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P15. Risk factors and dementia

Detailed programme and abstracts

P15.1. SaniMemorix: A public health awareness campaign to promote a brain-healthy lifestyle

STEYAERT Jan

Expertisecentrum Dementie Vlaanderen, Antwerp, Belgium

Background: Across the world, a lot of investment goes into finding a cure for dementia (for future generations) and providing good care to persons with dementia and their family caregivers (for the current generation). Over the past years, research has emerged on the relation between lifestyle at middle age and risk for dementia at old age.  A scholarly consensus has grown that up to 30% of future cases of dementia could be avoided if everybody adopts a brain-healthy lifestyle.

However, there is currently a very low awareness among citizens and health and care professionals about this link between lifestyle and dementia risk. Raising that awareness is a first necessary step to start work on primary prevention of dementia.

Methods: In June 2018, a representative baseline survey was organised to measure what the Flemish citizens at middle-age (between 40 and 75) know about dementia and the link with brain-health related lifestyle aspects. Only 34.8% of these had awareness about the link between lifestyle at middle age and risk of dementia at high age.

On the international Alzheimer day (21th of September 2018), a public campaign was launched to raise the awareness. This campaign consisted of distributing “SaniMemorix vaccine boxes” at railway stations and through the network of pharmacies. The contents were not a traditional vaccine, but information on brain-health. This was followed by another similar action during the brain health week, March 2019.

Results: A follow-up survey by IPSOS showed that the awareness among Flemish adults grew from 34.8% tot 44.8%, and grew equally across all educational levels.

During our presentation, we will present the aims and activities of our awareness campaign, more results from the survey and observations how such campaign might be organised elsewhere.

P15.2. Dementia risk reduction and the NHS Health Check

BROCK Helen

Public Health England, London, United Kingdom

Introduction: 30% of dementia is potentially avoidable through modifiable lifestyle factors, with current evidence suggesting mid-life changes can have most impact on reducing risk (Lancet Commission, 2017). However public understanding is low, with only 34% of British adults thinking it was possible to reduce their risk of developing dementia (Alzheimer’s Research UK, 2019).

Methodology: The NHS Health Check is a health check-up for all adults in England aged 40-74. It's designed to spot early signs of cardiovascular disease. It represents an ideal opportunity to highlight dementia risk reduction given the overlap with cardiovascular risk factors. When the dementia component on the NHS Health Check was introduced in 2013, it was focused on raising awareness of the condition amongst those aged 65-74 years.

Following a successful pilot project in 2016/17, dementia risk reduction messaging is now recommended and offered to everyone attending an NHS Health Check. Support for commissioners, providers, and practitioners is crucial to both the likelihood of dementia risk reduction messages being included in the NHS Health Check, and to the quality of the information shared.

Results: To support the implementation of the dementia risk reduction component of the NHS Health Check, the following actions have been taken:

  • Publication of a range of training resources specifically for the NHS Health Check, by Public Health England, Alzheimer’s Research UK, Alzheimer’s Society and Health Education England
  • An audit to understand the extent to which the dementia risk reduction messaging was being locally implemented and the type of support local stakeholders wanted
  • Communications planned to further embed dementia risk reduction messaging in the NHS Health Check

Conclusion: This presentation will demonstrate the experience and learning from work to promote dementia risk reduction messaging as part of the NHS Health Check in England.

P15.3. MyBrainRobbie, a new initiative to help promote brain health in school-age children

BAYEN Eléonore1, GOURIOU Clémentine2, CLERET DE LANGAVANT Laurent3, PRADAT-DIEHL Pascale1, YAFFE Kristine4, LAWLOR Brian6

1Sorbonne Université - Pitié-Salpêtrière hospital, Paris, France, 2Pitié-Salpêtrère hospital, Paris, France, 3Université Paris-Est Créteil, Créteil, France, 4University of California, San Francisco, United States, 6Trinity College Dublin, Dublin, Ireland

Background: Recent research projects that up to 35% of dementia cases may be preventable by targeting modifiable risk factors (Yaffe 2014, The Lancet Commission 2017). MyBrainRobbie was launched in 2019 in English and French languages to promote brain health among children with support from the Global Brain Health Institute and the Alzheimer's Association.

