Frisoni Giovanni B, Altomare Daniele, Ribaldi Federica, Villain Nicolas, Brayne Carol, Mukadam Naaheed, Abramowicz Marc, Barkhof Frederik, Berthier Marcelo, Bieler-Aeschlimann Melanie, Blennow Kaj, Brioschi Guevara Andrea, Carrera Emmanuel, Chételat Gaël, Csajka Chantal, Demonet Jean-François, Dodich Alessandra, Garibotto Valentina, Georges Jean, Hurst Samia, Jessen Frank, Kivipelto Miia, Llewellyn David J, McWhirter Laura, Milne Richard, Minguillón Carolina, Miniussi Carlo, Molinuevo José Luis, Nilsson Peter M, Noyce Alastair, Ranson Janice M, Grau-Rivera Oriol, Schott Jonathan M, Solomon Alina, Stephen Ruth, van der Flier Wiesje, van Duijn Cornelia, Vellas Bruno, Visser Leonie N C, Cummings Jeffrey L, Scheltens Philip, Ritchie Craig, Dubois Bruno
Memory Center, Department of Rehabilitation and Geriatrics, University Hospitals and University of Geneva Geneva, Switzerland.
Institut de la Mémoire et de la Maladie d'Alzheimer, IM2A, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France.
Lancet Reg Health Eur. 2023 Jan 31;26:100576. doi: 10.1016/j.lanepe.2022.100576. eCollection 2023 Mar.
Observational population studies indicate that prevention of dementia and cognitive decline is being accomplished, possibly as an unintended result of better vascular prevention and healthier lifestyles. Population aging in the coming decades requires deliberate efforts to further decrease its prevalence and societal burden. Increasing evidence supports the efficacy of preventive interventions on persons with intact cognition and high dementia risk. We report recommendations for the deployment of second-generation memory clinics (Brain Health Services) whose mission is evidence-based and ethical dementia prevention in at-risk individuals. The cornerstone interventions consist of (i) assessment of genetic and potentially modifiable risk factors including brain pathology, and risk stratification, (ii) risk communication with ad-hoc protocols, (iii) risk reduction with multi-domain interventions, and (iv) cognitive enhancement with cognitive and physical training. A roadmap is proposed for concept validation and ensuing clinical deployment.
观察性人群研究表明，痴呆症和认知能力下降的预防正在取得成效，这可能是更好的血管预防措施和更健康生活方式带来的意外结果。未来几十年的人口老龄化需要我们做出深思熟虑的努力，以进一步降低其患病率和社会负担。越来越多的证据支持对认知功能完好但痴呆风险较高的人群进行预防性干预的有效性。我们报告了关于第二代记忆诊所（脑健康服务）部署的建议，其使命是在高危个体中基于证据并合乎道德地预防痴呆症。核心干预措施包括：（i）评估遗传和潜在可改变的风险因素，包括脑病理学，并进行风险分层；（ii）通过临时方案进行风险沟通；（iii）通过多领域干预降低风险；（iv）通过认知和体育训练增强认知能力。本文提出了一个概念验证及后续临床部署的路线图。
