Dementia Prevention Program Research Articles

Effectiveness of Korean medicine treatments in improving cognitive function and prefrontal cortex activity in older individuals with mild cognitive impairment: retrospective observational study.

Mild cognitive impairment (MCI) is a growing concern among older adults, with limited effective pharmacological treatments available. Despite the potential of herbal medicine and acupuncture in managing MCI, there is a lack of research on their long-term effects on cognitive function and brain activity in clinical practice settings. This study aimed to address this gap by exploring the effects of a community-based program integrating herbal medicine and acupuncture on cognitive function and neural responses in older individuals with MCI. Nineteen individuals were enrolled from a pool of 250 individuals registered in the 2021 Busan Dementia Prevention & Care Program. Participants with MCI received herbal medicine, acupuncture, and pharmacopuncture treatments over a 6-month period. The Montreal Cognitive Assessment (MoCA) was administered at baseline and after 3 and 6 months to evaluate cognitive function. Functional near-infrared spectroscopy (fNIRS) was used to measure prefrontal cortex activity during cognitive task performance, including verbal fluency, Stroop color and word, and digit span backward tests. Seventeen participants (13 female; mean age, 69.5 years) with MCI completed the study. Following the 6-month intervention, they exhibited a significant increase in the MoCA total score over time [F(2.32) =10.59, p < 0.0001]. Additionally, the deoxygenated hemoglobin beta coefficient in the left frontopolar prefrontal cortex significantly decreased during the Stroop task after the intervention. The Dementia Prevention & Care Program, which integrates herbal medicine and acupuncture, may enhance cognitive function in individuals with MCI. Moreover, the observed changes in prefrontal cortex activity after completion of the program suggest a need for further investigation of the underlying mechanisms.

Awareness of dementia risk factors among healthcare professionals at Hamad Medical Corporation, Qatar: a cross-sectional survey.

Dementia, a degenerative neurological disorder, is estimated to affect 82 million people worldwide by 2030 and 152 million by 2050, with a sharp increase in its incidence in the Middle East and Qatar. Lifestyle factors, such as smoking, physical inactivity, and obesity, may account for up to 40% of dementia cases. Healthcare practitioners who play an important role in health promotion must understand the modifiable risk and protective factors for dementia. This study investigated healthcare professionals' knowledge of dementia risk factors at Hamad Medical Corporation in Qatar. A sample of 737 healthcare professionals was recruited using simple random sampling from Hamad Medical Corporation. The target population included physicians, nurses, and allied healthcare workers from various departments. The participants completed an online survey between 1st January and December 31, 2023. The survey included questions on modifiable risk factors, preventive interventions, and dementia-related information sources. The study revealed that 76% of participants believed in dementia prevention and 87.4% were interested in learning about lifestyle choices and dementia risk. The majority of the participants were female and non-Qataris. Challenges to dementia risk reduction include lack of understanding, time restrictions, and motivational obstacles. Awareness of risk factors such as depression, alcohol use, and physical inactivity was identified. Digital platforms are the dominant source of information, highlighting the need for more dementia education and prevention programs. Given the gaps identified in knowledge, we recommend further training to improve the knowledge of healthcare professionals. In addition, further exploration of patients and caregiverss is warranted.

Community-based dementia risk management and prevention program for Aboriginal Australians (DAMPAA): a randomised controlled trial study protocol

IntroductionAboriginal and Torres Strait Islander peoples are the First Peoples of Australia. Up to 45% of dementia in these populations is due to potentially modifiable risk factors. The Dementia Prevention...

Social relationship factors, depressive symptoms, and incident dementia: a prospective cohort study into their interrelatedness.

