Journal Article 1 Mention
Umbrella review and Delphi study on modifiable factors for dementia risk reduction
Colin Rosenau2023
Sebastian KöhlerLion M. Soons
Top 1% · 99th Percentile
70 citations · Sociology and Political Science
Open Access

TLDR

Three changeable areas stood out as especially promising for lowering dementia risk: hearing problems, limited social connection, and poor sleep. Dementia checklists should be updated as better evidence becomes available.

Summary

1 Study Aim

The authors aimed to identify modifiable risk and protective factors for dementia and prioritize candidates for updating the LIfestyle for BRAin health (LIBRA) index, a tool estimating personal room for brain-health improvement. They tested whether new evidence justified revising LIBRA. The study sought to make dementia risk scores more current and useful for prevention.

2 Study Design

The researchers conducted an umbrella review (a review of systematic reviews) covering 148 systematic reviews and meta-analyses (studies combining results from multiple studies). These reviews included 608 unique prospective cohort studies, which follow people over time. Searches covered PubMed, Embase, Web of Science, and PsycINFO. The team then ran two Delphi consensus rounds, a structured process for collecting expert judgments. Eighteen dementia experts joined the first round, and 17 joined the second. Experts evaluated existing LIBRA factors, proposed new ones, and distributed 100 points among leading candidates. The researchers combined published evidence with expert rankings to select factors for a revised risk score.

3 Findings

The umbrella review and experts prioritized six factors: hearing impairment (reduced ability to hear), social contact, sleep, life course inequalities (disadvantages accumulating across life), atrial fibrillation (an irregular heart rhythm), and psychological stress. Hearing impairment, social contact, and sleep received the strongest support for individual prevention and possible inclusion in updated LIBRA scores. Functional social contact, such as social engagement and loneliness, appeared more useful than network size or living alone. No single sleep measure clearly stood out. The authors noted that observational evidence cannot prove that changing these factors prevents dementia. They recommended clearer long-term studies and randomized trials where feasible. Population policies should also address inequality, head injury, education, and air pollution. Updated risk scores may offer more useful prevention guidance, but their accuracy requires testing in independent groups.

Abstract

A 2013 systematic review and Delphi consensus study identified 12 modifiable risk and protective factors for dementia, which were subsequently merged into the "LIfestyle for BRAin health" (LIBRA) score. We systematically evaluated whether LIBRA requires revision based on new evidence. To identify modifiable risk and protective factors suitable for dementia risk reduction, we combined an umbrella review of systematic reviews and meta-analyses with a two-round Delphi consensus study. The review of 608 unique primary studies and opinions of 18 experts prioritized six modifiable factors: hearing impairment, social contact, sleep, life course inequalities, atrial fibrillation, and psychological stress. Based on expert ranking, hearing impairment, social contact, and sleep were considered the most suitable candidates for inclusion in updated dementia risk scores. As such, the current study shows that dementia risk scores need systematic updates based on emerging evidence. Future studies will validate the updated LIBRA score in different cohorts. HIGHLIGHTS: An umbrella review was combined with opinions of 18 dementia experts. Various candidate targets for dementia risk reduction were identified. Experts prioritized hearing impairment, social contact, and sleep. Re-assessment of dementia risk scores is encouraged. Future work should evaluate the predictive validity of updated risk scores.

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