Individualized dementia risk identification and prevention – a vision for the future of brain health in Europe

Many of the experts presenting at Think Brain Health – a policy, clinical and research challenge, our first virtual conference, feature as authors in a just-published paper focusing on the needs and opportunities for brain health clinics to help reduce the burden of preventable dementia.1

Led by Professor Giovanni Frisoni of the University of Geneva, Switzerland (and a member of the Think Brain Health steering committee), the authors summarize the state of the art in determining and modifying brain disease risk among cognitively normal people who have modifiable risk factors. Risk reduction mostly targets lifestyle factors and is most effective when combined into multi-domain interventions, such as actions to improve cardiovascular health (that is, what’s good for the heart is good for the brain). This primary prevention has the chance to reduce the incidence of overall dementia by as much as 35%, which is a substantial benefit to individual and public health.

Secondary prevention, that is, reducing or delaying disease onset among those subjects with biomarkers indicative of a high risk of dementia, will require the development of drugs that target Alzheimer’s disease pathology, such as anti-amyloid or anti-tau agents. Therefore, suitable biomarkers for study in relevant populations are essential.

To achieve the potential benefits of preventive strategies, a major overhaul of healthcare services based around memory clinics is needed. This needs to include developments in the passage of individuals from primary to appropriate specialist care. Structural and functional improvements will be required to implement novel technologies and to accommodate increasing patient demands. Any new brain health services will also need to establish ethically appropriate skills for profiling and communicating personalized risk and risk reduction plans.

Such integrated, innovative healthcare platforms are not without their challenges. However, the opportunity to reduce substantially the burden due to brain disease is certainly one worth taking.

Reference

1 Frisoni GB et al. Precision prevention of Alzheimer’s and other dementias: Anticipating future needs in the control of risk factors and implementation of disease-modifying therapies. Alzheimers Dement 2020;16:1457‒68.