Dementia Risk Score Research Articles

Change in CAIDE Dementia Risk Score and Neuroimaging Biomarkers During a 2-Year Multidomain Lifestyle Randomized Controlled Trial: Results of a Post-Hoc Subgroup Analysis.

The CAIDE (Cardiovascular Risk Factors, Aging and Dementia) Risk Score is a validated tool estimating dementia risk. It was previously associated with imaging biomarkers. However, associations between dementia risk scores (including CAIDE) and dementia-related biomarkers have not been studied in the context of an intervention. This study investigated associations between change in CAIDE score and change in neuroimaging biomarkers (brain magnetic resonance imaging [MRI] and Pittsburgh Compound B-positron emission tomography [PiB-PET] measures) during the 2-year Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) (post-hoc analyses). FINGER targeted at-risk older adults, aged 60–77 years, from the general population. Participants were randomized to either multidomain intervention (diet, exercise, cognitive training, and vascular risk management) or control group (general health advice). Neuroimaging (MRI and PiB-PET) data from baseline and 2-year visits were used. A toal of 112 participants had repeated brain MRI measures (hippocampal, total gray matter, and white matter lesion volumes, and Alzheimer’s disease signature cortical thickness). Repeated PiB-PET scans were available for 39 participants. Reduction in CAIDE score (indicating lower dementia risk) during the intervention was associated with less decline in hippocampus volume in the intervention group, but not the control group (Randomization group × CAIDE change interaction β coefficient = −0.40, p = .02). Associations for other neuroimaging measures were not significant. The intervention may have benefits on hippocampal volume in individuals who succeed in improving their overall risk level as indicated by a reduction in CAIDE score. This exploratory finding requires further testing and validation in larger studies.

A protocol to assess the risk of dementia among patients with coronary artery diseases using CAIDE score

Introduction: The impact of coronary artery disease (CAD) on the later development of dementia is not well studied globally. Therefore, this study aims to determine the long-term risk of dementia using a mobile application-based tool in addition to elucidating the contributing factors among CAD patients. Protocol: This cross-sectional study collected data from 285 stable CAD patients admitted to the “Ibrahim Cardiac Hospital and Research Institute” for coronary revascularization from August 2019 to July 2020. The patients were recruited using a convenient sampling technique due to economic and logistical issues. Data were collected through a face-to-face interview using a pretested semi-structured questionnaire. Physical parameters (blood pressure and anthropometry) were measured while maintaining the adequate privacy of the patients. The biochemical parameters analyzed by the hospital lab were also collected. The next phase of this study involves the use of a mobile application that uses the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) dementia risk score, to determine the risk factors associated with dementia. In addition, a descriptive statistical and inferential analysis will also be performed to determine the key contributing risk factors linked to the development of dementia. Ethics and dissemination: The study has been reviewed and approved by the Ethical Review Committee of Bangladesh University of Health Sciences. The results will be actively disseminated through peer-reviewed journals, conference presentations, social media, online news portal, the internet, and various community/stakeholder engagement activities. Conclusion: As a baseline study of the country, this study will fill a key knowledge gap in the pathway to the development of better interventions for dementia in Bangladesh. Outcomes from this study will also help with raising awareness on the association of mental health-related issues with cardiovascular diseases so that an improved cardiac rehabilitation program can be implemented in Bangladesh.

Middle-age dementia risk scores and old-age cognition: a quasi-experimental population-based twin study with over 20-year follow-up

BackgroundMiddle-age risk scores predict cognitive impairment, but it is not known if these associations are evident when controlling for shared genetic and environmental factors. Using two risk scores, self-report educational-occupational...

A Novel Score for Predicting Alzheimer's Disease Risk from Late Life Psychopathological and Health Risk Factors.

