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Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions

The first WHO guidelines for risk reduction of cognitive decline and dementia marked an important milestone in the field of dementia prevention. In this paper, we discuss the evidence reviewed as part of the guidelines development and present the main themes emerged from its synthesis, to inform fut...

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Autores principales: Stephen, Ruth, Barbera, Mariagnese, Peters, Ruth, Ee, Nicole, Zheng, Lidan, Lehtisalo, Jenni, Kulmala, Jenni, Håkansson, Krister, Chowdhary, Neerja, Dua, Tarun, Solomon, Alina, Anstey, Kaarin J., Kivipelto, Miia
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8577650/
https://www.ncbi.nlm.nih.gov/pubmed/34764935
http://dx.doi.org/10.3389/fneur.2021.763573
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author Stephen, Ruth
Barbera, Mariagnese
Peters, Ruth
Ee, Nicole
Zheng, Lidan
Lehtisalo, Jenni
Kulmala, Jenni
Håkansson, Krister
Chowdhary, Neerja
Dua, Tarun
Solomon, Alina
Anstey, Kaarin J.
Kivipelto, Miia
author_facet Stephen, Ruth
Barbera, Mariagnese
Peters, Ruth
Ee, Nicole
Zheng, Lidan
Lehtisalo, Jenni
Kulmala, Jenni
Håkansson, Krister
Chowdhary, Neerja
Dua, Tarun
Solomon, Alina
Anstey, Kaarin J.
Kivipelto, Miia
author_sort Stephen, Ruth
collection PubMed
description The first WHO guidelines for risk reduction of cognitive decline and dementia marked an important milestone in the field of dementia prevention. In this paper, we discuss the evidence reviewed as part of the guidelines development and present the main themes emerged from its synthesis, to inform future research and policies on dementia risk reduction. The role of intervention effect-size; the mismatch between observational and intervention-based evidence; the heterogeneity of evidence among intervention trials; the importance of intervention duration; the role of timing of exposure to a certain risk factor and interventions; the relationship between intervention intensity and response; the link between individual risk factors and specific dementia pathologies; and the need for tailored interventions emerged as the main themes. The interaction and clustering of individual risk factors, including genetics, was identified as the overarching theme. The evidence collected indicates that multidomain approaches targeting simultaneously multiple risk factors and tailored at both individual and population level, are likely to be most effective and feasible in dementia risk reduction. The current status of multidomain intervention trials aimed to cognitive impairment/dementia prevention was also briefly reviewed. Primary results were presented focusing on methodological differences and the potential of design harmonization for improving evidence quality. Since multidomain intervention trials address a condition with slow clinical manifestation—like dementia—in a relatively short time frame, the need for surrogate outcomes was also discussed, with a specific focus on the potential utility of dementia risk scores. Finally, we considered how multidomain intervention could be most effectively implemented in a public health context and the implications world-wide for other non-communicable diseases targeting common risk factors, taking into account the limited evidence in low-middle income countries. In conclusion, the evidence from the first WHO guidelines for risk reduction of cognitive decline and dementia indicated that “one size does not fit all,” and multidomain approaches adaptable to different populations and individuals are likely to be the most effective. Harmonization in trial design, the use of appropriate outcome measures, and sustainability in large at-risk populations in the context of other chronic disorders also emerged as key elements.
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spelling pubmed-85776502021-11-10 Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions Stephen, Ruth Barbera, Mariagnese Peters, Ruth Ee, Nicole Zheng, Lidan Lehtisalo, Jenni Kulmala, Jenni Håkansson, Krister Chowdhary, Neerja Dua, Tarun Solomon, Alina Anstey, Kaarin J. Kivipelto, Miia Front Neurol Neurology The first WHO guidelines for risk reduction of cognitive decline and dementia marked an important milestone in the field of dementia prevention. In this paper, we discuss the evidence reviewed as part of the guidelines development and present the main themes emerged from its synthesis, to inform future research and policies on dementia risk reduction. The role of intervention effect-size; the mismatch between observational and intervention-based evidence; the heterogeneity of evidence among intervention trials; the importance of intervention duration; the role of timing of exposure to a certain risk factor and interventions; the relationship between intervention intensity and response; the link between individual risk factors and specific dementia pathologies; and the need for tailored interventions emerged as the main themes. The interaction and clustering of individual risk factors, including genetics, was identified as the overarching theme. The evidence collected indicates that multidomain approaches targeting simultaneously multiple risk factors and tailored at both individual and population level, are likely to be most effective and feasible in dementia risk reduction. The current status of multidomain intervention trials aimed to cognitive impairment/dementia prevention was also briefly reviewed. Primary results were presented focusing on methodological differences and the potential of design harmonization for improving evidence quality. Since multidomain intervention trials address a condition with slow clinical manifestation—like dementia—in a relatively short time frame, the need for surrogate outcomes was also discussed, with a specific focus on the potential utility of dementia risk scores. Finally, we considered how multidomain intervention could be most effectively implemented in a public health context and the implications world-wide for other non-communicable diseases targeting common risk factors, taking into account the limited evidence in low-middle income countries. In conclusion, the evidence from the first WHO guidelines for risk reduction of cognitive decline and dementia indicated that “one size does not fit all,” and multidomain approaches adaptable to different populations and individuals are likely to be the most effective. Harmonization in trial design, the use of appropriate outcome measures, and sustainability in large at-risk populations in the context of other chronic disorders also emerged as key elements. Frontiers Media S.A. 2021-10-26 /pmc/articles/PMC8577650/ /pubmed/34764935 http://dx.doi.org/10.3389/fneur.2021.763573 Text en Copyright © 2021 Stephen, Barbera, Peters, Ee, Zheng, Lehtisalo, Kulmala, Håkansson, Chowdhary, Dua, Solomon, Anstey and Kivipelto. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Stephen, Ruth
Barbera, Mariagnese
Peters, Ruth
Ee, Nicole
Zheng, Lidan
Lehtisalo, Jenni
Kulmala, Jenni
Håkansson, Krister
Chowdhary, Neerja
Dua, Tarun
Solomon, Alina
Anstey, Kaarin J.
Kivipelto, Miia
Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions
title Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions
title_full Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions
title_fullStr Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions
title_full_unstemmed Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions
title_short Development of the First WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia: Lessons Learned and Future Directions
title_sort development of the first who guidelines for risk reduction of cognitive decline and dementia: lessons learned and future directions
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8577650/
https://www.ncbi.nlm.nih.gov/pubmed/34764935
http://dx.doi.org/10.3389/fneur.2021.763573
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