It is an exciting time in dementia and Alzheimer research and care. World Alzheimer's Month takes place every September, and this year it was wonderful to see a wide variety of events and the great interest from various stakeholders. In addition, the WHO recently launched its Global status response on the public health response to dementia. To achieve the goals of the global action plan 2017-2025, joint global efforts, coordinated research, and implementation of available knowledge are needed. Several important pieces of the complex dementia challenge are now coming together; we are moving from observation to action into dementia prevention and risk reduction and there are new possibilities for early detection and diagnoses as well as better treatment and care.
Prevention has been highlighted as the key element in managing the global dementia epidemic. The most recent estimates indicate that 40% of dementias are related to modifiable risk factors, providing a clear prevention potential. Further, several novel risk factors are currently being further studied, such as stress, sleeping disturbances, and various dietary factors. The COVID-19 pandemic has had a negative impact on several risk factors for brain health, particularly lifestyle factors that were disrupted due to public health restrictions. The multifactorial aetiology of dementia and late-life Alzheimer´s highlights the importance of multidomain prevention approaches; targeting several risk factors and mechanisms simultaneously to get an optimal preventive effect.
The FINGER trial was the first large, long-term randomized control trial showing that it is possible to prevent cognitive and functional decline among at risk elderly persons from general population with a multidomain lifestyle-based intervention. The intervention phase lasted two years and we have just started the 11-year follow-up of participants. Besides several clinical outcomes, there will be a deeper focus on biomarkers and biorepository data, which is important to increase knowledge about mediating pathways and mechanisms and to further characterize which individuals respond best to such interventions and identify factors that increase long-term adherence to lifestyle modification measures.
Due to global challenge of dementia, the World-Wide FINGER network was launched in 2017 to support different countries to test, adapt, and optimize the multidomain lifestyle intervention model in various populations and settings. Prospective harmonization gives a unique opportunity to compare the results from different cultural and economic settings. The network is developing infrastructure for large-scale data sharing and joint analyses, which are essential for gaining optimal information about effective and feasible interventions in diverse populations world-wide. There are currently more than 40 countries in the World-Wide FINGER network, including several low- and middle-income countries, which are often underrepresented in randomized dementia prevention trials, despite the fact that dementia is rapidly increasing in these settings, making World-Wide FINGERs a truly global platform for multimodal dementia prevention trials.
As the COVID-19 pandemic has had a clear negative impact on several risk factors for brain health, the focus on dementia prevention and risk reduction is even more important now, and innovative approaches and broad collaboration are needed. A positive result of the pandemic is that there has been a rapid increased in the testing and implementing of e-health tools. Digital technology may facilitate personalised, effective, and feasible interventions and implementation and has the potential to improve diagnosis and build support networks.
Current findings suggest that social components of multidomain interventions are important, and there are ongoing efforts to create hybrid models that combine face-to-face and digital components to dementia prevention. It is also hypothesized that dementia prevention may be optimized by combining lifestyle modifications with pharmacological interventions and trials are underway to assess this, while bridging the gap between pharmacological and non-pharmacological approaches. These efforts all help to achieve information to define a precision prevention approach; where the right risk interventions are targeted to the right people at the right time.
There are several priorities for advancing dementia prevention and management. First, early detection is crucial. In order to achieve this, awareness about the early signs and symptoms of dementia and Alzheimer’s disease need to increase among the general population and healthcare workers. Second, dementia prevention models need to be implemented in real-world settings. Indeed, the World-Wide FINGERS network supports rapid translation of results into personalized interventions and clinical practice. We also need to ensure that the voice of the patient is heard in relation to both research programs and policy development. These are some of the priority areas that we are already working on within initiatives such as EURO-FINGERS where we are identifying the best ways to talk about prevention and risk reduction in persons at risk of dementia, and how to communicate disease risk according to biomarkers, as well as hoe to better motivate people to initiate and adhere to lifestyle changes.
We are facing a huge, global challenge to tackle this complex disorder. However, there is hope if we work together and prioritize dementia as a public health priority, enhance global collaboration, and start implementing the knowledge that we have already gained. We can all start to do something today by targeting the different pillars and activating the ‘five fingers’ of the multidomain model for increasing brain health; physical exercise, healthy balanced diet, cognitive activities, social activities and monitoring and managing of all vascular and metabolic risk factors. We should be ambitious with our prevention goals both at the societal level and as individuals.
__________
Professor Miia Kivipelto is professor in Clinical Geriatrics at the Karolinska Institutet Center for Alzheimer Research and Director for research and development of theme aging, Karolinska University Hospital, Stockholm, Sweden. She is chair in Neuroepidemiology, Ageing Epidemiology Research Unit, School of Public Health at Imperial College London, UK, and founder and scientific leader of World-Wide FINGERS and FINGERS Brain Health Institute.