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Review
. 2024 Jan 6;14(1):55.
doi: 10.3390/brainsci14010055.

Brain Health and Cognition in Older Adults: Roadmap and Milestones towards the Implementation of Preventive Strategies

Federico Emanuele Pozzi  1   2   3 , Giulia Remoli  1   2 , Lucio Tremolizzo  1   2   3 , Ildebrando Appollonio  1   2   3 , Carlo Ferrarese  1   2   3 , Luca Cuffaro  1   2   3
Affiliations
Review

Brain Health and Cognition in Older Adults: Roadmap and Milestones towards the Implementation of Preventive Strategies

Federico Emanuele Pozzi et al. Brain Sci. .

Abstract

In this narrative review, we delve into the evolving concept of brain health, as recognized by the WHO, focusing on its intersection with cognitive decline. We emphasize the imperative need for preventive strategies, particularly in older adults. We describe the target population that might benefit the most from risk-based approaches-namely, people with subjective cognitive decline. Additionally, we consider universal prevention in cognitively unimpaired middle-aged and older adults. Delving into multidomain personalized preventive strategies, we report on empirical evidence surrounding modifiable risk factors and interventions crucial in mitigating cognitive decline. Next, we highlight the emergence of brain health services (BHS). We explain their proposed role in risk assessment, risk communication, and tailored interventions to reduce the risk of dementia. Commenting on ongoing BHS pilot experiences, we present the inception and framework of our own BHS in Monza, Italy, outlining its operational structure and care pathways. We emphasize the need for global collaboration and intensified research efforts to address the intricate determinants of brain health and their potential impact on healthcare systems worldwide.

Keywords: Alzheimer’s disease; brain health; cognition; prevention; subjective cognitive decline.

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Conflict of interest statement

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Potentially modifiable risk factors for dementia, according to 2020 Lancet Commission report. Attributable risk for poor sleep and oral health are still controversial.
Figure 2
Figure 2
Brain health approaches in Europe as of today. Brain health services are limited to pilot experiences in Amsterdam (the Netherlands), Barcelona (Spain), Geneva (Switzerland), Köln (Germany), Monza (Italy), Paris (France), and Stockholm (Sweden). National brain health plans are ongoing in Scotland and Norway.
Figure 3
Figure 3
Care pathway for cognitive impairment at our institution.
See this image and copyright information in PMC

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