Towards dementia risk reduction among individuals with a parental family history of dementia

Tackling modifiable risk factors for dementia, such as diabetes and physical inactivity, can reduce the risk of dementia. Especially individuals with a parental family history (PFH) of dementia may benefit from this, since they have more often modifiable risk factors for dementia. Nevertheless, changing health behaviour is difficult. Therefore, we investigated the knowledge, beliefs and attitudes towards dementia (risk reduction) among the general population and among individuals with a PFH of dementia. We found that the knowledge about dementia (risk reduction) is insufficient. Additionally, older individuals perceived dementia as a more severe disease, but perceived less benefits of performing health-enhancing behaviour for their brain health. Young and highly educated individuals perceived less barriers, but had more confidence in their ability to perform the desired behaviour. Perceived benefits and cues-to-action were associated with the intention to change physical activity and alcohol consumption, and perceived barriers were associated with the intention to change diet. Smokers who perceived more barriers to change their smoking behaviour were less likely to have the intention to change this behaviour. Further, we found that individuals with a PFH of dementia feel the need of exchanging experiences of having a parent with dementia, which seemed a prerequisite to thinking about their own health. The Demin study (www.demin.nl) focuses on tackling risk factors for dementia among individuals (40-60) with a PFH of dementia by an online lifestyle programme. In order for dementia risk reduction programmes to be effective, knowledge, beliefs and attitudes towards dementia (risk reduction) should be improved

Correction to:Cross-cultural validation of the motivation to change lifestyle and health behaviours for dementia risk reduction scale in the Dutch general population

An amendment to this paper has been published and can be accessed via the original article

Cross-cultural validation of the motivation to change lifestyle and health behaviours for dementia risk reduction scale in the Dutch general population

Background: This study aimed to translate and validate the Motivation to Change Lifestyle and Health Behaviours for Dementia Risk Reduction (MCLHB-DRR) scale in the Dutch general population. Methods: A random sample of Dutch residents aged between 30 and 80 years old were invited to complete an online questionnaire including the translated MCLHB-DRR scale. Exploratory and confirmatory factor analyses (EFA and CFA) were conducted to assess construct validity. Cronbach's alpha was calculated to assess internal consistency. Results: Six hundred eighteen participants completed the questionnaire. EFA and Cronbach's alpha showed that four items were candidate for deletion. CFA confirmed that deleting these items led to an excellent fit (RMSEA = 0.043, CFI = 0.960, TLI = 0.951, χ2/df = 2.130). Cronbach's alpha ranged from 0.69 to 0.93, indicating good internal consistency. Conclusion: The current study demonstrated that the Dutch MCLHB-DRR scale is a valid scale for assessing health beliefs and attitudes towards dementia risk reduction among Dutch adults aged between 30 and 80 years old

Association between dementia parental family history and mid-life modifiable risk factors for dementia:a cross-sectional study using propensity score matching within the Lifelines cohort

