Dementia prevention in memory clinics: recommendations from the European task force for brain health services.

Observational population studies indicate that prevention of dementia and cognitive decline is being accomplished, possibly as an unintended result of better vascular prevention and healthier lifestyles. Population aging in the coming decades requires deliberate efforts to further decrease its prevalence and societal burden. Increasing evidence supports the efficacy of preventive interventions on persons with intact cognition and high dementia risk. We report recommendations for the deployment of second-generation memory clinics (Brain Health Services) whose mission is evidence-based and ethical dementia prevention in at-risk individuals. The cornerstone interventions consist of (i) assessment of genetic and potentially modifiable risk factors including brain pathology, and risk stratification, (ii) risk communication with ad-hoc protocols, (iii) risk reduction with multi-domain interventions, and (iv) cognitive enhancement with cognitive and physical training. A roadmap is proposed for concept validation and ensuing clinical deployment.

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© 2022 The Author(s).

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GBF has received funding through the Private Foundation of 10.13039/501100006388Geneva University Hospitals from: A.P.R.A.—Association Suisse pour la Recherche sur la Maladie d’Alzheimer, Genève; 10.13039/501100023259Fondation Segré, Genève; Race Against Dementia Foundation, London, UK; Fondation Child Care, Genève; Fondation Edmond J. Safra, Genève; Fondation Minkoff, Genève; Fondazione Agusta, Lugano; McCall Macbain Foundation, Canada; Nicole et René Keller, Genève; Fondation AETAS, Genève. He has received funding through the 10.13039/501100006389University of Geneva or Geneva University Hospitals: for IISSs from ROCHE Pharmaceuticals, OM Pharma, EISAI Pharmaceuticals, Biogen Pharmaceuticals, and Novo Nordisk; for competitive research projects from: H2020, 10.13039/501100010767Innovative Medicines Initiative (IMI), IMI2, 10.13039/100000001Swiss National Science Foundation, and VELUX Foundation; for consulting from: Biogen, Diadem, Novo Nordisk, and Roche; for honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from: Biogen, Roche, Novo Nordisk, and GE HealthCare. DA received funding by the Fondation Recherche Alzheimer and the 10.13039/100000001Swiss National Science Foundation (project CRSK-3_196354/1). FR is funded in part by the 10.13039/100000001Swiss National Science Foundation under grant agreement 320030_182772: Brain connectivity and metacognition in persons with subjective cognitive decline (COSCODE). NV received research support from Fondation Bettencourt-Schueller, Fondation Servier, Union Nationale pour les Intérêts de la Médecine (UNIM) and Fondation pour la Recherche sur l’Alzheimer; travel grant from the Movement Disorders Society, Merz-Pharma and GE Healthcare SAS; is an unpaid sub-investigator in NCT04241068 (aducanumab, Biogen), NCT04437511 (donanemab, Eli-Lilly), NCT04592341 (gantenerumab, Roche), NCT03887455 (lecanemab, Eisai), NCT03352557 (gosuranemab, Biogen), NCT03828747 and NCT03289143 (semorinemab, Roche), NCT04619420 (JNJ-63733657, Janssen–Johnson & Johnson), NCT04374136 (AL001, Alector), NCT04592874 (AL002, Alector); and has given unpaid lectures in symposia organized by Eisai. FB is supported by the NIHR biomedical research centre at UCLH. FB is a steering committee or iDMC member for Biogen, Merck, Roche, EISAI. Consultant for Roche, Biogen, Merck, IXICO, Jansen, Combinostics. Research agreements with Novartis, Merck, Biogen, GE, Roche. FB is co-founder and share–holder of Queen Square Analytics LTD. KB has served as a consultant, at advisory boards, or at data monitoring committees for Abcam, Axon, BioArctic, Biogen, JOMDD/Shimadzu. Julius Clinical, Lilly, MagQu, Novartis, Ono Pharma, Pharmatrophix, Prothena, Roche Diagnostics, and Siemens Healthineers, and is a