Development: The MyBrainRobbie.org project engaged a wide inter-professional collaboration of experts (neuroscientists, medical/health professionals, education specialists, teachers, parents, communication/design experts) as well as Atlantic Fellows from the Global Brain Health Institute, and faculty from Sorbonne University, University of California San Francisco and Trinity College Dublin. The initiative includes (1) a 7-minutes video (free on YouTube) of a little brain character (Robbie) which helps children learn about eight simple and lifelong healthy lifestyles, (2) a web site with links to scientific references and educational resources to support public health interventions in schools.

A pilot implementation of 1-hour class on brain health prevention was carried in three French elementary schools (13 classes) in June 2018 to assess the acceptability of MyBrainRobbie initiative, after obtaining principals’ and teachers’ approval. The class included viewing of the video, use of the educational pack of MyBrainRobbie.org, Q&As about the brain and brain health. Global results in 303 students aged 6-11 years showed that student’s satisfaction of the video was high (ratings ‘excellent’=64%, ‘good’=29.7%); the video was self-rated as ‘very easy’ and ‘easy’ to understand in 68.4% and 24.6% respectively; on average, students memorized a mean of 7 neuro-protective factors (SD=1.3; min=1-max=8).  

Conclusion: MyBrainRobbie brings positive messages to empower children while pointing out that lots of pleasant daily life activities are good for the brain. MyBrainRobbie aims at increasing global public awareness of the importance of brain health across the lifespan in an enthusiastic way while reducing social health inequities. Adaptation in five more languages is underway.  

P15.4. Social health and structural brain changes in older adults

VAN DER VELPEN Isabelle1, MELIS René2, PERRY Marieke3, KAS Martien4, VERNOOIJ-DASSEN Myrra5, IKRAM Arfan6, VERNOOIJ Meike1

1Department of Epidemiology, Erasmus MC, Rotterdam; Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, Netherlands, 2Department of Geriatric Medicine/Radboud UMC Alzheimer Center, Radboud UMC, Nijmegen; Radboud Institute for Health Sciences, Radboud UMC, Nijmegen, Netherlands, 3Department of Geriatric Medicine/Radboud UMC Alzheimer Center, Radboud UMC, Nijmegen; Department of Primary and Community Care, Radboud UMC, Nijmegen, Netherlands, 4Groningen Institute for Evolutionary Life Science, University of Groningen, Groningen, Netherlands, 5Department of IQ Healthcare, Radboud UMC, Nijmegen, Netherlands, 6Department of Epidemiology, Erasmus MC, Rotterdam, Netherlands

Background:Poor quality of social connections has been shown to increase the risk of dementia. We hypothesize that social health influences brain health and consequently cognitive function. We studied loneliness and perceived social support in relation to structural brain changes.

Methods:Cross-sectional data were collected from 2002-2008 in the Rotterdam Study. Loneliness was measured by a single question on the Center for Epidemiologic Studies depression scale (CES-D). Perceived social support was measured by a 5-item questionnaire on relationships with family and friends. Brain structure was measured by magnetic resonance imaging (MRI). Markers used were brain volumes, small vessel disease markers (white matter lesion (WML) volume, presence of microbleeds and lacunar infarcts) and white matter structural integrity (fractional anisotropy, mean diffusivity). We used regression analyses to adjust the crude associations for age, sex, intracranial volume, mini mental state examination (MMSE) and education. Additionally, we performed stratified analyses for age and sex.

Results:The study sample comprised 3,812 subjects (mean age 59.1 years, 54.6% female). Compared to non-lonely subjects, lonely subjects had smaller total brain and white matter (WM) volumes (mL) (β(se) -3.87 (1.62), p=0.02; -4.10 (1.67), p=0.01 respectively), with larger WML volume and worse WM integrity. Better social support was associated with larger total brain and grey matter volumes (β(se) 1.32 (0.58), p=0.02; β(se) 1.16 (0.51), p=0.02 respectively), smaller WML volume and better WM integrity. Effects of loneliness were more pronounced for males and for younger subjects (<65 years). Social support effects on brain volumes were larger for older subjects, and the effect on grey matter volume was larger for females.

