Reducing the Risk or Delaying the Onset of Dementia

The population on the island of Ireland is ageing. Given that ageing is the biggest risk factor for dementia; both jurisdictions face a substantial rise in the number of people with dementia in the coming decades. This puts dementia risk reduction at the heart of policy in NI and ROI and makes continued research and awareness in the area a key priority. While age, gender and genetics play a role in the development of dementia, an increasing body of evidence has emerged in the international literature to highlight the role of modifiable risk and protective factors in exacerbating or reducing an individual’s risk of developing dementia in later life. In this section you can expect to find the growing number of papers exploring these issues in an Irish context.

Mapping longitudinal studies to risk factors in an ontology for dementia.

Roantree, M., O’Donoghue, J., O’Kelly, N., Pierce, M., Irving, K., Van Boxtel, M. and Köhler, S.
Health informatics journal
2015
In this paper by Roantree et al. (2015), members of the Innovative Midlife Intervention for Dementia Deterrence (In-MINDD) project discuss the difficulty of matching new disease ontologies to old datasets.
In particular they describe the development of a dementia risk ontology and the further development of an automated mapping system based on stemming and comparison at phrase level. The project successfully maps this ontology of dementia risk to data within the Maastricht Aging Study.

Promoting modifiable risk factors for dementia: is there a role for general practice?

O’Donnell, C.A., Manera, V., Köhler, S. and Irving, K.
British Journal of General Practice.
2015
This paper by O’Donnell et al. (2015) discusses the context and rationale for the Innovative Midlife Intervention for Dementia Deterrence (In-MINDD) project.
The authors discuss the increasing recognition of factors that exacerbate or reduce the risk of developing dementia and the potential to modify these risks among people in mid-life. They point to evidence that the public remains not yet fully aware of the links between health related behaviour and dementia. This project set in France, Netherlands, Ireland and Scotland has already identified and ranked risk factors and developed an online profiler that results in the production of a personalised Lifestyle for Brain Health (LIBRA) global score and profile. This is then supported with information for the person on identified risk factors, recommendations and goal setting for behaviour change. The programme will conclude with a RCT feasibility study to explore participant, GP and practice nurses’ understanding of modifiable risk factors and use of the personalised Libra score and profile.

Reducing dementia risk by targeting modifiable risk factors in mid-life: study protocol for the Innovative Midlife Intervention for Dementia Deterrence (In-MINDD) randomised controlled feasibility trial.

O’Donnell, C.A., Browne, S., Pierce, M., McConnachie, A., Deckers, K., van Boxtel, M.P., Manera, V., Köhler, S., Redmond, M., Verhey, F.R. and Van den Akker, M.
Pilot and feasibility studies
2015
This paper by O’Donnell et al. (2015) outlines the study protocol for the Innovative Midlife Intervention for Dementia Prevention (In-MINDD) study.
It describes the rationale for undertaking a feasibility randomised controlled trial (RCT) and for adopting normalisation process theory as the underpinning theoretical framework for the process evaluation. This protocol paper presents the study aims and describes the study design in detail including recruitment, baseline data collection, randomisation, the intervention and control arm of the feasibility RCT as well as the process evaluation and its role in understanding the experiences and perspectives of the In-MINDD participants. The authors then discuss the primary outcomes and present the analysis plan for the study.

Lifestyle for Brain Health (LIBRA): A new model of dementia prevention

Schiepers O.J.G., Kohler, S., Deckers, K., Irving, K., O’Donnell, C., Van den Akker, M., Berhey, F.R.J., Vos, S.J.B., de Vugt, M.E. and van Boxtel, M.P.J.
International journal of geriatric psychiatry
2017
Schiepers et al. (2017) report on a new prediction model for dementia that focuses exclusively on modifiable risk factors.
The Lifestyle for Brain Health (LIBRA) model was developed as part of the Innovative Midlife Intervention for Dementia Prevention (In-MINDD) project, led by Dublin City University. The project aimed to support people in midlife to reduce their risk of developing dementia or at least delaying its onset by making lifestyle changes. The model is based on 11 dementia risk and protective factors: alcohol consumption, coronary heart disease, physical inactivity, diabetes, high cholesterol, smoking, obesity, hypertension, Mediterranean diet, depression, and cognitive activity. The model was evaluated in a large population-based study, the Maastricht Ageing Study, a 12-year longitudinal study focusing on cognitive ageing. A LIBRA risk score for dementia was developed. When comprised only of modifiable risk factors, Lifestyle for Brain Health predicted future risk of dementia and cognitive impairment. A one-point increase in LIBRA scores related to a 19% higher risk for dementia and a 9% higher risk of cognitive impairment. From these results, it could be concluded that modifiable risk factors have an influence on a person’s risk of developing dementia. Focusing on modifiable risk factors is important and LIBRA may contribute to new prevention strategies for dementia, such as raising awareness that people in middle age may have a window of opportunity for reducing their dementia risk by prioritising lifestyle changes.

