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dc.contributor.authorRanson, Janice M
dc.contributor.authorRittman, Timothy
dc.contributor.authorHayat, Shabina
dc.contributor.authorBrayne, Carol
dc.contributor.authorJessen, Frank
dc.contributor.authorBlennow, Kaj
dc.contributor.authorvan Duijn, Cornelia
dc.contributor.authorBarkhof, Frederik
dc.contributor.authorTang, Eugene
dc.contributor.authorMummery, Catherine J
dc.contributor.authorStephan, Blossom C M
dc.contributor.authorAltomare, Daniele
dc.contributor.authorFrisoni, Giovanni B
dc.contributor.authorRibaldi, Federica
dc.contributor.authorMolinuevo, José Luis
dc.contributor.authorScheltens, Philip
dc.contributor.authorLlewellyn, David J
dc.date.accessioned2021-11-22T14:35:32Z
dc.date.available2021-11-22T14:35:32Z
dc.date.issued2021-10-11
dc.identifier.issn1758-9193
dc.identifier.otherPMC8507172
dc.identifier.other34635138
dc.identifier.urihttps://www.repository.cam.ac.uk/handle/1810/330789
dc.description.abstractWe 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.
dc.languageeng
dc.rightsAttribution 4.0 International
dc.rights.urihttps://creativecommons.org/licenses/by/4.0/
dc.sourceessn: 1758-9193
dc.sourcenlmid: 101511643
dc.subjectAging
dc.subjectPrevention
dc.subjectAlzheimer’s disease
dc.subjectDementia
dc.subjectrisk factors
dc.subjectPublic Health
dc.subjectRisk Profiling
dc.subjectBrain Health Services
dc.titleModifiable risk factors for dementia and dementia risk profiling. A user manual for Brain Health Services-part 2 of 6.
dc.typeArticle
dc.date.updated2021-11-22T14:35:32Z
prism.issueIdentifier1
prism.publicationNameAlzheimer's research & therapy
prism.volume13
dc.identifier.doi10.17863/CAM.78232
rioxxterms.versionofrecord10.1186/s13195-021-00895-4
rioxxterms.versionVoR
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by/4.0/
dc.contributor.orcidAltomare, Daniele [0000-0003-1905-8993]
pubs.funder-project-idSwiss National Science Foundation (IZSEZ0_193593, 193593)


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