Secondary Prevention of Dementia: Combining Risk Factors and Scalable Screening Technology

Alzheimer's disease (AD) is a progressive neurodegenerative disorder that is the most common cause of dementia. Over a third of dementia cases are estimated to be due to potentially modifiable risk factors, thus offering opportunities for both identification of those most likely to be in early...

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Autores principales:	Triin Ojakäär, Ivan Koychev
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	dementia Alzheimer's disease secondary prevention diabetes hypertension chronic kidney disease Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/64e90d709f69493c8e1d0e31eaa1849a
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spelling	oai:doaj.org-article:64e90d709f69493c8e1d0e31eaa1849a2021-11-15T06:48:20ZSecondary Prevention of Dementia: Combining Risk Factors and Scalable Screening Technology1664-229510.3389/fneur.2021.772836https://doaj.org/article/64e90d709f69493c8e1d0e31eaa1849a2021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.772836/fullhttps://doaj.org/toc/1664-2295Alzheimer's disease (AD) is a progressive neurodegenerative disorder that is the most common cause of dementia. Over a third of dementia cases are estimated to be due to potentially modifiable risk factors, thus offering opportunities for both identification of those most likely to be in early disease as well as secondary prevention. Diabetes, hypertension and chronic kidney failure have all been linked to increased risk for AD and dementia and through their high prevalence are particularly apt targets for initiatives to reduce burden of AD. This can take place through targeted interventions of cardiovascular risk factors (shown to improve cognitive outcomes) or novel disease modifying treatments in people with confirmed AD pathology. The success of this approach to secondary prevention depends on the availability of inexpensive and scalable methods for detecting preclinical and prodromal dementia states. Developments in blood-based biomarkers for Alzheimer's disease are rapidly becoming a viable such method for monitoring large at-risk groups. In addition, digital technologies for remote monitoring of cognitive and behavioral changes can add clinically relevant data to further improve personalisation of prevention strategies. This review sets the scene for this approach to secondary care of dementia through a review of the evidence for cardiovascular risk factors (diabetes, hypertension and chronic kidney disease) as major risk factors for AD. We then summarize the developments in blood-based and cognitive biomarkers that allow the detection of pathological states at the earliest possible stage. We propose that at-risk cohorts should be created based on the interaction between cardiovascular and constitutional risk factors. These cohorts can then be monitored effectively using a combination of blood-based biomarkers and digital technologies. We argue that this strategy allows for both risk factor reduction-based prevention programmes as well as for optimisation of any benefits offered by current and future disease modifying treatment through rapid identification of individuals most likely to benefit from them.Triin OjakäärIvan KoychevFrontiers Media S.A.articledementiaAlzheimer's diseasesecondary preventiondiabeteshypertensionchronic kidney diseaseNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	dementia Alzheimer's disease secondary prevention diabetes hypertension chronic kidney disease Neurology. Diseases of the nervous system RC346-429
spellingShingle	dementia Alzheimer's disease secondary prevention diabetes hypertension chronic kidney disease Neurology. Diseases of the nervous system RC346-429 Triin Ojakäär Ivan Koychev Secondary Prevention of Dementia: Combining Risk Factors and Scalable Screening Technology
description	Alzheimer's disease (AD) is a progressive neurodegenerative disorder that is the most common cause of dementia. Over a third of dementia cases are estimated to be due to potentially modifiable risk factors, thus offering opportunities for both identification of those most likely to be in early disease as well as secondary prevention. Diabetes, hypertension and chronic kidney failure have all been linked to increased risk for AD and dementia and through their high prevalence are particularly apt targets for initiatives to reduce burden of AD. This can take place through targeted interventions of cardiovascular risk factors (shown to improve cognitive outcomes) or novel disease modifying treatments in people with confirmed AD pathology. The success of this approach to secondary prevention depends on the availability of inexpensive and scalable methods for detecting preclinical and prodromal dementia states. Developments in blood-based biomarkers for Alzheimer's disease are rapidly becoming a viable such method for monitoring large at-risk groups. In addition, digital technologies for remote monitoring of cognitive and behavioral changes can add clinically relevant data to further improve personalisation of prevention strategies. This review sets the scene for this approach to secondary care of dementia through a review of the evidence for cardiovascular risk factors (diabetes, hypertension and chronic kidney disease) as major risk factors for AD. We then summarize the developments in blood-based and cognitive biomarkers that allow the detection of pathological states at the earliest possible stage. We propose that at-risk cohorts should be created based on the interaction between cardiovascular and constitutional risk factors. These cohorts can then be monitored effectively using a combination of blood-based biomarkers and digital technologies. We argue that this strategy allows for both risk factor reduction-based prevention programmes as well as for optimisation of any benefits offered by current and future disease modifying treatment through rapid identification of individuals most likely to benefit from them.
format	article
author	Triin Ojakäär Ivan Koychev
author_facet	Triin Ojakäär Ivan Koychev
author_sort	Triin Ojakäär
title	Secondary Prevention of Dementia: Combining Risk Factors and Scalable Screening Technology
title_short	Secondary Prevention of Dementia: Combining Risk Factors and Scalable Screening Technology
title_full	Secondary Prevention of Dementia: Combining Risk Factors and Scalable Screening Technology
title_fullStr	Secondary Prevention of Dementia: Combining Risk Factors and Scalable Screening Technology
title_full_unstemmed	Secondary Prevention of Dementia: Combining Risk Factors and Scalable Screening Technology
title_sort	secondary prevention of dementia: combining risk factors and scalable screening technology
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/64e90d709f69493c8e1d0e31eaa1849a
work_keys_str_mv	AT triinojakaar secondarypreventionofdementiacombiningriskfactorsandscalablescreeningtechnology AT ivankoychev secondarypreventionofdementiacombiningriskfactorsandscalablescreeningtechnology
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Secondary Prevention of Dementia: Combining Risk Factors and Scalable Screening Technology

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