With the increasing size of the aging population, dementia risk reduction has become a main public health concern. Dementia risk models or indices may help to identify individuals in the community at high risk to develop dementia. We have aimed to develop a novel dementia risk index focused on the late-life (65 years or more) population, that addresses risk factors for Alzheimer’s disease (AD) easily identifiable at primary care settings. These risk factors include some shown to be associated with the risk of AD but not featured in existing indices, such as hearing loss and anxiety. Our index is also the first to account for the competing risk of death. The Zaragoza Dementia and Depression Project (ZARADEMP) Alzheimer Dementia Risk Score predicts an individual´s risk of developing AD within 5 years. The probability of late onset AD significantly increases in those with risk scores between 21 and 28 and, furthermore, is almost 4-fold higher for those with risk scores of 29 or higher. Our index may provide a practical instrument to identify subjects at high risk of AD and to design preventive strategies targeting the contributing risk factors.

Quantifying dementia prevention potential in the FINGER randomized controlled trial using the LIBRA prevention index.

IntroductionIndividuals in early dementia prevention trials may differ in how much they benefit from interventions depending on their initial risk level. Additionally, modifiable dementia risk scores might be used as surrogate/intermediate outcomes.MethodsIn the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), we investigated in post hoc analyses (N = 1207) whether the cognitive benefits of the 2‐year multi‐domain lifestyle intervention differed by baseline dementia risk measured with the “LIfestyle for BRAin Health” (LIBRA) score. We also investigated intervention effects on change in LIBRA score over time.ResultsOverall, higher baseline LIBRA was related to less cognitive improvement over time. This association did not differ between the intervention and control groups. The intervention was effective in decreasing LIBRA scores over time, regardless of baseline demographics or cognition.DiscussionThe cognitive benefit of the FINGER intervention was similar across individuals with different LIBRA scores at baseline. Furthermore, LIBRA may be useful as a surrogate/intermediate endpoint and surveillance tool to monitor intervention success during trial execution.

Recruitment and Baseline Characteristics of Participants in the AgeWell.de Study-A Pragmatic Cluster-Randomized Controlled Lifestyle Trial against Cognitive Decline.

Targeting dementia prevention, first trials addressing multiple modifiable risk factors showed promising results in at-risk populations. In Germany, AgeWell.de is the first large-scale initiative investigating the effectiveness of a multi-component lifestyle intervention against cognitive decline. We aimed to investigate the recruitment process and baseline characteristics of the AgeWell.de participants to gain an understanding of the at-risk population and who engages in the intervention. General practitioners across five study sites recruited participants (aged 60–77 years, Cardiovascular Risk Factors, Aging, and Incidence of Dementia/CAIDE dementia risk score ≥ 9). Structured face-to-face interviews were conducted with eligible participants, including neuropsychological assessments. We analyzed group differences between (1) eligible vs. non-eligible participants, (2) participants vs. non-participants, and (3) between intervention groups. Of 1176 eligible participants, 146 (12.5%) dropped out before baseline; the study population was thus 1030 individuals. Non-participants did not differ from participants in key sociodemographic factors and dementia risk. Study participants were M = 69.0 (SD = 4.9) years old, and 52.1% were women. The average Montreal Cognitive Assessment/MoCA score was 24.5 (SD = 3.1), indicating a rather mildly cognitively impaired study population; however, 39.4% scored ≥ 26, thus being cognitively unimpaired. The bandwidth of cognitive states bears the interesting potential for differential trial outcome analyses. However, trial conduction is impacted by the COVID-19 pandemic, requiring adjustments to the study protocol with yet unclear methodological consequences.

Pattern and degree of individual brain atrophy predicts dementia onset in dominantly inherited Alzheimer's disease.

