18 Apr 2016
This article was originally published in MJA Insight.
We’re using big data to identify universal and demographic-specific risk and protective factors for dementia, write Henry Brodaty and Perminder Sachdev…
LAST month marked the first anniversary of The Dementia Momentum®, an initiative of the Centre for Healthy Brain Ageing (CHeBA) at the University of New South Wales.
The main objective of the initiative is to bring CHeBA’s “big data” approach to bear upon the epidemiology of dementia. At the same time, it aims to raise community awareness about the challenge of dementia, and presents an opportunity for philanthropists to effect real, societal change in dementia incidence by investing in The Dementia Momentum®.
A significant number of leaders in the corporate and philanthropic community have joined as Members of The Dementia Momentum®, with $1.9 million raised towards the $10 million goal over 5 years.
This investment has been accompanied by significant outreach, including two fundraising and awareness campaigns run as part of Wipeout Dementia®, a corporate strength-for-surfing training event which gained the support and involvement of former Prime Minister Tony Abbott and NSW Premier Mike Baird in the culminating “Surf Off” competitions in May and November 2015. These events gained national and international media attention. A third Wipeout Dementia will take place in May 2016.
The central aim of The Dementia Momentum is to identify universal and demographic-specific risk and protective factors for dementia, by combining and analysing findings from international studies using four consortia – Cohort Studies of Memory in an International Consortium (COSMIC), the International Centenarian Consortium of Dementia (ICC-Dementia), STROKOG and the Psychosocial Research Consortium (PROMOTE).
The first findings from The Dementia Momentum® were published in the November 2015 edition of PLOS ONE and established more reliable estimates of mild cognitive impairment (MCI) prevalence. MCI, which is conceptualised as an intermediate step between normal cognitive function and early dementia, is increasingly a target for trials of new drugs to treat Alzheimer disease.
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Using the “big data” approach, standardised criteria were applied to 11 international studies from the US, Europe, Asia and Australia in COSMIC, resulting in estimates of overall MCI prevalence of 6–12% in people over the age of 60 years, a much narrower range than previously published estimates of 5–37%.
The lack of uniform criteria for diagnosing MCI has previously resulted in a wide range of unreliable estimates for global prevalence of this disorder, with significant implications for health policy and planning.
People with MCI are at an increased risk of progressing to dementia, with about 10–12% of those attending clinics being diagnosed with dementia per year of subsequent follow-up.
Since it needs to be differentiated from normal age-related changes in cognition, the diagnosis of MCI is complex and even minor differences in definition and the diagnostic tests used can significantly alter the rates of estimated prevalence.
This is the first time that data from so many studies from diverse countries have been brought together and the data harmonised so that direct comparisons make sense.
A similar approach is being used with ICC-Dementia to establish more reliable estimates of dementia in very long-lived individuals internationally.
Currently, ICC-Dementia includes 17 studies from Australia, the UK, Poland, Italy, the Netherlands, Portugal, Hong Kong, Japan, Germany, Sweden and the US, with data received from 15 studies. An article describing the methodology used by the consortium is in press with BMC Neurology and findings from the dementia prevalence study are currently being written up for submission later in 2016.
Findings about risk and protective factors for dementia from CHeBA-led consortia will shape the development of intervention strategies for the general community. Later in 2016, recruitment will begin for CHeBA’s prevention study – Maintain Your Brain.
This is the largest web-based intervention trial of its kind using online tools designed to reduce dementia risk in community-dwelling individuals aged 55-75 years.
With projections about the social and economic impact of dementia increasingly raising concern among health professionals, economists and policy makers, The Dementia Momentum® aims to provide the latest, innovative research findings to help shape this debate over the coming years.
Professor Henry Brodaty and Professor Perminder Sachdev are Co-Directors of the Centre for Healthy Brain Ageing (CHeBA).