Modifiable Risk Factors For Dementia Research Articles

Dementia awareness, motivation and modifiable risk factors amongst older Australians in regional communities

AbstractBackgroundDementia is the second leading cause of death in regional Australia. A large body of research into modifiable dementia risk factors and awareness levels has been gathered with metropolitan communities, yet this remains unexplored within regional areas. Therefore, this study aims to 1) identify awareness of modifiable dementia risk factors; 2) identify the presence/absence of modifiable dementia risk factors; and 3) explore sociodemographic and motivation characteristics associated with modifiable dementia risk in regional areas of AustraliaMethodCross‐sectional data of dementia awareness and risk levels in 180 adults >65 living in rural and remote regions within New South Wales, were collected using an online survey. Data included demographics, awareness of dementia risk factors (British Social Attitudes survey), presence/absence of modifiable dementia risk factors (LIBRA), motivation to reduce dementia risk (MCLHB‐DRR) and social connections (LSNS‐6). Descriptive analyses was used to identify awareness as well as presence/absence of risk factors and univariate associations were used to explore demographic factors and motivation characteristics, associated with dementia awareness and dementia risk.ResultParticipants had a mean age of 72.2 (SD = 5.5) years, majority were female (70%), and had less than 10 years of education (41.1%). 41.7% were from a low socio‐economic background and 97.2% were born in an English‐speaking country. A substantial proportion of participants agreed that dementia risk is modifiable (73.3%) and identified an average of 5.7 (SD = 3.1, out of 12) dementia risk factors correctly. The motivation domain of perceived susceptibility towards dementia was low (11.3 out of 20; SD = 3.4; [4‐20]), and few social connections were reported (8.2; SD = 9.3; [0‐30]).ConclusionRural and remote Australian older adults having a basic understanding that dementia is not inevitable, however, they remain unaware of more than half of the risk and protective factors for dementia. Given the consistencies in dementia risk and the inconsequential association between sociodemographic variables in regional areas, future interventions should adopt a population health approach to improve awareness and create opportunities for communities to target health risk factors contributing to dementia.

Update of the “LIfestyle for BRAin health” (LIBRA) index: Results from an umbrella review and Delphi consensus study on modifiable dementia risk factors

AbstractBackgroundGiven the projected increase in the number of people with dementia and the lack of curative treatment, there is increasing attention to the contribution of modifiable risk and protective factors to dementia risk. In 2015, the “LIfestyle for BRAin health" (LIBRA) index was developed based on the results of a systematic literature review and Delphi expert study (Deckers et al., 2015). LIBRA consists of twelve modifiable risk factors for cognitive decline and dementia. Although this risk index has been well‐validated for cognitive decline and dementia risk in numerous population‐based cohorts and intervention studies, newly emerged risk factors might ask for an update (Deckers et al., 2019; Deckers et al., 2020).MethodTo update LIBRA, we conducted an umbrella review to assess all systematic reviews (SR) and meta‐analyses (MA) on modifiable dementia risk factors published between January 2015 and June 2021 in four databases (Pubmed, Embase, Web of Science, and PsychINFO). In parallel, a two‐round Delphi expert study was conducted. In the first round (May‐June 2022), eighteen dementia experts were asked to evaluate the factors currently included in LIBRA. Additionally, we asked to list new modifiable factors not previously included in LIBRA. In the second round (December 2022‐January 2023), the experts ranked the most important risk factors identified in the umbrella review and first Delphi round.ResultThe search returned 6,540 hits, of which 147 SR/MA were included in our umbrella review. Next to the existing LIBRA factors, new candidate risk factors that were consistently associated with increased risk for cognitive decline and dementia included: low social engagement, hearing impairment, vision impairment, atrial fibrillation, and anxiety. After triangulation of the results of the umbrella review and the first Delphi round, the experts identified hearing impairment, lifecourse inequalities, social contact, atrial fibrillation, and sleep as the most important new modifiable risk factors in the second Delphi round.ConclusionSeveral new modifiable risk factors for cognitive decline and dementia have been identified in this umbrella review and Delphi consensus study. These factors will be used for updating the existing LIBRA index, which will subsequently be externally validated in population‐based cohort studies.

