study found no evidence that high dementia risk among former professional soccer players was associated with potentially modifiable general health and lifestyle dementia risk factors. These data support continuation of measures directed toward reducing exposure to repetitive head impacts and traumatic brain injury in sport.

Blood DNA Methylation Signature for Incident Dementia: Evidence from Longitudinal Cohorts

INTRODUCTION

Distinguishing between molecular changes that precede dementia onset and those resulting from the disease is challenging with cross-sectional studies.

METHODS

We studied blood DNA methylation (DNAm) differences and incident dementia in two large longitudinal cohorts: the Offspring cohort of the Framingham Heart Study (FHS) and the Alzheimer's Disease Neuroimaging Initiative (ADNI) study. We analyzed blood DNAm samples from over 1,000 cognitively unimpaired subjects.

RESULTS

Meta-analysis identified 44 CpGs and 44 differentially methylated regions consistently associated with time to dementia in both cohorts. Our integrative analysis identified early processes in dementia, such as immune responses and metabolic dysfunction. Furthermore, we developed a Methylation-based Risk Score, which successfully predicted future cognitive decline in an independent validation set, even after accounting for age, sex, APOE ε4, years of education, baseline diagnosis, and baseline MMSE score.

DISCUSSION

DNA methylation offers a promising source of biomarker for early detection of dementia.

Barriers and facilitators to implementation of physical activity programs for individuals with dementia living in aged care homes: A systematic review

OBJECTIVES

This systematic review aimed to identify barriers and facilitators to the implementation of physical activity programs for residents with dementia in aged care homes.

METHODS

A search was conducted using the databases Medline, PubMed, PsycINFO, CINAHL, Embase, and ProQuest, and captured articles were assessed for inclusion in the review. Included studies were appraised using the Mixed Methods Appraisal Tool (MMAT). Data extraction was performed for study characteristics, identified barriers and facilitators to physical activity implementation, and synthesised narratively.

RESULTS

Following full-text screening, 13 articles were included in the review. Reporting quality was high in the majority of studies (69 %). Overall, barriers to implementation of physical activity programs were linked to factors related to the resident or the aged care facility, rather than inherently with the physical activity itself. The most identified barriers were understaffing (62 %), resident fatigue or lack of motivation (46 %), distrust of staff (31 %), and fear of injury (31 %). The most identified facilitators were having a structured physical activity protocol (46 %), opportunities for social interaction (38 %), instructor-led sessions (38 %) and offering an individually tailored program (31 %).

CONCLUSIONS

Addressing barriers of understaffing and resident fatigue whilst simultaneously offering structured, personalised group physical activity programs led by instructors may help optimise implementation. Future research should focus on developing tailored implementation plans, evaluating their effectiveness and cost-effectiveness, and identifying best practices to support the delivery of physical activity interventions in residential aged care settings.

PROSPERO REGISTRATION NUMBER

CRD42022372308.

Genomic Insights into Dementia: Precision Medicine and the Impact of Gene-Environment Interaction

The diagnosis, treatment, and management of dementia provide significant challenges due to its chronic cognitive impairment. The complexity of this condition is further highlighted by the impact of gene-environment interactions. A recent strategy combines advanced genomics and precision medicine methods to explore the complex genetic foundations of dementia. Utilizing the most recent research in the field of neurogenetics, the importance of precise genetic data in explaining the variation seen in dementia patients can be investigated. Gene-environment interactions are important because they influence genetic susceptibilities and aid in the development and progression of dementia. Modified to each patient's genetic profile, precision medicine has the potential to detect groups at risk and make previously unheard-of predictions about the course of diseases. Precision medicine techniques have the potential to completely transform treatment and diagnosis methods. Targeted medications that target genetic abnormalities will probably appear, providing the possibility for more efficient and customized medical interventions. Investigating the relationship between genes and the environment may lead to preventive measures that would enable people to change their surroundings and minimize the risk of dementia, leading to the improved lifestyle of affected people. This paper provides a comprehensive overview of the genomic insights into dementia, emphasizing the pivotal role of precision medicine, and gene-environment interactions.

Dynamics of Cognitive Impairment in MCI Patients over a Three-Year Period: The Informative Role of Blood Biomarkers, Neuroimaging, and Genetic Factors

Given the high growth rates of cognitive decline among the elderly population and the lack of effective etiological treatments, early diagnosis of cognitive impairment progression is an imperative task for modern science and medicine. It is of particular interest to identify predictors of an unfavorable subsequent course of cognitive disorders, specifically, rapid progression. Our study assessed the informative role of various risk factors on the dynamics of cognitive impairment among mild cognitive impairment (MCI) patients. The study included patients with MCI (N = 338) who underwent neuropsychological assessment, magnetic resonance imaging (MRI) examination, blood sampling for general and biochemical analysis, APOE genotyping, and polygenic risk score (PRS) evaluation. The APOE ε4/ε4 genotype was found to be associated with a diminished overall cognitive scores initial assessment and negative cognitive dynamics. No associations were found between cognitive changes and the PRS. The progression of cognitive impairment was associated with the width of the third ventricle and hematological parameters, specifically, hematocrit and erythrocyte levels. The absence of significant associations between the dynamics of cognitive decline and PRS over three years can be attributed to the provided suitable medical care for the prevention of cognitive impairment. Adding other risk factors and their inclusion in panels assessing the risk of progression of cognitive impairment should be considered.