Different aspects of social relationships (e.g., social network size or loneliness) have been associated with dementia risk, while their overlap and potentially underlying pathways remain largely unexplored. This study therefore aimed to (1) discriminate between different facets of social relationships by means of factor analysis, (2) examine their associations with dementia risk, and (3) assess mediation by depressive symptoms. Thirty-six items from questionnaires on social relationships administered in Wave 2 (2004/2005) of the English Longitudinal Study of Ageing (n = 7536) were used for exploratory and confirmatory factor analysis. Factors were then used as predictors in Cox proportional hazard models with dementia until Wave 9 as outcome, adjusted for demographics and cardiovascular risk factors. Structural equation modeling tested mediation by depressive symptoms through effect decomposition. Factor analyses identified six social factors. Across a median follow-up time of 11.8 years (IQR = 5.9-13.9 years), 501 people developed dementia. Higher factor scores for frequency and quality of contact with children (HR = 0.88; p = 0.021) and more frequent social activity engagement (HR = 0.84; p < 0.001) were associated with lower dementia risk. Likewise, higher factor scores for loneliness (HR = 1.13; p = 0.011) and negative experiences of social support (HR = 1.10; p = 0.047) were associated with higher dementia risk. Mediation analyses showed a significant partial effect mediation by depressive symptoms for all four factors. Additional analyses provided little evidence for reverse causation. Frequency and quality of social contacts, social activity engagement, and feelings of loneliness are associated with dementia risk and might be suitable targets for dementia prevention programs, partly by lowering depressive symptoms.

A Polysocial Approach in Exploring Racial and Ethnic Differences in Dementia and Cognitive Decline Among U.S. Older Adults: Health and Retirement Study.

The racial or ethnic disparity in the burden of dementia exists among older adults in the United States, whereas gaps remain in understanding the synergic effect of multiple social determinants of health on diminishing this disparity. We aim to build a polysocial score for dementia and investigate the racial or ethnic difference in dementia risk among older persons with different polysocial score categories. In this prospective cohort study, we utilized longitudinal data from the Health and Retirement Study in the United States recruiting 6 945 participants aged ≥65 years who had data on 24 social determinants of health in 2006/2008. The dementia status of participants was measured by a modified version of the Telephone Interview of Cognitive Status. The stepwise Cox regression was applied to select social determinants of health associated with incident dementia to construct a polysocial score. The multivariable Poisson model and linear mixed model were utilized to investigate the associations between polysocial score and incident dementia and cognitive decline, respectively. Eight social determinants of health were used to build the polysocial score. Non-Hispanic Black older participants had a higher incidence rate (incidence rate difference [IRD] = 22.7; 95% confident interval [95% CI] = 12.7-32.8) than non-Hispanic White older adults in the low polysocial score, while this difference was substantially attenuated in the high polysocial score category (IRD = 0.5; 95% CI = -6.4 to -7.5). The cognitive decline of non-Hispanic older Black adults with high polysocial score was 84.6% slower (averaged cognitive decline: non-Hispanic White: -2.4 [95% CI = -2.5 to -2.3] vs non-Hispanic Black: -1.3 [95% CI = -1.9 to -0.8]) than that of non-Hispanic older White persons. These findings may help comprehensively understand and address racial and ethnic disparities in dementia risk and may be integrated into existing dementia prevention programs to provide targeted interventions for community-dwelling older adults with differentiated social disadvantages.

Elucidating the Link Between Anxiety/Depression and Alzheimer’s Dementia in the Australian Imaging Biomarkers and Lifestyle (AIBL) Study

BackgroundThe associations between mood disorders (anxiety and depression) and mild cognitive impairment (MCI) or Alzheimer’s dementia (AD) remain unclear.MethodsData from the Australian Imaging, Biomarker & Lifestyle (AIBL) study were subjected to logistic regression to determine both cross-sectional and longitudinal associations between anxiety/depression and MCI/AD. Effect modification by selected covariates was analysed using the likelihood ratio test.ResultsCross-sectional analysis was performed to explore the association between anxiety/depression and MCI/AD among 2,209 participants with a mean [SD] age of 72.3 [7.4] years, of whom 55.4% were female. After adjusting for confounding variables, we found a significant increase in the odds of AD among participants with two mood disorders (anxiety: OR 1.65 [95% CI 1.04–2.60]; depression: OR 1.73 [1.12–2.69]). Longitudinal analysis was conducted to explore the target associations among 1,379 participants with a mean age of 71.2 [6.6] years, of whom 56.3% were female. During a mean follow-up of 5.0 [4.2] years, 163 participants who developed MCI/AD (refer to as PRO) were identified. Only anxiety was associated with higher odds of PRO after adjusting for covariates (OR 1.56 [1.03–2.39]). However, after additional adjustment for depression, the association became insignificant. Additionally, age, sex, and marital status were identified as effect modifiers for the target associations.ConclusionOur study provides supportive evidence that anxiety and depression impact on the evolution of MCI/AD, which provides valuable epidemiological insights that can inform clinical practice, guiding clinicians in offering targeted dementia prevention and surveillance programs to the at-risk populations.