Virtual Cognitive Testing‐ Neuropsychology, MyCogHealth and Cogniciti

AbstractBackgroundIt is increasingly possible to mobilize technology to more readily evaluate effects of lifestyle interventions. Past research has found virtual administration of neuropsychological testing yields comparable results to in‐person assessments. Self‐administered paradigms using app‐and web‐based assessments have likewise shown promise for measuring cognition longitudinally. The Brain Health Support Program (BHSP) investigates three highly scalable cognitive assessment approaches for use in dementia prevention trials.MethodThe BHSP includes 60‐minute traditional neuropsychological assessments administered remotely via videoconferencing by a study coordinator (baseline & 12‐mos.), 20‐minute self‐administered web‐based cognitive screening assessments with Cogniciti (baseline, 6, and 12‐mos.), and self‐administered ecological momentary assessments using the MyCogHealth app. An intensive measurement protocol is implemented with MyCogHealth whereby participants completed five assessment “bursts” in three‐month intervals. Each “burst” involved five‐minute cognitive testing sessions completed twice daily across seven days. Remote neuropsychological assessments and Cogniciti were completed at home on personal devices. Study phones were provided to those without a smartphone capable of operating MyCogHealth. A three‐month feasibility pilot was completed in early 2022.ResultThe BHSP Pilot found 100% compliance with remote neuropsychological assessments. Participants averaged 85% compliance with the MyCogHealth burst testing schedule. Self‐reported satisfaction with MyCogHealth ranged from 85% (comfort using the app) to 95% (satisfaction with burst testing schedule). During the BHSP Baseline, all participants successfully completed the remote neuropsychological assessment, Cogniciti, and MyCogHealth. 82% had a personal mobile device for operating MyCogHealth and the remainder were provided study phones. Mixed linear regression analyses modeling cognitive trajectories over the first six months of the BHSP in relation to modifiable dementia risk factors and change in health behaviours will be presented. Marginal and conditional R‐Squared values will characterize the relative sensitivity of the three virtual testing paradigms for measuring change.ConclusionAll three approaches to virtual cognitive testing were feasible for use with the BHSP cohort. Longitudinal results provide an evidence base to inform future applications of virtual testing in dementia prevention trials. Virtual cognitive testing could be stage‐setting by saving clinic visits and lowering trial costs that would in turn expand geographic diversity of participants and enable more interventions to be evaluated.

Dementia prevention strategies in Low and Middle Income Countries: A systematic review

AbstractBackgroundAmidst the global efforts to target potentially modifiable dementia risk factors, Low and Middle Income Countries (LMIC) have been described as having considerable potential for prevention. Although there is growing interest in the design, testing and implementation of preventive strategies, most of the existing literature focuses on countries with higher income levels. This systematic review aims to 1) describe the approaches that have been tried in LMIC to prevent dementia in adults over 50 years old at high risk 2) explore the key potential mechanisms and contexts associated with a positive outcome.MethodWe conducted our search on appropriate electronic databases for articles published between January 2010 to January 2023. We included all primary research intervention studies meeting a priori criteria. Our primary outcomes were any change in cognition, and/or dementia diagnosis. Two authors are independently reviewing articles and assessing study quality using the Mixed Methods Appraisal Tool (MMAT). We will narratively synthesise results.ResultIn line with current literature on dementia prevention, and due to both the diversity of populations and the broad range of possible approaches, we expect heterogeneity of studies with mixed results. We also expect multi‐domain interventions to be reported as the most effective.ConclusionThis project will add to current knowledge on how dementia prevention is being approached in the context of LMIC. Findings will allow us to understand which factors make local interventions work and inform the implementation of preventive strategies for people at high risk of dementia.