Correlates of frailty In Alzheimer’s Disease and Mild Cognitive Impairment

NI MHAOLAIN, A., GALLAGHER, D., CROSBY, L., RYAN, D., LACEY, L., COEN, R., BRUCE, I., WALSH, J.B., CUNNINGHAM, C., LAWLOR, B.A.
Age and Ageing, 40(5)
2011

Ni Mhaolain et al. (2011) examine the relationship between frailty and a range of domains including age, comorbidity, course of illness, cognitive impairment, functional limitations and abnormalities of behaviour in a group of patients with AD and MCI.

The study found that 51% of the patients were robust or not-frail, with 49% at an intermediate or complete stage of frailty.  It suggests that escalating frailty is positively associated with increasing number of medical comorbidities and advancing age rather than being a marker of cognitive decline and severity of illness. The study suggests that optimising the management of co-morbid illness in people with dementia may play a role in minimizing the health impact of frailty in this group. 

Cost-effectiveness of prion filtration of red blood cells to reduce the risk of transfusion-transmitted variant Creutzfeldt-Jakob disease in the Republic of Ireland

TELJEUR, C., FLATTERY, M., HARRINGTON, P., O’NEILL, M., MORAN, P.S., MURPHY, L., RYAN, M.
Transfusion, 52(November)
2012

This study by Telijeur et al.

(2012) evaluated the cost-effectiveness of implementing a policy of prion filtration of red blood cells in ROI, based on a literature review on efficacy and safety of prion filters, a cost effectiveness analysis and analysis of two models of prion filtration. It concluded that the introduction of prion filtration for all transfusion recipients was not cost-effective by traditional standards of cost-effectiveness, whilst acknowledging that factors other than cost-effectiveness may influence the decision on whether or not to implement a policy of prion filtration of red blood cells in ROI.  

Lithium and prevention of cognitive impairment

ABIDAN, Z., COONEY, C., JACKSON, D., FREYNE, A.
Irish Journal of Psychological Medicine
2014

A retrospective study by Abidan et al. (2014) was undertaken in the context of increased interest in the neuro-protective effects of lithium and studies suggesting lithium may have a protective role in dementia.

Covering the period 1998 to 2007, it involved 29 patients attending a lithium treatment clinic who had been commenced on lithium treatment for affective disorders such as depression, bipolar disorder and schizoaffective disorder. The study reported that no new cases of dementia developed over a mean follow-up period of 38 months. Given the limitations, the authors tentatively suggest that lithium may have a protective effect against cognitive decline in people with affective disorder and in those with concurrent affective disorder and cognitive impairment.

Very rare and unusual causes account for about 5% of cases of dementia.  Variant CJD, a human prion disease, is one of the rarer causes of dementia, caused when meat from cattle infected with bovine spongiform encephalopathy (BSE) is eaten. It typically affects younger adults. ROI has the second highest rate of vCJD in the world, with four cases reported to date. To complement existing measures adopted to contain the risk of vCJD transmission from transfusion of blood or blood products originating from subclinical carriers of the disease, prion-removing filters have been developed to reduce the risk of vCJD transmission. 

Education, occupation and retirement age effects on the age of onset of Alzheimer’s disease

LUPTON, M.K., STAHL., D., ARCHER, N., FOY, C., POPPE, M., LOVESTONE, S., HOLLINGSWORTH, P., WILLIAMS, J., OWEN, M.J., DOWZELL, K., ABRAHAM., R., SIMS, R., BRAYNE, C., RUBINSZTEIN, D., GILL., M., LAWLOR, B.A., LYNCH, A., POWELL., J.F
International journal of geriatric psychiatry
2010

This study by Lupton et al. (2010) is based on data from a sample of 1,320 people with probably Alzheimer’s disease from the UK and the ROI, who were primarily recruited to investigate candidate genes that may increase susceptibility to Alzheimer’s disease.

Data was analysed (using multiple regression analysis) to determine the effects of early life education, midlife employment and later life age of retirement on the age of onset of Alzheimer’s disease. This study found no effect of education or employment on the age of onset of Alzheimer’s disease, but found a significant effect of a later retirement age in delaying the onset of Alzheimer’s disease.