RESUMEN
Dementia stands as the primary reason for disability among older adults. Research indicates that dementia's risk factors are a blend of pathological, lifestyle, and genetic elements, with nearly 40% of the potential risk factors being modifiable. In the absence of a definitive cure, the foremost strategies for managing dementia involve its early detection and measures to decelerate its progression. In this regard, lifestyle multimodal preventive strategies have emerged, guiding precision prevention of dementia. Based on the LETHE clinical trial, a digitized version of the FINGER protocol, we present a novel digital lifestyle intervention framework, which operates within the LETHE Platform, with its primary purpose being the federation and classification of study participant's weekly performance on a wide spectrum of lifestyle behaviors including physical activity, cognitive exercise, diet, smoking, alcohol consumption. The system has been deployed and is currently being used for the explicit purpose of supporting the LETHE clinical trial. The present study reports on quantitative operational metrics of the digital intervention component of the LETHE platform, as well as illustrates initial aggregate results of the intervention with respect to path classification for the first year of the trial.Clinical Relevance-The observed adherence and engagement patterns confirm that structured digital guidance enhances engagement, reducing persistent low adherence, and promoting sustained lifestyle changes. Over 58 weeks, the intervention group maintained a higher proportion of green-path adherence, with nearly 40% of weekly classifications indicating sustained adherence compared to approximately 35% in the control group. The red path (persistent low adherence) was notably lower in the intervention group, representing 16% of weekly classifications compared to 25% in the control group. These findings highlight the efficacy and effectiveness of digital tools in preventive healthcare as well as the clinical relevance of structured digital guidance, emphasizing its potential to reduce disengagement and support long-term lifestyle improvements, ultimately contributing to dementia risk reduction.
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Disfunción Cognitiva , Estilo de Vida , Humanos , Disfunción Cognitiva/prevención & control , Femenino , Masculino , Anciano , Factores de Riesgo , Ejercicio Físico , Demencia/prevención & controlRESUMEN
BACKGROUND: Recent evidence identifies that Positive Mental Health (PMH) factors such as purpose in life, life satisfaction, and emotional well-being, may protect against cognitive decline and dementia. Interventions aiming to enhance PMH ("Positive Psychological Interventions") have also been shown to improve engagement in behaviours protective for brain-health such as good nutrition, smoking cessation, and adherence to hypertension treatment. These positive-psychological interventions (PPIs) - often involving skills such as gratitude, mindfulness, and cognitive restructuring -may be a valuable addition to multi-domain interventions for dementia prevention by bolstering effectiveness and promoting sustained change. However, while evidence suggests the benefits of PPIs for risk factor modification, it remains unclear whether this will improve cognitive outcomes. Therefore, GenWell-BRAVE aims to (1) evaluate the feasibility of prescribing PPI within a multi-domain intergenerational program and (2) estimate relative program efficacy for improving dementia risk profiles of older adults compared to an intergenerational program without PPI. METHOD: GenWell-BRAVE is a sub-study of The INTEGRITY Trial (ACTRN12623000127606) and delivers multi-domain intervention in an intergenerational environment. The pilot will recruit 40 community-dwelling adults aged 65+, with no cognitive impairment, and 40 pre-school children aged 3-6. Four preschools will be cluster-randomised into two arms. The intervention arm will receive the GenWell-BRAVE program, involving physical, social, and cognitive activities whilst building PMH skills through PPI. Participants will receive the GenWell-Brave program at the preschool for 20 weeks, for 2 hours each week. The active control arm will receive a comparable program without PPI. Pre-post questionnaires (at baseline and end of program), qualitative interviews, and systematic behavioural observations will be used to evaluate the program. RESULT: The primary outcome is comparison, between the trial arms, of change in cognitive score (NIH Toolbox Cognition Battery). Additional outcomes include change in PMH (MHC-SF), dementia risk score (LIBRA-2), and emotional regulation (DERS-SF). Feasibility will be evaluated through measures of adherence, retention, implementation fidelity, and acceptability (TFA-Q). CONCLUSION: We anticipate GenWell-BRAVE will show adequate feasibility. We expect to establish the value of PPI in multi-domain intervention, through providing preliminary evidence that a program which co-intervenes on PPI has superior effectiveness in maintaining cognition.
