Implications of COSMIC Findings Discussed in Neurology

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CHeBA’s findings on the use of standardised criteria to establish more reliable global estimates of mild cognitive impairment (MCI) could have significant implications for future trials aiming to slow disease progression and screening tests, according to a recent news article published in Nature Reviews Neurology.

The implications of CHeBA’s recent work were discussed by authors Harald Hampel and Simone Lista in an upcoming issue of the eminent research journal, Nature Reviews Neurology (published online January 2016).

In November 2015, CHeBA published its first findings from research undertaken through the international consortium, Cohort Studies of Memory in an International Consortium (COSMIC) in PLOS ONE. The study found that a lack of uniform criteria for diagnosing mild cognitive impairment (MCI) has resulted in a wide range of unreliable estimates for global prevalence of this disorder. By applying standardised criteria to international studies, researchers led by CHeBA have greatly reduced this variation to provide a more reliable estimate of MCI prevalence. 

According to Hampel and Lista, improving diagnostic criteria is a crucial precursor to more effective research into therapies aimed at slowing the progression of dementia, including Alzheimer’s disease. To date, therapeutic trials have failed to identify a cure or way to slow down the disease in patients. Hampel and Lista argue that this could, in part, be due to the wide variation in clinical trial participants who may meet different diagnostic criteria, making it hard to draw comparisons. This difficulty is compounded by the variety of pathways between normal cognition and dementia, which may include reversion to normal cognition, patients remaining at a stable stage of MCI or progressing to dementia, including Alzheimer’s disease. Hampel and Lista argue that working with clearly defined participation populations, such as conducting clinical trials which distinguish between patients with MCI as a precursor to Alzheimer’s disease, patients with early Alzheimer’s disease and so on, is required to effectively evaluate proposed therapeutic treatments which may work only for some groups or at earlier stages of the disease. This approach relies on more effective, standardised diagnostic criteria, as discussed in CHeBA’s recent research.     

While Hampel and Lista note that diagnostic criteria will need to be constantly revised as new evidence comes to light, standardised approaches like that proposed and tested by CHeBA as part of the COSMIC collaboration provide an excellent starting point.

“It’s encouraging that our findings are helping to shape the future of dementia incidence, not just in Australia but internationally,” said study leader and Co-Director of CHeBA, Professor Perminder Sachdev.

“We strongly believe that international collaboration is the best strategy we have for tackling the enormous burden dementia poses. These early findings from COSMIC show the importance of developing sound, evidence-based understandings of the prevalence of MCI so that we can best target future research and health policy in this area.”

Discussing the lack of effective treatment measures and recent findings concerning good cognitive functioning in later life, Hampel and Lista highlighted the need to focus on preventative measures to reduce the overall impact of dementia. They called for the creation of initiatives aimed at promoting modifiable lifestyle factors for healthy brain ageing across the lifespan, an approach CHeBA took with the launch of The Dementia Momentum in 2015. With its focus on prevention, standardisation and collaboration, The Dementia Momentum draws on the strengths of international collaboration by harnessing “big data” from around the world to identify risk and protective factors for dementia, to inform modifiable lifestyle changes to reduce dementia incidence.  Ultimately, The Dementia Momentum seeks to increase the dialogue with the community about this disease and give an opportunity for philanthropists and corporates to invest in driving momentum in awareness, research and societal change.

“At CHeBA, we believe that prevention is the best tool we have in the fight against dementia,” said Professor Sachdev.

“To date, studies have shown that even small changes in lifestyle can result in significant benefits for brain health in later life and we know that it’s never too early or too late to make these changes. The Dementia Momentum aims to identify these risk and protective factors, both universally and for at-risk groups, and our research is driven by CHeBA’s mission of translating evidence to inform community practice and create a brighter future for us all.”

Date Published: 
Thursday, 24 March 2016
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