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P2. Genetics, prevention and treatment: Genetics, modifiable risk factors and prevention

Detailed programme, abstracts and presentations

P2.1. ApoE4 bma. A new non-genetic method to evaluate Alzheimer´s Disease risk using clinical chemistry platforms

VEIGA Sergio1, RODRÍGUEZ-MARTÍN Andrés1, CALERO Olga2, GARCÍA-ALBERT Luis2, RODÓN Elisenda3, PÉREZ Almudena3, GASSÓ Sergi3, CALERO Miguel2

1Biocross SL, MADRID, Spain, 2Instituto de Salud Carlos III, Madrid, Spain, Barcelona, Spain, 3Pragmatic Diagnostics SL, Barcelona, Spain

To date only the presence of one or two alleles ε4 of the apolipoprotein E gene (APOE)is accepted as a reliable biomarker and risk factor for developing late onset Alzheimer´s Disease (AD). The presence of one allele ε4 of theAPOEgene increases the risk of suffering AD by 3-5 fold, while the presence in homozygosis increases the risk by 15-20 fold. Therefore,APOEε4 carriers constitute a target population where research, clinical trials and prevention strategies should be focused. Despite of its clear clinical utility,APOEgenotyping is not requested by neurologists due to economic and logistic inconveniences of genetic analysis.

Biocross in collaboration with CIBERNED and the ISCIII has developed a non-genetic, cost effective and highly reliable patented method to detect the presence of the apoE4 isoform in human plasma. The method was initially developed as an ELISA and adapted to a immunoturbidimetry-based assay to allow its implementation into the clinical analysis routine.

The adaptation to immunoturbidimetry was carried out using a semiautomatic biochemistry analyzer and included lot-to-lot variability, interference, precision, prozone and stability studies, which led to the creation of a design-freeze kit, consisting in two ready-to-use reagents, one point-calibrator and positive and negative controls. The sensitivity and specificity of the test was evaluated in 172 human plasma samples (125APOEε4 non-carriers and 47APOEε4 carriers), whose results were compared withAPOEgenotype determined by Real-Time PCR. Sensitivity and specificity was found to be 100% and 98%, respectively. The assay was tested without modifications in two of the most common high throughput biochemistry analyzers used in hospitals, ARCHITECT and ADVIA XPT, with the same excellent performance.

Our results show thatApoE4 blood marker assayis a simple, cost effective and highly reliable method that could be easily implemented in the routine settings of hospitals.

P2.2. MijnBreincoach: a public health awareness campaign to promote a brain-healthy lifestyle

DECKERS Kay, HEGER Irene, VAN BOXTEL Martin, DE VUGT Marjolein, VERHEY Frans, KÖHLER Sebastian

1Maastricht University, Maastricht, Netherlands

Background: Preventing or delaying dementia onset is a public health priority, but requires definition of target groups and tailored strategies for prevention. We previously developed the ‘’LIfestyle for BRAin Health’’ (LIBRA) index that captures lifestyle-related dementia risk and identifies individual ''room-for-improvement''. An implementation project that uses this score in a public health campaign to raise awareness for dementia prevention has been launched in March 2018 (until January 2019).

Methods: MijnBreincoach is a public health campaign (‘'We are the medicine’') targeting people aged 40-75 years in the Province of Limburg (Netherlands). The campaign will be tested on a local level (three living labs with different socio-economic backgrounds) as well as a provincial roll-out. As part of this campaign, an eHealth platform has been developed. It will give people insight into their personal room-for-improvement and individual target behaviours using LIBRA. A baseline assessment of the public knowledge about brain and lifestyle has been carried out in 600 people.

Results: Most people (56%) were unaware of a relation between lifestyle and dementia risk. Among a list of potential risk and protective factors, cognitive (79%) and physically (63%) activity and healthy diet (50%) were identified most frequently, while vascular factors were named less often (±25%). ‘Lack of knowledge’ (42%) was the largest barrier for engaging in a brain-healthy lifestyle, and most people (82%) stated they would like to use an app to help them change their health behaviour.