The cardiovascular risk factors, aging and dementia risk score and Australian national university Alzheimer’s disease risk index among Ethiopians

AbstractIntroductionThe burden of dementia is highest in LMICs, and the dementia prevention potential is greater than in high‐income countries. However, the burden of modifiable dementia risk factors is not determined in Ethiopia. The objective of this study is to determine the need for personalized dementia risk reduction among high risk patients in Ethiopia using the Cardiovascular Risk Factors, Aging and Dementia Risk Score (CAIDE) and Australian National University Alzheimer’s Disease Risk Index (ANU‐ADRI) for midlife and late life.MethodsOf the 381 participants in the Amharic Dementia Tool –Ethiopia, 182 (48%) were at their midlife (40‐64 years of age) and studied for CAIDE, and 200 (52%) were at their late‐life (65‐90 years of age) and studied for ANU‐ADRI. Baseline data was collected on exposure to 6 of the 7 risk factors included in the CAIDE study and to 10 of the 12 risk factors included in the ANU‐ADRI study.ResultsThe mean midlife CAIDE score was 6.97 (SD 2.1), and a quarter of midlife study participants (25.5%) had a score value of 9‐12. The mean late life ANU‐ADRI score was 15.3 (SD 11.9) for males and 14.2 (SD 8.5) for females respectively.ConclusionA quarter of midlife CAIDE study participants of our study have a higher risk of progressing to dementia. The calculated mean ANU‐ADRI score 15.3 (SD 11.9) for our study was lower than the calculated mean ANU‐ADRI score for the Rush Memory and Aging Project 20.3 (SD 11.78), and the Kungsholmen Project 32.38 (SD 7.67), but higher than the calculated mean for the Cardiovascular Health Cognition Study 8.86 (SD 8.77). We strongly propose the need for the establishment of Brain Health Services (BHS) in Ethiopia alongside with the memory clinic to assess risk, risk profiling and communication, and interventions.

Older adults’ awareness of modifiable risk and protective factors for dementia and interest in eHealth interventions for brain health: a comparison between the Netherlands and Germany

BackgroundEvidence on modifiable risk factors for dementia is accumulating rapidly, including e.g. smoking, hypertension, and diabetes. Comparing knowledge of risk factors for dementia and factors associated with knowledge and motivation to learn about dementia risk reduction in different countries may support the design of tailored public health campaigns. We investigated (1) differences in knowledge of risk and protective factors for dementia between the Netherlands and Germany, and interest in (2) information on brain health and (3) eHealth for brain health.Materials and methodsPopulation-based telephone (Germany) or web-based surveys (Netherlands) were conducted among adults aged 60–75 (ntotal=614; Germany: n = 270; Netherlands: n = 344), assessing sociodemographic factors, knowledge of risk and protective factors for dementia, interest in information on brain health and respective eHealth-tools. Correlates of knowledge, interest in information on brain health and eHealth for brain health were analyzed using multivariable regression, by country and in pooled analyses.ResultsIn the total sample (Mage: 67.3 (SD: 4.3) years; %female: 48.6), knowledge of risk and protective factors (sum score assessing number of correctly identified factors) was higher among German participants (M (SD) = 7.6 (2.5) vs. 6.0 (4.3), p < .001). This was confirmed using linear regression analyses, controlling for sociodemographic covariates (b = 1.51; 95% CI: 1.00; 2.01). High education was linked to better knowledge of risk and protective factors (b = 1.61; 95% CI: 0.89; 2.34). Controlling for covariates, interest in information on brain health (OR: 0.05, 95% CI: 0.02; 0.09) and eHealth for brain health (OR: 0.40, 95% CI: 0.25; 0.65) was lower in German participants. Widowed participants were less interested in information on brain health, while widowed and single participants expressed less interest in eHealth for brain health in pooled analyses. Further associations between sociodemographic factors, interest in information on brain health and eHealth for brain health by country were detected.DiscussionEngaging older adults in the design of eHealth interventions and cooperation with trusted sources, e.g., general practitioners, might enhance appreciation of eHealth for brain health. Education on risk and protective factors for dementia is warranted in both countries. However, differences in recruitment and assessment need to be acknowledged.