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Demencia , Salud Mental , Salud Pública , Humanos , Demencia/prevención & control , Anciano , Femenino , Masculino , Proyectos Piloto , Disfunción Cognitiva/prevención & controlRESUMEN
BACKGROUND: Risk and protective factors for dementia are well established. Multidomain lifestyle interventions have shown promise in reducing dementia risk, yet their effectiveness often varies across predictors and subgroups. To enhance prevention strategies, it is crucial to tailor interventions more effectively. While research is focusing on single risk factors or sum scores, evidence on more specific risk profiles is lacking. The LIfestyle for BRAin Health (LIBRA) index is a standardized index to calculate dementia risk by integrating modifiable risk and protective factors. We aimed to identify distinct risk profiles for dementia based on the LIBRA factors. METHOD: Using a three-step procedure, a Latent Class Analysis was conducted with n = 106,192 participants of the German National Cohort (NAKO; aged 40-75, mean age 51.4 years, 49.4% women) to identify distinct classes (i.e. risk profiles). Ten LIBRA factors (coronary heart disease, hypertension, diabetes, hypercholesterolemia, depression, obesity, smoking, alcohol consumption, physical inactivity, and low social participation) were used as indicators, followed by analyses of sociodemographic predictors of class membership and class-specific differences in cognitive functioning accounting for classification uncertainty. RESULT: A latent four-class model fitted the data best: The largest class (>60%) represents a low-risk group with low probabilities across all factors. A second class (â¼16%) was defined by cardiometabolic risks (high probabilities of hypercholesterolemia, hypertension and comparatively high values for heart disease and diabetes). A third class (14%) is mainly defined by low social participation but also high smoking rates and comparatively higher physical inactivity, alcohol intake, and depression. The fourth and smallest class (â¼8%) consisted entirely of individuals with obesity and high hypertension probability. Results are preliminary and will be detailed regarding predictors and cognitive functioning at the conference. CONCLUSION: Identifying four distinct dementia risk profiles offers the potential for more targeted prevention strategies. Instead of a one-size-fits-all approach, tailored interventions may yield greater benefits for individuals characterized by a specific high-risk profile. Highlighting the importance of replication and validation in future studies, these findings have the potential to reshape intervention study designs and public health campaigns. Early interventions could be better tailored, ultimately contributing to more effective dementia risk reduction.
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Demencia , Estilo de Vida , Salud Pública , Humanos , Femenino , Masculino , Persona de Mediana Edad , Anciano , Factores de Riesgo , Adulto , Demencia/epidemiología , Demencia/prevención & control , Alemania/epidemiología , Estudios de CohortesRESUMEN
BACKGROUND: The Western Pacific Region (WPR) currently has the third-highest prevalence of dementia globally and is projected to have the highest prevalence by 2050, with >76 million cases. The 2024 Lancet Commission on Dementia suggests that tackling 14 modifiable risk factors could prevent 45% of cases globally1. However, the WPR is socioeconomically and culturally diverse, requiring region-specific strategies to address dementia effectively. METHOD: The population attributable risk (PAR) for nine (out of 14) Lancet Commission factors was calculated for 19 WPR countries using relative risk values from the Lancet Commission and published risk factor prevalence data. The nine factors comprised low education, hearing loss, depression, physical inactivity, diabetes, smoking, hypertension, obesity, and alcohol misuse. Mean PAR values were also calculated for high-income, upper-middle income, and low-middle income WPR countries. RESULTS: PAR values varied across WPR countries (Table 1). The greatest differences were observed for education (18.5%) and obesity (12.0%) and smallest for depression (3.3%) and alcohol (2.1%). In low-middle income countries, the highest mean PAR value was for education (9.75%) (Figure 1). By contrast, the highest values in middle-high and high-income countries were for diabetes (9.21%) and inactivity (6.42%). Smoking had the second highest mean PAR value in all three groups (range: 5.9-9.2). Hearing loss and obesity also ranked highly across all groups. CONCLUSION: Country-specific population-level strategies are urgently needed to effectively reduce dementia risk. Low-middle income countries will benefit most from interventions and policies that improve access to education; middle-high income countries from targeting diabetes, and high-income countries from targeting physical inactivity. Targeting smoking and hearing loss will benefit the entire WPR region. Strategic partnerships between academics, policy makers and industry will ensure appropriate resources are directed to where they will have the most impact. References Livingston G et al. (2024). Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet, Volume 404, Issue 10452, 572-628. Clarke AJ et al. (2024). Risk factors for the neurodegenerative dementias in the Western Pacific region. The Lancet Regional Health - Western Pacific, Volume 50,101051.
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Demencia , Salud Pública , Humanos , Demencia/epidemiología , Demencia/prevención & control , Factores de Riesgo , Prevalencia , Factores SocioeconómicosRESUMEN
BACKGROUND: Modifiable factors account for 45% of current dementia cases, and midlife is a critical time to reduce risks. Little research examines modifiable risks in women, or how risks relate to midlife memory and menopause. This project assessed women's menopause stage, dementia risk, and memory at baseline (BL) and 1-year after (Y1) receiving risk reduction recommendations. METHOD: We analyzed data from women with a family history of dementia at BL (N = 280; age M=53.1; education M=16.7; 88% White; 93% Non-Hispanic) and Y1 (N = 96; age M=55.5; education = 16.6; 88% White; 95% Non-Hispanic). Total risk score was the sum (0/1 absent/present) of: <12 years of education; self-reported history of high cholesterol, diabetes, hypertension, head injury, hearing loss, vision disorder, and depression; current lack of social support, tobacco use, >7 alcoholic beverages per week, and low physical activity; and baseline BMI>30. At Y1, risk scores used baseline plus new diagnoses for history variables, and Center for Epidemiologic Studies of Depression Scale for depression. Menopause stage was assessed via self-report (pre- or post-menopause), and for a subset, Stages of Reproductive Aging Workshop (STRAW) interview. Supplementary analyses added self-reported stress, low cognitive activity, and sleep apnea to risk. Wilcoxon signed ranks examined differences between BL and Y1 risk, and Mann-Whitney tests pre/post menopause differences. Spearman correlation assessed relationship between risk and memory. RESULT: Common BL risks included depression, stress, high cholesterol, and BMI>30. Y1risks were similar, with the addition of high blood pressure. At Y1, women showed lower overall total and supplemented risk scores (Z=-3.98, p < .001; Z=-2.855, p = .004). Greater BL risk scores were marginally related to poorer Y1 verbal learning and memory (r = -0.27, p = .07; r=-0.27, p = .082). Postmenopausal women showed worse BL memory (FNAME: Z=-2.98, p = .003; RAVLT learning: Z=-2.08, p = .038; RAVLT delay: -1.62, p = .11) and marginally worse Y1 memory (FNAME: Z=-1.69, p = .09), though only worse BL learning (-2.10, p = .035) was significantly linked to STRAW post-menopause. CONCLUSION: Vascular and psychosocial risks were common in women, and personalized lifestyle recommendations reduced total risks over one year. Nonetheless, memory differences in postmenopausal women and those with greater baseline dementia risks at midlife suggest need for further research on effective intervention.
