Multidomain interventions : state-of-the-art and future directions for protocols to implement precision dementia risk reduction. A user manual for Brain Health Services—part 4 of 6
on behalf of the European Task Force for Brain Health Services; Solomon, Alina; Stephen, Ruth; Altomare, Daniele; Carrera, Emmanuel; Frisoni, Giovanni B.; Kulmala, Jenni; Molinuevo, José Luis; Nilsson, Peter; Ngandu, Tiia; Ribaldi, Federica; Vellas, Bruno; Scheltens, Philip; Kivipelto, Miia; Abramowicz, Marc; Barkhof, Frederik; Berthier, Marcelo; Bieler, Melanie; Blennow, Kaj; Brayne, Carol; Brioschi, Andrea; Chételat, Gael; Csajka, Chantal; Demonet, Jean François; Dodich, Alessandra; Dubois, Bruno; Garibotto, Valentina; Georges, Jean; Hurst, Samia; Jessen, Frank; Llewellyn, David; Mcwhirter, Laura; Milne, Richard; Minguillón, Carolina; Miniussi, Carlo; Nilsson, Peter M.; Ranson, Janice; Ritchie, Craig; Solomon, Alina; van Duijn, Cornelia; van der Flier, Wiesje; Visser, Leonie (2021)
on behalf of the European Task Force for Brain Health Services
Solomon, Alina
Stephen, Ruth
Altomare, Daniele
Carrera, Emmanuel
Frisoni, Giovanni B.
Kulmala, Jenni
Molinuevo, José Luis
Nilsson, Peter
Ngandu, Tiia
Ribaldi, Federica
Vellas, Bruno
Scheltens, Philip
Kivipelto, Miia
Abramowicz, Marc
Barkhof, Frederik
Berthier, Marcelo
Bieler, Melanie
Blennow, Kaj
Brayne, Carol
Brioschi, Andrea
Chételat, Gael
Csajka, Chantal
Demonet, Jean François
Dodich, Alessandra
Dubois, Bruno
Garibotto, Valentina
Georges, Jean
Hurst, Samia
Jessen, Frank
Llewellyn, David
Mcwhirter, Laura
Milne, Richard
Minguillón, Carolina
Miniussi, Carlo
Nilsson, Peter M.
Ranson, Janice
Ritchie, Craig
Solomon, Alina
van Duijn, Cornelia
van der Flier, Wiesje
Visser, Leonie
2021
171
Julkaisun pysyvä osoite on
https://urn.fi/URN:NBN:fi:tuni-202111258666
https://urn.fi/URN:NBN:fi:tuni-202111258666
Kuvaus
Peer reviewed
Tiivistelmä
Although prevention of dementia and late-life cognitive decline is a major public health priority, there are currently no generally established prevention strategies or operational models for implementing such strategies into practice. This article is a narrative review of available evidence from multidomain dementia prevention trials targeting several risk factors and disease mechanisms simultaneously, in individuals without dementia at baseline. Based on the findings, we formulate recommendations for implementing precision risk reduction strategies into new services called Brain Health Services. A literature search was conducted using medical databases (MEDLINE via PubMed and SCOPUS) to select relevant studies: non-pharmacological multidomain interventions (i.e., combining two or more intervention domains), target population including individuals without dementia, and primary outcomes including cognitive/functional performance changes and/or incident cognitive impairment or dementia. Further literature searches covered the following topics: sub-group analyses assessing potential modifiers for the intervention effect on cognition in the multidomain prevention trials, dementia risk scores used as surrogate outcomes in multidomain prevention trials, dementia risk scores in relation to brain pathology markers, and cardiovascular risk scores in relation to dementia. Multidomain intervention studies conducted so far appear to have mixed results and substantial variability in target populations, format and intensity of interventions, choice of control conditions, and outcome measures. Most trials were conducted in high-income countries. The differences in design between the larger, longer-term trials that met vs. did not meet their primary outcomes suggest that multidomain intervention effectiveness may be dependent on a precision prevention approach, i.e., successfully identifying the at-risk groups who are most likely to benefit. One such successful trial has already developed an operational model for implementing the intervention into practice. Evidence on the efficacy of risk reduction interventions is promising, but not yet conclusive. More long-term multidomain randomized controlled trials are needed to fill the current evidence gaps, especially concerning low- and middle-income countries and integration of dementia prevention with existing cerebrovascular prevention programs. A precision risk reduction approach may be most effective for dementia prevention. Such an approach could be implemented in Brain Health Services.
Kokoelmat
- TUNICRIS-julkaisut [19236]