Tracing the temporal trends of modifiable risk factors in dementia: insights from the English Longitudinal Study of Ageing (2004–2019)

BackgroundDementia's growing impact, especially in ageing societies such as the UK, emphasises the importance of modifiable risk factors as primary prevention targets. Despite this, the temporal progression and the population attributable fraction (PAF) of dementia attributable to these factors remain unclear. This investigation aims to examine the temporal trajectories of the modifiable risk factors for dementia in England from 2004 to 2019. MethodsWe used data from the English Longitudinal Study of Ageing collected between June, 2004, and July, 2019, covering 76 904 participants. We calculated the PAFs for 12 modifiable risk factors, as recommended by the Lancet Commission on dementia prevention, intervention, and care, and the individual weighted PAFs (IW-PAFs) for each risk factor. We analysed temporal trends to understand the changes in the overall PAF and IW-PAF over the study period. FindingsThe overall PAF for dementia showed a decrease from 46·31% in 2004–05 to 43·95% in 2018–19, but this trend was not significant (p=0·226). Hypertension, with an average IW-PAF of 8·67%, has been the primary modifiable determinant of dementia, trailed by obesity (6·42%), social isolation (5·84%), hearing loss (5·02%), depression (4·89%), low education (4·80%), physical inactivity (3·40%), diabetes (2·61%), smoking (2·08%), excessive alcohol consumption (1·22%), air pollution (0·44%), and traumatic brain injury (0·28%). During 2004–19, only IW-PAFs of low education (p=0·001), social isolation (p=0·034), and smoking (p=0·007) showed significant decreasing trends, whereas IW-PAFs of other factors had either stagnated with insignificant changes or, worryingly, climbed upwards. InterpretationThis investigation provides valuable insights into the temporal trends of modifiable risk factors for dementia in England. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them. Notable, PAF was based on a theoretical scenario in which dementia risk can be wholly eliminated by removing risk factors, which should be explained with caution in practice. FundingUK Foreign, Commonwealth and Development Office; National Institute for Health and Care Research (NIHR).

Sleep Quality and Cognitive Decline Across the Adult Age Range: Findings from the Maastricht Aging Study (MAAS).

Sleep disturbances have been linked with cognitive decline and a higher risk of dementia. However, there is a lack of studies with sufficient follow-up duration, a detailed neuropsychological assessment and adequate control of main confounders. To investigate the relation between self-reported sleep quality and cognitive decline over 12 years in cognitively healthy individuals from the general population. We used data from the Maastricht Aging Study (MAAS), a Dutch population-based prospective cohort study of 1,823 community-dwelling adults aged 24 to 82 years at baseline. Cognitive performance was measured at baseline, 6 and 12 years on verbal memory, executive functions, and information processing speed. Sleep quality was assessed at baseline using the sleep subscale score of the 90-item Symptom Checklist (SCL-90). Additional modifiable dementia risk factors were summarized in the LIfestyle for BRAin health (LIBRA) risk score. Weighted linear mixed models tested the association between continuous scores and tertiles of subjective sleep quality and change in cognitive performances over time. Models were adjusted for age, gender, educational level, LIBRA, and use of hypnotic (sleep) medication. Worse sleep quality was associated with faster decline in processing speed. At older age (≥65 years), it was also associated with faster decline in verbal memory. Association were independent of other modifiable dementia risk factors and use of hypnotic medication. Directionally similar but non-significant associations were found between worse sleep quality and executive functions. In this population-based study across the adult age range, poor self-reported sleep was associated with accelerated cognitive decline.