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Demencia , Menopausia , Salud Pública , Humanos , Femenino , Persona de Mediana Edad , Demencia/epidemiología , Demencia/prevención & control , Menopausia/psicología , Menopausia/fisiología , Factores de Riesgo , Adulto , Anciano , Depresión/epidemiologíaRESUMEN
BACKGROUND: By 2050, the global population aged 60+ will exceed 2.1 billion, making cognitive health a priority. Previous research highlighted the importance of maintaining a healthy lifestyle for dementia prevention, however to date it is not clear the natural history of multiple health-related behaviors in older populations. This study aimed to identify distinct trajectories of multiple lifestyle habits and their association with dementia risk in a population-base sample of older adults followed for 12 years. METHOD: The InveCe.Ab study (NCT01345110) recruited individuals aged 70-74 in Abbiategrasso (Milan) at baseline (November 2009-January 2011) and followed them after 2, 4, 8, and 12 years. We include participants without dementia at baseline and performing at least two follow-ups (n = 966). A multivariate longitudinal K-means clustering approach grouped participants based on the longitudinal patterns of six lifestyle habits (physical activity, healthy diet, smoking, alcohol use, cognitive activity, and social engagement). Cox proportional hazards models examined the risk of incident dementia across clusters, adjusting for age, sex, education, and ApoE4 status. RESULT: Over the follow-up, 159 participants (16.5%) developed dementia. Cluster analysis identified 3 different clusters (Figure 1). Cluster B (n = 390), characterized by healthier lifestyle patterns, was slightly younger, more educated, predominantly male (table 1). Compared with cluster B, cluster A (n = 531) had a 1.7-fold higher risk of dementia, while the less prevalent cluster C (n = 45) showed a non-significant increase with a wide confidence interval (table 2). CONCLUSION: Among community-dwelling older adults, 40% displayed a pattern of health-related behaviors characterized by consistently higher engagement in multiple leisure-time activities, no smoking, healthy diet, and moderate alcohol consumption. This lifestyle pattern was associated with reduced dementia incidence in late-life, controlling for non-modifiable factors. These findings underscore the importance of multifaceted lifestyle habits in preserving cognitive health among older adults and could inform future community-level preventive initiatives.
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Demencia , Estilo de Vida , Salud Pública , Humanos , Masculino , Femenino , Anciano , Demencia/epidemiología , Demencia/prevención & control , Estudios Longitudinales , Factores de Riesgo , Ejercicio Físico , Consumo de Bebidas AlcohólicasRESUMEN
BACKGROUND: U.S. POINTER was a multisite randomized controlled trial testing the impact of multidomain lifestyle intervention on cognitive function in cognitively unimpaired older adults at risk for cognitive decline and dementia. Inspired by the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), the study aimed to assess the generalizability of FINGER's positive cognitive findings in a diverse and representative U.S. METHOD: The U.S. POINTER interventions were modeled on FINGER, targeting physical activity, nutrition, cognitive/social challenge, and cardiometabolic risk management. Additional goals included (1) delivering the intervention within the community, (2) collaborating with community partners (Alzheimer's Association, community exercise facilities) to ensure/test intervention sustainability, (3) incorporating objective adherence metrics to permit responder analyses, (4) adapting the MIND diet, and (5) introducing a cognitive training program with greater potential for participant adoption. The interventions were designed and implemented using a cognitive-behavioral framework and theory driven self-motivation tools. Intervention fidelity was centrally monitored through data-driven reports and annual site visits. RESULTS: U.S. POINTER interventions included two arms, both targeting multidomain lifestyle modification but differing in intensity and accountability. Following the baseline assessment, participants were randomized to the Structured (STR) or Self-Guided (SG) arm. The STR intervention included 38 group sessions, a structured exercise prescription using community facilities, a nutrition program modeled on the MIND diet, BrainHQ computerized cognitive training, regular cognitive/social challenge, and frequent cardiometabolic health monitoring. The SG intervention included six facilitated group sessions, general health education across all intervention domains, and gift cards to support participants' chosen health behaviors. Adherence was tracked using objective and self-report metrics, with central monitoring to ensure consistent implementation across sites. CONCLUSION: U.S. POINTER expands upon FINGER with modifications aimed at improving intervention uptake and accountability in a U.S. COHORT: The study design will permit extensive analyses of adherence as it relates to cognitive response. Findings could have significant implications for future trials and for public health programs aimed at reducing Alzheimer's disease and dementia risk in older U.S. adults.