Tea, coffee, and caffeine intake and risk of dementia and Alzheimer's disease: a systematic review and meta-analysis of cohort studies

Background: Limited and conflicting evidence exists for the associations between tea, coffee, and caffeine intake and risk of dementia and Alzheimer's disease (AD). This meta-analysis aimed to elucidate these associations and quantify potential dose-response relationships. Methods: PubMed, EMBASE, and Web of Science were searched up to 11 June 2024 for cohort studies. Random effects models were used to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs), with the dose-response relationship assessed using restricted cubic splines. The Grading of Recommendations Assessment Development and Evaluation (GRADE) tool was used to assess the risk of bias. Results: Our analysis encompassed 38 cohorts, totalling 751 824 participants and 13 017 dementia and 17 341 AD cases. For dementia, compared with the lowest category, the pooled RRs (95% CI) in the highest category of tea, coffee, and caffeine were 0.84 (0.74-0.96, n = 6), 0.95 (0.87-1.02, n = 9), and 0.94 (0.70-1.25, n = 5), with all rated as low certainty in GRADE. For AD, the pooled RRs (95% CI) in the highest category of tea, coffee, and caffeine compared to the lowest category were 0.93 (0.87-1.00, n = 6), 1.01 (0.90-1.12, n = 10), and 1.34 (1.04-1.74, n = 2), with certainty ratings of low, low, and very low, respectively. Dose-response analysis indicated a non-linear relationship between coffee intake (Poverall = 0.04 and Pnonlinear = 0.01) and dementia risk, showing the protective association of risk of dementia with 1 to 3 cups per day of coffee intake. There is a linear association between tea intake and risk of dementia, with a significantly decreased risk of dementia for each 1 cup per day increase in tea consumption (0.96, 95% CI 0.94-0.99, Poverall = 0.01 and Pnonlinear = 0.68). Conclusion: Increased tea consumption was associated with a decreased risk of dementia and AD, and a non-linear relationship was found between coffee and dementia, supporting public health recommendations for dementia prevention.

Integrating AI in fighting advancing Alzheimer: diagnosis, prevention, treatment, monitoring, mechanisms, and clinical trials

The application of artificial intelligence (AI) in neurology is a growing field offering opportunities to improve accuracy of diagnosis and treatment of complicated neuronal disorders, plus fostering a deeper understanding of the aetiologies of these diseases through AI-based analyses of large omics data. The most common neurodegenerative disease, Alzheimer's disease (AD), is characterized by brain accumulation of specific pathological proteins, accompanied by cognitive impairment. In this review, we summarize the latest progress on the use of AI in different AD-related fields, such as analysis of neuroimaging data enabling early and accurate AD diagnosis; prediction of AD progression, identification of patients at higher risk and evaluation of new treatments; improvement of the evaluation of drug response using AI algorithms to analyze patient clinical and neuroimaging data; the development of personalized AD therapies; and the use of AI-based techniques to improve the quality of daily life of AD patients and their caregivers.

Validity and reliability of the Turkish version of the Australian National University-Alzheimer's Disease Risk Index (ANU-ADRI)

INTRODUCTION

There is still a requirement for concise, practical scales that can be readily incorporated into everyday schedules and predict the likelihood of dementia onset in individuals without dementia. This study aimed to assess the reliability of the ANU-ADRI (Australian National University Alzheimer's Disease Risk Index)-Short Form in Turkish geriatric patients.

METHODS

This methodological study involved 339 elderly patients attending the geriatric outpatient clinic for various reasons. The known-group validity and divergent validity were assessed. The ANU-ADRI was administered during the baseline test and again within one week for retest purposes. Alongside the ANU-ADRI, all participants underwent a comprehensive geriatric assessment, including Activities of Daily Living (ADL), mobility assessment (Performance-Oriented Mobility Assessment (POMA) and Timed Up and Go Test), nutritional assessment (Mini Nutritional Assessment (MNA)), and global cognition evaluation (Mini-Mental State Examination (MMSE)).

RESULTS

The scale demonstrated satisfactory linguistic validity. A correlation was observed between the mean scores of the ANU-ADRI test and retest (r = 0.997, p < 0.001). Additionally, there existed a moderate negative linear association between the ANU-ADRI and MMSE scores (r = -0.310, p < 0.001), POMA (r = -0.406, p < 0.001), Basic ADL (r = -0.359, p < 0.001), and Instrumental ADL (r = -0.294, p < 0.001). Moreover, a moderate positive linear association was found between the ANU-ADRI and the Timed Up and Go Test duration (r = 0.538, p < 0.001).

CONCLUSION

The ANU-ADRI-Short Form was proved as a valuable tool for clinical practice, facilitating the assessment of Alzheimer's disease risk within the Turkish geriatric population.