Conclusions: There is a public need to raise more awareness for maintaining brain health and prevent or delay dementia onset. MijnBreincoach is a unique project that raises public awareness and gives people insight into their own dementia risk profile and personal lifestyle advice that supports long-term brain health.

P2.3. Multi-domain approach to dementia prevention: the FINGER model


1University of Eastern Finland, Kuopio, Finland, 2National Instiute for Health and Welfare, Helsinki, Finland, 4Karolinska Institutet, Stockholm, Sweden

Background: Dementia and Alzheimer’s disease (AD) are complex multifactorial conditions. Many modifiable risk factors have been identified, e.g. lifestyle-related, cardiovascular, or metabolic. Individuals with increased dementia risk based on such factors may benefit most from preventive interventions.

Methods: The Finnish Geriatric Intervention study to prevent cognitive impairment and disability (FINGER) was the first large, longer-term randomised controlled trial to show cognitive benefits in 1260 older at-risk individuals for a 2-year multi-domain lifestyle intervention (nutrition, exercise, cognitive training and social activities, and cardiovascular risk monitoring) versus regular health advice. The intervention additionally had benefits on health-related quality of life, everyday functioning, and multimorbidity in this at-risk general population. Following the success of the FINGER intervention model, several steps are currently being taken towards its implementation.

Results: The MUISTIKKO project in Finland has taken the first steps from a clinical trial context to real-life implementation of a dementia prevention program. Focus has been on the development stage of an operational model for dementia prevention, with emphasis on a high-risk primary care approach (i.e. targeting interventions to primary care patients with increased dementia risk). A similar project is ongoing in Sweden, where two pilot studies are also being planned to adapt and implement the FINGER model in primary care and at community level. The World-Wide FINGERS initiative launched in July 2017 brings together several clinical trials that will adapt and test the FINGER model in different populations and settings, from community level to patients with early stage (prodromal) AD, e.g. MIND-ADmini, UK-FINGER (Europe), US-POINTER (USA), MIND-China, and SINGER (Singapore).  

Conclusions: Prevention strategies targeting multiple risk factors and disease mechanisms simultaneously may be most effective. Such strategies are needed for different populations, and geographical, cultural and economic contexts.

P2.4. Spatial patterns of white matter hyperintensities associated to Alzheimer’s disease risk factors in a cognitively healthy middle-aged cohort

BRUGULAT Anna1, SALVADÓ Gemma1, SUDRE Carole H2, GRAU-RIVERA Oriol1, SUÁREZ-CALVET Marc1, FALCON Carles1, CARDOSO M. Jorge2, BARKHOF Frederik2,3, MOLINUEVO José Luis1, GISPERT Juan Domingo1, FAURIA Karine1

1BarcelonaBeta Brain Research Center, Barcelona, Spain, 2University College London and Dementia Research Centre, UCL, London, United Kingdom, 3VU University Medical Centre, Amsterdam, Netherlands

Background: White matter hyperintensities (WMH) have been found to be related with an increased risk of developing Alzheimer’s Disease (AD). This study aims to describe the WMH topological patterns associated with AD risk actors in middle-aged cognitively-healthy subjects.

Methods: Magnetic resonance imaging (MRI) and AD risk factors were collected in 561 ALFA Study participants [1]. Regional WMH volumes were automatically calculated for each brain lobe and four equidistant layers of distance to the ventricles [2]. Global and regional patterns of WMH load were sought against CAIDE Dementia Risk Score [3], which is a validated tool to predict late-life dementia risk. A secondary analysis was performed to search associations with individual risk factors regressing out two main factors: age and hypertension.

