Review

. 2025 May;12(5):100098.

doi: 10.1016/j.tjpad.2025.100098. Epub 2025 Mar 17.

Brain health services for the secondary prevention of cognitive impairment and dementia: Opportunities, challenges, and the business case for existing and future facilities

Giovanni B Frisoni¹, Federica Ribaldi², Gilles Allali³, Théophile Bieth⁴, Andrea Brioschi Guevara⁵, Stefano Cappa⁶, Lisa Cipolotti⁷, Kristian Steen Frederiksen⁸, Jean Georges⁹, Frank Jessen¹⁰, Giacomo Koch¹¹, Hugh Masters¹², Augusto J Mendes², Lutz Frölich¹³, Valentina Garibotto¹⁴, Oriol Grau-Rivera¹⁵, Federico E Pozzi¹⁶, Dorota Religa¹⁷, Ayda Rostamzadeh¹⁸, Lenny Shallcross¹⁹, Susan D Shenkin²⁰, Wiesje M van der Flier²¹, Meike W Vernooij²², Leonie N C Visser²³, Jeffrey L Cummings²⁴, Philip Scheltens²⁵, Bruno Dubois²⁶, Elena Moro⁸, Claudio L A Bassetti²⁷, Miia Kivipelto²⁸

Affiliations

¹ Memory Center, Department of Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland. Electronic address: giovanni.frisoni@unige.ch.
² Memory Center, Department of Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland.
³ Leenaards Memory Centre, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
⁴ Institut de la Mémoire et de la Maladie d'Alzheimer, IM2A, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France.
⁵ Leenaards Memory Centre, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
⁶ Federation of the European Societies of Neuropsychology (FESN) University Institute of Advanced Studies Pavia, Italy; IRCCS Istituto Auxologico Italiano, Milan.
⁷ Federation of the European Societies of Neuropsychology (FESN), Switzerland.
⁸ European Academy of Neurology (EAN), Switzerland.
⁹ Alzheimer Europe, Switzerland.
¹⁰ Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany; Excellence Cluster Cellular Stress Responses in Aging-Related Diseases (CECAD), Medical Faculty, University of Cologne, Germany.
¹¹ Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), Ferrara, Italy.
¹² Brain Health Scotland United Kingdom.
¹³ European Alzheimer's Disease Consortium, Switzerland.
¹⁴ European Association of Nuclear Medicine (EANM), Switzerland.
¹⁵ Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.
¹⁶ Clinica Neurologica, IRCCS San Gerardo dei Tintori, Monza, Italy.
¹⁷ European geriatric medicine society (EuGMS), Switzerland; Karolinska Institutet, Stockholm, Sweden.
¹⁸ Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
¹⁹ World Dementia Forum, London, UK.
²⁰ European geriatric medicine society (EuGMS), Switzerland; University of Edinburgh, Edinburgh, Scotland United Kingdom.
²¹ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands; Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.
²² European Society of Neuroradiology (ESNR), Switzerland.
²³ Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
²⁴ Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.
²⁵ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands; EQT Life Sciences, Amsterdam, The Netherlands.
²⁶ Institut de la Mémoire et de la Maladie d'Alzheimer, IM2A, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France; Institut du Cerveau et de la Moelle Épinière, UMR-S975, INSERM, Paris, France Hôpital de la Pitié-Salpêtrière, France.
²⁷ European Brain Council, European Academy of Neurology, Swiss Brain Health Plan, Switzerland; Inselspital and Faculty of Medicine, University of Bern, Bern, Switzerland.
²⁸ Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden; The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK.

PMID: 40102145
PMCID: PMC12183968
DOI: 10.1016/j.tjpad.2025.100098

Review

Brain health services for the secondary prevention of cognitive impairment and dementia: Opportunities, challenges, and the business case for existing and future facilities

Giovanni B Frisoni et al. J Prev Alzheimers Dis. 2025 May.

. 2025 May;12(5):100098.

doi: 10.1016/j.tjpad.2025.100098. Epub 2025 Mar 17.