Associations between physical inactivity and dementia prevalence: ecological study using global data

ObjectivesGiven the predicted rise in dementia prevalence around the world, targeting modifiable risk factors (often lifestyle related) is a priority. This work sought to understand the role of physical inactivity (PI) as a modifiable risk factor for dementia. Study designEcological study using globally available ecological data (both 2010 and 2016) from 192 countries. MethodsAge-standardised PI prevalence and dementia prevalence data were accessed from the World Health Organisation (WHO) and the Global Burden of Disease Study. Linear regression was used to assess the relationship between PI and dementia, with stratified analyses used to further explore the impact of sex, WHO region, and World Bank income group on the relationship. ResultsLinear regression showed a positive association between inactivity and dementia prevalence in 2010 (b = 1.38 [95% confidence interval {CI}: 0.04, 2.71] P = 0.044) and 2016 (coefficient = 2.52 [95% CI: 1.07, 3.96] P = 0.0007). Sub-group analyses of sex-specific data showed the strength of the relationship was stronger in men than in women. Rates of both dementia and inactivity rose with increasing world income group. ConclusionsThis analysis of global data indicates the presence of a positive relationship between prevalence of PI and dementia prevalence, which has increased in strength with time, and is stronger in men than in women. This highlights the importance of public health interventions on a global scale to reduce the percentage of the population failing to reach or exceed the recommended physical activity guidelines.

Epidemiology of neurocognitive disorders in adults from urban-marginalized areas: a door-to-door population-based study in Puente Piedra, Lima, Peru.

In Latin America (LA), the prevalence of dementia is expected to triple to 150 million people by 2050. The 2020 Lancet Commission report identified several modifiable dementia risk factors, yet few social and environmental factors, most relevant to vulnerable regions of LA, were highlighted in this report. We sought to assess the epidemiology of neurocognitive disorders (NCD) in Puente Piedra, one of the most socially and economically vulnerable districts of Lima, the capital of Peru. This was a cross-sectional door-to-door observational study that used two-stage household sampling. One young adult (30-59 years) and one older adult (>60 years) per household were enrolled. We collected demographic, clinical, and neurocognitive data. Addenbrooke's Cognitive Examination (young adults) and the RUDAS-PE (older adults) were used, classifying participants as cognitively normal, possible mild NCD, or possible major NCD. We enrolled 247 participants (median age 46 years; 67% female). One-fourth had not completed secondary school and more than 50% completed only secondary school. Most participants were housewives (46%) and 21% did not have health insurance. The overall prevalence of possible NCD was 30% (25.6 and 41.8% among younger adults and older adults, respectively). Among younger adults, those ages 55-59 years more frequently had NCD (70%) compared to younger age ranges. Among older adults, only 3 subjects (4.5%) had major NCD. We found a high frequency of possible NCDs in a socially and economically vulnerable community in Lima, Peru, with younger adults showing levels of NCD higher than expected. Our findings support the need for health systems to incorporate cognitive screenings programs for NCD in younger ages. Future research on NCD would include younger populations, particularly in vulnerable communities.

Artificial intelligence for dementia prevention.

A wide range of modifiable risk factors for dementia have been identified. Considerable debate remains about these risk factors, possible interactions between them or with genetic risk, and causality, and how they can help in clinical trial recruitment and drug development. Artificial intelligence (AI) and machine learning (ML) may refine understanding. ML approaches are being developed in dementia prevention.We discuss exemplar uses and evaluate the current applications and limitations in the dementia prevention field. Risk-profiling tools may help identify high-risk populations for clinical trials; however, their performance needs improvement. New risk-profiling and trial-recruitment tools underpinned by ML models may be effective in reducing costs and improving future trials. ML can inform drug-repurposing efforts and prioritization of disease-modifying therapeutics. ML is not yet widely used but has considerable potential to enhance precision in dementia prevention. Artificial intelligence (AI) is not widely used in the dementia prevention field. Risk-profiling tools are not used in clinical practice. Causal insights are needed to understand risk factors over the lifespan. AI will help personalize risk-management tools for dementia prevention. AI could target specific patient groups that will benefit most for clinical trials.