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Disfunción Cognitiva , Demencia , Estilo de Vida , Humanos , Disfunción Cognitiva/prevención & control , Anciano , Masculino , Femenino , Ejercicio Físico , Estados Unidos , Demencia/prevención & control , CogniciónRESUMEN
BACKGROUND: The 2024 Lancet Commission report on dementia identified 14 modifiable dementia risk factors. The Norwegian HUNT study uniquely includes data collection of all 14 risk factors in the same individuals throughout adulthood, as well as a study-specific dementia diagnosis. We aimed to evaluate the potential for dementia prevention associated with these 14 risk factors, along with three additional sociodemographic risk factors in this retrospective cohort. METHODS: This retrospective cohort study included data on participants with study-specific diagnosis from the HUNT4 70+ study (2017-19) and was linked with national administrative registries (1960-2018) and earlier HUNT surveys (1984-2008) with data on dementia risk factors at ages 35-92 years. Inverse probability weighting was applied to account for non-response. Logistic regression estimated dementia risk associated with exposure to less education in early adult life (age <45 years), hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol use in midlife (age 45-65 years), and social isolation, air pollution, and vision loss in late life (age >65 years). Midlife occupational physical activity and marital and employment status were added to the Lancet model. The potential for dementia prevention was assessed using population attributable fraction (PAF). FINDINGS: Between Sept 1, 2017, and Feb 28, 2019, 19 403 individuals were invited to participate and 9745 participants (1525 with dementia, 8220 without dementia) were included. 4445 (45·6%) of 9745 participants were male and 5300 (54·4%) were female. The total PAF for the 14 Lancet risk factors was 50·9% (95% CI 37·7-61·4). Including family-related and work-related risk factors increased the PAF to 54·9% (42·3-64·7; p<0·0001). When these factors were added for women, the total PAF increased from 48·0% (95% CI 29·4-61·7) to 52·2% (34·2-65·3; p=0·0090), whereas no significant change was observed in men (56·2% [95% CI 35·5-70·2] to 56·7 [95% CI 36·1-70·6]; p=0·71). INTERPRETATION: Addressing all 14 Lancet risk factors could prevent over half of all dementia cases. Adding factors related to marital and occupational status offers additional preventive potential, particularly among women. FUNDING: The National Institutes of Health and NRC-ATWORK.
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Demencia , Humanos , Demencia/epidemiología , Demencia/prevención & control , Femenino , Masculino , Estudios Retrospectivos , Factores de Riesgo , Anciano , Persona de Mediana Edad , Noruega/epidemiología , Anciano de 80 o más Años , AdultoRESUMEN
Voters approve new effort modeled after the state's long-running cancer research institute.
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Academias e Institutos , Investigación Biomédica , Demencia , Investigadores , Apoyo a la Investigación como Asunto , Humanos , Academias e Institutos/economía , Investigación Biomédica/economía , Demencia/prevención & control , Investigadores/economía , TexasRESUMEN
OBJECTIVE: Various modifiable risk factors have been identified for dementia, but it remains unclear whether these associations and importance vary according to genetic predisposition. METHODS: We included 182,473 dementia-free individuals from United Kingdom (UK) Biobank cohort. We calculated the hazard ratios (HRs) and population-attributable fractions (PAF) of 11 modifiable risk factors (smoking status, drinking status, diet, physical activity, hypertension, diabetes, waist-to-hip ratio, education, depression, social contact, and air pollution) for dementia in general population and across various genetic groups based on APOE genotypes and a weighted polygenic-risk score (PRS). RESULTS: During 12.42-year follow-up, a total of 2,065 incident all-cause dementia (ACD) cases were documented. Low social contact, diabetes, and abdominal obesity were top 3 modifiable risk factors associated with an increased risk of dementia, especially in low APOE risk (ε2ε2 or ε2ε3) group. The HRs associated with low social contact, diabetes, and abdominal obesity were 3.86 (95% CI: 2.08-7.17), 2.18 (95% CI: 1.43-3.32) and 1.29 (95% CI: 0.88-1.89) for dementia in the low APOE risk. The same patterns were also observed in PRS groups. In terms of PAFs, abdominal obesity contributed the most in low genetic risk groups (PAF: 13.68 to 15.73%). In contrast, less education was the largest contributor in high APOE and high PRS groups (PAF: 11.35% [95% CI: 5.32-17.38%] and 11.24% [95% CI: 4.40-18.07%], respectively), followed by hypertension (PAF: 9.09% [95% CI: 2.01-16.17%] and 5.29% [95% CI: -2.72 to 13.29%], respectively). Overall, the total PAF decreased with increasing genetic risk, particularly for metabolic risk factors. INTERPRETATION: Our findings highlight the importance of personalized risk assessments and the development of tailored interventions based on genetic background to prevent dementia more effectively. ANN NEUROL 2025;98:1210-1221.
