I had always been convinced that dementia risk assessment was not so interesting for young people (too far), and kind of scary for older people (as there is no cure, while shall I know that in advance?). However, a number of international surveys tell that I was wrong: most of people, both young and elderly, would like to undergo genetic testing and other forms of dementia risk assessment to know if they are at risk of developing Alzheimer, or other forms of dementia.
Genetic testing vs. other dementia risk assessment strategies
So far, genetic testing is reliable only to detect a rare form of Alzheimer’s disease (AD) with an early onset (before age 65) and strong genetic component. This accounts for less than 5% of the AD cases. However, and this is good news, AD it’s not all in our genes! More and more research suggests that many factors affect the probability to develop dementia. In particular, lifestyle has an important impact. Specifically, there are
- lifestyle-related risk factors that increase our dementia risk, and
- lifestyle-related protective factors that decrease our dementia risk
And most of these factors are modifiable! This means that we can actively do something to decrease our risk of developing dementia, and to improve our brain health.
How can we do a personalized dementia risk assessment?
Today we can find online most of what we need, as many risk and protective factors are measurable through fast and reliable self-screening questionnaires. Some dementia risk assessment tools are adapted to people older than 65 years, while others are more adapted to middle-aged persons (typically, 40-60 years). But most of them cover common risk and protective factors. Let’s review them shortly!
Dementia risk assessment: age and gender
Age is the main risk factor of dementia: as we grow old, our chances to develop dementia increase. This is why population aging is leading a worldwide ‘dementia epidemic’. But, if we look at the worldwide statistics, the proportion of dementia cases is increasing mainly in the developing countries. Why? Because age is not the only risk factor: we cannot prevent aging, but we can try to age well!
Gender differences in the probability to develop dementia are more debated. However, statistics say that women are affected by AD more often than men, and, apparently, this is not completely explained by the fact that women have a tendency, on average, to live longer. Possible explanations include genetic differences, but also cultural and psychosocial components, such as the fact that, on average, women have a lower education and a lower occupational history compared to men. In contrast, men are at greater risk of developing mild cognitive impairment (MCI), a state between the normal cognitive changes associated with aging and early dementia.
Dementia risk assessment: cardiovascular risk factors
What’s good for your heart is good for your brain. This is not just a quote. Our brain burns a lot of energy, and if our heart is not working well, the brain does not get all what it need. Problems related to the vascular system, such as strokes, are the main cause of vascular dementia; and can contribute to worsen AD and related disorders, leading to the so called mixed dementias. High blood pressure (hypertension), high cholesterol (hypercholesterolemia), and obesity are the most studies risk factors. All of them should be monitored by a doctor, but improvements can be made by modifying several lifestyle habits, such as diet, physical exercise, alcohol consumption and smoking.
Dementia risk assessment: diet and alcohol
Dietary habits may play an important role in protecting against dementia, or in increasing the risk to develop it. In particular, Mediterranean diet is an important protective factor. The Mediterranean diet is characterized by high intake of fish, vegetables, legumes, fruits, cereals and unsaturated fatty acids, and low intake of dairy products, meat and saturated fatty acids. You can find online all the information you need to set up a Mediterranean diet!
Heavy alcohol intake is associated with an increased risk of developing dementia. Binge drinking (more than 5 bottles of beer or a bottle of wine on one occasion) is consistently associated with higher dementia risk. However, small alcohol quantities, especially of wine, can represent a protective factor against dementia.
Dementia risk assessment: smoking
Smoking increases the risk of AD and of other forms of dementia. Smoking worsens atheromatus plague formation in the arteries and increases blood pressure, thus increasing the risk of heart disease.
Dementia risk assessment: mood
We all know that mood affects our brain functioning. In particular, there is evidence that people experiencing depression have a higher risk of developing dementia. Treatment for depression such as ensuring a healthy diet, exercise and social engagement and talking therapies can improve your cognitive function, and thus reduce dementia risk. Sleep problems often accompany depression. See http://flexaging.com/light-therapy-for-insomnia/ to find out more about non-pharmacological solutions for insomnia.
Dementia risk assessment: physical activity
Being physical active is one of the most important steps to take to improve our overall health and protect against dementia. People who do regular physical activity lower their risk of dementia by up to 30%! Regular physical evidence helps the blood flow to the brain. It helps reduce the risk of stroke, heart attack and diabetes, which are all risk factors for dementia. It can also improve our mood, overall fitness level and keep our hearts healthy.
Dementia risk assessment: cognitive activity and social engagement
It is important as we age to keep our brain active, and to engage in social activities. Those with low levels of educational attainment and low level of participation in cognitively and socially engaging activities are at a higher risk of developing dementia. Anything that challenges your brain will work as a protective factor. This includes, among others, playing games (see http://flexaging.com/video-games-for-elderly/), learning new languages, reading books, going to concerts, listening to music, dining with friends.