A Scoping Survey to Inform Design of Digital Dementia Risk Reduction Interventions for Adults Concerned about their Cognitive Health.

Digital dementia risk reduction interventions are cost-effective and scalable. However, it is unknown how they are perceived by people already experiencing cognitive concerns or decline. To understand the current use, interest, and preferences for online learning courses and interest in learning about factors influencing brain health and dementia risk among adults ≥45. To explore potential differences between individuals experiencing cognitive concerns and those without. Adults aged 45 and older completed a survey on technology use and healthy ageing (n = 249, Mean age = 65.6, 76.3% female). The Memory Assessment Clinic-Questionnaire was used to assess subjective memory decline, and 153 participants met the study criteria for cognitive concerns (≥25). Almost all participants (98.4%) reported using two or more digital devices, and 51.8% reported increasing device usage following COVID-19. Most (92.1%) were interested in learning about healthy living and memory within an online course, and over 80% indicated a high interest in learning about dementia risk factors. People with cognitive concerns were more likely to report using a 'routine or system' to aid memory than people without (82.4% versus 62.9%, p = 0.001). However, no significant difference was found in technology use, course preferences, or interest in learning about different risk factors. We conclude that adults 45 years and over are interested in online methods for learning about brain health and offer unique insights into adapting dementia prevention programs for cognitive concerns.

Factors influencing dementia preventive behaviors of older adults at high risk of dementia: Application of extended health belief model

Purpose: The purpose of this study was to identify the factors influencing dementia preventive behaviors of older adults at high risk of dementia based on extended health belief model. Methods: The subjects were 140 older adults at high risk of dementia living in H-gun, Gyeongsangnam-do, Republic of Korea. The data was collected from April 21 to May 28, 2021 by using structured questionnaires. The data was analyzed using t-test, ANOVA, Scheffé test, Pearson’s correlation coefficient, and hierarchical multiple regression by SPSS/WIN 24.0 program. Results: The mean score of dementia preventive behaviors of older adults at high risk of dementia was 3.47±0.49 (range 1-5). The factors influencing dementia preventive behaviors were self-efficacy (β=.82, p&lt;.001), cues to action(β=.17, p=.013), ages 75-79 (β=0.35, p=.003; reference: ages 65-69), ages ≥80 (β=0.27, p=.021; reference: ages 65-69), which together explained 82.0% of total variance in dementia preventive behaviors (F=25.21, p&lt;.001). Conclusion: Based on the results of this study, it is highly recommended to develop and apply the dementia prevention program that can increase self-efficacy and cues to action for improving dementia preventive behavior of older adults at high risk of dementia.

Cross-sectional associations between neighborhood characteristics, cognition and dementia risk factor burden in middle-aged and older Australians