South Asian, Black and White ethnicity and the effect of potentially modifiable risk factors for dementia: A study in English electronic health records.

We aimed to investigate ethnic differences in the associations of potentially modifiable risk factors with dementia. We used anonymised data from English electronic primary care records for adults aged 65 and older between 1997 and 2018. We used Cox regression to investigate main effects for each risk factor and interaction effects between each risk factor and ethnicity. We included 865,674 people with 8,479,973 person years of follow up. Hypertension, dyslipidaemia, obesity and diabetes were more common in people from minority ethnic groups than White people. The impact of hypertension, obesity, diabetes, low HDL and sleep disorders on dementia risk was increased in South Asian people compared to White people. The impact of hypertension was greater in Black compared to White people. Dementia prevention efforts should be targeted towards people from minority ethnic groups and tailored to risk factors of particular importance.

Change in physical activity and systolic blood pressure trajectories throughout mid-life and the development of dementia in older age: the HUNT study

BackgroundThere is lack of research on combinations of possible modifiable risk factors for dementia in a life-time perspective. Dementia has currently no cure, and therefore new knowledge of preventive factors is important. The purpose of this study is to investigate if changes in physical activity (PA) in combinations with systolic blood pressure (SBP) trajectories in mid to late life are related to development of dementia in older age.MethodsThis prospective cohort study uses data from four consecutive surveys of the HUNT Study, Norway. Dementia was assessed in the HUNT4 70 + sub-study (2017–19). Group-based trajectory modelling identified three SBP trajectories from HUNT1 (1984–86) to HUNT3 (2006–2008): low, middle, and high. Change in PA was categorized into four groups based on high or low PA level at HUNT1 and HUNT3 and were combined with the SBP trajectories resulting in 12 distinct categories. Logistic regression was used to estimate odds ratios (ORs) of dementia.ResultsA total of 8487 participants (55% women, mean age (SD) 44.8 (6.5) years at HUNT1) were included. At HUNT4 70 + , 15.2% had dementia. We observed an overall decrease in OR of dementia across the PA/SBP categories when ranked from low to high PA (OR, 0.96; 95% CI, 0.93 to 1.00, P = 0.04). Within PA groups, a low SBP trajectory was associated with lower OR for dementia, apart from those with decreasing PA. The strongest association was observed for people with stable high PA and low SBP trajectory (OR, 0.38; 95% confidence interval (CI), 0.13 to 1.10 and adjusted risk difference, -8.34 percentage points; 95% CI, -15.32 to -1.36).ConclusionOur findings illustrate the clinical importance of PA and SBP for dementia prevention and that favorable levels of both are associated with reduced occurrence of dementia.

Women with hearing loss show increased dementia risk and brain atrophy.

Hearing loss is a modifiable risk factor for dementia. However, it is unknown whether risk differs by sex. Study 1 used Cox proportional hazard models to examine sex differences in the association between hearing loss (measured by speech-reception thresholds) and dementia risk. Study 2 examined how 2-year changes in hearing is associated with changes in brain volume in auditory-limbic regions. Both studies used UK Biobank data. Women with poor hearing had the greatest risk of dementia, whereas women and men with insufficient hearing were at similar risk. Men with poor hearing did not have increased risk. Presence of social isolation/depressed mood minimally contributed to dementia risk in men and women. Women, but not men, with hearing loss had greater atrophy in auditory and limbic regions compared to normal hearing women and men. Women with hearing loss show greater risk of dementia and brain atrophy, highlighting the need to examine sex-specific mechanisms.

The Rehabilitation Potential of Neurostimulation for Mild Traumatic Brain Injury in Animal and Human Studies.

