On 31 January 2023, an international task force led by the University of Geneva (UNIGE) and Geneva University Hospitals (HUG) published guidelines for innovative services to help prevent Alzheimer’s disease. The guidelines are detailed in an article titled "Dementia prevention in memory clinics - recommendations from the European task force for brain health services", published in the journal Lancet Regional Health - Europe. The task force responsible for the recommendations is composed of representatives from 28 institutions and includes Jean Georges, Executive Director, Alzheimer Europe. Alzheimer’s disease can lead to a dramatic loss of autonomy for those affected, due to the memory loss, behavioural changes and cognitive deficits it causes. On top of this, related health costs are high, leading to a heavy financial impact for many people. Its prevention has become a real social challenge. With 10 million people in Europe affected by Alzheimer’s disease, it is the most common neurodegenerative disease and is characterised by progressive, disabling memory loss and cognitive deficits caused by an accumulation of toxic proteins in the brain. Its social and economic impact, with the latter estimated at around USD 1,500 billion (EUR 1,386,780,000) per year, on a global scale. Improved lifestyles (physical activity, better nutrition, cardiovascular health) have reduced the risk of developing Alzheimer’s disease and other types of dementia, however, the prevalence of dementia continues to rise with the ageing population.
The international task force led by the UNIGE and the HUG, and composed of scientists from twenty-eight institutions, is laying the foundations of a preventive protocol that could be deployed on a large scale. ‘‘We based this protocol on the experience of all the members of the task force. Some of the recommended interventions are ready to be applied or are already applied. Others are still under development,’’ explains Professor Giovanni Frisoni, Full Professor of Clinical Neuroscience at the UNIGE Faculty of Medicine and Director of the HUG Memory Centre. Prof. Frisoni and the co-authors of the article have identified four pillars (see graphic) of this novel concept in the field of dementia and Alzheimer’s:
• Risk assessment: The risk factors for Alzheimer’s disease and related disorders and their weight have been grouped together in an evaluation grid. These include factors associated with genes, such as APOE4, or those linked to lifestyle or conditions, such as hypertension, diabetes, alcohol consumption, social isolation, obesity, hearing loss, depression or head trauma.
• Risk communication: This second pillar, which is crucial in the relationship that is established with the patient, makes it possible to communicate the risk index in the most accurate and comprehensible way. Indeed, understanding the risk of developing a disease is more complex than understanding being actually affected by a disease. A series of recommendations based on the patient’s personality and background make it possible to choose the best tools for presenting the situation to the patient in a comprehensible manner.
• Risk reduction: Drug and non-drug interventions are proposed for risk reduction. These range from lifestyle improvements to cognitive training and the administration of anti-amyloid drugs, should these become available on the market. Interventions on the gut microbiota may also be considered in the future.
• Cognitive reinforcement: Different types of memory (subjective, objective, meta) can be reinforced or stimulated through paper-based exercises or computer games. Transcranial electrical or magnetic stimulation will also be an important tool to activate synapses in key brain regions and thus improve memory.
The hope is that these four pillars, which are detailed in the Lancet Regional Health - Europe article, will enable second generation memory clinics to reach out to the segment of the population whose memory is still functioning well and who wish to preserve or improve it, as the authors of this new paper stress that clinics are not currently equipped to support this population effectively.