Available instruments for dementia risk assessment
Today we can find online several free dementia risk assessment instruments. Many of them are based on sound scientific evidence, and are easy to fill in no more than half an hour. Let’s review the top 4!
N.B. None of these dementia risk assessment instruments is meant to make a diagnosis of dementia, or to replace in-person evaluation by a qualified physician; they can just help to determine whether a person is at increased risk for having dementia.
Tool for dementia risk assessment n. 1: the Dementia Risk Assessment (DRA)
The DRA questionnaire has been developed by a team at the Johns Hopkins School of Medicine. It is meant for elderly people, and takes 10 minutes to complete. It embeds a short memory test, and asks questions about: demographics, medical health, alcohol intake, smoking, physical activity, cognitive activity and mood. The results are available immediately after test completion, and take the form of a written report summarizing the addressed risk and protective factors, accompanied by short explanations. The DRA instrument has been validated on a large sample in US.
Brandt, J., Blehar, J., Anderson, A. & Gross, A.L. (2014). Further validation of the Dementia Risk Assessment. Journal of Alzheimer’s Disease, 41, 937-945.
Tool for dementia risk assessment n. 2: The ANU Alzheimer’s Disease Risk Index (ANU-ADRI)
The ANU-ADRI is an evidence-based, validated tool developed by researchers at the Australian National University. It is meant for people over 60 years, and assesses the following risk and protective factors: demographics, medical health, dementia family history, mood, physical activity, cognitive and leisure activity, social activities, diet, alcohol intake, smoking and exposure to pesticides. It takes 15-20 minutes to complete, and provides very intuitive results including graphs showing our risk and protection factors. Furthermore, it provides a short explanation for each factor, and basic advice on how to improve.
Anstey, K.J., Cherbuin, N., Herath, P.M., Qiu, C., Kuller, L.H., et al. (2014). A self-report risk index to predict occurrence of dementia in three independent cohorts of older adults: The ANU-ADRI. PLoS ONE 9(1): e86141.
Tool for dementia risk assessment n. 3: The CAIDE dementia risk score
The CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) Dementia Risk Score has been developed by researchers in Sweden in the context of a big study on dementia prevention (the FINGER study). It a validated tool for people in mid-life (40-65y) to predict late-life dementia risk. Merz Pharmaceuticals GmbH developed an app based on this score, which takes a few minutes to complete. It asks questions about demographics, and cardiovascular risk factors such as hypertension, hypercholesterolemia, obesity, and physical inactivity. The personalized dementia risk score is shown on a bar graph showing the probability to develop dementia in the next 20 years compared to the average probability.
Sindi, H., Calov, E., Fokkens, J., Ngandu, T., Soininen, H., Tuomilehto, J., & Kivipelto, M. (2015). The CAIDE Dementia Risk Score App: The development of an evidence-based mobile application to predict the risk of dementia. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 1(3), 328-333.
Tool for dementia risk assessment n. 4: The LIBRA score (COMING SOON!)
The Lifestyle for Brain Health (LIBRA) score is an evidence-based index developed in the context of a European FP7 project (In-MINDD) by Irish, Scottish, Dutch and French researchers. It is meant for people in midlife (40-60 years), and assesses the following areas: demographics, medical health (including diabetes, chronic kidney disease and cardiovascular pathologies), family medical history, mood, physical activity, cognitive activity, social and leisure activities, diet, alcohol intake, and smoking. The project ended in October 2015, and validation data will be released soon. It takes 15-20 minutes to complete, and provides very intuitive results, including graphs showing which factors we can improve, which ones are ok, and which ones we should remember to manage, if they cannot be modified. After getting the personalized LIBRA score, users can access a support environment with information concerning the different factors, and personalized advice on how to improve them. The In-MINDD profiler will be available online soon (mid 2016).
O’Donnell, C.A., Browne, S., Pierce, M., McConnachie, A., Deckers, K., van Boxtel, M.P.J., Manera, V., Köhler, S., Redmond, M., Verhey, F.R.J., van den Akker, M., Power, K., & Irving, K. (2015). Reducing dementia risk by targeting modifiable risk factors in mid-life: study protocol for the Innovative Midlife Intervention for Dementia Deterrence (In-MINDD) randomised controlled feasibility trial. Pilot and Feasibility Studies, 1(40), 1-12.
The following table shows a summary of the main features of each instrument. Based on your age, decide which dementia risk assessment tool you prefer to use. Remember, nothing prevents you from trying more than one, they are all free!
Tools for dementia risk assessment at a glance
We should be aware that having a high risk of developing dementia does not mean that we will develop dementia for sure. Similarly, a low dementia risk does not mean we are definitely immune to dementia. The dementia risk assessment tools talk about probabilities.
However, the good news is that what is good to reduce dementia risk, is good also to reduce the risk of a number of other pathologies, such as cardiovascular accidents. Doing physical exercise, quitting smoking, following a good diet, are good ideas for our brain, heart and body health. So, whether we fear about dementia or not, let’s take half an hour to check what we could do better!