IntroductionAsymptomatic and mildly symptomatic dominantly inherited Alzheimer's disease mutation carriers (DIAD‐MC) are ideal candidates for preventative treatment trials aimed at delaying or preventing dementia onset. Brain atrophy is an early feature of DIAD‐MC and could help predict risk for dementia during trial enrollment.MethodsWe created a dementia risk score by entering standardized gray‐matter volumes from 231 DIAD‐MC into a logistic regression to classify participants with and without dementia. The score's predictive utility was assessed using Cox models and receiver operating curves on a separate group of 65 DIAD‐MC followed longitudinally.ResultsOur risk score separated asymptomatic versus demented DIAD‐MC with 96.4% (standard error = 0.02) and predicted conversion to dementia at next visit (hazard ratio = 1.32, 95% confidence interval [CI: 1.15, 1.49]) and within 2 years (area under the curve = 90.3%, 95% CI [82.3%–98.2%]) and improved prediction beyond established methods based on familial age of onset.DiscussionIndividualized risk scores based on brain atrophy could be useful for establishing enrollment criteria and stratifying DIAD‐MC participants for prevention trials.

All-cause Dementia Prediction by Machine Learning: The Health, Aging, and Body Composition Study

There are several shortcomings of the currently available risk prediction models for dementia. We developed a risk prediction model for dementia using machine-learning approach and compared its performance with traditional approaches. Data were from the Health, Aging, and Body Composition Study, comprising 3,075 older adults (at least 70 years). Dementia was defined as (1) use of a prescribed dementia medication, (2) adjudicated dementia diagnosis, or (3) a race-stratified cognitive decline>1.5 SDs from the baseline mean. We selected 275 predictors collected from questionnaires, imaging data, performance testing, and biospecimen. We used random survival forest (RSF) to build the full model and rank the importance of predictors. Subsequently, we built parsimonious models with top-20 predictors using RSF and Cox regression. A dementia risk score was developed using top-ranked variables. We used the C-statistic for performance evaluation. Over a median of 11.4 years of follow-up, 659 dementias (21.4%) occurred. The RSF model (both including all and top-20 variables) showed a higher C-statistic than the regression model. Digit symbol score, physical performance battery, finger tapping score, weight change since age 50, serum adiponectin, and APOE genotype were the top-6 variables. We created a dementia risk score (0-10) using the top-6 variables. A 1-unit increase in the risk score was associated with an 8% higher risk of dementia. The risk score demonstrated good discrimination (C-statistic=0.75). Machine learning methods offered improvement over traditional approaches in predicting dementia. The risk prediction score derived from a parsimonious model had good prediction performance.

Lifestyle habits and the risk factors of dementia: Evidence from Japan.

In this study, we seek to empirically understand the relationship between lifestyle habits and dementia risk. Through an original online survey, we first confirm the significant difference in the dementia risk indicators between good and bad lifestyle habits. Then, using regression analysis to hold other factors equal, we examine the relationships between lifestyle habits and an aggregate dementia risk indicator. Through the t-test results, we find that the average scores of dementia risk for respondents avoiding good habits and preferring bad habits are significantly higher than those of the respondents favoring good habits and avoiding bad habits. Our empirical findings showed that Japanese-style dietary habits significantly correlate with a decreased dementia risk. An additional 1-point increase in eating habits will reduce dementia risk scores by 0.148 points, on average. Furthermore, we also confirm that walking (more than three times per week) and watching TV (almost every day) help prevent dementia. We conclude that maintaining a good lifestyle helps prevent dementia. In particular, good eating habits, both in terms of types of food and eating routines, are essential to avoid the development of dementia. Most of these lifestyle habits belong to the targets of the "Health Japan 21" project. Therefore, our findings might provide some convincing evidence for promoting the project, which will not only extend healthy life expectancy, but also reduce the increasing number of older adults with dementia. Geriatr Gerontol Int 2021; 21: 203-208.

