Population Dementia Risk Reduction.
Background & Scientific Rationale
Maximising the potential of existing observational studies for targeted preventive interventional research is a high priority. Observational evidence from the population studies coordinated from Cambridge has shown that the prevalence of dementia in the population at particular ages has dropped, leading to stability in the estimates for total numbers of people with dementia despite considerable population ageing over the last two decades. These changes may be associated with dramatic reductions in vascular mortality and morbidity in most Western populations, thought to be due to a combination of improved risk profiles and medical management of vascular risks. Current cohorts offer the opportunity to extend what are currently observational cohorts to serve as a platform for intervention studies with extensively phenotyped samples.
This programme of work sought to strengthen at a local and study level the investment made into an internationally unique dementia platform. It was informed by local building blocks of earlier work in CLAHRC CP : programmes of evidence synthesis and research priority setting conducted through the previous CLAHRC in collaboration with the Alzheimer’s Society, James Lind Alliance and the Cochrane Collaboration and MRC funded population research such that pilot trials of promising interventions can now be developed.
Collaboration across the region enabled cohorts spanning a wide age range to work together to identify samples of individuals characterised as at different life-course stages of risk to be invited for trial participation, thus allowing a spectrum of primary, secondary and tertiary prevention approaches to be tested in representative populations.
The project is well aligned with the objectives of the NIHR School for Public Health Research’s Ageing Well programme. These cohorts are named in the Dementias Platform UK (DPUK) in which 22 UK based cohorts aim to support a step change in the potential for innovation and experimental medicine.
Aim and research questions
A key aim of this work was to create the capacity to support pilots and trials of promising interventions for dementia that can be rigorously trialled in representative populations with specific targeting for the different types of prevention (primary, secondary and tertiary). It concentrated on secondary and tertiary, the latter complementing the main thrust of the DPUK which will be towards early interventions. Specifically, this proposal aimed to strengthen our input into the DPUK as well as developing packages of intervention relevant to dementia, frailty and end of life which UKDP will be less well placed to implement. Development of the work was in close collaboration with the relevant DPUK activities, which partially cover many of these elements.
The project integrated and built on work to develop the MRC-CFAS cohort as a prevention platform already started with strong input from collaborators in multiple centres.
Key findings and outputs
CLAHRC EoE BITE-sized summaries:
- BITE 16 – Changing risk behaviours and promoting cognitive health in older adults
- BITE 17 Mid-life approaches to prevent or delay dementia, disability and frailty
- Olanrewaju O. et al. A multimodal approach to dementia prevention: A report from the Cambridge Institute of Public Health. Alzheimer’s & Dementia: Translational Research & Clinical Interventions. 2015; 1:151-156 article pdf
- Lafortune et al. Public Health England. Evidence-based resource for changing risk behaviours and promoting cognitive health in older adults: Summary of public health interventions for local authorities and commissioners. 2016. PHE: London. report link
- Olanrewaju O, Kelly S, Cowan A, Brayne C, and Lafortune L. Physical Activity in Community Dwelling Older People: A Systematic Review of Reviews of Interventions and Context. PLoS ONE 2016 11(12): e0168614. article link
- Kelly, S. and Olanrewaju, O. Alcohol in older people: Systematic reviews of interventions and context. In: The Lancet Public Health Science: A National Conference Dedicated to New Research in UK Public Health. 2016. Vol. 388, S64. article pdf
- Olanrewaju O et al. Physical activity in community dwelling older people: A review of systematic reviews of interventions and context. In: The Lancet Public Health Science: A National Conference Dedicated to New Research in UK Public Health. 2016 Vol. 388, S83. article pdf
- Kelly S, Olanrawaju O, Cowan A, Brayne C, and Lafortune L. Interventions to prevent and reduce excessive alcohol consumption in older people: a systematic review and meta-analysis. Age and Ageing. 2017. 0:1-10. DOI:10.1093/ageing/afx132 article link
- Kelly S, Olanrewaju O, Cowan A, Brayne C, Lafortune L. Alcohol and older people: a systematic review of barriers, facilitators and context of drinking in older people and implications for intervention design. PLOS One. January 25 2018. DOI:10.1371/journal.pone.0191189 article link
- University of Cambridge Press Release: New cases of dementia in the UK fall by 20% over two decades