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Demencia , Predisposición Genética a la Enfermedad , Humanos , Demencia/genética , Demencia/prevención & control , Demencia/epidemiología , Masculino , Femenino , Factores de Riesgo , Predisposición Genética a la Enfermedad/genética , Estudios Prospectivos , Anciano , Persona de Mediana Edad , Apolipoproteínas E/genética , Reino Unido/epidemiología , Estudios de CohortesRESUMEN
BACKGROUND: In the Aspirin in Reducing Events in the Elderly (ASPREE) clinical trial, low-dose aspirin was not associated with survival free of dementia and persistent physical disability (a measure of a healthy lifespan); however, there was a small increased risk of death. Given the long pre-clinical phase of many ageing conditions, we aimed to examine the legacy effect (post-trial) and the longer-term effect of aspirin versus placebo through extended follow-up in the ASPREE-XT observational study. METHODS: Between March 10, 2010, and Dec 24, 2014, 19 114 community-dwelling people in Australia and the USA, aged predominantly 70 years and older, were randomly assigned to low-dose aspirin or placebo for a median of 4·7 years as part of the ASPREE trial. Post-trial observational follow-up continued for a median of 4·3 years (IQR 4·1-4·6). All components of the primary endpoint (ie, incident dementia, persistent physical disability, and death) were adjudicated by masked expert panels. Analyses used Cox proportional hazards models with intention-to-treat. FINDINGS: 15 633 participants (8836 [56·5%] were women, 6797 [43·5%] were men; 981 [6·3%] were not White) were eligible for and agreed to observational follow-up. There was no effect of randomisation to aspirin (34·37 events per 1000 person-years) versus placebo (33·68 per 1000 person-years) on the primary endpoint (hazard ratio [HR] 1·02; 95% CI 0·94-1·11; p=0·63) in the ASPREE-XT period. Similarly, over the period of both ASPREE and ASPREE-XT, no long-term effect of aspirin versus placebo was observed on the composite outcome of death, dementia, or persistent physical disability over almost a decade of follow-up (HR 1·01; 95% CI 0·95-1·08; p=0·65), including no long-term effect on deaths (1·06; 0·99-1·14; p=0·10). No effect of aspirin on incident major haemorrhagic events as compared with placebo was found in ASPREE-XT; however, aspirin was associated with an increased hazard for incident major haemorrhagic events across both ASPREE and ASPREE-XT (1·24; 1·10-1·39). INTERPRETATION: Low-dose aspirin does not appear to be effective in promoting a healthy lifespan in initially healthy, community-dwelling older people. FUNDING: National Institute on Aging and the National Cancer Institute (USA).
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Aspirina , Longevidad , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Aspirina/administración & dosificación , Aspirina/efectos adversos , Aspirina/uso terapéutico , Australia/epidemiología , Demencia/epidemiología , Demencia/prevención & control , Longevidad/efectos de los fármacos , Modelos de Riesgos Proporcionales , Estados Unidos/epidemiología , Estudios Observacionales como AsuntoRESUMEN
The Japan Brain Dock Society, established in 1992, embodies two primary objectives: the detection of unruptured cerebral aneurysms and white matter lesions. In 2018, in response to the needs of an increasingly aging society, the Society broadened its mission to include dementia prevention, adopting the subtitle "A Medical Society for the Prevention of Stroke and Dementia." Although brain dock examinations are not covered by public health insurance and are offered as self-funded services, they have become widely accepted as a form of preventive medicine in Japan. This acceptance is supported by high public health awareness and proactive participation from municipalities and corporations. Among OECD countries, Japan has the highest number of MRI units per capita, ensuring easy access to neuroimaging and facilitating the detection of asymptomatic brain diseases. Consequently, Japan has already amassed a substantial volume of brain dock data. Recent rapid advances in artificial intelligence (AI) are now being applied to the brain dock field, particularly for the early diagnosis of dementia. This article explores how brain dock programs are integrating AI technologies and how they are expected to contribute to the early detection and prevention of dementia.
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Encéfalo , Demencia , Humanos , Inteligencia Artificial , Encéfalo/diagnóstico por imagen , Demencia/prevención & control , Demencia/diagnóstico , Diagnóstico PrecozRESUMEN
INTRODUCTION: This study aimed to identify distinct dementia risk profiles in middle-aged adults with two or more potential dementia risk factors, to inform targeted prevention strategies. METHODS: Cross-sectional analysis of baseline sociodemographic, clinical, and dementia-risk data from the HAPPI MIND trial. Dementia risk was assessed using the Australian National University Alzheimer's Disease Risk Index. Risk profiles were identified using latent class analysis (LCA). RESULTS: Among 403 participants (mean age 56.4 ± 5.7 years, 62.5% female), the median number of dementia risk factors was 5.0; hyperlipidaemia (92.5%), low cognitive activity (72.5%), obesity (57.6%), and hypertension (52.7%) were the most prevalent. Several risk factors showed significant positive correlations. LCA identified three distinct classes: 1-High Cardiometabolic Burden; 2-High Behavioural and Psychosocial Risk; and 3-Low Risk with Healthy Behaviours. DISCUSSION: The identified latent classes highlight heterogeneity of dementia risk profile in midlife. Tailored, multidomain interventions addressing each group's specific needs may improve dementia risk profiles and support broader health outcomes. HIGHLIGHTS: Middle-aged Australians who participated in the HAPPI MIND dementia risk reduction trial had a median of five modifiable risk factors. Significant positive correlations were observed between behavioral and clinical risk factors, such as depression, along with poor diet, social isolation, and smoking. Latent class analysis revealed three distinct profiles: High Cardiometabolic Burden; High Behavioral and Psychosocial Risk; and Low Risk with Healthy Behaviors. The findings suggest there is a need for personalized, multidomain prevention strategies tailored to individual risk profiles in primary care.
