The midlife cognitive profiles of adults at high risk of late-onset Alzheimer’s disease: The PREVENT study.
Ritchie K, Carrière I, Su L, O’Brien JT, Lovestone S, Wells K, Ritchie CW.
Alzheimer’s & dementia: the journal of the Alzheimer’s Association. 2017
10.1016/j.jalz.2017.02.008
Researchers analysed the results from PREVENT participants on various memory and thinking assessments. They found performance on particular spatial and navigation based tasks may be useful in differentiating between those deemed at high or low risk for later life dementia.
In this analysis, researchers were interested in the performance of PREVENT participants on a range of memory and thinking tasks in their mid-life to determine if there were any associations with increased risk of dementia in later life.
It is likely that traditional memory tests such as those used in memory clinic or in drug trials involving participants with established dementia may not be sensitive enough to identify the very earliest subtle changes in brain health. In this report the authors suggest that volunteers deemed at greater risk for dementia based on factors such as genetics and cardiovascular health, seemed to perform slightly worse on certain tasks, principally those which involved detailed spatial and navigation skills.
This initial data came from a relatively small number of the very first volunteers to enter the study. The results also come from only the first study visit and so capture only one snapshot in time. Whilst these findings alone are not enough to inform any one individual’s risk profile they do generate interesting areas to focus on when following participants throughout the duration of the study.
At, with and beyond risk: expectations of living with the possibility of future dementia.
Milne R, Diaz A, Badger S, Bunnik E, Fauria K, Wells K.
Sociology of health & illness. 2017.
10.1111/1467-9566.12731
Focus groups were held with PREVENT participants to develop discussions around disclosure of dementia risk.
As research into novel treatments for dementia shifts towards earlier intervention and greater understanding of risk factors in a younger population, this generates important new issues of how best to manage risk disclosure. What are the implications of an individual learning their dementia risk? How should this best be communicated? And how might this impact on future life decisions?
To explore these types of questions researchers held focus groups with PREVENT participants to gather opinion on the consequences of these new topics. The discussions centred around the groups expectations on discovering test results that may have implications for risk of future dementia. The three key areas under discussion were; ‘Living At Risk’ – taking proactive steps to reduce risk, ‘Living With Risk’ – maximising cognitive health and accessing healthcare services and ‘Living Beyond Risk’ – planning for later life and adjustment to symptoms.
Cerebral small vessel disease in middle age and genetic predisposition to late-onset Alzheimer’s disease.
Stefaniak JD, Su L, Mak E, Sheikh-Bahaei N, Wells K, Ritchie K, Waldman A, Ritchie CW, O’Brien JT.
Alzheimer’s & Dementia. 2017
10.1016/j.jalz.2017.08.017
Studying brain scans of PREVENT participants, the health of the small blood vessels that feed the brain did not appear to significantly differ between those considered at higher risk of Alzheimer’s disease based on genetic factors compared to those at lower risk.
Increased wear and tear of the small blood vessels supplying the brain is known to be associated with Alzheimer’s dementia in older people. Researchers studied the MRI brain scans of 160 PREVENT participants to see if they could identify any signs of greater wear and tear in those middle-aged participants deemed at potentially higher risk of developing Alzheimer’s disease. The level of risk attributed was based on genetic influences; having a parent with dementia and the version of a particular gene (the APOE gene) that someone has.
The group did not find any overall difference in the condition of the blood vessels between participants designated at increased risk of Alzheimer’s compared to those at lower risk. This might suggest that these brain changes happen closer to the onset of Alzheimer’s symptoms and were not yet present in our younger volunteers – with an average age of 51. The scans only captured one snapshot in time and so the group are keen to look at how the brains of PREVENT participants may change as they attend future follow up visits.
The PREVENT research programme–a novel research programme to identify and manage midlife risk for dementia: the conceptual framework.
Ritchie CW, Wells K, Ritchie K.
International Review of Psychiatry. 2013
10.3109/09540261.2013.869195
This article outlines the vision of the PREVENT study and how, through in depth study of people in their mid-life, PREVENT can generate novel evidence to inform future interventional trials and improve future care.
Advances in research have helped form our current understanding that the earliest brain changes relating to Alzheimer’s disease occur many years before the emergence of any symptoms. This paper highlights the unmet need for measurable markers that can inform us of an individual’s risk profile for later life dementia.
The authors provide a detailed breakdown of the main aims of the PREVENT programme and introduce the methods used to collect the wide range of information from volunteers. They speculate how knowledge gained from PREVENT and other similar studies can shape future prevention strategies to delay or halt the progression of Alzheimer’s disease.
The PREVENT study: a prospective cohort study to identify mid-life biomarkers of late-onset Alzheimer’s disease.
Ritchie CW, Ritchie K.
BMJ open. 2012
10.1136/bmjopen-2012-001893
This publication describes the importance of developing a study to investigate markers present in midlife that could identify people at increased risk for later life dementia.
As research aiming to intervene in the onset or progression of Alzheimer’s disease shifts ever earlier in the life-course of the disease this brings new challenges. Firstly, how to identify those at highest risk who may benefit most from interventions to prevent Alzheimer’s. Secondly, as studies begin to test drugs or other interventions in individuals who do not show any observable symptoms, what changes in the body or brain can be measured to indicate whether or not an intervention is working.
Identifying accurate markers that correlate with brain health can help tackle these key issues. Here the authors outline the rationale and design of the PREVENT dementia research programme. They describe how, through using detailed biological and psychological measures, this study aims to identify these very earliest markers of changes in brain health.
Fundraising to Support New Genetic Analysis
Our wonderful CDP runners took to the streets once again for this year’s Edinburgh Marathon Festival to tackle the 5k, 10k and marathon relay. All their hard work and excellent fundraising will make a huge contribution towards growing the PREVENT Dementia Research Programme.
In addition to our sponsored runners we are extremely grateful to the University of Edinburgh Estates Department who held an excellent bake sale series raising a staggering £2000 for the Centre. In a fantastic year of fundraising our volunteers have generated a total of over £7000 and counting!
These funds will help establish the PREVENT Dementia Genetics Core. This exciting new initiative will be led by Dr Riccardo Marioni at the University of Edinburgh who described the importance of the project:
“PREVENT Dementia is an internationally leading clinical study of Alzheimer’s dementia prevention but currently lacks a genetics and genomics element to help (1) inform our mechanistic understanding of Alzheimer’s and (2) further improve risk prediction.
University of Edinburgh Estates team hosted a series of successful Bake Sales
We have recently applied for grant funding, which if successful, will be used in tandem with your fundraising efforts to support the collection of multiple biological measures, including genetics, epigenetics (chemical changes that turn genes on/off), and protein levels to complement the existing neurologic, biologic, cognitive, and brain imaging data in PREVENT.”
Clare Dolan of the CDP ran the Edinburgh 5k for PREVENT Dementia
Integral to the value of this new analysis is the desire to share world leading, novel information with the global dementia research community.
“We intend to make these data accessible to researchers from around the world. This open science policy will promote collaboration with national and international researchers, accelerating progress towards our common goal of defeating dementia.”
The PREVENT Dementia project thrives on contributions made from its generous supporters and with more events planned in the coming months we are excited to see how this globally important study progresses.
Thank you so much to all our fantastic fundraisers, we are thrilled and humbled by the amazing support the project has received so far. With your help we can begin to understand the very earliest brain changes that occur in Alzheimer’s disease and this knowledge will power our ultimate goal of preventing dementia.
To find out more about our runners and to support the team see our JustGiving page.