Neurostimulation carries high therapeutic potential, accompanied by an excellent safety profile. In this review, we argue that an arena in which these tools could provide breakthrough benefits is traumatic brain injury (TBI). TBI is a major health problem worldwide, with the majority of cases identified as mild TBI (mTBI). MTBI is of concern because it is a modifiable risk factor for dementia. A major challenge in studying mTBI is its inherent heterogeneity across a large feature space (e.g., etiology, age of injury, sex, treatment, initial health status, etc.). Parallel lines of research in human and rodent mTBI can be collated to take advantage of the full suite of neuroscience tools, from neuroimaging (electroencephalography: EEG; functional magnetic resonance imaging: fMRI; diffusion tensor imaging: DTI) to biochemical assays. Despite these attractive components and the need for effective treatments, there are at least two major challenges to implementation. First, there is insufficient understanding of how neurostimulation alters neural mechanisms. Second, there is insufficient understanding of how mTBI alters neural function. The goal of this review is to assemble interrelated but disparate areas of research to identify important gaps in knowledge impeding the implementation of neurostimulation.

An online, public health framework supporting behaviour change to reduce dementia risk: interim results from the ISLAND study linking ageing and neurodegenerative disease

BackgroundUnmanaged cardiometabolic health, low physical and cognitive activity, poor diet, obesity, smoking and excessive alcohol consumption are modifiable health risk factors for dementia and public health approaches to dementia prevention have been called for. The Island Study Linking Ageing and Neurodegenerative Disease (ISLAND) is a dementia prevention public health study examining whether improving knowledge about modifiable dementia risk factors supports behaviour changes that reduce future dementia risk.MethodsResidents of Tasmania, Australia, aged 50 + years who joined the 10-year ISLAND study were asked to complete annual online surveys about their knowledge, motivations and behaviours related to modifiable dementia risk. ISLAND included two knowledge-based interventions: a personalised Dementia Risk Profile (DRP) report based on survey responses, and the option to do a 4-week Preventing Dementia Massive Open Online Course (PDMOOC). Longitudinal regression models assessed changes in the number and type of risk factors, with effects moderated by exposures to the DRP report and engagement with the PDMOOC. Knowledge and motivational factors related to dementia risk were examined as mediators of risk behaviour change.ResultsData collected between October 2019 and October 2022 (n = 3038, av. 63.7 years, 71.6% female) showed the mean number of modifiable dementia risk factors per participant (range 0 to 9) reduced from 2.17 (SD 1.24) to 1.66 (SD 1.11). This change was associated with the number of exposures to the DRP report (p = .042) and was stronger for PDMOOC participants (p = .001). The interaction between DRP and PDMOOC exposures yielded a significant improvement in risk scores (p = .004). The effect of PDMOOC engagement on behaviour change was partly mediated by increased knowledge (12%, p = .013). Self-efficacy enhanced the effect of knowledge on behaviour change, while perceived susceptibility to dementia mitigated this relationship.ConclusionsThe ISLAND framework and interventions, a personalised DRP report and the four-week PDMOOC, work independently and synergistically to increase dementia risk knowledge and stimulate health behaviour change for dementia risk reduction. ISLAND offers a feasible and scalable public health approach for redressing the rising prevalence of dementia.

Dementia Prevention and Individual and Socioeconomic Barriers: Avoiding "Lifestyle" Stigma.

Recent decades have seen exponential growth in research on modifiable risk factors for dementia across the lifespan, which has considerably advanced our understanding of brain health. Not all modifiable risk factors are equal, however, in the ease with which they can be addressed. Some individuals and populations face significant barriers to engaging in dementia risk-reduction behaviors. With the evolution of the dementia prevention field, there is a need to broaden our approach from identifying individual risk factors toward addressing inclusive and globally effective intervention strategies. Here, we argue for a greater awareness of individual and socioeconomic barriers to behavior change-oriented dementia risk reduction. We caution against inadvertently increasing health inequities through "lifestyle" stigma and call for an approach that both harnesses current dementia risk-reduction knowledge and effectively addresses barriers to change. A greater focus on more positive aspects of reducing dementia risk, such as enhancing mental well-being, may also be beneficial. Evidence for the negative ramifications of stigma in dementia is discussed as well as overly simplistic media representations of dementia as a disease, which one can "stave off" through lifestyle. Further, we explore potential negative implications for research funding and policy resulting from stigma. More research regarding the experience of stigma in dementia is needed, across diverse cultural and socioeconomic groups.