Dementia disproportionately affects individuals from disadvantaged backgrounds, including those living in areas of lower neighborhood-level socioeconomic status. It is important to understand whether there are specific neighborhood characteristics associated with dementia risk factors and cognition which may inform dementia risk reduction interventions. We sought to examine whether greenspace, walkability, and crime associated with the cumulative burden of modifiable dementia risk factors and cognition. This was a cross-sectional analysis of 2016–2020 data from the Healthy Brain Project, a population-based cohort of community-dwelling individuals across Australia. Participants were aged 40–70 and free of dementia. Measures included greenspace (greenspace % in the local area, and distance to greenspace, n = 2,181); and intersection density (n = 1,159), and crime (rate of recorded offences; n = 1,159). Outcomes included a modified Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) dementia risk score to index the burden of modifiable vascular dementia risk factors; and composite scores of both memory and attention, derived from the Cogstate Brief Battery. Linear regressions adjusted for age, sex, education, and personal socio-economic status, demonstrated distance to greenspace (b ± SE per 2-fold increase = 0.09 ± 0.03, p =.005) and crime rate (b ± SE per 2-fold increase = 0.07 ± 0.03, p =.018) were associated with higher modified CAIDE. Higher crime was associated with lower memory performance (b ± SE = -0.03 ± 0.01, p =.018). The association between distance to greenspace and modified CAIDE was only present in low-moderate socioeconomic status neighborhoods (p interaction = 0.004). Dementia prevention programs that address modifiable risk factors in midlife should consider the possible role of neighborhood characteristics.

How might secondary dementia prevention programs work in practice: a pre-implementation study of the APPLE-Tree program

BackgroundOver 850,000 people in the UK currently have dementia, and that number is expected to grow rapidly. One approach that may help slow or prevent this growth is personalized dementia prevention. For most people, this will involve targeted lifestyle changes. These approaches have shown promise in trials, but as of yet, the evidence for how to scale them to a population level is lacking. In this pre-implementation study, we aimed to explore stakeholder perspectives on developing system-readiness for dementia prevention programs. We focused on the APPLE-Tree program, one of several low-intensity, lifestyle-based dementia prevention interventions currently in clinical trials.MethodsWe conducted semi-structured interviews with health and social care professionals without previous experience with the APPLE-Tree program, who had direct care or managerial experience in services for older adults with memory concerns, without a dementia diagnosis. We used the Consolidated Framework for Implementation Research to guide interviews and thematic analysis.ResultsWe interviewed 26 stakeholders: commissioners and service managers (n = 15) and frontline workers (n = 11) from eight NHS and 11 third sector organizations throughout England. We identified three main themes: (1) favorable beliefs in the effectiveness of dementia prevention programs in enhancing cognition and wellbeing and their potential to fill a service gap for people with memory concerns, (2) challenges related to funding and capacity to deliver such programs at organizations without staff capacity or higher prioritization of dementia services, and (3) modifications to delivery and guidance required for compatibility with organizations and patients.ConclusionThis study highlights likely challenges in scale-up if we are to make personalized dementia prevention widely available. This will only be possible with increased funding of dementia prevention activities; integrated care systems, with their focus on prevention, may enable this. Scale-up of dementia prevention programs will also require clear outlines of their core and adaptable components to fit funding, patient, and facilitator needs.

CERIA: A Community Empowerment as Dementia Preventive Measure among Elderly

Background: Dementia is predicted to double in the next 15 years and causes adverse socioeconomic effects, yet the clinical therapy for dementia has not shown satisfactory results for many years. Preventive efforts involving the active role of the elderly and supported by the development of information technology are strongly needed. Method: This is a quasi-experimental study aimed to evaluate the effectiveness of CERIA as community-based intervention and to increase the awareness of dementia. CERIA (Cerdas Hindari Demensia) was implemented for 32 elderlies in Pasar Minggu District, South Jakarta who were willing to participate. The interventions implemented were memory training, brain vitalization gymnastics, playing angklung, and storytelling to toddlers. We measured the pre-and post-intervention scores of the elderly using an assessment tool of dementia screening, then compared the results using Student T-test. We also created a dementia prevention manual book (Buku Panda) and built a smartphone app for educational purposes. Results: As many as 97% of the elderly have a good daily activity score and 90.9% have a good body balance. Assessment of pre-intervention cognitive function showed a mean value of 27 and increased to 29 after intervention. The pre-intervention emotional assessment showed a mean value of 1 and decreased in post-intervention to 0. Some of the most afflicted diseases of the elderlies were hypertension (30,3%) and diabetes mellitus (18,2%). Conclusion: This dementia prevention program has a strong potential to be implemented in wider scope. Further improvement involving parties such as the Ministry of Health is needed to replicate this effort.

Programme Dementia Prevention (pdp): A Nationwide Program for Personalized Prevention in Luxembourg.