Guideline for the cognitive assessment and follow-up in the Guangdong-Hong Kong-Macao Greater Bay Area (2024 edition)

This practice guideline focuses on the cognitive assessment for mild cognitive impairment in the Guangdong-Hong Kong-Macao Greater Bay Area. To achieve the standardization and normalization of its clinical practice and generate individualized intervention, the National Core Cognitive Center of the Second Affiliated Hospital of Guangzhou Medical University, the Cognitive Disorders Branch of Chinese Geriatic Society, the Dementia Group of Neurology Branch of Guangdong Medical Association and specialists from Hong Kong and Macao developed guidelines based on China's actual conditions and efficiency, economic cost and accuracy. The article addresses the significance, background, and the process of the assessment and follow-up to realize the promotion and dissemination of cognitive assessment.

Non-linear relationship between serum cholesterol levels and cognitive change among older people in the preclinical and prodromal stages of dementia: a retrospective longitudinal study in Taiwan

BACKGROUND

Adverse effects of rigorously lowering low-density lipoprotein cholesterol on cognition have been reported; therefore, we aimed to study the contribution of serum cholesterol in cognitive decline in older people with or without dementia.

METHODS

Cognitive function was assessed by the Cognitive Abilities Screening Instrument (CASI). We investigated associations between serum cholesterol with cognitive decline using multiple regressions controlling for the effects of demographics, vascular risk factors, and treatments.

RESULTS

Most associations between cholesterol and CASI scores could be explained by non-linear and inverted U-shaped relationships (R2 = 0.003-0.006, p < 0.016, Šidákcorrection). The relationships were most evident between changes in cholesterol and CASI scores in older people at the preclinical or prodromal stages of dementia (R2 = 0.02-0.064, p values < 0.016). There were no differences in level of changes in CASI scores between individuals in 1st decile and 10th decile groups of changes in cholesterol (p = 0.266-0.972). However, individuals in the 1st decile of triglyceride changes and with stable and normal cognitive functions showed significant improvement in CASI scores compared to those in the 10th decile (t(202) = 2.275, p values < 0.05).

CONCLUSION

These findings could implicate that rigorously lowering cholesterol may not be suitable for the prevention of cognitive decline among older people, especially among individuals in preclinical or prodromal stages of dementia.

Dietary patterns in mild cognitive impairment and dementia in older adults from Yucatan, Mexico

Background

Some dietary patterns and dietary components have an important role in preventing and helping to improve patients' quality of life of individuals with Mild Cognitive Impairment (MCI) and dementia. In Mexico, it is unknown what the dietary patterns are among older adults with MCI and dementia. We aimed to identify the dietary patterns of older adults with MCI and dementia living in Yucatan, Mexico.

Methods

A cross-sectional study was carried out among 39 patients as controls and 34 individuals as cases (MCI and dementia). A food frequency questionnaire collected diet information, anthropometric and clinical parameters, and lifestyle characteristics. The dietary patterns were evaluated through Partial Least-Squares Discriminant Analysis (PLS-DA).

Results

The food groups that showed discrimination between groups and were classified into the dietary patterns of MCI and dementia individuals were "pastries and cookies," "soups," and "legumes." The dietary pattern of older adults without cognitive impairment was characterized by "nuts and seeds," "candies," "vegetables," "coffee and tea," and "water." The consumption of "pastries and cookies" showed an increasing correlation with serum insulin levels (r = 0.36, p = 0.01), and "soups" showed an inverse correlation with total cholesterol levels (r = -0.36, p = 0.02) in patients with MCI and dementia. In controls, there is a positive correlation between the consumption of "nuts and seeds" (r = 0.333, p = 0.01) and "vegetables" (r = 0.32, p = 0.02) with levels of urea; "coffee and tea" showed a positive association with levels of insulin (r = 0.378, p = 0.05).

Conclusion

The dietary pattern of individuals with MCI and dementia has some nutritional deficiencies. Including an adequate intake of vegetables, fruits, and protein could improve the quality of life of subjects living with these conditions in Yucatan, Mexico.

Monitoring risk factors for dementia in middle-aged and older adults: a longitudinal study

Given the importance of dementia syndrome and its impacts on the population, interest in studying modifiable risk factors for dementia is growing.

Objective

To compare the prevalence of risk factors for dementia in middle-aged and older adults over a two-year period and to identify what variables in baseline were predictive of cognitive decline in the follow-up.

Methods

Longitudinal and quantitative study, with follow-up evaluation after two years, conducted with 200 participants aged 45 years or more, registered in Primary Care Units. In the baseline (2018/2019) and follow-up (2021) assessments, sociodemographic data were collected, and cognitive performance and risk factors for dementia were evaluated (education, hearing loss, head trauma, high blood pressure, alcohol use, obesity, smoking, depressive symptoms, social isolation, physical inactivity, and diabetes mellitus). Data were compared using the McNemar's test. Individual multinomial logistic regression models were performed to identify the factors associated with cognitive decline after two years.

Results

The percentages of low education, traumatic brain injury, and smoking remained the same in both assessments. There was a significant increase in the prevalence of high blood pressure (from 55.0 to 62.0%) and physical inactivity (from 58.5 to 74.5%) and a significant reduction in social isolation (from 25.0 to 18.0%). Participants with depressive symptoms in baseline had a higher risk of cognitive decline in follow-up.