Results: Higher CAIDE scores were significantly associated with increased WMH load globally. Regionally, this association was significant in periventricular areas of temporal and frontal lobes and in frontal deep white matter (DWM). Secondary analysis age and hypertension showed the most significant effect and largest spatial spread, mainly in anterior areas. Modifiable factors such as hypercholesterolemia, education, and physical exercise were associated with a frontal pattern being the latest two protective factors. A juxtacortical pattern was related to sex, anxiety and depression. Maternal family history of AD was found to be related to higher WMH load in DWM in occipital and temporal areas.APOE-ε4homozygotes, but not heterozygotes, showed and increased WMH burden in parietal DWM.

Conclusions: Significant patterns of WMH load were found in association to AD risk factors in middle-aged cognitively healthy individuals. This suggests that those participants might benefit from the control of modifiable risk factors to prevent or delay the onset of dementia.

P2.5. Self-rated hearing and self-rated memory: a cross-sectional analysis of SHARE data from 18 European nations

CUTLER Stephen1, ILINCA Corina2

1University of Vermont, Burlington, United States, 2University of Bucharest, Bucharest, Romania

Recent work indicates a connection between hearing loss and dementia.  Our prior research has shown strong relationships between self-reported hearing ability and self-reports of memory functioning. Although analytically rigorous, this research was based on data from only the United States.  Indeed, virtually all research in this area is country-specific.  In the present study, we replicate the basic US, cross-sectional research using data on Rs ages 50+ from 18 European nations included in the Survey of Health, Ageing, and Retirement in Europe (SHARE), with country Ns ranging from 6,287 to 1,560. Rs in each of the countries were asked the following questions: Is your hearing (using a hearing aid as usual [if R wears one]) excellent, very good, good, fair, or poor; and [h]ow would you rate your memory at the present time [using the same response categories]?  We use correlation analysis to examine bivariate relationships and regression analysis (with controls for age, marital status, education, gender, and health) to examine multivariate relationships.  In every European country included in SHARE, the bivariate relationship between self-reported hearing and self-reported memory is positive and significant, averaging .343.  Likewise, the multivariate relationships with controls are also positive and significant (the average beta is .228).  We conclude by noting (1) that the positive relationship between self-reported hearing and self-reported memory extends well beyond the US, (2) that the role subjective hearing may play in memory assessments and dementia merits much more detailed study, and (3) that practitioners need to pay attention to their patients’ hearing for processes requiring remembering (e.g., informed consent) to be effective.  Further research might examine the implications of hearing loss for stress and social isolation, as these factors have been tied to dementia.  Replication of these relationships in Latin American nations and in other non-Western settings would also be valuable.

P2.6. “JAPI” a comprehensive care for people with dementia


FAE, Madrid, Spain

Developing a comprehensive long-term care plan is important for everyone, but crucial for those diagnosed with dementia and Alzheimer's. Since October 2017 FAE has been offering a comprehensive service that is intended to slow down the evolutionary process of dementia working from the cognitive, physical, and emotional dimension. The program is planned to take place from Monday to Thursday from 10pm to 13pm and it address various non-pharmacological strategies that include stimulation of cognitive functions, reminiscence therapy, reality orientation therapy, art therapy, music therapy, psychomotor skills, balance, psychological support, emotional management, discussion groups, relaxation and sensory visualization.

To carry out this program, an occupational therapist, a psychologist and music therapist make up the JAPI team including new technologies such as most current neurostimulation apps in tablets and digital whiteboards. As a most important novelty, art therapy session included in the JAPI program is given by a user with early onset Alzheimer’s disease. At the same time, family members who accompany them to the Centre will find a meeting point where establish relations with others caregivers. Given that public authorities are not offering a similar program that can provide a solution intermediate before their institutionalization, we may consider having an innovative nature for society as it favorably affects the quality of life of the person with dementia and their families being an effective alternative for maintenance their capacities and favoring a respite space for caregivers.



Last Updated: Tuesday 13 November 2018


  • Acknowledgements

    The 28th AE Conference in Barcelona received funding under an operating grant from the European Union’s Health Programme (2014-2020). Alzheimer Europe, CEAFA and Fundación Alzheimer España gratefully acknowledge the support of all conference sponsors.
  • European Union
  • Roche