With continuously aging societies, an increase in the number of people with cognitive decline is to be expected. Aside from the development of causative treatments, the successful implementation of prevention strategies is of utmost importance to reduce the high societal burden caused by neurodegenerative diseases leading to dementia among which the most common cause is Alzheimer's disease. The aim of the Luxembourgish "programme dementia prevention (pdp)" is to prevent or at least delay dementia in an at-risk population through personalized multi-domain lifestyle interventions. The current work aims to provide a detailed overview of the methodology and presents initial results regarding the cohort characteristics and the implementation process. In the frame of the pdp, an extensive neuropsychological evaluation and risk factor assessment are conducted for each participant. Based on the results, individualized multi-domain lifestyle interventions are suggested. A total number of 450 participants (Mean age = 69.5 years; SD = 10.8) have been screened at different recruitment sites throughout the country, among whom 425 participants (94.4%) met the selection criteria. We provide evidence supporting the feasibility of implementing a nationwide dementia prevention program and achieving successful recruitment of the target population by establishing a network of different healthcare providers.

Digitally supported lifestyle program to promote brain health among older adults (LETHE pilot trial) – Study design and progress

AbstractBackgroundDementia prevention is a global public health priority. The FINGER multimodal lifestyle intervention is the only intervention model so far that has demonstrated significant cognitive and other health benefits in at‐risk older adults. LETHE proposes a new multimodal precision prevention approach where FINGER intervention is complemented with digital tools to optimize intervention delivery, personalize recommendations based on individual risk profile, and support risk factor self‐management. The multinational 2‐year randomized controlled LETHE pilot trial aims to test the feasibility of a digitally supported, adapted FINGER intervention among older adults at risk of cognitive decline and dementia.MethodA total of 160 individuals aged 60‐77 years and with risk factors for dementia but no substantial cognitive impairment are recruited at four sites (Austria, Finland, Italy, Sweden; N = 40 per country). Digital readiness and experience with smart devices are required. Participants are randomized 1:1 to 1) structured multimodal lifestyle intervention (dietary guidance, exercise, cognitive training, vascular/metabolic risk management, social stimulation, sleep/stress management) where in‐person individual and group‐based activities are supported with the LETHE smartphone app developed in the project; or 2) self‐guided lifestyle intervention (regular health advice and access to a simplified app with no personalized/interactive content). Both groups wear a smartwatch to gather passive data (e.g., activity, sleep). Primary outcomes are retention rate, adherence to intervention and engagement with the app, and change in dementia risk based on validated risk scores (CAIDE, LIBRA). Secondary outcomes are lifestyle changes and changes in cognition, stress‐related symptoms, sleep, health‐related quality of life, and health literacy. Participant experiences will also be explored. The LETHE Advisory Board (members of the public) provided feedback on the trial protocol.ResultTrial is registered at ClinicalTrials.gov (NCT05565170), and ethical approval has been obtained in each country. Recruitment started in September 2022 and will be completed in Spring 2023. Updates and results on study progress will be presented.ConclusionLETHE pilot trial will inform about the feasibility of technological solutions and a digitally assisted lifestyle program to support brain health among older adults. If proved to induce sustained behavioural changes, digital tools could offer potential for large‐scale, cost‐effective dementia prevention programs.

Older adults participation and adoption among a lifestyle‐based multidomain dementia prevention program