Authors

Affiliations

¹ Memory Center, Department of Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland. Electronic address: giovanni.frisoni@unige.ch.
² Memory Center, Department of Rehabilitation and Geriatrics, University Hospitals and University of Geneva, Geneva, Switzerland.
³ Leenaards Memory Centre, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland.
⁴ Institut de la Mémoire et de la Maladie d'Alzheimer, IM2A, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France.
⁵ Leenaards Memory Centre, Department of Clinical Neurosciences, University Hospital of Lausanne (CHUV), Lausanne, Switzerland; Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
⁶ Federation of the European Societies of Neuropsychology (FESN) University Institute of Advanced Studies Pavia, Italy; IRCCS Istituto Auxologico Italiano, Milan.
⁷ Federation of the European Societies of Neuropsychology (FESN), Switzerland.
⁸ European Academy of Neurology (EAN), Switzerland.
⁹ Alzheimer Europe, Switzerland.
¹⁰ Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany; German Center for Neurodegenerative Diseases (DZNE), Bonn-Cologne, Germany; Excellence Cluster Cellular Stress Responses in Aging-Related Diseases (CECAD), Medical Faculty, University of Cologne, Germany.
¹¹ Department of Clinical and Behavioural Neurology, Santa Lucia Foundation IRCCS, 00179, Rome, Italy; Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy; Center for Translational Neurophysiology of Speech and Communication (CTNSC), Italian Institute of Technology (IIT), Ferrara, Italy.
¹² Brain Health Scotland United Kingdom.
¹³ European Alzheimer's Disease Consortium, Switzerland.
¹⁴ European Association of Nuclear Medicine (EANM), Switzerland.
¹⁵ Barcelonaβeta Brain Research Center (BBRC), Pasqual Maragall Foundation, Barcelona, Spain.
¹⁶ Clinica Neurologica, IRCCS San Gerardo dei Tintori, Monza, Italy.
¹⁷ European geriatric medicine society (EuGMS), Switzerland; Karolinska Institutet, Stockholm, Sweden.
¹⁸ Department of Psychiatry, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
¹⁹ World Dementia Forum, London, UK.
²⁰ European geriatric medicine society (EuGMS), Switzerland; University of Edinburgh, Edinburgh, Scotland United Kingdom.
²¹ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands; Amsterdam Neuroscience, Neurodegeneration, Amsterdam, The Netherlands; Epidemiology and Data Science, Vrije Universiteit Amsterdam, Amsterdam UMC location VUmc, Amsterdam, The Netherlands.
²² European Society of Neuroradiology (ESNR), Switzerland.
²³ Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Amsterdam, The Netherlands.
²⁴ Chambers-Grundy Center for Transformative Neuroscience, Department of Brain Health, School of Integrated Health Sciences, University of Nevada, Las Vegas, NV, USA.
²⁵ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, Amsterdam, The Netherlands; EQT Life Sciences, Amsterdam, The Netherlands.
²⁶ Institut de la Mémoire et de la Maladie d'Alzheimer, IM2A, Groupe Hospitalier Pitié-Salpêtrière, Sorbonne Université, Paris, France; Institut du Cerveau et de la Moelle Épinière, UMR-S975, INSERM, Paris, France Hôpital de la Pitié-Salpêtrière, France.
²⁷ European Brain Council, European Academy of Neurology, Swiss Brain Health Plan, Switzerland; Inselspital and Faculty of Medicine, University of Bern, Bern, Switzerland.
²⁸ Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden; The Ageing Epidemiology Research Unit, School of Public Health, Imperial College London, London, UK.

PMID: 40102145
PMCID: PMC12183968
DOI: 10.1016/j.tjpad.2025.100098

Abstract

A European Task Force has recently developed and published the concept and protocols for the setup of the innovative health offer of Brain Health Services for the secondary prevention of dementia and cognitive impairment (dBHS). dBHS are outpatient health care facilities where adult persons can find an assessment of their risk of developing cognitive impairment and dementia, have their risk level and contributing factors communicated using appropriate language supported by adequate communication tools, can decide to participate to programs for personalized risk reduction if at higher risk, and benefit from cognitive enhancement interventions. This health offer is distinct from that of currently active memory clinics. The ultimate aim of dBHS is to extend healthy life, free from cognitive impairment. Here, we (i) discuss the pertinent opportunities and challenges for those persons who want to benefit from dBHS, professionals, and wider society, (ii) describe the concepts, protocols, organizational features, and patient journeys of some currently active dBHS in Europe, and (iii) argue in favor of the business case for dBHS in Europe.

Keywords: Brain health services (dBHS); Dementia; Preventive healthcare; Public health; Secondary prevention.

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Conflict of interest statement

