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With an effective treatment for dementia proving notoriously elusive, recent years have seen an increasing focus on secondary prevention – detecting and treating those at high risk or in preclinical stages of the disease as early as possible to reduce its impact. Now, a new review summarises the landscape of secondary prevention of dementia and outlines what needs to happen next.

A woman who is wearing a wrist device to track her health while tying her running shoe.

The review article, published last week in Frontiers in Neurology, was written by Senior Clinical Researcher at Dementias Platform UK, Dr Ivan Koychev, and Triin Ojakäär from Five Lives. Five Lives is a technology company focused on monitoring and improving cognitive health.

Triin Ojakäär said: ‘Advances in technologies that monitor and assess dementia risk offer a unique opportunity to intervene before clinical symptoms emerge. These tools are available to millions of people at a fraction of the cost of traditional methods. Anyone can now use these technologies to assess their risk of dementia and take the necessary steps towards a longer and healthier life.’

In the review, Koychev and Ojakäär make a strong case for the secondary prevention of dementia, with compelling evidence such as roughly 40% of dementia cases being attributable to potentially modifiable risk factors. They systematically explore the risk factors that best lend themselves to active monitoring for Alzheimer’s disease, including diabetes, chronic kidney disease, and high blood pressure.

As these conditions only increase a person’s risk of developing dementia, rather than guaranteeing an impending diagnosis, the authors propose that people in these at-risk groups are closely monitored to identify the earliest signs of dementia.

Dr Ivan Koychev – who also leads DPUK’s research volunteer registries including Great Minds – said: ‘Our knowledge of what the main drivers of dementia risks are has expanded considerably in recent years. Together with the developments in the ability to detect the processes leading to dementia, we can now move towards a world where we monitor and look after our future brain health – just like we do for our physical health.’

Historically, this monitoring strategy was expensive and invasive, requiring procedures such as brain scans. However, Koychev and Ojakäär propose scalable and cost-effective tools for monitoring people with these risk factors, which have advanced in recent years.

One such method they suggest is using blood-based biomarkers, which are features of the blood – like the presence of proteins associated with Alzheimer’s disease – that indicate someone is likely to develop dementia. Blood sampling is a quick and cheap procedure that requires skills or equipment available in a standard healthcare setting.

Another tool explored in the review is the use of digital biomarkers which monitor changes in thinking, sensory and motor skills. The authors argue that digital technology is now intrinsic to most people’s lives, so monitoring a person’s health in this way would likely be an insignificant adjustment. They discuss the options for both active digital monitoring – such as repeated phone-based memory tests – and passive monitoring of things like typing patterns and physical activity.

Finally, Koychev and Ojakäär call upon healthcare decision makers to invest in the necessary infrastructure to make early detection and intervention a reality. Plus, they recognise the need for public engagement to improve wider understanding that dementia is not an inevitable part of ageing, and that people can modify their risk.

For more information about healthy brain ageing, visit the ‘Keeping your brain healthy’ section of the DPUK website.