AbstractBackgroundOlder adult participation in lifestyle‐based programs has been described round 80%. (Lee et al., 2018). Participation at dementia prevention programs has been influenced by age, gender, marital status, and interest in receiving health education (Coley et al., 2021). The aim of this study is to evaluate the participation and adoption of lifestyle changes of older adults in a multidomain dementia prevention program from the LatAm Fingers Initiative, in MexicoMethodhealthy cognitive older adults between 60 to 77 years old were recruited. 148 pre‐screenings were done to complete a 100 participants sample, all of them were randomized between Systematic (SIG) (supervised participation) or Flexible FIG (educational advises) Lifestyle Intervention groups (50 per group). Participation is defined as attendance to educational session for physical, nutritional, cognitive and cardiovascular health plus attendance to physical activities, diary diet delivery, and 48 levels per week of cognitive online activities through 6‐months. Participation was classified as low, moderate, and high.ResultMean age was 70.06 (±5.4) years old, and 70.8% participants were females. From 48 participants of the systematic group (SIG) there were two dropouts because problems for traveling, and work. 45% of the SIG, are participating on the four intervention domains. 40 participants are currently at the physical activity intervention. From them high participation and adoption of physical activity was 52.5%, moderate participation was 37.5% and low, 10%. From Nutritional intervention are 26 participants who showed high participation at 57.7%, 11.5% moderate and 30.8%, low. The 21 participants that are at the Cognitive intervention stage, 33.3% had high participation, 52.4% moderate and 14.3% low participation. From the 18 participants at the health intervention stage, 94.4% participants had high participation and 5.6% low.Conclusionfrom this preliminary data, we found that the in the SIG the participation rates, are moderate to high. Physical, nutritional, and cardiovascular health activities showed more than 50% of participation rate. Also, nutritional domain showed the lowest percentage of participation among the four interventions.

Designing Attitudinal Environments to Address Stigma: Virtual Film Screenings and Panel Discussions on Dementia in a Health Promotion Program

AbstractBackgroundIntersectoral partnerships are critical for effective and sustainable health promotion programs. Yet stigma and misperception continue to interfere with public engagement in dementia prevention programs, outreach, and willingness to access to dementia and‐or mental health related services for persons living with Alzheimer’s and‐or related disorders and personal carers. The aim of our Public Health Agency of Canada Dementia Community Investment project, What Connects Us∼Ce Qui Nous Lie (2020‐2023), was to collaboratively cultivate sociocultural environments worth living in using shared activities and events to address stigma at the intersection of dementia, aging and mental health. In this paper, we present initial results on the effectiveness of using on‐line, community screenings of short films featuring stories about living with dementia, followed by curated panel discussions with the film directors, arts/culture partners, policy makers and other stakeholders.MethodWe employed a mixed methods ethnographic approach to describe and measure the impact of six film screenings with pre/post‐film and then later post‐discussion measures of semantic sentiment. All discussions were simultaneously interpreted, and based on open‐ended qualitative questions that had been developed with panelists prior to the screening. The qualitative questions asked for one word/phrase responses to generate word clouds in French and English. Three researchers then assessed the words/phrases until agreement on positive or negative value was reached. French words were back‐translated into English prior to analysis using suzy‐net, a natural language processor, to confirm positive/negative valence and to measure changes within each film screening and across all film screenings.ResultThere was a significant change in sentiment from negative (e.g., frustration, lies, loss, confusion) to positive sentiment (e.g., humanity, empathy, compassion, understanding) across all waves within and across the six screenings, with the most change occurring post‐discussion. In addition, partners and project‐related team members were removed from the analysis to test for partner participation confounding with the overall shift in valence remaining the same.ConclusionFilms about living with dementia, and curated questions developed in collaboration with panelists and directors of 1st person experiences can positively impact changes in sentiment about dementia.

Response of the elderly to cognitive intervention through brainHQ training software; LatAm‐FINGERS Mexico

