Dementia prevention in memory clinics: recommendations from the European task force for brain health services

Giovanni B Frisoni¹, Daniele Altomare¹, Federica Ribaldi¹, Nicolas Villain^{2

3}, Carol Brayne⁴, Naaheed Mukadam⁵, Marc Abramowicz⁶, Frederik Barkhof^{7

8}, Marcelo Berthier⁹, Melanie Bieler-Aeschlimann^{10

11}, Kaj Blennow¹², Andrea Brioschi Guevara^{10

13}, Emmanuel Carrera¹⁴, Gaël Chételat¹⁵, Chantal Csajka¹⁶, Jean-François Demonet^{10

17}, Alessandra Dodich¹⁸, Valentina Garibotto¹⁹, Jean Georges²⁰, Samia Hurst²¹, Frank Jessen^{22

23

24}, Miia Kivipelto^{25

26

27

28}, David J Llewellyn^{29

30}, Laura McWhirter³¹, Richard Milne^{4

32}, Carolina Minguillón^{33

34

35}, Carlo Miniussi^{18

36}, José Luis Molinuevo^{33

37}, Peter M Nilsson^{38

39}, Alastair Noyce⁴⁰, Janice M Ranson²⁹, Oriol Grau-Rivera³³, Jonathan M Schott⁴¹, Alina Solomon^{42

43

28}, Ruth Stephen⁴², Wiesje van der Flier^{44

45

46}, Cornelia van Duijn^{47

48}, Bruno Vellas⁴⁹, Leonie N C Visser^{25

50}, Jeffrey L Cummings⁵¹, Philip Scheltens^{44

52}, Craig Ritchie⁵³, Bruno Dubois^{2

3}

Affiliations

¹ Memory Center, Department of Rehabilitation and Geriatrics, University Hospitals and University of Geneva Geneva, Switzerland.
² Institut de la Mémoire et de la Maladie d'Alzheimer, IM2A, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France.
³ Institut du Cerveau et de la Moelle Épinière, UMR-S975, INSERM, Paris, France.
⁴ Cambridge Public Health, University of Cambridge, Cambridge, UK.
⁵ Division of Psychiatry, University College London, London, UK.
⁶ Genetic Medicine, Diagnostics Dept, University Hospitals and University of Geneva, Geneva, Switzerland.
⁷ Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
⁸ Queen Square Institute of Neurology, University College London, London, UK.
⁹ Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Malaga, Spain.
¹⁰ Leenaards Memory Centre, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
¹¹ Infections Disease Service, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
¹² Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden.
¹³ Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
¹⁴ Stroke Center, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Geneva, Switzerland.
¹⁵ Normandie University, UNICAEN, INSERM, U1237, PhIND Physiopathology and Imaging of Neurological Disorders, Cyceron, Caen, France.
¹⁶ Center of Research and Innovation in Clinical Pharmaceutical Sciences, University Hospital and University of Lausanne, Lausanne, Switzerland.
¹⁷ French Clinical Research Infrastructure Network, INSERM, University Hospital of Toulouse, France.
¹⁸ Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy.
¹⁹ Division of Nuclear Medicine and Molecular Imaging, University Hospitals of Geneva and NIMTLab, University of Geneva, Geneva, Switzerland.
²⁰ Alzheimer Europe, Luxembourg.
²¹ Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
²² Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
²³ German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany.
²⁴ Excellence Cluster Cellular Stress Responses in Aging-Related Diseases (CECAD), Medical Faculty, University of Cologne, Germany.
²⁵ Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
²⁶ Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
²⁷ Theme Aging, Karolinska University Hospital, Stockholm, Sweden.
²⁸ The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK.
²⁹ College of Medicine and Health, University of Exeter, UK.
³⁰ Alan Turing Institute, Exeter, UK.
³¹ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
³² Engagement and Society, Wellcome Connecting Science, Hinxton, UK.
³³ Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.
³⁴ IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
³⁵ CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
³⁶ Centre for Medical Sciences (CISMed), University of Trento, Rovereto, Italy.
³⁷ H. Lundbeck A/S, Denmark.
³⁸ Department of Clinical Science, Lund University, Sweden.
³⁹ Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
⁴⁰ Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
⁴¹ Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK.
⁴² Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
⁴³ Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.
⁴⁴ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands.
⁴⁵ Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.
⁴⁶ Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, the Netherlands.
⁴⁷ Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
⁴⁸ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁴⁹ Gerontopole and Alzheimer's Disease Research and Clinical Center, Toulouse University Hospital, Toulouse, France.
⁵⁰ Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands.
⁵¹ Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.
⁵² EQT Life Sciences, Amsterdam, the Netherlands.
⁵³ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.