Conclusion

There was an increase in the prevalence of high blood pressure and physical inactivity and a reduction in social isolation after two years. Depressive symptoms predict cognitive decline.

Agricultural activities and risk of Alzheimer's disease: the TRACTOR project, a nationwide retrospective cohort study

Data regarding Alzheimer's disease (AD) occurrence in farming populations is lacking. This study aimed to investigate whether, among the entire French farm manager (FM) workforce, certain agricultural activities are more strongly associated with AD than others, using nationwide data from the TRACTOR (Tracking and monitoring occupational risks in agriculture) project. Administrative health insurance data (digital electronic health/medical records and insurance claims) for the entire French agricultural workforce, over the period 2002-2016, on the entire mainland France were used to estimate the risk of AD for 26 agricultural activities with Cox proportional hazards model. For each analysis (one for each activity), the exposed group included all FMs that performed the activity of interest (e.g. crop farming), while the reference group included all FMs who did not carry out the activity of interest (e.g. FMs that never farmed crops between 2002 and 2016). There were 5067 cases among 1,036,069 FMs who worked at least one year between 2002 and 2016. Analyses showed higher risks of AD for crop farming (hazard ratio (HR) = 3.72 [3.47-3.98]), viticulture (HR = 1.29 [1.18-1.42]), and fruit arboriculture (HR = 1.36 [1.15-1.62]). By contrast, lower risks of AD were found for several animal farming types, in particular for poultry and rabbit farming (HR = 0.29 [0.20-0.44]), ovine and caprine farming (HR = 0.50 [0.41-0.61]), mixed dairy and cow farming (HR = 0.46 [0.37-0.57]), dairy farming (HR = 0.67 [0.61-0.73]), and pig farming (HR = 0.30 [0.18-0.52]). This study shed some light on the association between a wide range of agricultural activities and AD in the entire French FMs population.

Secondhand Smoke Exposure and Risk of Dementia in Nonsmokers: A Population-Based Cohort Study

BACKGROUND

Large population-based prospective studies are necessary to provide clarification on the associations of panoramic secondhand smoking burden, including prenatal and postnatal secondhand smoke (SHS) exposure, with the risk of developing dementia.

METHODS

Our study comprised a sample of 353,756 dementia-free individuals from the UK Biobank who were nonsmokers had data on the exposure of maternal smoking as well as SHS exposure in daily life, which was quantified in terms of hours per week (h/week) and whether they lived with household smokers. Multivariable Cox regression models were utilized to analyze the independent and joint associations of maternal smoking and daily life SHS exposure with dementia risk.

RESULTS

During a median follow-up of 11.8 years, 4,113 participants developed dementia. Compared with those who lived in the environment without smokers, multivariable-adjusted hazard ratios (HRs) (95% CIs) were 1.11 (1.02, 1.20) and 1.31 (1.13, 1.52) for those who exposed to SHS for >0 but ≤4 h/week and >4 h/week, respectively, and was 1.25 (1.13, 1.39) for those who lived with smokers in the household. A positive history of maternal smoking was associated with a modestly higher risk of dementia (HR = 1.07; 95% CI: 1.01, 1.15). Furthermore, compared with participants with neither history of maternal smoking nor exposure to SHS, a particularly higher risk of dementia was observed among those with both exposures (HR = 1.48; 95% CI: 1.18, 1.86). Additionally, the HR (95% CI) was 1.32 (1.10, 1.59) when comparing participants with a history of maternal smoking who lived with smokers in their households with those who had neither exposures.

CONCLUSIONS

Having a history of maternal smoking, longer exposure to SHS, and living with smokers in the household were each associated with an increased risk of developing dementia. Individuals who were simultaneously exposed to maternal smoking and SHS or lived with household smokers had a particularly higher dementia risk.

Brain Health and Cognition in Older Adults: Roadmap and Milestones towards the Implementation of Preventive Strategies

In this narrative review, we delve into the evolving concept of brain health, as recognized by the WHO, focusing on its intersection with cognitive decline. We emphasize the imperative need for preventive strategies, particularly in older adults. We describe the target population that might benefit the most from risk-based approaches-namely, people with subjective cognitive decline. Additionally, we consider universal prevention in cognitively unimpaired middle-aged and older adults. Delving into multidomain personalized preventive strategies, we report on empirical evidence surrounding modifiable risk factors and interventions crucial in mitigating cognitive decline. Next, we highlight the emergence of brain health services (BHS). We explain their proposed role in risk assessment, risk communication, and tailored interventions to reduce the risk of dementia. Commenting on ongoing BHS pilot experiences, we present the inception and framework of our own BHS in Monza, Italy, outlining its operational structure and care pathways. We emphasize the need for global collaboration and intensified research efforts to address the intricate determinants of brain health and their potential impact on healthcare systems worldwide.

