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dc.contributor.authorSolomon, Alina
dc.contributor.authorStephen, Ruth
dc.contributor.authorAltomare, Daniele
dc.contributor.authorCarrera, Emmanuel
dc.contributor.authorFrisoni, Giovanni B
dc.contributor.authorKulmala, Jenni
dc.contributor.authorMolinuevo, José Luis
dc.contributor.authorNilsson, Peter
dc.contributor.authorNgandu, Tiia
dc.contributor.authorRibaldi, Federica
dc.contributor.authorVellas, Bruno
dc.contributor.authorScheltens, Philip
dc.contributor.authorKivipelto, Miia
dc.contributor.authorEuropean Task Force for Brain Health Services
dc.date.accessioned2021-11-19T00:30:15Z
dc.date.available2021-11-19T00:30:15Z
dc.date.issued2021-10-11
dc.identifier.issn1758-9193
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/330741
dc.description.abstractAlthough 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.
dc.format.mediumElectronic
dc.languageeng
dc.publisherSpringer Science and Business Media LLC
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.subjectEuropean Task Force for Brain Health Services
dc.titleMultidomain 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.
dc.typeArticle
prism.issueIdentifier1
prism.publicationDate2021
prism.publicationNameAlzheimers Res Ther
prism.startingPage171
prism.volume13
dc.identifier.doi10.17863/CAM.78182
dcterms.dateAccepted2021-07-06
rioxxterms.versionofrecord10.1186/s13195-021-00875-8
rioxxterms.versionVoR
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserved
rioxxterms.licenseref.startdate2021-10-11
dc.contributor.orcidAltomare, Daniele [0000-0003-1905-8993]
dc.identifier.eissn1758-9193
rioxxterms.typeJournal Article/Review
cam.issuedOnline2021-10-11


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Attribution 4.0 International
Except where otherwise noted, this item's licence is described as Attribution 4.0 International