OBJECTIVE: Individuals with a parental family history (PFH) of dementia have an increased risk to develop dementia, regardless of genetic risks. The aim of this study is to investigate the association between a PFH of dementia and currently known modifiable risk factors for dementia among middle-aged individuals using propensity score matching (PSM). DESIGN: A cross-sectional study. SETTING AND PARTICIPANTS: A subsample of Lifelines (35–65 years), a prospective population-based cohort study in the Netherlands was used. OUTCOME MEASURES: Fourteen modifiable risk factors for dementia and the overall Lifestyle for Brain Health (LIBRA) score, indicating someone’s potential for dementia risk reduction (DRR). RESULTS: The study population included 89 869 participants of which 10 940 (12.2%) had a PFH of dementia (mean (SD) age=52.95 (7.2)) and 36 389 (40.5%) without a PFH of dementia (mean (SD) age=43.19 (5.5)). Of 42 540 participants (47.3%), PFH of dementia was imputed. After PSM, potential confounding variables were balanced between individuals with and without PFH of dementia. Individuals with a PFH of dementia had more often hypertension (OR=1.19; 95% CI 1.14 to 1.24), high cholesterol (OR=1.24; 95% CI 1.18 to 1.30), diabetes (OR=1.26; 95% CI 1.11 to 1.42), cardiovascular diseases (OR=1.49; 95% CI 1.18 to 1.88), depression (OR=1.23; 95% CI 1.08 to 1.41), obesity (OR=1.14; 95% CI 1.08 to 1.20) and overweight (OR=1.10; 95% CI 1.05 to 1.17), and were more often current smokers (OR=1.20; 95% CI 1.14 to 1.27) and ex-smokers (OR=1.21; 95% CI 1.16 to 1.27). However, they were less often low/moderate alcohol consumers (OR=0.87; 95% CI 0.83 to 0.91), excessive alcohol consumers (OR=0.93; 95% CI 0.89 to 0.98), socially inactive (OR=0.84; 95% CI 0.78 to 0.90) and physically inactive (OR=0.93; 95% CI 0.91 to 0.97). Having a PFH of dementia resulted in a higher LIBRA score (RC=0.15; 95% CI 0.11 to 0.19). CONCLUSION: We found that having a PFH of dementia was associated with several modifiable risk factors. This suggests that middle-aged individuals with a PFH of dementia are a group at risk and could benefit from DRR. Further research should explore their knowledge, beliefs and attitudes towards DRR, and whether they are willing to assess their risk and change their lifestyle to reduce dementia risk

Uptake and effectiveness of a tailor-made online lifestyle programme targeting modifiable risk factors for dementia among middle-aged descendants of people with recently diagnosed dementia:study protocol of a cluster randomised controlled trial (Demin study)

INTRODUCTION: Descendants of patients with dementia have a higher risk to develop dementia. This study aims to investigate the uptake and effectiveness of an online tailor-made lifestyle programme for dementia risk reduction (DRR) among middle-aged descendants of people with recently diagnosed late-onset dementia. METHODS AND ANALYSIS: Demin is a cluster randomised controlled trial, aiming to include 21 memory clinics of which 13 will be randomly allocated to the passive (poster and flyer in a waiting room) and 8 to the active recruitment strategy (additional personal invitation by members of the team of the memory clinic). We aim to recruit 378 participants (40-60 years) with a parent who is recently diagnosed with Alzheimer's disease or vascular dementia at one of the participating memory clinics. All participants receive a dementia risk assessment (online questionnaire, physical examination and blood sample) and subsequently an online tailor-made lifestyle advice regarding protective (Mediterranean diet, low/moderate alcohol consumption and high cognitive activity) and risk factors (physical inactivity, smoking, loneliness, cardiovascular diseases (CVD), hypertension, high cholesterol, diabetes, obesity, renal dysfunction and depression) for dementia. The primary outcome is the difference in uptake between the two recruitment strategies. Secondary outcomes are change(s) in (1) the Lifestyle for Brain Health score, (2) individual health behaviours, (3) health beliefs and attitudes towards DRR and (4) compliance to the tailor-made lifestyle advice. Outcomes will be measured at 3, 6, 9 and 12 months after baseline. The effectiveness of this online tailor-made lifestyle programme will be evaluated by comparing Demin participants to a matched control group (lifelines cohort). ETHICS AND DISSEMINATION: This study has been approved by the Dutch Ministry of Health, Welfare and Sport according to the Population Screening Act. All participants have to give online informed consent using SMS-tan (transaction authentication number delivered via text message). Findings will be disseminated through peer-reviewed journals and (inter)national conferences. TRIAL REGISTRATION NUMBER: NTR7434

The validity and reliability of the digital Ruff Figural Fluency Test (RFFT) in the general adult population