Interest in genetic susceptibility testing and disclosure of AD dementia risk in cognitively normal adults: a survey study

BACKGROUND

Apolipoprotein-E (APOE) genetic testing for Alzheimer's disease is becoming more important as clinical trials are increasingly targeting individuals carrying APOE-ε4 alleles. Little is known about the interest in finding out one's genetic risk for Alzheimer's disease in the general population. Our objective was to examine this in a sample of cognitively normal (CN) adults within a population-based online research registry with the goal to implement APOE-ε4 status for trial recruitment.

METHODS

An online survey was completed by 442 CN participants between the age of 49 and 75 years (56% female) from the Dutch Brain Research Registry. The survey assessed interest in participation in research into, and disclosure of, genetic risk for dementia. The survey assessed interest in participation in research into, and disclosure of, genetic risk for dementia and knowing their genetic risk in different hypothetical risk scenarios (10%, 30%, and 50% genetic risk for dementia at age 85, corresponding to APOEε2/ε2 or ε2/ε3, APOEε3/ε4 or ε2ε4, and APOE-ε4/ε4 genotypes). Cochran's Q and post hoc McNemar tests were used to analyse differences in frequencies across scenarios.

RESULTS

Most participants were interested in participating in research into and disclosure of their genetic risk (81%). The most reported reason was to contribute to scientific research (94%). Interest was higher in males, whilst lower-educated participants were more often undecided. When provided with different risk scenarios, interest in knowing their risk was somewhat higher in the scenarios with higher risk, i.e. in the 50% (79%) compared to the 10% scenario (73%;χ2(2) = 7.98; p = .005). Most individuals expected they would share their genetic risk with close relatives (77-89%), would participate in medication trials (79-88%), and would make long-term arrangements, e.g. retirement, health care, will (69-82%), with larger proportions for scenarios with higher hypothetical genetic risk.

CONCLUSIONS

Our findings indicate that the vast majority of CN adults participating in a research registry expresses interest in AD genetic risk research and disclosure. Interest in genetic risk disclosure is higher in scenarios corresponding to the APOE-ε4 genotype. This suggests APOE-ε4 screening within an online research registry is potentially a well-received method to accelerate inclusion for trials.

Development and Concurrent Validity of the Short-Form CogDrisk Dementia Risk Assessment Tool

Evidence-based dementia risk assessment is required to inform individual and policy-level dementia risk reduction interventions. We developed the CogDrisk Short Form (CogDrisk-SF) to assess dementia risk factors, for situations where time and resources are limited. To evaluate concurrent validity with the original CogDrisk, we conducted an online survey using a repeated-measures, counterbalanced design. Community dwelling participants (n = 647, 50.1% were female, mean age 62.2 years, age range 40-89) completed the survey. The mean(sd) score for CogDrisk-SF and the CogDrisk was 9.7 (5.3) and 9.9 (5.5), respectively. The intraclass correlation between the risk score obtained from CogDrisk and CogDrisk-SF was 0.92. Fish intake, insomnia and depression had percentage agreements of 79%, 87% and 89% respectively. Other items had >95% agreement except for loneliness (94%), hypertension (94%), cholesterol (93%), atrial fibrillation (91%) and cognitive activity (90%). Very high agreement between the CogDrisk-SF and original CogDrisk shows that CogDrisk-SF is valid for use in research and clinical practice.

Artificial intelligence for biomarker discovery in Alzheimer's disease and dementia

With the increase in large multimodal cohorts and high-throughput technologies, the potential for discovering novel biomarkers is no longer limited by data set size. Artificial intelligence (AI) and machine learning approaches have been developed to detect novel biomarkers and interactions in complex data sets. We discuss exemplar uses and evaluate current applications and limitations of AI to discover novel biomarkers. Remaining challenges include a lack of diversity in the data sets available, the sheer complexity of investigating interactions, the invasiveness and cost of some biomarkers, and poor reporting in some studies. Overcoming these challenges will involve collecting data from underrepresented populations, developing more powerful AI approaches, validating the use of noninvasive biomarkers, and adhering to reporting guidelines. By harnessing rich multimodal data through AI approaches and international collaborative innovation, we are well positioned to identify clinically useful biomarkers that are accurate, generalizable, unbiased, and acceptable in clinical practice. HIGHLIGHTS: Artificial intelligence and machine learning approaches may accelerate dementia biomarker discovery. Remaining challenges include data set suitability due to size and bias in cohort selection. Multimodal data, diverse data sets, improved machine learning approaches, real-world validation, and interdisciplinary collaboration are required.

Cardiovascular Disease and Alzheimer's Disease: The Heart-Brain Axis

Cardiovascular disease (CVD) remains one of the leading causes of morbidity and mortality in aging adults across the United States. Prior studies indicate that the presence of atherosclerosis, the pathogenic basis of CVD, is linked with dementias. Alzheimer's disease (AD) and AD-related dementias are a major public health challenge in the United States. Recent studies indicate that ≈3.7 million Americans ≥65 years of age had clinical AD in 2017, with projected increases to 9.3 million by 2060. Treatment options for AD remain limited. Development of disease-modifying therapies are challenging due, in part, to the long preclinical window of AD. The preclinical incubation period of AD starts in midlife, providing a critical window for identification and optimization of AD risk factors. Studies link AD with CVD risk factors such as hypertension, inflammation, and dyslipidemia. Both AD and CVD are progressive diseases with decades-long development periods. CVD can clinically manifest several years earlier than AD, making CVD and its risk factors a potential predictor of future AD. The current review focuses on the state of literature on molecular and metabolic pathways modulating the heart-brain axis underlying the potential association of midlife CVD risk factors and their effect on AD and related dementias. Further, we explore potential CVD/dementia preventive strategies during the window of opportunity in midlife and the future of research in the field in the multiomics and novel biomarker use era.

