Publications

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.

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.

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.

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.

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.