PMID: 36895446
PMCID: PMC9989648
DOI: 10.1016/j.lanepe.2022.100576

Review

Dementia prevention in memory clinics: recommendations from the European task force for brain health services

Giovanni B Frisoni et al. Lancet Reg Health Eur. 2023.

. 2023 Jan 31:26:100576.

doi: 10.1016/j.lanepe.2022.100576. eCollection 2023 Mar.

Authors

Affiliations

¹ Memory Center, Department of Rehabilitation and Geriatrics, University Hospitals and University of Geneva Geneva, Switzerland.
² Institut de la Mémoire et de la Maladie d'Alzheimer, IM2A, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France.
³ Institut du Cerveau et de la Moelle Épinière, UMR-S975, INSERM, Paris, France.
⁴ Cambridge Public Health, University of Cambridge, Cambridge, UK.
⁵ Division of Psychiatry, University College London, London, UK.
⁶ Genetic Medicine, Diagnostics Dept, University Hospitals and University of Geneva, Geneva, Switzerland.
⁷ Radiology & Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
⁸ Queen Square Institute of Neurology, University College London, London, UK.
⁹ Unit of Cognitive Neurology and Aphasia, Centro de Investigaciones Médico-Sanitarias (CIMES), University of Malaga, Malaga, Spain.
¹⁰ Leenaards Memory Centre, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
¹¹ Infections Disease Service, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
¹² Clinical Neurochemistry Laboratory, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden.
¹³ Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
¹⁴ Stroke Center, Department of Clinical Neurosciences, University Hospitals and University of Geneva, Geneva, Switzerland.
¹⁵ Normandie University, UNICAEN, INSERM, U1237, PhIND Physiopathology and Imaging of Neurological Disorders, Cyceron, Caen, France.
¹⁶ Center of Research and Innovation in Clinical Pharmaceutical Sciences, University Hospital and University of Lausanne, Lausanne, Switzerland.
¹⁷ French Clinical Research Infrastructure Network, INSERM, University Hospital of Toulouse, France.
¹⁸ Center for Mind/Brain Sciences (CIMeC), University of Trento, Rovereto, Italy.
¹⁹ Division of Nuclear Medicine and Molecular Imaging, University Hospitals of Geneva and NIMTLab, University of Geneva, Geneva, Switzerland.
²⁰ Alzheimer Europe, Luxembourg.
²¹ Institute for Ethics, History, and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
²² Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
²³ German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany.
²⁴ Excellence Cluster Cellular Stress Responses in Aging-Related Diseases (CECAD), Medical Faculty, University of Cologne, Germany.
²⁵ Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
²⁶ Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.
²⁷ Theme Aging, Karolinska University Hospital, Stockholm, Sweden.
²⁸ The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK.
²⁹ College of Medicine and Health, University of Exeter, UK.
³⁰ Alan Turing Institute, Exeter, UK.
³¹ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland, UK.
³² Engagement and Society, Wellcome Connecting Science, Hinxton, UK.
³³ Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.
³⁴ IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
³⁵ CIBER Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain.
³⁶ Centre for Medical Sciences (CISMed), University of Trento, Rovereto, Italy.
³⁷ H. Lundbeck A/S, Denmark.
³⁸ Department of Clinical Science, Lund University, Sweden.
³⁹ Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
⁴⁰ Preventive Neurology Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
⁴¹ Dementia Research Centre, UCL Queen Square Institute of Neurology, London, UK.
⁴² Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland.
⁴³ Division of Clinical Geriatrics, NVS, Karolinska Institutet, Stockholm, Sweden.
⁴⁴ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, the Netherlands.
⁴⁵ Amsterdam Neuroscience, Neurodegeneration, Amsterdam, the Netherlands.
⁴⁶ Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, the Netherlands.
⁴⁷ Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
⁴⁸ Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
⁴⁹ Gerontopole and Alzheimer's Disease Research and Clinical Center, Toulouse University Hospital, Toulouse, France.
⁵⁰ Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, the Netherlands.
⁵¹ Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.
⁵² EQT Life Sciences, Amsterdam, the Netherlands.
⁵³ Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.

PMID: 36895446
PMCID: PMC9989648
DOI: 10.1016/j.lanepe.2022.100576

Abstract

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.

Keywords: Cognitive enhancement; Dementia; Memory clinic; Prevention; Risk assessment; Risk communication; Risk reduction.

