Risk identification and prevention of cognitive decline and dementia

The research in this thesis investigates the relationship between modifiable risk factors and dementia, emphasizing their potential for risk stratification and prevention. Observational data suggest that up to 40% of dementia cases may be attributable to cardiovascular risk factors, presenting opportunities for preventive strategies.
The first part of the thesis examines the association between risk factors and dementia incidence. Findings indicate that long-term use of anticholinergic drugs, particularly antidepressants and antipsychotics, is linked to an increased risk of dementia, likely influenced by protopathic bias. Neuroimaging studies assess the utility of arterial spin labeling (ASL) parameters in evaluating cerebral perfusion. While in our research ASL-sCoV correlates more strongly with atherosclerotic risk scores than traditional markers, it does not reliably predict cognitive decline or dementia. In stroke patients, a CT-derived brain frailty score, incorporating white matter lesions, medial temporal lobe atrophy, and global atrophy, is associated with increased post-stroke dementia risk. Lastly, we describe that diagnostic strategies for dementia vary widely among Dutch hospitals, with advanced testing used more frequently in university hospitals and declining with patient age.
The second part explores dementia prevention through risk factor modification. A systematic review of multidomain interventions targeting multiple risk factors shows limited efficacy in preventing dementia but some cognitive benefits, especially with cognitive training. The PRODEMOS study evaluates a mobile health intervention for dementia prevention, demonstrating the importance of user-centered design in optimizing intervention acceptability. These findings underscore the complexity of dementia risk assessment and the need for tailored preventive strategies.