Declaration of competing interest Giovanni B. Frisoni has received funding through the Private Foundation of Geneva University Hospitals from: A.P.R.A. – Association Suisse pour la Recherche sur la Maladie d'Alzheimer, Genève; Fondation Segré, Genève; Ivan Pictet, 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. GBF has received funding through the University 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, Innovative Medicines Initiative (IMI), IMI2, Swiss 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. Federica Ribaldi is funded in part by the Swiss National Science Foundation under grant agreement 320,030_182,772: Brain connectivity and metacognition in persons with subjective cognitive decline (COSCODE). Gilles Allali is supported by the Swiss National Science Foundation (grant# 214,855), the Leenaards Foundation, the Solis Foundation, the Empiris Foundation and the Synapsis Foundation. GA serves as a scientific advisor for Roche and Lilly and received speaker's fees from Schwabe and Lilly. Andrea Brioschi Guevara has received funding from the Swiss Health Promotion foundation, Leenaards foundation, Dragon Bleu and Floshield foundations. Kristian Steen Frederiksen serves on an advisory board for Novo Nordisk and Eisai AD with compensation paid to his institution. KSF has been an invited speaker for Novo Nordisk and Lundbeck A/S with compensation paid to his institution. KSF has served as associate editor since 2023 and is the incoming Editor-in-Chief for Alzheimer´s Research & Therapy. Jean Georges 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, Swedish Research Council. Grant agreement: INTER/JPND/19/BM/14,012,609. Frank Jessen has received fees for advisory boards and speaker fees from: AC immune, Biogen, Cogthera, Eisai, Eli Lilly, GE Healthcare, Grifols, Janssen, Novo Nordisk, Roche. Giacomo Koch has received funding (competitive grants) not related to the current manuscript from the Alzheimer Drug Discovery Foundation (ADDF), European Commission Horizon 2020, Italian Ministry Of Health, Italian Ministry of Education (MIUR), Brightfocus Foundation. GK also received funding from PIAM farmaceutici Spa and Epitech Group. GK is scientific co-founder and holds stocks of Sinaptica Therapeutics. GK has received payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from: Epitech, Roche, Novo Nordisk. GK has a patent on “combination drug formulations including rotigotine and an acetylcholinesterase inhibitor for the treatment of neurodegenerative diseases” (20,220,040,148) and another on “systems and methods for providing personalized targeted non-invasive stimulation to a brain network” (20,230,381,512). Lutz Frölich is an investigator in clinical trials sponsored by Axon Neuroscience, Anavex, Alector, Boehringer Ingelheim, Eisai, Hummingbird, NovoNordisk, Noselab and serves on an advisory board for Biogen, BioVie, Eisai, Grifols, Janssen Cilag, Neurimmune, Noselab, NovoNordisk, Roche, TauRX, Schwabe with personal compensation. LF has received honoraria for Clinical Study Committees from Avanir/Otsuka, PharmatrophiX, Charité Berlin, Neuroscios, Vivoryon. Valentina Garibotto is supported by the Swiss national science foundation (project n.320030_185,028 and 320,030_169,876), the Aetas Foundation, the Schmidheiny Foundation, the Velux Foundation, the Synapsis foundation, the Fondation privée des HUG. VG received support for research and speakers‘fees from Siemens Healthineers, GE HealthCare, Janssen, Novo Nordisk, all paid to her institution. Oriol Grau-Rivera is supported by the Spanish Ministry of Science, Innovation and Universities (IJC2020–043,417-I), receives research support from F. Hoffmann-La Roche Ltd and has given lectures in symposia sponsored by Roche Diagnostics. Ayda Rostamzadeh has received fees from Eisai for presentations. Wiesje M. van der Flier has been funded by ZonMW, NWO, EU-FP7, EU-JPND, Alzheimer 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 has performed contract research for Biogen MA Inc, and Boehringer Ingelheim. WvdF has been an invited speaker at Boehringer Ingelheim, Biogen MA Inc, DaThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1 — **Fig. 1**
Patient journeys in eight pilot dBHS in Europe. The first three rows of the spreadsheet illustrate the ideal patient journey in a dBHS, detailing the primary activities within each of the four pillars: risk assessment, risk communication, risk reduction, and cognitive enhancement. Pilot dBHS are ordered from the most clinically oriented to the most research oriented. Brown shades denote the clinical setting, blue shades denote research projects. The stage of development is denoted as follows: dark shades are ongoing activities, medium shades are activities under development, light shades are activities being planned. Cells with diagonal lines indicate that advice and referral to other specialists is provided to users rather than inclusion into structured programs.

formula image — **Fig. 1**
Patient journeys in eight pilot dBHS in Europe. The first three rows of the spreadsheet illustrate the ideal patient journey in a dBHS, detailing the primary activities within each of the four pillars: risk assessment, risk communication, risk reduction, and cognitive enhancement. Pilot dBHS are ordered from the most clinically oriented to the most research oriented. Brown shades denote the clinical setting, blue shades denote research projects. The stage of development is denoted as follows: dark shades are ongoing activities, medium shades are activities under development, light shades are activities being planned. Cells with diagonal lines indicate that advice and referral to other specialists is provided to users rather than inclusion into structured programs.

Fig 2 — **Fig. 2**
Results from simulations of a hypothetical intervention reducing the risk of dementia by 20% over five years. The figure shows the cost savings and value of health gains (in terms of quality-adjusted life-years, QALYs), expressed as EUR per patient per year of treatment. Results are shown separately by European region and patient group: age at the start of intervention, and relative risk of dementia.

See this image and copyright information in PMC

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Brain health services for the secondary prevention of cognitive impairment and dementia: Opportunities, challenges, and the business case for existing and future facilities

Affiliations

Brain health services for the secondary prevention of cognitive impairment and dementia: Opportunities, challenges, and the business case for existing and future facilities

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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Medical