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Demencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Australia/epidemiología , Estudios Transversales , Demencia/epidemiología , Demencia/prevención & control , Análisis de Clases Latentes , Factores de Riesgo , Análisis de Datos SecundariosRESUMEN
BACKGROUND: Postoperative cognitive decline (POCD) and dementia are significant risks in older patients after surgery. Dexmedetomidine, an α2-adrenergic agonist, has shown neuroprotective properties in preclinical models, but its role in preventing dementia in postoperative patients remains unexplored. METHODS: We conducted a retrospective cohort study using data from Taiwan's National Health Insurance Research Database from 2012 to 2020. The cohort included 59 194 older patients (≥70 years) who underwent hip fracture surgery. Patients were categorised based on postoperative dexmedetomidine use. The primary outcome was the incidence of dementia, including Alzheimer's disease (ad) and vascular dementia (VaD), assessed using multivariable Cox regression models adjusted for confounders. Competing risk analysis was also performed. RESULTS: Patients administered dexmedetomidine postoperatively had a significantly lower risk of dementia compared to those who did not receive the drug [adjusted hazard ratio (aHR) 0.53, 95% confidence interval (CI) 0.45-0.60]. The reduction in ad risk was more pronounced (aHR 0.38, 95% CI 0.30-0.47) compared to VaD (aHR 0.58, 95% CI 0.49-0.68). These effects persisted after adjusting for confounders, including age, sex, comorbidities, and socioeconomic factors. CONCLUSIONS: This study is the first to provide clinical evidence supporting dexmedetomidine's potential in reducing dementia risk, particularly ad, in older postoperative patients. Further randomised trials are needed to confirm these findings and determine the optimal use of dexmedetomidine in postoperative care. If validated, dexmedetomidine could become a critical strategy in reducing the long-term cognitive burden in ageing populations.
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Agonistas de Receptores Adrenérgicos alfa 2 , Demencia , Dexmedetomidina , Fracturas de Cadera , Complicaciones Cognitivas Postoperatorias , Complicaciones Posoperatorias , Humanos , Dexmedetomidina/uso terapéutico , Anciano , Masculino , Femenino , Estudios Retrospectivos , Anciano de 80 o más Años , Taiwán/epidemiología , Demencia/epidemiología , Demencia/prevención & control , Demencia/diagnóstico , Demencia/etiología , Factores de Riesgo , Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Agonistas de Receptores Adrenérgicos alfa 2/administración & dosificación , Incidencia , Fracturas de Cadera/cirugía , Medición de Riesgo , Complicaciones Cognitivas Postoperatorias/prevención & control , Complicaciones Cognitivas Postoperatorias/epidemiología , Complicaciones Cognitivas Postoperatorias/diagnóstico , Bases de Datos Factuales , Factores de Edad , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiologíaRESUMEN
OBJECTIVES: Approximately 20â¯% of the UK population aged ≥â¯65 have Mild Cognitive Impairment (MCI), with 1 in 10 progressing to dementia. Fourteen modifiable risk factors, encompassing: less education, hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, excessive alcohol consumption, social isolation, air pollution, and visual loss account for around 45â¯% of worldwide dementias. There is growing consensus that interventions targeting risk behaviours may prevent or delay dementia and reduce the likelihood that MCI will progress to dementia. Healthcare professionals, especially in memory assessment services, play a crucial role in communicating dementia risk. This study explores the placement, form, and function of discussions about modifiable lifestyle dementia risks during consultations in which individuals are being diagnosed with MCI. METHODS: The data were 43 MCI diagnostic feedback consultations, video-recorded in nine UK-based memory assessment services from 2014 to 2015. All data are British English. Conversation analytic methods were used to identify recurrent interactional practices related to lifestyle risk-talk. RESULTS: Clinicians lead risk-talk discussions throughout the consultations. Three activities of risk-talk were identified: (1) risk identification - clinicians elicit the nature of patient's risk behaviors; (2) risk categorisation - informing patients about the risks of dementia; and (3) risk management - clinicians recommend strategies for dementia risk reduction. Clinicians tailor these discussions to each patient, focusing on their specific risk factors, or provide generic advice in the absence of identifiable risks. CONCLUSIONS: This study broadens the understanding of risk-talk activities and how they are delivered interactionally. It demonstrates how healthcare professionals skillfully integrate risk-talk throughout consultations while managing the inherent uncertainty surrounding health risks. It highlights the moral, interactional, and social delicacy of these exchanges. PRACTICAL IMPLICATIONS: Tailored messaging about lifestyle risks and modifications can be delicately incorporated throughout healthcare consultations, providing strategies for dementia risk reduction.