CAIDE dementia risk score and cognitive correlates among Filipinos with mild cognitive impairment

AbstractBackgroundThe Cardiovascular Risk Factors, Aging and Dementia (CAIDE) dementia risk score is a validated tool predicting the risk of dementia.1,2 It includes age, sex, education, blood pressure, cholesterol, body mass index (BMI), and physical inactivity, with higher scores indicating increased risk of subsequent dementia.1,2 Mild Cognitive Impairment (MCI) is a The objective is to compare the cognitive profiles of Mild Cognitive Impairment (MCI) participants with significant modifiable risk factors (CAIDE > 6) in a Filipino cohort.MethodA total of 60 participants with MCI from the Filipino Multicomponent Intervention to Maintain Cognitive Performance among High Risks Population (FINOMAIN) study were included. Data on age, sex, educational level, blood pressure, cholesterol, body mass index (BMI), and physical activity were obtained. Mini Mental Status Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scores were obtained. Participants were administered the Mini‐Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), and Alzheimer’s Disease Assessment Scale Cognitive Subscale (ADAS‐Cog).ResultForty‐four participants (73%) have significant modifiable risk factors (CAIDE > 6). Compared to participants without significant risk factors, participants with significant modifiable risk factors (CAIDE > 6) have more impaired cognition with lower MoCA scores (16 + 4 vs 19 + 3, p=0.02). MMSE was noted to be lower (25 + 3 vs 27 + 2, p=0.06); and ADAS‐Cog scores higher (13.6 + 6 vs 11.8 + 5, p=0.2), however, it was not significant.ConclusionThis study shows that MCI participants with significant modifiable risk factors (CAIDE > 6) have more cognitive impairment suggesting the utility of CAIDE in the community to screen individuals at risk for dementia. Findings support the need to address modifiable risk factors to prevent cognitive deterioration. Further trials that investigate the effects of multi‐domain intervention and treatment for risk factors in improving cognition, delaying cognitive deterioration and dementia conversion.

External validation of a proprietary delirium superimposed on dementia risk score using claims data and predictive analytics

AbstractBackgroundDelirium is an acute change in mental status, attention, and cognition that develops over a short period of time and can fluctuate in course. When delirium occurs in patients with underlying dementia, it is known as dementia superimposed on delirium (DSD). The prevalence of DSD is high in all care settings and patients with DSD have a 15‐fold increase in walking dependence, 5‐fold increase in nursing home placement, and 2‐fold increase in mortality according to published studies.MethodCognitive claims from long term care insurance (LTCI) were processed using proprietary predictive analytics from Neurocern Inc, a neuroinformatics and data analytics company. The insurance third party administrator (TPA) who processes claims was blinded to the results from the predictive analytics. Claims data including carrier approval and denial decisions were provided. A DSD risk score was given to cognitive claims that met clinical criteria for delirium. A third party neurology task force validated Neurocern’s proprietary analytics and DSD score.ResultA total of 67 claims (F=41, M=26) were assessed by the third party task force, the proprietary DSD score had a sensitivity of 94.7% and a specificity of 100%. Inter‐rater reliability was high. Females had a higher incidence of DSD than males. Delirium was missed on 28% of approved claims by both the insurance carrier and the TPA.ConclusionClaims flagged with a DSD score should be medically assessed before any severity of dementia or benefit eligibility workup is performed. The high number of delirium cases missed by the insurance carrier and TPA represent claims where the patient’s condition may have improved with appropriate medical management and support. DSD claims represent high cost and high mortality claims that require appropriate financial reserving from insurance carriers.

Change in CAIDE dementia risk score and neuroimaging biomarkers during a 2‐year multidomain lifestyle randomized controlled trial

