Umbrella review and Delphi study on modifiable factors for dementia risk reduction

Colin Rosenau; Sebastian Köhler; Lion M Soons; Kaarin J Anstey; Carol Brayne; Henry Brodaty; Knut Engedal; Francesca R Farina; Mary Ganguli; Gill Livingston; Constantine G Lyketsos; Francesca Mangialasche; Laura E Middleton; Marcel G M Olde Rikkert; Ruth Peters; Perminder S Sachdev; Nikolaos Scarmeas; Geir Salbaek; Martin P J van Boxtel; Kay Deckers

doi:10.1002/alz.13577

Umbrella review and Delphi study on modifiable factors for dementia risk reduction

Alzheimers Dement. 2024 Mar;20(3):2223-2239. doi: 10.1002/alz.13577. Epub 2023 Dec 30.

Authors

Colin Rosenau¹, Sebastian Köhler¹, Lion M Soons¹, Kaarin J Anstey^{2

3

4}, Carol Brayne⁵, Henry Brodaty⁶, Knut Engedal⁷, Francesca R Farina⁸, Mary Ganguli⁹, Gill Livingston¹⁰, Constantine G Lyketsos¹¹, Francesca Mangialasche^{12

13}, Laura E Middleton^{14

15}, Marcel G M Olde Rikkert^{16

17}, Ruth Peters^{4

18

19}, Perminder S Sachdev⁶, Nikolaos Scarmeas^{20

21}, Geir Salbaek^{7

22

23}, Martin P J van Boxtel¹, Kay Deckers¹

Affiliations

¹ Alzheimer Centrum Limburg, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands.
² School of Psychology, University of New South Wales, Kensington, New South Wales, Australia.
³ Neuroscience Research Australia (NeuRA), Sydney, New South Wales, Australia.
⁴ UNSW Ageing Futures Institute, Kensington, New South Wales, Australia.
⁵ Cambridge Public Health, University of Cambridge, Cambridge, UK.
⁶ Centre for Healthy Brain Ageing (CHeBA), Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia.
⁷ Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway.
⁸ Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, Illinois, USA.
⁹ Departments of Psychiatry, Neurology, and Epidemiology, School of Medicine and School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁰ Division of Psychiatry, University College London, London, UK.
¹¹ Richman Family Precision Medicine Center of Excellence in Alzheimer's Disease, Johns Hopkins Bayview, Johns Hopkins Medicine, Baltimore, Maryland, USA.
¹² Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Center for Alzheimer Research, Karolinska Institutet, Stockholm, Sweden.
¹³ Theme Inflammation and Aging, Medical Unit Aging, Karolinska University Hospital, Stockholm, Sweden.
¹⁴ Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
¹⁵ Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada.
¹⁶ Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, the Netherlands.
¹⁷ Radboudumc Alzheimer Center, Donders Center of Medical Neurosciences, Nijmegen, the Netherlands.
¹⁸ The George Institute for Global Health, Newtown, New South Wales, Australia.
¹⁹ School of Biomedical Sciences, University of New South Wales, Kensington, New South Wales, Australia.
²⁰ 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece.
²¹ Department of Neurology, Columbia University, New York, New York, USA.
²² Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.
²³ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.

Abstract

A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the "LIfestyle for BRAin health" (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta-analyses with a two-round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts. HIGHLIGHTS: An umbrella review was combined with opinions of 18 dementia experts. Various candidate targets for dementia risk reduction were identified. Experts prioritized hearing impairment, social contact, and sleep. Re-assessment of dementia risk scores is encouraged. Future work should evaluate the predictive validity of updated risk scores.

Keywords: Delphi study; brain health; cognitive decline; cognitive impairment; dementia; etiological risk factors; hearing impairment; lifestyle; prevention; protective factors; risk prediction; risk reduction; sleep; social contact; umbrella review.

Publication types

Review

MeSH terms

Cognitive Dysfunction* / psychology
Delphi Technique
Dementia* / epidemiology
Dementia* / prevention & control
Dementia* / psychology
Hearing Loss* / epidemiology
Humans
Risk Factors
Risk Reduction Behavior
Systematic Reviews as Topic