AbstractBackgroundComputerized training has been used to improve cognitive functioning and has been shown to be effective in a wide range of populations. However, its use in elders can be complicated due to many factors including schooling, motivation, perception of difficulty and unfamiliarity with the technology. For the multidomain dementia prevention program LatAm‐FINGERS, the brainHQ software is being used to perform the cognitive training. The aim of this work is to show the perception of participants about this program.MethodTwenty‐five urban‐Mexican elders cognitively healthy but with risk factors for dementia, are receiving the cognitive training through brainHQ. They indicated in a 5‐point Likert scale (1 = low, 5 = high) how enthusiastic and fearful they felt to begin the training and how difficult it has been. They also reported if they used a smartphone, a computer or a tablet before and how comfortable they felt using it.ResultsParticipants were between 60‐77 years old, with an average age of 70.9 ± 4.7 years old and an average schooling of 9.33 ± 3.5 years, 56% were females. Most of the sample (92%) uses smart technology, mainly smartphones, but only 8% feels very comfortable using it, 55% reports regular comfort and 37% feels not comfortable at all. When asked about brainHQ training, over half of the sample (56%) reported high enthusiasm, 68% reported little fear and more than half reported some degree of difficulty (see figure 1). No significant differences between men and women were found. Using Spearman`s test, a significant negative correlation between schooling and perceived difficulty was found (rho = ‐.68, p = .03), but not between schooling and enthusiasm or fear.ConclusionIn general, the participants have a good attitude towards the use of brainHQ, although they reported not feeling very comfortable with the use of intelligent technologies, they were enthusiastic about starting the training, and most of them were not afraid. However, the perceived difficulty could hinder training, especially in those with less schooling, therefore, it is important to develop strategies that encourage them to continue with the program to obtain the benefits of computerized training.

Number of Live Births, Age at the Time of Having a Child, Span of Births and Risk of Dementia: A Population-Based Cohort Study of 253,611 U.K. Women.

Objectives: The association between birth-related factors and dementia is unclear. We aimed to investigate their association and subsequent risk of dementia in a large-scale follow-up prospective study. Materials and Methods: This population-based cohort study used data from U.K. Biobank (2006-2010), and the median follow-up was 12.0 years. Multivariable-adjusted Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) between number of children, age of first live birth, age of last live birth, span of births, and dementia. Restricted cubic spline models were used to quantify dose-response relationships. Results: A total of 253,611 women with mean age (standard deviation) of 56.3 (8.0) years were included. Compared with women with no child, women who had three or more children and first birth at age before 25 years, had elevated risk of all-cause dementia (HR: 1.30, 95% CI: 1.10-1.54), Alzheimer's disease (AD; 1.21, 1.00-1.46), and vascular dementia (VD; 1.59, 1.19-2.13). Also, women with three or more children and the last birth at age before 30 years, had increased risk of all-cause dementia (1.33, 1.11-1.59), AD (1.27, 1.03-1.57), and VD (1.55, 1.12-2.13). Moreover, women who had three or more children in <7 years, had an increased risk of all-cause dementia (1.25, 1.04-1.49). Dose-response relationship showed a lowest risk of dementia at having two children, and having three or more children in 7-9 years. Conclusions: Number of children, age of births, and span of births were all related to risk of dementia. These findings may help developing fertility policies or dementia prevention programs.

Co‐design of an Aboriginal Health Practitioner‐led dementia prevention program (DAMPAA) using a Theory of Change framework

AbstractBackgroundDementia prevalence and incidence in Aboriginal Australians is three to five times that of the general population. Many of the known risk factors for dementia in this population are modifiable (e.g., head injury, hypertension, previous stroke and poor mobility). However, there is currently no evidence‐base on how to delay or prevent cognitive decline and dementia in Aboriginal Australians. Therefore, a comprehensive program to target dementia risk factors in this population is required.MethodIn partnership with three Aboriginal Community Controlled Health Services (ACCHS) in Western Australia, we have developed an Aboriginal health practitioner‐led health program (DAMPAA) to target key dementia risk factors for Aboriginal people over 45 years. The DAMPAA program was co‐designed by the research team, Elders and Aboriginal community‐controlled organisations. Qualitative data to inform the co‐design was collected through ACCHS staff workshops, Elders yarning groups and interviews with DAMPAA Aboriginal and non‐Aboriginal researchers using a Theory of Change framework. Additionally, a small pilot study was conducted in 2020, which included participant exit interviews conducted by Aboriginal researchers. Qualitative data from all data sources was analysed thematically by a qualitative researcher, and member checked by two DAMPAA Aboriginal researchers and the Elders Governance group.ResultThe DAMPAA program includes group physical activity, education, goal setting and medication management. Program enablers identified by ACCHS, research staff and participants include (but not limited to) group Aboriginal community controlled organisation based walking and yarning sessions, with additional activities such as aqua aerobics, tai chi and boot scooting, a buddy system for home exercising, connecting with others, transport, healthy food, being Aboriginal led, and the ACCHS partnership. An additional enabler identified by the Elders governance group include Aboriginal language education sessions. Program barriers identified include (but not limited to) family commitments, caring for grandchildren, travel for funerals and other appointments and participant contact details changed.ConclusionThe barriers and enablers identified from participants, ACCHS and DAMPAA staff have informed the development of the program protocol. DAMPAA will be evaluated through a randomised controlled trial implemented at four sites in Western Australia and process evaluation using a Theory of Change framework.