AbstractBackgroundThe Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) risk score was the first validated risk score estimating dementia risk based on a midlife risk profile. This exploratory study investigated associations of change in CAIDE score with change in neuroimaging biomarkers: brain magnetic resonance imaging (MRI) and Pittsburgh compound B‐positron emission tomography (PiB‐PET) measures during the 2‐year Finnish Geriatric Intervention Study to prevent cognitive impairment and disability (FINGER).MethodFINGER targeted an at‐risk 60‐77 years old general population without dementia/substantial cognitive impairment. Data from baseline and 2‐year visits were used. 112 participants (59 intervention, 53 control) had repeated brain MRI measures (hippocampal, total gray matter, and white matter lesion volumes, and Alzheimer’s disease (AD) signature cortical thickness). Repeated PiB‐PET scans were available for 39 participants (18 intervention, 21 control). Linear regressions were used to test the association of CAIDE score change with change in MRI and PiB‐PET measures.ResultReduction in CAIDE score was associated less decline in hippocampus volume in the intervention group, but not the control group (randomization group x CAIDE change interaction β‐coefficient= ‐0.40; p=0.02). Associations for other MRI measures and amyloid accumulation on PiB‐PET scans were not significant.ConclusionReduction in estimated dementia risk as indicated by the CAIDE score change may result in more pronounced intervention benefits on hippocampus volume. Findings from this study should be verified in clinical trials with larger neuroimaging sample sizes and longer follow‐up.

Association of late‐onset dementia risk scores and Alzheimer’s disease pathology status in preclinical older adults

AbstractBackgroundDementia risk scores (DRS) for the prediction of Alzheimer’s disease (AD) have the potential to identify at‐risk individuals for secondary prevention trials. To date, risk scores have focused primarily on predicting dementia symptoms rather than AD histopathology. Prediction of biological disease status could inform more precise targeting of at‐risk populations for prevention strategies.In this study, we compare the predictive value of three late‐life DRSs, namely the revised CAIDE (younger and older old) and the Reitz DRS (Reitz et al. 2010). Capacity for distinguishing pathogenic amyloid‐beta status and relation to multi‐domain cognitive performance was explored.Methods1378 cognitively‐unimpaired participants aged 60‐85 years from the UK Cognitive Health in Ageing Register: Investigational, Observational, and Trial Studies in Dementia Research: Prospective Readiness cOhort (CHARIOT‐PRO) Sub‐study had cerebral amyloid load dichotomized as positive vs negative. The predictive value of the Reitz and CAIDE risk scores for determining amyloid status were tested in separate logistic regression models. Associations of the risk scores with global and multi‐domain cognitive performance (assessed via the RBANS) were further evaluated. Finally, the contributions of individual components of the risk scores on amyloid status and cognitive performance were tested in multiple logistic and linear regression models.Results19.3% of the participants were amyloid‐positive. The Reitz and CAIDE young‐old (age<75) scores were higher in the amyloid positive versus negative group (median(IQR): 20 (10) vs 15 (11), 1 (2) vs 0 (2) respectively; P<0.05). Higher Reitz and CAIDE younger‐old scores were associated with increased risk of amyloid positivity (OR=1.05 (1.03‐1.08) and 1.17 (1.03‐1.34) respectively; P<0.05). Reitz score alone was negatively correlated with global cognition, memory and visuospatial indices (r ranges from ‐0.10 to ‐0.14; P<0.05). The potential contributing factors for predicting amyloid status were age, ApoE‐e4, and ethnicity; while diabetes and education predicted cognitive performance. In contrast, nil associations of CAIDE older‐old (age≥75) score with amyloid status or cognitive performance were noted (P>0.05).ConclusionsThe risk scores tested revealed differential predictive abilities in relation to amyloid pathology status and late‐life cognitive performance. Risk composites focusing on identified genetic and metabolic factors may be useful for more precise participant selection in targeted prevention and risk‐reduction trials.