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Disfunción Cognitiva , Comunicación , Demencia , Estilo de Vida , Relaciones Médico-Paciente , Derivación y Consulta , Humanos , Disfunción Cognitiva/diagnóstico , Disfunción Cognitiva/psicología , Anciano , Femenino , Masculino , Demencia/prevención & control , Factores de Riesgo , Reino Unido , Anciano de 80 o más Años , Medición de RiesgoRESUMEN
INTRODUCTION: This study updates the population attributable fractions (PAFs) for 12 dementia risk factors in China, categorized as early life (education), midlife (obesity, hypertension, hearing loss, alcohol abuse, and traumatic brain injury), and later life (smoking, depression, social isolation, physical inactivity, air pollution, and diabetes). METHOD: Relative risks and communality were calculated from literature. The prevalence was estimated using the latest Chinese Health and Retirement Longitudinal Study (CHARLS); other nationwide surveys substitute for lacking CHARLS factors. RESULTS: The 12 risk factors account for 60.3% of dementia cases in China, including 14.0% in early life, 8.8% in midlife, and 37.5% in later life. Some factors (e.g., alcohol abuse, depression) showed wide confidence intervals indicating lack of evidence. DISCUSSION: This study highlights the potential for dementia prevention in China, but more evidence is needed to estimate PAFs for specific risk factors (e.g., midlife factors). HIGHLIGHTS: We used the most recent and nationally representative data to calculate population attributable fractions (PAFs) for dementia risk factors in China. In China, 60.3% of dementia cases were attributed to the 12 modifiable risk factors. Education was estimated to contribute 14.0% of dementia cases, and 37.5% was attributed to later-life lifestyle and health factors in China. It is necessary to consider incorporating China-specific factors and updating the PAF calculation method.
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Demencia , Conducta de Reducción del Riesgo , Factores de Riesgo , Demencia/epidemiología , Demencia/prevención & control , China/epidemiología , Prevalencia , Estudios Longitudinales , Encuestas y Cuestionarios/estadística & datos numéricos , Persona de Mediana Edad , Anciano , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Sacubitril/valsartan, an angiotensin receptor neprilysin inhibitor (ARNI), has become a cornerstone therapy for heart failure (HF) since its approval over a decade ago. However, concerns have emerged about potential cognitive risks, as neprilysin inhibition may contribute to the accumulation of amyloid-beta (Aß) in the brain-a hallmark of Alzheimer's disease, the most common form of dementia. OBJECTIVE: Given the already elevated risk of dementia in patients with HF and the widespread use of sacubitril/valsartan, this meta-analysis aimed to evaluate whether its use is associated with an increased risk of all-cause dementia in HF populations. METHODS: A systematic literature search was conducted on 23 March 2025, to identify eligible studies comparing the risk of dementia in patients receiving sacubitril/valsartan versus those receiving placebo, no treatment, or other HF medications. Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled using a random-effects model. RESULTS: Six studies, comprising 101,074 participants and published between 2017 and 2024, were included in the meta-analysis. Treatment with sacubitril/valsartan was associated with a significant 15% reduction in the risk of all-cause dementia (RR = 0.85; 95% CI: 0.74-0.98; p = 0.02). Leave-one-out sensitivity and subgroup analyses confirmed the robustness of the findings. CONCLUSIONS: This meta-analysis suggests that sacubitril/valsartan is associated with a reduced risk of dementia in patients with HF, helping to alleviate previous concerns about potential cognitive adverse effects. These findings support the continued use of sacubitril/valsartan as a foundational therapy in this high-risk population.
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Aminobutiratos , Antagonistas de Receptores de Angiotensina , Compuestos de Bifenilo , Demencia , Insuficiencia Cardíaca , Valsartán , Humanos , Insuficiencia Cardíaca/tratamiento farmacológico , Insuficiencia Cardíaca/complicaciones , Compuestos de Bifenilo/uso terapéutico , Compuestos de Bifenilo/efectos adversos , Combinación de Medicamentos , Aminobutiratos/uso terapéutico , Aminobutiratos/efectos adversos , Valsartán/uso terapéutico , Valsartán/efectos adversos , Demencia/prevención & control , Antagonistas de Receptores de Angiotensina/uso terapéutico , Antagonistas de Receptores de Angiotensina/efectos adversos , Neprilisina/antagonistas & inhibidoresRESUMEN
Having osteoporosis significantly increases the risk of having dementia, particularly when combined with smoking and diabetes, but regular exercise can reduce this risk. Implementing a national health screening program is crucial for early detection of these modifiable risk factors and prevention of dementia in aging populations. PURPOSE: To assess osteoporosis as a risk factor for dementia in the general population using nationwide dataset. METHODS: This study included 261,343 women aged 66 years who participated in the National Screening Program for Transitional Ages for Koreans and underwent their first medical checkup between January 2013 and December 2016. Participants were categorized into three groups based on bone mineral density (BMD): normal BMD, osteopenia, and osteoporosis. We investigated participants' demographic characteristics and chronic comorbidities that could affect dementia incidence. The hazard ratios (HRs) for dementia in individuals with osteoporosis and osteopenia were calculated and adjusted based on several risk factors. RESULTS: Despite adjusting for demographic characteristics and chronic comorbidities, the risk of dementia was 1.18-fold higher in the osteoporosis group than in the normal BMD group. Regarding Alzheimer's disease and vascular dementia, the risk was 1.18- and 1.25-fold higher in the osteoporosis group, respectively. Notably, participants with osteoporosis who smoked had a 1.82-fold higher HR than that of nonsmoking participants with normal BMD; participants with diabetes mellitus (DM) had a 1.92-fold higher HR than that of participants with normal BMD without DM. The HR for participants with osteoporosis who exercised regularly was 1.00, whereas it was 1.18 for those who did not exercise. CONCLUSION: This population-based cohort study demonstrates that having osteoporosis significantly increases dementia risk, which is amplified by smoking and diabetes but reduced by regular exercise.