The Associations between Cognitive Function, Depressive Symptoms, and Contact with Adult Children in Older Couples

The aim of this study was to investigate the association between cognitive function and depressive symptoms in older couples while also examining the relationship between cognitive performance and the frequency of contact with adult children. A total of 96 couples volunteered for this study and provided their informed consent at enrollment. Participants completed a neuropsychological test battery consisting of five cognitive domains: attention, language and related functions, visuospatial functions, memory, and frontal/executive functions. Symptoms of depression were assessed using the short version of the Geriatric Depression Scale. The number of contacts with children was categorized into ≥1 per month and <1 per month. We found that the cognitive functions of husbands with depressed wives were significantly lower in the frontal/executive functions. In contrast, the wives' cognitive performance was not associated with the husbands' depressive symptoms. For couples who had contact with their adult children less than once a month, the odds of the husbands with lower cognitive performance were significantly higher, which was reflected in their scores in visuospatial and executive functions. Among older married couples, the cognitive functions of husbands may be influenced more by their wives' mental health and degree of contact with their adult children. This infers that wives and offspring may act as a buffer against the cognitive impairment of older married men.

Frailty, Cognitive Impairment, and Incident Major Neurocognitive Disorders: Results of the NuAge Cohort Study

BACKGROUND

Frailty is associated with an increased risk of major neurocognitive disorders (MNCD).

OBJECTIVE

This study aims to compare the Fried physical model and the CARE deficit accumulation model for their association with incident major neurocognitive disorders (MNCD), and to examine how the addition of cognitive impairment to these frailty models impacts the incidence in community-dwelling older adults.

METHODS

A subset of community dwellers (n = 1,259) who participated in the "Quebec Longitudinal Study on Nutrition and Successful Aging" (NuAge) were selected in this Elderly population-based observational cohort study with 3 years of follow-up. Fried and CARE frailty stratifications into robust, pre-frail and frail groups were performed using the NuAge baseline assessment. Incident MNCD (i.e., Modified Mini Mental State (3MS) score <  79/100 and Instrumental Activity Daily Living (IADL) score <  6/8) were collected each year over a 3-year follow-up period.

RESULTS

A greater association with incident MNCD of the CARE frail state was observed with an increased predictive value when combined with cognitive impairment in comparison to Fried's one, the highest incidences being observed using the robust state as the reference. Results with the Fried frail state were more heterogenous, with no association with the frail state alone, whereas cognitive impairment alone showed the highest significant incidence.

CONCLUSION

The association of the CARE frail state with cognitive impairment increased the predictive value of MNCD, suggesting that the CARE frailty model may be of clinical interest when screening MCND in the elderly population.

[Prevention and health promotion in dementia: motivation for change within preventive interventions-Empirical results]

BACKGROUND

Aging healthily and prevention of diseases are statutory and a national health target. There is convincing evidence that describes the modifiable risk factors, which are principally suitable for preventive measures.

OBJECTIVE

Definition of terms, presentation of the roots of prevention in laws, strategies and guidelines. Presentation of the risk factors for dementia, outline of effective preventive measures and their promising components.

MATERIAL AND METHODS

Prevention is systematically described. The available evidence on risk factors, health behavior and preventive measures is analyzed. A multimodal intervention is presented and the influence of motivation on a change in behavior is outlined, exemplified by physical activity.

RESULTS AND DISCUSSION

Aging healthily is a national health target and prevention of disease is rooted and defined in both the legislation and guidelines. The current evidence on modifiable risk factors for dementia originates from 12 factors. These include behavior-associated factors, such as inactivity, diabetes and smoking. The efficacy of preventive measures can be described by their effectiveness, the utilization when available and the principal availability for all people for whom they are indicated. Changing a health behavior is complex and dependent among other things on the motivation to want to change a behavior. Currently, multimodal prevention programs appear to be very promising for the prevention of cognitive disorders and dementia.

[Brain health services: individual dementia risk profiling at the Cologne Alzheimer Prevention Center]

BACKGROUND

According to current knowledge approximately 30-40% of all cases of dementia can be attributed to modifiable risk factors. As a result, dementia prevention and the concept of brain health are becoming increasingly relevant.

RESEARCH QUESTION

The requirements for brain health services and their implementation are discussed and the Cologne Alzheimer Prevention Center (KAP) of the University Hospital Cologne is described as an example.

MATERIAL AND METHODS

In addition to a report on international brain health initiatives, the main activities of the KAP are presented. A program for individual risk profiling and risk communication is provided, which was piloted in the KAP in the context of the "Individual risk profiling for Alzheimer's disease and dementia prevention (INSPIRATION)" study. The prevalence of risk factors in a cognitively healthy sample aged 50-86 years (n = 162) with interest in dementia prevention is presented.