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Conflict of interest statement

GBF has received funding through the Private Foundation of 10.13039/501100006388Geneva University Hospitals from: A.P.R.A.—Association Suisse pour la Recherche sur la Maladie d’Alzheimer, Genève; 10.13039/501100023259Fondation Segré, Genève; Race Against Dementia Foundation, London, UK; Fondation Child Care, Genève; Fondation Edmond J. Safra, Genève; Fondation Minkoff, Genève; Fondazione Agusta, Lugano; McCall Macbain Foundation, Canada; Nicole et René Keller, Genève; Fondation AETAS, Genève. He has received funding through the 10.13039/501100006389University of Geneva or Geneva University Hospitals: for IISSs from ROCHE Pharmaceuticals, OM Pharma, EISAI Pharmaceuticals, Biogen Pharmaceuticals, and Novo Nordisk; for competitive research projects from: H2020, 10.13039/501100010767Innovative Medicines Initiative (IMI), IMI2, 10.13039/100000001Swiss National Science Foundation, and VELUX Foundation; for consulting from: Biogen, Diadem, Novo Nordisk, and Roche; for honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from: Biogen, Roche, Novo Nordisk, and GE HealthCare. DA received funding by the Fondation Recherche Alzheimer and the 10.13039/100000001Swiss National Science Foundation (project CRSK-3_196354/1). FR is funded in part by the 10.13039/100000001Swiss National Science Foundation under grant agreement 320030_182772: Brain connectivity and metacognition in persons with subjective cognitive decline (COSCODE). NV received research support from Fondation Bettencourt-Schueller, Fondation Servier, Union Nationale pour les Intérêts de la Médecine (UNIM) and Fondation pour la Recherche sur l’Alzheimer; travel grant from the Movement Disorders Society, Merz-Pharma and GE Healthcare SAS; is an unpaid sub-investigator in NCT04241068 (aducanumab, Biogen), NCT04437511 (donanemab, Eli-Lilly), NCT04592341 (gantenerumab, Roche), NCT03887455 (lecanemab, Eisai), NCT03352557 (gosuranemab, Biogen), NCT03828747 and NCT03289143 (semorinemab, Roche), NCT04619420 (JNJ-63733657, Janssen–Johnson & Johnson), NCT04374136 (AL001, Alector), NCT04592874 (AL002, Alector); and has given unpaid lectures in symposia organized by Eisai. FB is supported by the NIHR biomedical research centre at UCLH. FB is a steering committee or iDMC member for Biogen, Merck, Roche, EISAI. Consultant for Roche, Biogen, Merck, IXICO, Jansen, Combinostics. Research agreements with Novartis, Merck, Biogen, GE, Roche. FB is co-founder and share–holder of Queen Square Analytics LTD. KB has served as a consultant, at advisory boards, or at data monitoring committees for Abcam, Axon, BioArctic, Biogen, JOMDD/Shimadzu. Julius Clinical, Lilly, MagQu, Novartis, Ono Pharma, Pharmatrophix, Prothena, Roche Diagnostics, and Siemens Healthineers, and is a co-founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program, all outside the work presented in this paper. GC has received research support from the 10.13039/501100007601European Commission Horizon 2020 research and innovation programme (grant agreement number 667696), Fondation d'entreprise MMA des Entrepreneurs du Futur, Fondation Alzheimer, Programme Hospitalier de Recherche Clinique, 10.13039/501100001665Agence Nationale de la Recherche, Région Normandie, 10.13039/501100003750Association France Alzheimer et maladies apparentées, 10.13039/100014808Fondation Vaincre Alzheimer, Fondation Recherche Alzheimer and Fondation pour la Recherche Médicale (all to Inserm), and personal fees from Inserm, Fondation Alzheimer and Fondation d'entreprise MMA des Entrepreneurs du Futur. JG has received funding for the EURO-FINGERS project which is supported through the following funding organisations under the aegis of JPND www.jpnd.eu: Finland, Academy of Finland; Germany, Federal Ministry of Education and Research; Spain, National Institute of Health Carlos III; Luxembourg, National Research Fund; Hungary, National Research, Development and Innovation Office; Netherlands, Netherlands Organisation for Health Research and Development; Sweden, 10.13039/501100004359Swedish Research Council. Grant agreement: INTER/JPND/19/BM/14012609. AN reports grants from 10.13039/501100000304Parkinson's UK, 10.13039/100015652Barts Charity, Cure Parkinson's, NIHR, 10.13039/501100006041Innovate UK, Virginia Keiley benefaction, Alchemab, Aligning Science Across Parkinson's and Michael J Fox Foundation. Consultancy and personal fees from Astra Zeneca, AbbVie, Profile, Roche, Biogen, UCB, Bial, Charco Neurotech, uMedeor and Britannia, outside the submitted work. JMR and DJL are funded by Alzheimer's Research UK and the 10.13039/100012338Alan Turing Institute/Engineering and Physical Sciences Research Council (EP/N510129/1). DJL is also funded by National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) South West Peninsula, 10.13039/501100000925National Health and Medical Research Council (NHMRC), 10.13039/100000049National Institute on Aging/10.13039/100000002National Institutes of Health (RF1AG055654). WvdF has been funded by ZonMW, NWO, EU-FP7, EU-JPND, 10.13039/501100010969Alzheimer Nederland, Hersenstichting CardioVascular Onderzoek Nederland, Health Holland, Topsector Life Sciences & Health, stichting Dioraphte, Gieskes-Strijbis fonds, stichting Equilibrio, Edwin Bouw fonds, Pasman stichting, stichting Alzheimer & Neuropsychiatrie Foundation, Philips, Biogen MA Inc, Novartis-NL, Life-MI, AVID, Roche BV, Fujifilm, Combinostics. WvdF holds the Pasman chair. WvdF, PS and LNV are recipients of ABOARD, which is a public-private partnership receiving funding from ZonMW (#73305095007) and Health ∼ Holland, Topsector Life Sciences & Health (PPP-allowance; #LSHM20106). WvdF, PS, and LNV are recipients of the EU Joint Programme - Neurodegenerative Disease Research (JPND) project EURO-FINGERS (ZonMW-Memorabel #733051102). WvdF has performed contract research for Biogen MA Inc, and Boehringer Ingelheim. WvdF has been an invited speaker at Boehringer Ingelheim, Biogen MA Inc, Danone, Eisai, WebMD Neurology (Medscape), Swiss National Science Foundation, Switzerland, European Commission Horizon 2020, Belgium, Springer Healthcare. WvdF is consultant to Oxford Health Policy Forum CIC, Roche, and Biogen MA Inc. WvdF participated in advisory boards of Biogen MA Inc and Roche. All funding is paid to her institution. WvdF was associate editor of Alzheimer, Research & Therapy in 2020/2021. WvdF is associate editor at Brain. BV is an investigator in clinical trials sponsored by Biogen, Lilly, Roche, Eisai Pharmaceuticals, and the Toulouse University Hospital (Inspire Geroscience Program). He has served as scientific advisor for Biogen, Alzheon, Green Valley, Norvo Nordisk, Longeveron, but received no personal compensation. He has served as consultant and/or scientific advisor for Roche, Lilly, Eisai, TauX with personal compensation. All other coauthors declare no competing interests.