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Demencia , Ejercicio Físico , Osteoporosis Posmenopáusica , Fumar , Humanos , Femenino , Anciano , Ejercicio Físico/fisiología , Demencia/epidemiología , Demencia/etiología , Demencia/prevención & control , Demencia/fisiopatología , Factores de Riesgo , Densidad Ósea/fisiología , Fumar/epidemiología , Fumar/efectos adversos , Osteoporosis Posmenopáusica/epidemiología , Osteoporosis Posmenopáusica/fisiopatología , Osteoporosis Posmenopáusica/complicaciones , República de Corea/epidemiología , Incidencia , Medición de Riesgo/métodos , Diabetes Mellitus/epidemiología , Diabetes Mellitus/fisiopatología , Enfermedades Óseas Metabólicas/epidemiología , Enfermedades Óseas Metabólicas/fisiopatología , Enfermedades Óseas Metabólicas/complicaciones , Estudios de Cohortes , Comorbilidad , Anciano de 80 o más AñosRESUMEN
BACKGROUND: Polyphenols have been associated with brain health, but their impact on humans, especially in combinations, has been less explored. OBJECTIVE: This study aimed to investigate the association between dietary polyphenol patterns (PPs), dementia incidence, and cognitive changes over time in the elderly. METHODS: A total of 1041 individuals without dementia (mean age 73.1, standard deviation [SD] = 4.9) were followed longitudinally. Participants provided baseline dietary data via a validated food frequency questionnaire. Dementia was diagnosed through clinical and neuropsychological evaluations, and cognitive performance was assessed using a neuropsychological battery. Principal component analysis of 11 polyphenol classes identified 3 distinct PPs. Generalized Estimating Equations assessed cognitive decline rates, whereas Cox regression models evaluated dementia risk, adjusting for covariates such as age, sex, education, energy intake, physical activity, smoking, alcohol consumption, hypertension, diabetes mellitus, stroke history, coronary disease, and baseline mild cognitive impairment. RESULTS: Over the follow-up period of 3.0 y (SD = 0.8), 62 participants developed dementia. The PPs explained up to 77.4% of the variance. The third polyphenol pattern (PP3), characterized by lignans, flavonols, and isoflavonoids, predominantly provided by cruciferous vegetables, pulses, and leafy vegetables, was associated with a slower rate of cognitive decline. A 1-unit increase in PP3 intake was associated with 0.9% of a SD less decline per year in the global cognitive score (ß = 0.009; 95% confidence interval [CI]: 0.000, 0.017, P = 0.041). For incident dementia, participants in the third quartile of PP3 had a 71% lower risk than those in the first quartile (hazard ratio [HR]: 0.29; 95% CI: 0.12, 0.67, P-trend = 0.018). No significant associations were observed for the other PPs. CONCLUSIONS: A PP high in lignans, flavonols, and isoflavonoids was associated with a reduced risk of dementia and cognitive decline in elderly Greeks. These findings offered encouraging evidence for combined polyphenol intake, suggesting further validation in different population samples.
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Disfunción Cognitiva , Demencia , Dieta , Polifenoles , Humanos , Demencia/epidemiología , Demencia/prevención & control , Polifenoles/administración & dosificación , Anciano , Masculino , Femenino , Disfunción Cognitiva/prevención & control , Disfunción Cognitiva/epidemiología , Análisis de Componente Principal , Estudios Longitudinales , Factores de Riesgo , Anciano de 80 o más AñosRESUMEN
INTRODUCTION: Tumor necrosis factor-alpha inhibitors (TNFi), commonly prescribed for rheumatoid arthritis (RA), have been studied for their potential association with dementia risk. However, previous findings are inconclusive. This study aimed to evaluate the impact of TNFi use on dementia in patients with RA. METHODS: A systematical search of MEDLINE, Embase, and CENTRAL databases from inception to October 1, 2023, was conducted. Longitudinal comparative studies investigating the association between TNFi use and risk of dementia in patients with RA were included. Pooled adjusted risks of dementia and meta-analysis were conducted to synthesize relative estimates with 95% confidence intervals (CIs). RESULTS: Seven observational studies involving 633,089 patients with RA were included, of which 6 were included in the meta-analysis. The pooled meta-analysis comparing the risk of dementia (hazard ratio [HR] = 0.77, 95% CI: 0.64-0.93) and Alzheimer's disease (AD) (odds ratio = 0.31, 95% CI: 0.23-0.43) between TNFi users and non-users showed a significant association. However, the pooled HR for AD risk was inconsistent. Also, the subgroup analyses indicated that TNFi use was associated with a decreased dementia risk in older adult patients with a mean age of ≥65 years at enrollment (HR = 0.86, 95% CI: 0.80-0.92) and TNFi new users (HR = 0.86, 95% CI: 0.80-0.92). CONCLUSIONS: Systematic review and meta-analysis suggest that lowering the level of systemic TNF-alpha by using TNFi could lower the risk of dementia. However, given the retrospective nature of the included studies, further prospective studies are needed to evaluate the role of TNFi in dementia onset.