RESULTS

The most common risk factors were non-Mediterranean diet, obesity, subjective poor sleep quality and increased stress. Based on these results, preventive interventions can be developed that are adapted to the individual risk profile as a personalized medicine approach.

DISCUSSION

Structures such as the KAP can provide individual risk factor assessment and personalized dementia prevention. The efficacy of this approach on dementia risk reduction needs to be evaluated.

Dementia prevention in memory clinics: recommendations from the European task force for brain health services

Observational population studies indicate that prevention of dementia and cognitive decline is being accomplished, possibly as an unintended result of better vascular prevention and healthier lifestyles. Population aging in the coming decades requires deliberate efforts to further decrease its prevalence and societal burden. Increasing evidence supports the efficacy of preventive interventions on persons with intact cognition and high dementia risk. We report recommendations for the deployment of second-generation memory clinics (Brain Health Services) whose mission is evidence-based and ethical dementia prevention in at-risk individuals. The cornerstone interventions consist of (i) assessment of genetic and potentially modifiable risk factors including brain pathology, and risk stratification, (ii) risk communication with ad-hoc protocols, (iii) risk reduction with multi-domain interventions, and (iv) cognitive enhancement with cognitive and physical training. A roadmap is proposed for concept validation and ensuing clinical deployment.

Serum Cathepsin D Is a Potential Biomarker for Alzheimer's Disease Dementia and Cognitive Decline

BACKGROUND

The lysosomal protease cathepsin D (catD) has been reported to be upregulated in postmortem Alzheimer's disease (AD) cortex, where it colocalized with neurofibrillary tangles and correlated with levels of phosphorylated tau, suggesting pathophysiological links between catD and neurodegeneration. In contrast, studies of serum catD in AD have yielded conflicting results, and potential associations between baseline serum catD and functional outcomes of patients are at present unknown.

OBJECTIVE

We aimed to examine the status of serum catD in a Singapore-based longitudinal study of dementia and investigate catD associations with functional and cognitive decline.

METHODS

35 subjects with no cognitive impairment, 40 patients with cognitive impairment no dementia and 34 with AD dementia underwent annual neuropsychological assessments (mean follow-up=4.3 years), as well as collection of baseline serum for catD measurements by ELISA.

RESULTS

Higher serum catD at baseline was associated with AD clinical diagnosis (odds ratios [OR]: 10.0; 95% confidence interval [CI]: 1.02-97.95) as well as with cortical atrophy. Furthermore, higher catD was associated with global cognitive and functional decline (OR: 9.94; 95% CI: 1.02-97.34).

CONCLUSION

The associations of serum catD with AD dementia as well as atrophy provide further support for the proposed links between catD and neurodegeneration, as well as for the assessment of serum catD as a prognostic biomarker predicting global cognitive and functional decline in larger studies.

Translation and Validation of the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) Questionnaire among the General Israeli Population

OBJECTIVE

The need to promote awareness of dementia prevention is broadly emphasized in Israel. Currently, there is no valid version of a Hebrew questionnaire to assess attitudes and beliefs related to dementia prevention. This study aimed to translate and validate the MCLHB-DRR questionnaire among the general Israeli population.

METHODS

A total sample of 328 participants between the ages of 50-83 years (mean = 58.7, SD = 6.9) were included in this study. Participants completed the online translated MCLHB-DRR questionnaire. Exploratory factor analyses (EFA) and confirmatory factor analyses (CFA) were conducted to assess the questionnaire's validity. Internal consistency was assessed using Cronbach's alpha.

RESULTS

The EFA analysis revealed a seven-factor model with 27 items. One item related to perceived barriers and two items related to perceived severity were deleted. The CFA analysis confirmed a good model fit with the deleted items (χ²/df = 2.146, CFI = 0.930, TLI = 0.916, RMSEA = 0.049). Cronbach's alpha values ranged from 0.61 to 0.92.

CONCLUSIONS

The Hebrew MCLHB-DRR questionnaire is a valid and reliable measurement tool for assessing attitudes and beliefs related to health behaviours and lifestyle changes for dementia risk reduction in Israeli adults over the age of 50.

The association between low cognitive reserve and subjective memory complaints in functionally independent older women

BACKGROUND

Several factors have been found to defend against pathologic cognitive decline in aging (i.e., cognitive reserve [CR]); however, other factors, including subjective memory complaints (SMC) and decreased functionality are considered early indicators of underlying neurocognitive dysfunction. Despite these known associations, the relationship between the presence of CR and SMC remains equivocal. This study sought to determine the relationship between objectively measured CR and SMC in a sample of functionally independent older women.

METHODS

This cross-sectional study recruited women aged ≥60 years who attended fitness or continuing education programs at the University for Seniors in Mexico City. Participants underwent a battery of physical and cognitive evaluations, including the Cognitive Reserve Questionnaire (CRQ), and were asked probing questions used to identify the presence of SMC.