co-founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program, all outside the work presented in this paper. GC has received research support from the 10.13039/501100007601European Commission Horizon 2020 research and innovation programme (grant agreement number 667696), Fondation d'entreprise MMA des Entrepreneurs du Futur, Fondation Alzheimer, Programme Hospitalier de Recherche Clinique, 10.13039/501100001665Agence Nationale de la Recherche, Région Normandie, 10.13039/501100003750Association France Alzheimer et maladies apparentées, 10.13039/100014808Fondation Vaincre Alzheimer, Fondation Recherche Alzheimer and Fondation pour la Recherche Médicale (all to Inserm), and personal fees from Inserm, Fondation Alzheimer and Fondation d'entreprise MMA des Entrepreneurs du Futur. JG has received funding for the EURO-FINGERS project which is supported through the following funding organisations under the aegis of JPND www.jpnd.eu: Finland, Academy of Finland; Germany, Federal Ministry of Education and Research; Spain, National Institute of Health Carlos III; Luxembourg, National Research Fund; Hungary, National Research, Development and Innovation Office; Netherlands, Netherlands Organisation for Health Research and Development; Sweden, 10.13039/501100004359Swedish Research Council. Grant agreement: INTER/JPND/19/BM/14012609. AN reports grants from 10.13039/501100000304Parkinson's UK, 10.13039/100015652Barts Charity, Cure Parkinson's, NIHR, 10.13039/501100006041Innovate UK, Virginia Keiley benefaction, Alchemab, Aligning Science Across Parkinson's and Michael J Fox Foundation. Consultancy and personal fees from Astra Zeneca, AbbVie, Profile, Roche, Biogen, UCB, Bial, Charco Neurotech, uMedeor and Britannia, outside the submitted work. JMR and DJL are funded by Alzheimer's Research UK and the 10.13039/100012338Alan Turing Institute/Engineering and Physical Sciences Research Council (EP/N510129/1). DJL is also funded by National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula, 10.13039/501100000925National Health and Medical Research Council (NHMRC), 10.13039/100000049National Institute on Aging/10.13039/100000002National Institutes of Health (RF1AG055654). WvdF has been funded by ZonMW, NWO, EU-FP7, EU-JPND, 10.13039/501100010969Alzheimer Nederland, Hersenstichting CardioVascular Onderzoek Nederland, Health Holland, Topsector Life Sciences & Health, stichting Dioraphte, Gieskes-Strijbis fonds, stichting Equilibrio, Edwin Bouw fonds, Pasman stichting, stichting Alzheimer & Neuropsychiatrie Foundation, Philips, Biogen MA Inc, Novartis-NL, Life-MI, AVID, Roche BV, Fujifilm, Combinostics. WvdF holds the Pasman chair. WvdF, PS and LNV are recipients of ABOARD, which is a public-private partnership receiving funding from ZonMW (#73305095007) and Health ∼ Holland, Topsector Life Sciences & Health (PPP-allowance; #LSHM20106). WvdF, PS, and LNV are recipients of the EU Joint Programme - Neurodegenerative Disease Research (JPND) project EURO-FINGERS (ZonMW-Memorabel #733051102). WvdF has performed contract research for Biogen MA Inc, and Boehringer Ingelheim. WvdF has been an invited speaker at Boehringer Ingelheim, Biogen MA Inc, Danone, Eisai, WebMD Neurology (Medscape), Swiss National Science Foundation, Switzerland, European Commission Horizon 2020, Belgium, Springer Healthcare. WvdF is consultant to Oxford Health Policy Forum CIC, Roche, and Biogen MA Inc. WvdF participated in advisory boards of Biogen MA Inc and Roche. All funding is paid to her institution. WvdF was associate editor of Alzheimer, Research & Therapy in 2020/2021. WvdF is associate editor at Brain. BV is an investigator in clinical trials sponsored by Biogen, Lilly, Roche, Eisai Pharmaceuticals, and the Toulouse University Hospital (Inspire Geroscience Program). He has served as scientific advisor for Biogen, Alzheon, Green Valley, Norvo Nordisk, Longeveron, but received no personal compensation. He has served as consultant and/or scientific advisor for Roche, Lilly, Eisai, TauX with personal compensation. All other coauthors declare no competing interests.