Associations of Perceived Stress and Psychological Resilience With Cognition and a Modifiable Dementia Risk Score in Middle-Aged Adults.

Psychological stress has been proposed as a risk factor for cognitive impairment and dementia. However, it remains unclear how an individual's stress-coping ability (i.e., psychological resilience) is related to cognition. This cross-sectional study investigated whether perceived stress and psychological resilience were associated with cognition and a modifiable dementia risk score in a large community-based sample of cognitively normal adults. The moderating effect of psychological resilience was also examined. Participants (mean age = 57 ± 7 years) enrolled in the web-based Healthy Brain Project completed the Perceived Stress Scale and the Connor-Davidson Resilience Scale. Domains of attention and working memory were assessed using the Cogstate Brief Battery (n = 1,709), and associative memory was assessed using the Cambridge Neuropsychological Test Automated Battery (n = 1,522). Dementia risk was estimated for 1,913 participants using a modified version of the Cardiovascular Risk Factors, Aging, and Incidence of Dementia dementia risk score, calculated using only readily modifiable dementia risk factors. In separate linear regression analyses adjusted for age, sex, education, and race, greater levels of perceived stress and lower levels of psychological resilience were associated with poorer performance across all cognitive domains, as well as a higher modifiable dementia risk score. Psychological resilience did not moderate the effect of perceived stress on cognition or the dementia risk score. Higher perceived stress and lower resilience were associated with poorer cognition and a greater burden of modifiable dementia risk factors. Intervention studies are required to determine if lowering stress and building resilience can mitigate cognitive deficits and reduce dementia risk.

Longitudinal trajectories of memory among middle-aged and older people with hearing loss: the influence of cochlear implant use on cognitive functioning.

Cochlear implants (CI) are the gold standard intervention for severe to profound hearing loss, a known modifiable risk factor for dementia. However, it remains unknown whether CI use might prevent the age-related cognitive decline. Recent studies are encouraging but are limited, mainly by short follow-up periods and, for ethical reasons, lack of appropriate control groups. Further, as age-related cognitive decline is multifaceted and not linear, other statistical approaches have to be evaluated. Immediate and delayed recall as measures of cognitive function were assessed in 75 newly implanted CI users (mean age 65.41 years ± 9.19) for up to 5 years (mean 4.5 ± 0.5) of CI use and compared to 8,077 subjects of the same age range from two longitudinal cohort studies, the Health and Retirement Study (HRS) and the English Longitudinal Study of Aging (ELSA). Linear and quadratic changes in cognitive trajectories were analyzed in detail using mixed growth models, considering possible confounders. For CI users, the linear time slope showed a significant improvement in the specific domains (recall and delayed recall) over time. The quadratic time slope clearly indicated that the predicted change after CI provision followed an inverted U-shape with a predicted decline 2 years after CI provision. In the hearing-impaired group, a significant decline over time was found, with steeper declines early on and the tendency to flatten out in the follow-up. Cochlear implant use seems to boost cognitive trajectories in the first years after implantation. However, long-term prevention of dementia seems to need far more than restoration of hearing loss.

Evaluation of hearing levels and vestibular function and the impact on cognitive performance in (pre)-symptomatic patients with DFNA9: protocol for a prospective longitudinal study (Rosetta study)

IntroductionUntreated hearing loss is the largest potentially modifiable risk factor for dementia. Additionally, vestibular dysfunction has been put forward as a potential risk factor for accelerated cognitive decline. Patients with...