CAIDE risk score for the prediction of dementia risk in Mexican elders: 10/66 Dementia Research Group, population‐based study in Mexico

AbstractBackgroundCAIDE (Cardiovascular Risk Factors, Aging, and dementia) Dementia Risk Score was developed to identify subjects with risk for developing dementia; using cardiovascular risk factors for dementia. CAIDE has showed to have a good predictive value. Mexican elders have different risk factors for dementia; the use of this type of score could be a good alternative to detect subjects at risk and implementing prevention strategies.MethodWe include 1,111 subjects of >65 years of age, without cognitive impairment and who had the information complete to calculate CAIDE [age (< 47, 47‐53, >53 years old), gender, education (> 10 years, 7‐9 years, < 7 years), systolic blood pressure (<140 or >140mmHg), body mass index (<30 or >30 kg/m2), the auto‐report of dyslipidaemia (the original CAIDE use only hypercholesterolemia) and physical activity. Diagnosis of dementia after the follow‐up was according to 10/66 algorithms, we determinate the predictive properties of CAIDE score.ResultThose with a CAIDE score of 6‐7 showed a sensitivity of 66.23%, specificity of 34.7% and the 37.63% of proper classification at three years of follow‐up; for those with score of 8‐9, had a sensitivity 24.68%, specificity of 73.69% and the 69.18%, and for those with a score 10‐11, shown a sensitivity of 5.19%, specificity of 93.5% and the 85.4% of proper classification.ConclusionCAIDE score show a good specificity and sensibility. CAIDE scores of 6‐7 showed the best sensitivity but the 8‐9 scores obtain the best specificity. But we should consider different things for example we population have > 65 years old, this conditioning all our sample to obtain 4 points, and we use self‐report for some measures. CAIDE does not include diabetes, which has demonstrated to be an important risk factor for dementia in our population.

Suitability of dementia risk scores as surrogate outcomes for lifestyle‐based multidomain prevention trials

AbstractBackgroundAlthough not designed as such, dementia risk scores, such as the CAIDE or LIBRA, might be useful as surrogate outcome measures for dementia prevention trials conducted from midlife onwards. In the risk scores’ original categorical scoring systems, changes in risk factors are only taken into account when crossing cut‐off values, which may limit responsiveness and ability to detect intervention effects. We hypothesized that scoring systems based on continuous z‐score measures of risk factors may improve the performance of risk scores in this respect.MethodIn three large multidomain dementia prevention trials (MAPT, preDIVA and HATICE) with 1.5‐2 years of follow up, we assessed of the original and z‐score versions of the CAIDE and LIBRA scores: 1) responsiveness and 2) actual and simulated intervention effects.ResultAcross the three trials, 48 to 58% of intervention group participants underwent change on the CAIDE score between baseline and follow‐up. The LIBRA index was more responsive: 61 to 79% of participants changed over time. The z‐score versions registered changes in risk factors that were not detected by the original scores: subjects with no change over time in the original score showed great variability in their change in z‐scores, ranging from as much as ‐1.25 to 1.25 for the CAIDE. Conversely, for very small changes in z‐score, the change in original CAIDE or LIBRA scores was as much as ‐5 to 5 points, indicating multiple small changes in risk factors just across the cut‐off values for the original scoring system. Original scores and z‐scores were equally able to detect modest but significant intervention effects. When simulating very large intervention effects, mean between‐group differences of ‐0.50 points (23% of potential for improvement) could be attained for original CAIDE score and ‐0.52 points for original LIBRA index (15% of potential for improvement). Their z‐score versions could attain a maximum of ‐0.24 standard deviations for CAIDE and ‐0.15 standard deviations for the LIBRA index.ConclusionDementia risk scores as well as their z‐score versions show potential as surrogate outcomes. How changes in risk scores affect long‐term dementia incidence rates remains to be determined.

The Barcelonabeta dementia prevention research clinic: Study design, recruitment profiles and inclusion in prevention studies — An update

