The future of dementia risk reduction research: barriers and solutions

Abstract

BACKGROUNDWe examine why dementia prevention and risk reduction are relatively underfunded and suggest potential remediation strategies. The paper is aimed at researchers, funders and policy-makers, both within dementia and also the wider health prevention field.METHODSA discussion-led workshop, attended by 58 academics, clinicians, funders and policy-makers.RESULTSThe key barriers identified were the gaps in understanding the basic science of dementia; the complex interplay between individual risk factors; variations in study methodology; disincentives to collaboration; a lack of research capacity and leadership and the broader stigma of the condition. Recommendations were made to encourage strategic leadership, provide greater support for grant applications, promote collaboration and support randomized control trials for the research field.CONCLUSIONHaving identified the barriers, the key challenge is how to implement the potential solutions. This will require engagement with decision-makers within funding, policy and research to ensure that action takes place.

Prevention of Alzheimer's Disease: Lessons Learned and Applied

“…The reasons are unknown, but may be explained in part by a host of modifiable and nonmodifiable risk factors (Table ). Up to 30% of AD cases may be preventable through modification of risk factors and behavioral changes to mitigate the effect of those risk factors that are not modifiable . There is an ongoing debate as to whether the current evidence base is sufficient to initiate prevention programs because it is difficult to prove causation from observational studies, and it is difficult to pool multiple RCTs because of differences in study design, measurements used, and anticipated outcomes .…”

“…Up to 30% of AD cases may be preventable through modification of risk factors and behavioral changes to mitigate the effect of those risk factors that are not modifiable . There is an ongoing debate as to whether the current evidence base is sufficient to initiate prevention programs because it is difficult to prove causation from observational studies, and it is difficult to pool multiple RCTs because of differences in study design, measurements used, and anticipated outcomes . Although a well‐balanced, healthy lifestyle may be the cornerstone of disease prevention and brain health, each risk factor (vascular, lifestyle choices, psychosocial) may both act independently and potentiate the effects of each other .…”

“…In the absence of robust biomarkers that mark disease onset and progression, rather than just the presence of pathology, RCT design will remain a challenge . Barriers to prevention studies include limited understanding of the real relationship between dementia risk factors and the effect of risk reduction; complexity of the effect of life course on dementia risk factors; lack of standardization of study design, definitions, and outcomes; difficulty translating RCT findings into real‐world practice; cultural and social barriers to implementation; lack of research capacity to enroll large research cohorts for long periods of time; and pervasive social stigma associated with AD …”

“…23 Barriers to prevention studies include limited understanding of the real relationship between dementia risk factors and the effect of risk reduction; complexity of the effect of life course on dementia risk factors; lack of standardization of study design, definitions, and outcomes; difficulty translating RCT findings into real-world practice; cultural and social barriers to implementation; lack of research capacity to enroll large research cohorts for long periods of time; and pervasive social stigma associated with AD. 18 Because effective prevention strategies are elusive despite significant advances in understanding of the biology and pathophysiology of AD, an alternative approach would be to take advantage of precision medicine designs used in oncology trials to tailor interventions to an individual's phenotypic and genotypic expression. With better classification and phenotyping of individuals with AD, trial-ready cohorts can be targeted more appropriately with interventions (pharmacological and nonpharmacological) designed to ameliorate specific pathological mechanisms, based on specific biomarkers and individual characteristics.…”

Effects of a Mindfulness-Based Intervention on Circulating Cytokine Levels in Individuals with Amnestic Mild Cognitive Impairment: A Pilot Study

“…No effective treatment is currently available to reverse or stop the progression of AD. In light of the many failed attempts at developing effective treatments, hope is now put in primary and secondary prevention strategies targeting modifiable risk factors of AD such as depression, anxiety, smoking, diabetes, hypertension, obesity, cognitive inactivity, low educational attainment, physical inactivity, and inflammation at early stages of the disease [2][3][4][5][6][7].…”