RESULTS

The 269 participants had a median age of 69 years; most were single (40.5 %), lived alone (32.7 %), retired (58.2 %), well-educated (≥12 years of education), and functionally independent (89.2 %). 62 % scored "high" on the CRQ, while 9.3 % scored "low". After adjusting for multiple covariates, an independent association between CRQ score and the probability to have SMC was found (adjusted OR = 0.87, 95% CI 0.80-0.95, p-value = 0.002).

CONCLUSIONS

This study identified a relationship between low CR and the presence of SMC, independently of the cognitive function and motoric marker of muscle strength (i.e., low gait speed and handgrip strength) in functionally independent older women over 60y. This relationship remains independent of other variables such as age, symptoms of depression and instrumented activities of daily living.

Disclosure of Genetic Risk Factors for Alzheimer's Disease to Cognitively Healthy Individuals-From Current Practice towards a Personalised Medicine Scenario

Alzheimer's disease (AD) is a genetically complex disorder. In addition to the relatively small number of pathogenic variants causing autosomal dominant AD, many others have been associated with the much more common sporadic form. The E4 allele of the Apolipoprotein E (APOE) is the first discovered genetic risk factor for AD. In addition, more than 70 genetic risk loci contributing to AD have been identified. Current guidelines do not recommend AD susceptibility genetic testing in cognitively healthy adults because the implications for clinical care are limited. However, secondary prevention clinical trials of disease-modifying therapies enrol individuals based on genetic criteria, and participants are often informed of APOE testing results. Moreover, the availability of direct-to-consumer genetic testing allows individuals to learn their own AD genetic risk profile without medical supervision. A number of research protocols for AD susceptibility genetic testing have been proposed. In Italy, disclosure processes and protocols beyond those developed for inherited dementia have not been established yet. We reviewed the literature on the current practice and clinical issues related to disclosing AD genetic risk to cognitively healthy individuals and provide suggestions that may help to develop specific guidelines at the national level.

The European Prevention of Alzheimer's Dementia Programme: An Innovative Medicines Initiative-funded partnership to facilitate secondary prevention of Alzheimer's disease dementia

INTRODUCTION

Tens of millions of people worldwide will develop Alzheimer's disease (AD), and only by intervening early in the preclinical disease can we make a fundamental difference to the rates of late-stage disease where clinical symptoms and societal burden manifest. However, collectively utilizing data, samples, and knowledge amassed by large-scale projects such as the Innovative Medicines Initiative (IMI)-funded European Prevention of Alzheimer's Dementia (EPAD) program will enable the research community to learn, adapt, and implement change.

METHOD

In the current article, we define and discuss the substantial assets of the EPAD project for the scientific community, patient population, and industry, describe the EPAD structure with a focus on how the public and private sector interacted and collaborated within the project, reflect how IMI specifically supported the achievements of the above, and conclude with a view for future.

RESULTS

The EPAD project was a €64-million investment to facilitate secondary prevention of AD dementia research. The project recruited over 2,000 research participants into the EPAD longitudinal cohort study (LCS) and included over 400 researchers from 39 partners. The EPAD LCS data and biobank are freely available and easily accessible via the Alzheimer's Disease Data Initiative's (ADDI) AD Workbench platform and the University of Edinburgh's Sample Access Committee. The trial delivery network established within the EPAD program is being incorporated into the truly global offering from the Global Alzheimer's Platform (GAP) for trial delivery, and the almost 100 early-career researchers who were part of the EPAD Academy will take forward their experience and learning from EPAD to the next stage of their careers.

DISCUSSION

Through GAP, IMI-Neuronet, and follow-on funding from the Alzheimer's Association for the data and sample access systems, the EPAD assets will be maintained and, as and when sponsors seek a new platform trial to be established, the learnings from EPAD will ensure that this can be developed to be even more successful than this first pan-European attempt.

Analysis of ADORA2A rs5760423 and CYP1A2 rs762551 Genetic Variants in Patients with Alzheimer's Disease

Various studies have been conducted, exploring the genetic susceptibility of Alzheimer's disease (AD). Adenosine receptor subtype A2a (ADORA2A) and cytochrome P450 1A2 (CYP1A2) are implicated in pathways such as oxidative stress and caffeine metabolism, which are associated with AD. The aim of this study was to explore for any potential association between the ADORA2A rs5760423 and the CYP1A2 rs762551 genetic variants and AD. A case-control study was performed with a total of 654 subjects (327 healthy controls and 327 patients with AD). Five genetic models were assumed. We also examined the allele-allele combination of both variants. The value of 0.05 was considered as the statistical significance threshold. A statistically significant association was found between ADORA2A rs5760423 and AD, as the "T" allele was associated with increased AD risk in recessive (OR = 1.51 (1.03-2.21)) and log-additive (OR = 1.30 (1.04-1.62)) genetic modes. In the codominant model, the TT genotype was more prevalent compared to the GG genotype (OR = 1.71 (1.09-2.66)). The statistical significance was maintained after adjustment for sex. No association between CYP1A2 rs762551 or allele-allele combination and AD was detected. We provide preliminary indication for a possible association between the ADORA2A rs5760423 genetic polymorphism and AD.