Modifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services—part 2 of 6
Creators: name: Ranson, Janice M.
name: Rittman, Timothy
name: Hayat, Shabina
name: Brayne, Carol
name: Jessen, Frank
name: Blennow, Kaj
name: Van Duijn, Cornelia
name: Barkhof, Frederik
name: Tang, Eugene
name: Mummery, Catherine J.
name: Stephan, Blossom C. M.
name: Frisoni, Giovanni B.
name: Ribaldi, Federica
name: Molinuevo, José Luis
name: Scheltens, Philip
name: Llewellyn, David J.
name: Abramowicz, Marc
name: Altomare, Daniele
name: Berthier, Marcelo
name: Bieler, Melanie
name: Brioschi, Andrea
name: Carrera, Emmanuel
name: Chételat, Gael
name: Csajka, Chantal
name: Demonet, Jean-François
name: Dodich, Alessandra
name: Dubois, Bruno
name: Garibotto, Valentina
name: Georges, Jean
name: Hurst, Samia
name: Kivipelto, Miia
name: J. Llewellyn, David
name: McWhirter, Laura
name: Milne, Richard
name: Minguillón, Carolina
name: Miniussi, Carlo
name: Nilsson, Peter M.
name: Ritchie, Craig
name: Solomon, Alina
name: Van Der Flier, Wiesje
name: Vellas, Bruno
name: Visser, Leonie
Publisher: name: Apollo - University of Cambridge Repository
Year: 2021
Subjects: Review
Brain Health Services
Alzheimer’s disease
Dementia
Aging
Brain health services
Risk factors
Risk profiling
Prevention
Public health

description: Abstract: We envisage the development of new Brain Health Services to achieve primary and secondary dementia prevention. These services will complement existing memory clinics by targeting cognitively unimpaired individuals, where the focus is on risk profiling and personalized risk reduction interventions rather than diagnosing and treating late-stage disease. In this article, we review key potentially modifiable risk factors and genetic risk factors and discuss assessment of risk factors as well as additional fluid and imaging biomarkers that may enhance risk profiling. We then outline multidomain measures and risk profiling and provide practical guidelines for Brain Health Services, with consideration of outstanding uncertainties and challenges. Users of Brain Health Services should undergo risk profiling tailored to their age, level of risk, and availability of local resources. Initial risk assessment should incorporate a multidomain risk profiling measure. For users aged 39–64, we recommend the Cardiovascular Risk Factors, Aging, and Incidence of Dementia (CAIDE) Dementia Risk Score, whereas for users aged 65 and older, we recommend the Brief Dementia Screening Indicator (BDSI) and the Australian National University Alzheimer’s Disease Risk Index (ANU-ADRI). The initial assessment should also include potentially modifiable risk factors including sociodemographic, lifestyle, and health factors. If resources allow, apolipoprotein E ɛ4 status testing and structural magnetic resonance imaging should be conducted. If this initial assessment indicates a low dementia risk, then low intensity interventions can be implemented. If the user has a high dementia risk, additional investigations should be considered if local resources allow. Common variant polygenic risk of late-onset AD can be tested in middle-aged or older adults. Rare variants should only be investigated in users with a family history of early-onset dementia in a first degree relative. Advanced imaging with 18-fluorodeoxyglucose positron emission tomography (FDG-PET) or amyloid PET may be informative in high risk users to clarify the nature and burden of their underlying pathologies. Cerebrospinal fluid biomarkers are not recommended for this setting, and blood-based biomarkers need further validation before clinical use. As new technologies become available, advances in artificial intelligence are likely to improve our ability to combine diverse data to further enhance risk profiling. Ultimately, Brain Health Services have the potential to reduce the future burden of dementia through risk profiling, risk communication, personalized risk reduction, and cognitive enhancement interventions.