Search

Background: Evidence of modifiable risk factors for cognitive decline and dementia is accumulating, showing the potential of dementia risk reduction via lifestyle modification and cardiovascular risk management. People with low socioeconomic status (SES) have increased dementia risk and on average worse health. This study investigated whether the association between a modifiable dementia risk score and rate of cognitive decline differs across SES strata. Method: Data were used from Maastricht Aging Study (MAAS), a prospective cohort study with a 12‐year follow‐up. Participants aged ≥40 years with complete dementia risk profiles were included (n = 1223). The validated 'LIfestyle for BRAin health' (LIBRA) index was used to assess the modifiable dementia risk fraction. Cognitive performance was serially assessed at baseline, 6 and 12 years and measured in the domains of information processing speed, executive functioning and verbal memory function. A SES compound score was calculated from equivalent income and educational level and divided into tertiles (low, middle, high). Linear mixed models were used to study the association between LIBRA, SES and their interaction on the rate of cognitive decline. Result: Participants in the lowest SES tertile displayed more decline in information processing speed (vs. middle SES: X2 = 7.08, p = 0.029; vs. high SES: X2 = 9.49, p = 0.009) and verbal memory (vs. middle SES: X2 = 9.28, p<0.001; vs. high SES: X2 = 16.68, p<0.001) compared to their middle‐ and high‐SES counterparts. Higher (unhealthier) LIBRA scores were also associated with more decline in information processing speed (X2 = 12.66, p = 0.002) and verbal memory (X2 = 4.63, p = 0.032). No consistent effect modification by SES on the association between LIBRA and cognition was found. Conclusion: This study shows that lower SES and higher modifiable dementia risk predict faster decline in information processing speed and verbal memory function over 12 years. Results suggest that lifestyle is an important determinant of cognitive decline across SES groups. Yet, people with low SES had a more unfavourable modifiable risk score suggesting more potential for lifestyle‐based interventions. LIBRA could be useful as a participant selection tool or as a surrogate outcome measure in lifestyle intervention trials, and can inform people about individual risk behaviours as part of public health initiatives. [ABSTRACT FROM AUTHOR]

Background: Many studies showed that addressing modifiable risk factors has an impact on dementia prevalence and incidence. Most studies have focussed on universal prevention, irrespective of individual risk stage, with risk factors for dementia mainly identified in the general population. Less is known about the most important target risk factors in persons with subjective cognitive decline (SCD) or mild cognitive impairment (MCI), and hence, whether they have a similar potential for risk reduction as the general population. Therefore, this study aims to identify modifiable risk and protective factors for cognitive deterioration and dementia in persons with SCD or MCI. Method: We use a mixed‐methods approach combining findings from a systematic literature review and an online Delphi study. Four electronic databases (PubMed, EMBASE, PsycINFO, Web of Science) were searched to review relevant literature. A broad search term was developed in consultation with an experienced librarian and consisted of terms linked to SCD, MCI, dementia, modifiable risk factors and disease progression. Observational studies with at least 50 participants and 1 year of follow‐up were considered for inclusion. Twenty international dementia prevention experts were invited to participate in the online Delphi study. In two rounds, experts were asked to spontaneously name, rank and weigh modifiable risk and protective factors in order of importance for the target population. Result: Our search yielded 19,128 abstracts in total. After removal of duplicates, 9,862 abstracts were considered for inclusion and 203 full‐texts were read, of which 69 were included in our review. Several risk and protective factors were encountered including somatic, lifestyle and neuropsychiatric factors, and they are further scrutinized. Eighteen experts named 31 risk and protective factors in the first Delphi study round, of which physical activity, social isolation and hypertension were ranked highest. Results of round two are being collected. Conclusion: Findings from the current study will result in an inventory of relevant modifiable risk and protective factors linked with clinical progression in persons with SCD or MCI. Results will serve as the basis for the development and testing of an online dementia risk reduction tool for use in clinical populations with SCD and MCI. [ABSTRACT FROM AUTHOR]