Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies

Objective: Dementia has a multifactorial etiology, but the importance of individual health and lifestyle related risk factors is often uncertain or based on few studies. The goal of this paper is to identify the major modifiable risk factors for dementia as a first step in developing an effective preventive strategy and promoting healthy late life cognitive functioning.

Methods: A mixed-method approach combined findings from a systematic literature review and a Delphi consensus study. The literature search was conducted in PubMed and updated an earlier review by the United States National Institutes of Health from 2010. We reviewed the available evidence from observational epidemiological studies. The online Delphi study asked eight international experts to rank and weigh each risk factor for its importance for dementia prevention.

Results: Out of 3127 abstracts, 291 were included in the review. There was good agreement between modifiable risk factors identified in the literature review and risk factors named spontaneously by experts. After triangulation of both methods and re-weighting by experts, strongest support was found for depression, (midlife) hypertension, physical inactivity, diabetes, (midlife) obesity, hyperlipidemia, and smoking, while more research is needed for coronary heart disease, renal dysfunction, diet, and cognitive activity.

Conclusions: Findings provide good support for several somatic and lifestyle factors and will be used to inform the design of a new multicenter trial into dementia prevention.

International Journal of Geriatric Psychiatry. Volume 30, Issue 3, pages 234–246

Enhancing healthcare assistants’ dementia role

One in four inpatients in general hospitals has dementia care needs, and faces worse outcomes if these needs go unrecognised. One large NHS trust has introduced an enhanced dementia care role for healthcare assistants, offering training in how to recognise dementia and providing oneto-one support. This article outlines the content of the training and its impact on practice and teamwork at the trust.

Goodwin C (2015) Enhancing healthcare assistants’ dementia role. Nursing Times; 111: 9, 21-23.

Diabetes and depression linked to progression from mild cognitive impairment to dementia

Objective: Public health campaigns encouraging early help seeking have increased rates of mild cognitive impairment (MCI) diagnosis in Western countries, but we know little about how to treat or predict dementia outcomes in persons with the condition.

Method: The authors searched electronic databases and references for longitudinal studies reporting potentially modifiable risk factors for incident dementia after MCI. Two authors independently evaluated study quality using a checklist. Meta-analyses were conducted of three or more studies.

Results: There were 76 eligible articles. Diabetes and prediabetes increased risk of conversion from amnestic MCI to Alzheimer’s dementia; risk in treated versus untreated diabetes was lower in one study. Diabetes was also associated with increased risk of conversion from any-type or nonamnestic MCI to all-cause dementia. Metabolic syndrome and prediabetes predicted all-cause dementia in people with amnestic and any-type MCI, respectively. Mediterranean diet decreased the risk of conversion to Alzheimer’s dementia. The presence of neuropsychiatric symptoms or lower serum folate levels predicted conversion from any-type MCI to all-cause dementia, but less formal education did not. Depressive symptoms predicted conversion from any-type MCI to allcause dementia in epidemiological but not clinical studies.

Conclusions: Diabetes increased the risk of conversion to dementia. Other prognostic factors that are potentially manageable are prediabetes and the metabolic syndrome, neuropsychiatric symptoms, and low dietary folate. Dietary interventions and interventions to reduce neuropsychiatric symptoms, including depression, that increase risk of conversion to dementia may decrease new incidence of dementia.

Reference: Cooper, C et al. Modifiable Predictors of Dementia in Mild Cognitive Impairment: A Systematic Review and Meta-Analysis. American Journal of Psychiatry, 2015; appi.ajp.2014.1 DOI: 10.1176/appi.ajp.2014.14070878

What should we know about dementia in the 21st Century? A Delphi consensus study

This study delved into the underlying consensus among English-speaking dementia experts concerning contemporary knowledge about dementia. Delphi experts have identified 36 statements about dementia deemed to be “essential” to understanding the condition. These statements are primarily about care for people with dementia and their carers, but also relate to dementia characteristics, symptoms and progression, diagnosis and assessment, and treatment and prevention.

Annear, MJ. Toye, C. [and] McInerney, F. [et al] (2015). What should we know about dementia in the 21st Century? A Delphi consensus study. BMC Geriatrics, February 6th2015, Vol.15(1), 5. pp.1- 26.