Development and validation of a dementia risk index for use with administrative healthcare data in Canada

AbstractBackgroundIdentification of individuals at high risk for dementia is important for planning health services and targeting prevention strategies. While dementia risk indices are available with clinical data, few have been created for use with population‐based administrative data in Canada. The purpose of this study was to establish a dementia risk index for people aged 50 years and older in Alberta, Canada, utilizing routinely gathered administrative healthcare databases. Using population‐based data, we can better understand the risk of dementia to identify individuals and populations at greatest risk.MethodThe study population included all individuals in Alberta, Canada, aged 50 years or older and free of diagnosed dementia on April 1, 2013. Participants were followed for up to 5 years to assess new diagnoses of dementia using a validated algorithm. A total of 59 known measurable dementia risk factors were assessed as potential predictors of dementia. At a 3:2 ratio, the sample was randomly divided into derivation and validation sets. The risk prediction model was created using a Cox proportional hazard model from a list of candidate variables in the derivation sample, and its performance to predict dementia was evaluated in the validation sample.ResultOne million participants aged 50 years and older without dementia were included in the study sample (mean age 62.95 years, 50.52% female), and 41,834 (3.86%) individuals developed dementia during follow‐up (mean duration 4.78 years). Out of 59 candidate variables, 17 variables were identified as independent risk factors for dementia, including advanced age, female gender, increased overall medical comorbidity, neighborhood measures of socioeconomic deprivation, specific medical conditions, mental health diagnoses, and measures of health service utilization. The final multivariate Cox proportional hazards model demonstrated good discriminative ability (Harrel’s C‐statistic = 0.87).ConclusionThis risk prediction index, derived using population‐based data, can reliably identify Canadian adults at increased risk of dementia. This risk index may assist clinicians, and the general public in assessing their risks for dementia and facilitate discussions on the most effective ways to reduce this risk. Understanding individual or population‐based dementia risk differences can help design dementia prevention and health promotion programs.

Effectiveness of an Online Dementia Prevention Program on Cognitive Function and Depression in Community-Dwelling Older Adults during the COVID-19 Pandemic in Korea.

(1) Background: Continuous participation in a comprehensive dementia prevention program is important for community-dwelling older adults during the coronavirus disease (COVID-19) pandemic, as limitations on their communities and social participation have increased and participation in daily tasks has decreased. These factors can negatively affect their cognitive function and symptoms of depression. This study aimed to introduce an evidence-based online dementia prevention program in the South Korean context and to identify its effect on cognitive function and symptoms of depression in community-dwelling older adults during the COVID-19 pandemic. (2) Methods: One hundred and one community-dwelling older adults without dementia participated in twelve sessions of an online dementia prevention program designed by occupational therapists. Cognitive function and symptoms of depression were assessed before and after the program. Cognitive function was tested using the Cognitive Impairment Screening Test and symptoms of depression were assessed using the Korean version of the Short Geriatric Depression Scale. The participants' opinions were gathered using open-ended questions. (3) Results: After the program, according to the raw score, orientation was maintained and attention, visuospatial function, executive function, memory, and language function increased. The memory and total cognitive score was improved significantly. Symptoms of depression significantly decreased. The program's benefits according to the participants were participation in new activities, boredom reduction, online communication, and reminiscence. (4) Conclusions: An online dementia prevention program is effective in maintaining and increasing cognitive function and preventing depression in community-dwelling older adults. An online dementia prevention program is a useful method in providing opportunities to participate in cognitive training and continuous daily activities during the COVID-19 pandemic.