Figures

**Fig. 1**
Patient population and cornerstone interventions of Brain Health Services. Risk assessment, risk communication, and personalised prevention of cognitive decline are grouped together as they take place sequentially. Cognitive enhancement is conceptually independent from interventions on risk.

**Fig. 2**
Roadmap of the hypothetical deployment of BHSs from pilot experiences to clinical deployment in the context of key scientific and technological developments. At the present time, BHSs are proposed as pilot experiences (white background) targeting persons with cognitive complaints (subjective cognitive decline) and worried-well persons in clinical outpatient settings. The four pillars of risk assessment, risk communication, personalized prevention, and cognitive enhancement comprise individual components (expanded in the text) that will be implemented over time according to their maturity. Blood biomarkers may be the first scientific and technological advancements to be implemented by BHSs. Anti-amyloid or anti-tau monoclonal antibodies and other better tolerated drugs may follow depending on the outcome of currently ongoing preventive clinical trials (see text). The transition of BHSs from pilot experiences (white color) to clinical deployment (blue color) will take place after performance evaluation based on pre-defined endpoints. We anticipate that non-invasive brain stimulation may be adopted for cognitive enhancement, if ever, at a later time. If and when the two key enablers of blood biomarkers and well tolerated drugs for secondary prevention reach maturity and after a testing period in BHSs, some components may be transferred to at-risk persons from the general population with specific attention to low-middle income countries (beige color). At that point in time, individual- and population-based interventions will co-exist. The question mark denotes uncertain successful development. Timelines in the x-axis are hypothetical and heavily dependent on scientific and technological developments.

See this image and copyright information in PMC

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Dementia prevention in memory clinics: recommendations from the European task force for brain health services

Affiliations

Dementia prevention in memory clinics: recommendations from the European task force for brain health services

Authors

Affiliations

Abstract

Conflict of interest statement

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