Conclusion:In this cross-sectional study, lonely subjects had worse brain health than non-lonely subjects. Better perceived social support was associated with better brain health. These findings highlight potential for prevention, which we will further explore in longitudinal analyses.

P15.5. Self-reported sleep quality as a risk factor for cognitive decline: Maastricht Ageing Study (MAAS)

PARK Hyun Young (Hailey), VAN BOXTEL Martin, RUTTEN Bart, KÖHLER Sebastian

Maastricht University, Maastricht, Netherlands

Reduced sleep quality is an emerging risk factor for developing cognitive impairment in both preclinical and clinical Alzheimer’s disease (AD). Previous studies have examined the association between sleep quality and cognitive decline, however, there is still a lack of studies with a longitudinal design, sufficient power, and a detailed neuropsychological assessment. The aim of this study was to investigate the relation between self-reported sleep quality and cognitive decline in the general population and across the adults age span using data from the longitudinal Maastricht Ageing Study. Sleep quality was measured using the sleep subscale score of the 90-item Symptom Checklist. At each time points at baseline, 6, and 12 years, cognitive performances in multiple domains were assessed, including the immediate and delayed recall of the Visual Verbal Learning test (verbal memory), Concept Shifting Test, Stroop Color Word Test, Animal Fluency Test (all executive functions/attention), and Letter Digit Modality Test (processing speed). Linear mixed models were used to explore the association between continuous and tertiles of subjective sleep quality and cognitive change over time. Models were adjusted for demographic backgrounds and other health and lifestyle covariates. The results showed that sleep quality at younger age (<65 years) was associated with decline in executive functions/attention and processing speed, whereas at older age (≥65 years) it was associated with decline in verbal memory (immediate and delayed word recall). Additional analyses with gender showed that sleep quality was associated with decline in executive function/attention in men, but with decline in verbal memory and processing speed in women. Taken together, poor self-reported sleep is associated with age-accelerated cognitive decline in the general population. Differential association between younger and older adults and across sexes need further research.

P15.6. Quantifying an individual’s potential for dementia prevention: Validation and implementation of the “LIfestyle for BRAin health” (LIBRA) score

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

Alzheimer Centrum Limburg, School for Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands

Background: From a public health perspective, those at increased risk of dementia should be identifiable based on readily available risk factors that are truly amenable to change. To this end, the ‘’LIfestyle for BRAin Health’’ (LIBRA) score was developed after triangulation of results from a systematic literature review on risk and protective factors for dementia and an expert consensus study. LIBRA quantifies an individual’s potential for dementia prevention by flagging their ‘room for improvement’.

Methods: LIBRA consists of 12 risk and protective factors which can be targeted by lifestyle interventions and risk management in primary care. Risk factors are coronary heart disease, diabetes, hypercholesterolemia, hypertension, depression, obesity, smoking, physical inactivity and renal disease. Protective factors are low-to-moderate alcohol use, high cognitive activity and healthy diet. A weight is assigned to each factor based on the factor’s relative risk from meta-analyses (total score: -5.9 to 12.7), with higher scores indicating higher dementia risk.

Results: In pooled analyses from six prospective studies, a one-point change in LIBRA increased dementia risk by 15% (95%CI=9%-21%) in people aged <65 years and by 11% (95%CI=7%-15%) in those aged 65-75 years, but not at older ages. Higher LIBRA scores were also associated with cognitive decline in middle-aged individuals (Doetinchem Cohort Study), correlated with cognition scores in a health-seeking sample, related to intervention effects in early dementia prevention trials (preDIVA, FINGER) and associated with brain atrophy and cerebrovascular changes (Maastricht Study). Further, LIBRA is currently used by several international partners to give middle-aged individuals from the general population insight into their own lifestyle in order to promote brain health in later life.

Conclusions: There is a public need for knowledge transfer on brain health and potential for delaying dementia. LIBRA might be a useful tool to inform individuals of their profile and identify target behaviors.

 

 
 

Last Updated: Wednesday 19 June 2019

 

 
 

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