BackgroundThe Ruff Figural Fluency Test (RFFT) is a valid pencil-and-paper test for evaluating cognitive functioning in the general population. The assessment of the pencil-and-paper-RFFT is time-consuming and requires training of raters. We developed a digital-RFFT which can be filled in by people independently on an Ipad, after which RFFT patterns are automatically processed and stored. We aimed to investigate the validity and reliability of the digital-RFFT in the general population.MethodStratified randomization (based on age, gender, and education) was used to allocate participants either to the digital-RFFT or the pencil-and-paper-RFFT. After the first test, the other test was repeated (cross-over). The number of unique designs and perseverative errors of the pencil-and-paper-RFFT and digital-RFFT were assessed by an computerized algorithm (automatic) and by two independent trained human raters (criterion standard). For the statistical analysis, we used Intraclass correlation coefficients(ICC), sensitivity, specificity, %agreement, weighted Kappa, and Bland Altman plots, including limits-of-agreement(LoA).ResultsThe study population comprised 96 participants (58% women; mean(SD) age 40(15)years). The mean(SD) number of unique designs was 84.2 (26.0) (automatic assessment) and 85.3 (26.2) (human assessment) for the digital-RFFT and 91.3 (22.7) for the pencil-and-paper-RFFT. The median number(IQR) of perseverative errors was 4(2-7) (automatic assessment) and 4.5(2-8) (human assessment) for the digital-RFFT and 4.5(2-7.5) for the pencil-and-paper-RFFT. The percentage agreement (kappa) between the two human raters for the digital-RFFT and pencil-and-paper-RFFT was 0.94(0.90) and 0.94(0.81), respectively. ICC between human assessment and automatic assessment of the digital-RFFT (unique designs) was 0.988(95%CI:0.981-0.992); sensitivity and specificity was 0.98 and 0.96 respectively; mean difference(95%CI):-1.12(-1.92,-0.33); 95%Limits-of-Agreement -8.75,6.51). The ICC between digital-RFFT and pencil-and-paper-RFFT was 0.53(95%CI 0.37,0.67). When starting with the paper-and-pencil-RFFT, this ICC was 0.73 (95%CI:0.34,0.87). The mean difference (unique designs) between the digital-RFFT and pencil-and-paper-RFFT was -7.09 (95%CI -11.8 to -2.38 (95%limits-of-agreement: -52.12, 37.94). This was due to unclear instructions (i.e. complex examples) that were given on the Ipad (digital-RFFT) and learning effect.ConclusionsAlthough small and systematic differences between human assessment and automatic assessment of the digital-RFFT were found, we conclude that the digital-RFFT is a valid test to assess cognitive functioning among the general population if instructions of the digital-RFFT are improved

Implementation barriers and facilitators for referral from the hospital to community-based lifestyle interventions from the perspective of lifestyle professionals: A qualitative study.

PurposeA lifestyle front office (LFO) in the hospital is a not yet existing, novel concept that can refer patients under treatment in the hospital to community-based lifestyle interventions (CBLI). The aim of this study was to identify implementation barriers and facilitators regarding the implementation of an LFO in the hospital from the perspective of CBLI-professionals and to develop evidence-based implementation strategies to reduce these identified barriers.MethodsWe conducted semi-structured interviews until data saturation, with 23 lifestyle professionals working in the community. A semi-structured topic guide was used, inquiring about (1) community-based lifestyle interventions; (2) their views about referral from the LFO; and (3) their preferences, needs and recommendations for collaboration with the LFO in the hospital. The online interviews lasted on average 46 minutes, were audio-recorded and transcribed verbatim. A thematic content analysis was conducted. Found barriers and facilitators regarding the LFO where mapped using the consolidated framework for implementation research (CFIR) whereafter evidence based strategies were developed using the CFIR-Expert Recommendations for Implementing Change Strategy Matching Tool V.1.0 (CFIR-ERIC).ResultsBarriers and facilitators were divided into two main themes: 1) barriers and facilitators related to the referral from LFO to CBLI (i.e. financial, cultural, geographical, quality) and 2) barriers and facilitators related to the collaboration between LFO and CBLI (i.e. referral, communication platform and partnership). Thirty-seven implementation strategies concerning 15 barriers were developed and clustered into six overarching strategies: identify referral options, determine qualifications lifestyle professionals, develop support tools, build networks, facilitate learning collaboratives, and optimize workflow.ConclusionsIn this study, barriers and facilitators for the development of the LFO were found and matching implementation strategies were developed. Practical improvements, like identifying specific referral options or develop support tools, can be implemented immediately. The implementation of other strategies, like connecting care pathways in basic services, primary, secondary and tertiary care, will take more time and effort to come to full potential. Future research should evaluate all implemented strategies