AbstractBackgroundUp to 40% new patients in memory clinics complain of worse cognitive performance scoring within normal ranges in cognitive tests, hence presenting what is termed ‘subjective cognitive decline’ (SCD). Although usually dismissed, they present an increased progression rate to mild cognitive impairment (MCI) and dementia. There is, therefore, an emergent need for newly designed programs to provide individual risk estimates and tailored risk‐reduction plans. With the aim of assessing the emotional impact and cost‐benefit of these programs, we established the BarcelonaBeta Dementia Prevention Research Clinic (BBDPRC).MethodA longitudinal, prospective study of 400 participants (60‐80 years) with SCD or MCI was set‐up. General population participants concerned about their cognitive performance were pre‐selected by their replies to web‐based forms capturing information about their subjective cognitive performance. Those selected undergo baseline visit for (1) diagnosis, (2) collecting data to enable the estimation of a dementia risk score and (3) produce their personalised prevention action plan. At the subsequent visit, their risk estimates are disclosed and personalised primary prevention advice presented. Individuals with MCI are readily offered to enter studies/trials they may benefit from. The emotional impact of disclosure is measured at 1 and 6 weeks and 6 and 12 months post‐disclosure. At 6‐weeks, SCD participants are offered to enter suitable prevention studies (Fig.1). A cost‐benefit analysis of this program will also be performed using standard methods.ResultBBDPRC was presented in a press‐conference. 1,633 persons registered on the website and >50% of them were classified by an embedded algorithm as a priori eligible (Fig.2). To date, ∼300 persons (First‐Patient‐In 16/7/2018) have undergone baseline visit (screening failure 6.5%). From the ones with disclosed diagnosis, 18.5% were MCI, 55.0% SCDplus (fulfilling >3 SCDplus features) and 26.5% SCD. 52.9% of these participants comply with eligibility criteria with ongoing studies at BBRC and, remarkably, 69.9% were included in the studies proposed (Fig.3).ConclusionWe have established a web‐based registry that is proving to be very efficient in recruiting SCDplus or MCI individuals being more than half suited for dementia prevention studies and trials. Furthermore, this infrastructure sets the basis for future personalised approaches.

The type 2 diabetes-specific dementia risk score (DSDRS) is associated with frailty, cognitive and functional status amongst Mexican community-dwelling older adults

BackgroundThe type 2 diabetes (T2D) specific dementia-risk score (DSDRS) was developed to evaluate dementia risk in older adults with T2D. T2D-related factors have been shown increase the risk of age-related conditions, which might also increase dementia risk. Here, we investigate the associations of DSDRS with frailty, disability, quality of life (QoL) and cognition in community-dwelling older adults with T2D.MethodsWe included 257 community-dwelling older adults with T2D to evaluate the association between DSDRS and Mini-mental state examination (MMSE), Isaac’s set-test (IST), clock drawing test (CDT), quality of life (SF-36), risk of malnutrition (Mini-Nutritional Assessment or MNA), as well as frailty, Katz’ and Lawton-Brody scores. We also assessed the phenotype and correlates of high-estimated dementia risk by assessing individuals with DSDRS >75th age-specific percentiles.ResultsMean age of participants was 78.0 ± 6.2 years. DSDRS showed a significant correlation with MMSE test, IST, CDT, SF-36, MNA, Lawton-Brody and Katz scores, and an increasing number of frailty components. DSDRS was higher among frail, pre-frail, and subjects with limited ADL and IADL (p < 0.001). Participants with DSDRS >75th age-specific percentiles had lower education, MMSE, IST, SF-36, MNA, Katz, Lawton-Brody, and higher frailty scores. High-estimated 10-year dementia risk was associated with ADL and IADL disability, frailty and risk of malnutrition. When assessing individual components of DSDRS, T2D-related microvascular complications were associated to all outcome measures.ConclusionThe DSDRS is associated with frailty, disability, malnutrition and lower cognitive performance. These findings support that T2D-related factors have significant burden on functional status, QoL, disability and dementia risk.

Clinical Applicability of the Specific Risk Score of Dementia in Type 2 Diabetes in the Identification of Patients with Early Cognitive Impairment: Results of the MOPEAD Study in Spain.

