Dementia Prevention Guidelines Should Explicitly Mention Deprivation

Daly, Timothy

doi:10.1080/21507740.2023.2225461

Cited by 10 publications

(2 citation statements)

References 24 publications

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“…2) For enhanced consistency and comparability in analyses between cohorts, we did not include potentially relevant covariates in statistical models unless they were universally available. Although we included education level, which is an important marker of socioeconomic status, we did not include other markers of social deprivation that may be causally associated with dementia 47 . Similarly, genetic risk for dementia, often approximated using APOE ε4 status, was not adjusted for.…”

Section: Discussionmentioning

confidence: 99%

Frailty trajectories preceding dementia: an individual-level analysis of four cohort studies in the United States and United Kingdom

Ward,

Flint,

Littlejohns

et al. 2024

Preprint

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Frailty may represent a modifiable risk factor for dementia, but the direction of that association remains uncertain. We investigated frailty trajectories in the years preceding dementia onset using data from 23,672 participants (242,760 person-years of follow-up, 2,906 cases of incident dementia) across four cohort studies in the United States and United Kingdom. Bayesian non-linear models revealed accelerations in frailty trajectories 4–9 years before incident dementia. Among participants whose time between frailty measurement and incident dementia exceeded that prodromal period, frailty remained positively associated with dementia risk (adjusted hazard ratios ranged from 1.20 [95% confidence interval, CI = 1.15–1.26] to 1.43 [95% CI = 1.14–1.81]). This observational evidence suggests that frailty increases dementia risk independently of any reverse causality. These findings indicate that frailty measurements can be used to identify high-risk population groups for preferential enrolment into clinical trials for dementia prevention and treatment. Frailty itself may represent a useful upstream target for behavioural and societal approaches to dementia prevention.

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Section: Discussionmentioning

confidence: 99%

Frailty trajectories preceding dementia: an individual-level analysis of four cohort studies in the United States and United Kingdom

Ward,

Flint,

Littlejohns

et al. 2024

Preprint

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“… 86 Many dementia risk factors are associated with socioeconomic disadvantage or social inequality, so efforts to address structural societal factors are required alongside prevention efforts which target lifestyle change at an individual level. 87 , 88 …”

Section: Introductionmentioning

confidence: 99%

Experimental laboratory models as tools for understanding modifiable dementia risk

Sinclair,

Canty,

Ziebell

et al. 2024

Alzheimer's & Dementia

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Experimental laboratory research has an important role to play in dementia prevention. Mechanisms underlying modifiable risk factors for dementia are promising targets for dementia prevention but are difficult to investigate in human populations due to technological constraints and confounds. Therefore, controlled laboratory experiments in models such as transgenic rodents, invertebrates and in vitro cultured cells are increasingly used to investigate dementia risk factors and test strategies which target them to prevent dementia. This review provides an overview of experimental research into 15 established and putative modifiable dementia risk factors: less early‐life education, hearing loss, depression, social isolation, life stress, hypertension, obesity, diabetes, physical inactivity, heavy alcohol use, smoking, air pollution, anesthetic exposure, traumatic brain injury, and disordered sleep. It explores how experimental models have been, and can be, used to address questions about modifiable dementia risk and prevention that cannot readily be addressed in human studies.Highlights Modifiable dementia risk factors are promising targets for dementia prevention. Interrogation of mechanisms underlying dementia risk is difficult in human populations. Studies using diverse experimental models are revealing modifiable dementia risk mechanisms. We review experimental research into 15 modifiable dementia risk factors. Laboratory science can contribute uniquely to dementia prevention.

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Frailty Trajectories Preceding Dementia in the US and UK

Ward,

Flint,

Littlejohns

et al. 2024

JAMA Neurol

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ImportanceAn accessible marker of both biological age and dementia risk is crucial to advancing dementia prevention and treatment strategies. Although frailty is a candidate for that role, the nature of the relationship between frailty and dementia is not well understood.ObjectiveTo clarify the temporal relationship between frailty and incident dementia by investigating frailty trajectories in the years preceding dementia onset.Design, Setting, and ParticipantsParticipant data came from 4 prospective cohort studies: the English Longitudinal Study of Ageing, the Health and Retirement Study, the Rush Memory and Aging Project, and the National Alzheimer Coordinating Center. Data were collected between 1997 and 2024 and were analyzed from July 2023 to August 2024. The settings were retirement communities, national-level surveys, and a multiclinic-based cohort. Included individuals were 60 years or older and without cognitive impairment at baseline. Included individuals also had data on age, sex, education level, and ethnicity and a frailty index score calculated at baseline.ExposureFrailty was the main exposure, with participants’ degrees of frailty quantified using retrospectively calculated frailty index scores.Main Outcomes and MeasuresIncident all-cause dementia ascertained through physician-derived diagnoses, self- and informant-report, and estimated classifications based on combinations of cognitive tests.ResultsThe participant number before exclusions was 87 737. After exclusions, data from 29 849 participants (mean [SD] age, 71.6 [7.7] years; 18 369 female [62%]; 257 963 person-years of follow-up; 3154 cases of incident dementia) were analyzed. Bayesian generalized linear mixed regression models revealed accelerations in frailty trajectories 4 to 9 years before incident dementia. Overall, frailty was positively associated with dementia risk (adjusted hazard ratios [aHRs] ranged from 1.18; 95% CI, 1.13-1.24 to 1.73; 95% CI, 1.57-1.92). This association held among participants whose time between frailty measurement and incident dementia exceeded the identified acceleration period (aHRs ranged from 1.18; 95% CI, 1.12-1.23 to 1.43; 95% CI, 1.14-1.80).Conclusions and RelevanceThese findings suggest that frailty measurements may be used to identify high-risk population groups for preferential enrolment into clinical trials for dementia prevention and treatment. Frailty itself may represent a useful upstream target for behavioral and societal approaches to dementia prevention.

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Dementia Prevention Guidelines Should Explicitly Mention Deprivation

Cited by 10 publications

References 24 publications

Frailty trajectories preceding dementia: an individual-level analysis of four cohort studies in the United States and United Kingdom

Frailty trajectories preceding dementia: an individual-level analysis of four cohort studies in the United States and United Kingdom

Experimental laboratory models as tools for understanding modifiable dementia risk

Frailty Trajectories Preceding Dementia in the US and UK

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