Introduction: Although the Diabetes Specific Dementia Risk Score (DSDRS) was proposed for predicting risk of dementia at 10 years, its usefulness as a screening tool is unknown. For this purpose, the European consortium MOPEAD included the DSDRS within the specific strategy for screening of cognitive impairment in type 2 diabetes (T2D) patients attended in a third-level hospital. Material and Methods: T2D patients > 65 years, without known cognitive impairment, attended in a third-level hospital, were evaluated. As per MOPEAD protocol, patients with MMSE ≤ 27 or DSDRS ≥ 7 were referred to the memory clinic for complete neuropsychological assessment. Results: 112 T2D patients were recruited. A total of 82 fulfilled the criteria for referral to the memory unit (43 of them declined referral: 48.8% for associated comorbidities, 37.2% lack of interest, 13.95% lack of social support). At the Fundació ACE’s Memory Clinic, 34 cases (87.2%) of mild cognitive impairment (MCI) and 3 cases (7.7%) of dementia were diagnosed. The predictive value of DSDRS ≥ 7 as a screening tool of cognitive impairment was AUROC = 0.739, p 0.024, CI 95% (0.609–0.825). Conclusions: We found a high prevalence of unknown cognitive impairment in TD2 patients who attended a third-level hospital. The DSDRS was found to be a useful screening tool. The presence of associated comorbidities was the main factor of declining referral.

Dementia risk scores as surrogate outcomes for lifestyle-based multidomain prevention trials-rationale, preliminary evidence and challenges.

Although not designed as such, dementia risk scores might be useful surrogate outcomes for dementia prevention trials. Their suitability may be improved by using continuous scoring systems, taking into account all changes in risk factors, not only those crossing cut-off values. In three large multidomain dementia prevention trials with 1.5 to 2 years of follow-up (Multidomain Alzheimer Preventive Trial, Prevention of Dementia by Intensive Vascular Care and Healthy Ageing Through Internet Counselling in the Elderly) we assessed (1) responsiveness (sensitivity to change) and (2) actual and simulated intervention effects of the original and crude/weighted z-score versions of the cardiovascular risk factors, aging and incidence of dementia, and Lifestyle for Brain Health scores. All versions of the risk scores were generally responsive, and able to detect small though statistically significant between-group differences after multidomain interventions. Simulated intervention effects were well detected in z-score versions as well as in the original scores. Dementia risk scores and their z-score versions show potential as surrogate outcomes. How changes in risk scores affect dementia remains to be determined.

Diabetes-specific dementia risk score (DSDRS) predicts cognitive performance in patients with type 2 diabetes at high cardio-renal risk

AimTo investigate the relationship between the diabetes-specific dementia risk score (DSDRS) and concurrent and future cognitive impairment (CI) in type 2 diabetes (T2D). MethodsDSDRS were calculated for participants with T2D aged ≥60 years from the CARMELINA-cognition substudy (ClinicalTrials.gov Identifier: NCT01897532). Cognitive assessment included Mini-Mental State Examination (MMSE) and a composite attention and executive functioning score (A&E). The relation between baseline DSDRS and probability of CI (MMSE < 24) and variation in cognitive performance was assessed at baseline (n = 2241) and after 2.5 years follow-up in patients without baseline CI (n = 1312). ResultsHigher DSDRS was associated with a higher probability of CI at baseline (OR = 1.17 per point, 95% CI 1.12–1.22) and follow-up (OR = 1.24 per point, 95% CI 1.14–1.35). Moreover, in patients without baseline CI, higher DSDRS was also associated with lower baseline cognitive performance (MMSE: F(1, 1930) = 47.07, p < .0001, R2 = 0.02); A&E z-score: (F(1, 1871) = 33.44 p < .0001, R2 = 0.02) and faster cognitive decline at follow-up (MMSE: F(3, 1279) = 38.41, p < .0001; A&E z-score: F(3, 1206) = 148.48, p < .0001). ConclusionsThe DSDRS identifies patients with T2D at risk of concurrent as well as future CI. The DSDRS may thus be a supportive tool in screening strategies for cognitive dysfunction in patients with T2D.