None listed
Conditions
Brief summary
As there are no effective cures for dementia, it is essential that efforts focus on screening for potentially ‘modifiable risk factors’ of cognitive decline as it has been estimated that reductions in these treatable conditions could result in 1.1 million fewer cases of Alzheimer’s disease worldwide. These ‘modifiable risk factors’ include depression, diabetes, having high blood pressure, being overweight, being a smoker, being physically inactive, and having low education which in turn relates to not keeping the brain active enough. The internet is a powerful means by which to prevent health-related problems and to promote general health and wellbeing on a large-scale, referred to as ‘e-health’. E-health can be used to screen ‘at risk’ individuals, offer self-help through online interventions or deliver proactive and guided interventions facilitated by expert clinicians. The major advantage of e-health over standard models of care is the ability to recruit and deliver interventions on a large-scale, thereby being able to more effectively address major public health issues. Our team has developed a large scale “Healthy Brain Ageing” (HBA) e-health platform designed specifically for older adults who are ‘at risk’ of cognitive decline and dementia. Our goal is to establish a register of ‘at risk’ individuals with ongoing monitoring of cognition as well as potentially modifiable risk factors for cognitive decline, with a view to providing targeted interventions as appropriate. Prior to implementing this system, we seek to confirm that we can successfully recruit older adults ‘at risk’ of dementia via the HBA e-health platform. Additionally, we aim to establish that the assessment tools used in the e-health platform accurately screen for age-related cognitive impairment and correctly identify an individual’s dementia risk factors relative to gold-standard clinical assessment tools conducted in a face-to-face clinic setting. We will invite 1500 people from across NSW aged 50-70 years to complete an online screening questionnaire as well as a brief battery of online neuropsychological tests (Cogstate). Subsequently, a subsample of 180 participants with varying levels of cognitive impairment and/or modifiable risk factors will be invited to attend one of three assessment sites for detailed neuropsychological, medical, and psychological assessment. We will compare the results of these two evaluations to ensure that the online assessment tools are sensitive to dementia risk factors and cognitive decline (i.e., equivalent to standardised assessment tools used in clinical practice). Additionally, feasibility of recruitment will be assessed based on our ability to meet recruitment targets in specified project timelines.
Interventions
Online screening for ‘at risk’ profiles: Cognitive and modifiable risk data:
Modifiable risk factors: All participants (n=1500) will be asked to complete the HBA E-health Questionnaire (duration: up to 1 hour) to provide details about their demographics, medical history, mental health history (e.g., Generalized Anxiety Disorder Assessment (GAD-7), Kessler Psychological Distress Scale (K-10), cognition and functional status (e.g., HBA Functional Assessment Tool, WHO Disability Assessment Schedul
Online screening for ‘at risk’ profiles: Cognitive and modifiable risk data: Modifiable risk factors: All participants (n=1500) will be asked to complete the HBA E-health Questionnaire (duration: up to 1 hour) to provide details about their demographics, medical history, mental health history (e.g., Generalized Anxiety Disorder Assessment (GAD-7), Kessler Psychological Distress Scale (K-10), cognition and functional status (e.g., HBA Functional Assessment Tool, WHO Disability Assessment Schedule 2.0), sleep (e.g., Pittsburgh Sleep Quality Index (PSQI), physical activity (e.g., Active Australia Survey), nutrition and dietary habits (e.g., HBA Food Frequency Screening Questionnaire), alcohol and substance use history (e.g., Alcohol Use Disorders Identification Test (AUDIT-C), Alcohol, Smoking and Substance Involvement Screening Tests (ASSIST)), medications, and quality of life (e.g., WHO Quality of Life Scale). All data necessary for enabling comparisons with Australian-based dementia prediction algorithms for older individuals and the European-based personalised lifestyle for brain health (LIBRA) global score for middle-aged individuals will be collected. Modifiable risk factors for cognitive decline include the following: depressive symptoms (K-10>20); hypertension; hypercholesterolaemia; heart disease; high risk of Type 2 diabetes (AUSDRISK score=12) or diagnosed Type 1 or Type 2 diabetes; smoker, low education (less than year 9); low exercise (Active Australia guidelines for sufficient physical activity); obesity (BMI>30). Although not formally identified in the recent reviews of established risks, we will also define as risk a person with poor sleep quality (PSQI>5), or excess alcohol consumption (AUDIT-C>4). Cognitive decline: All participants will also complete an online cognitive assessment using CogState (duration: 15 minutes). Age-related cognitive decline will be defined as at least 1SD decline on CogState relative to age and education matched normative data. Face-to face clinical assessments: A subsample (n=180) participants will be drawn from the broader group and invited to attend their nearest study site (i) The Healthy Brain Ageing Clinic, Brain and Mind Centre, Camperdown; ii) Alzheimer’s Australia NSW Community Centre, Newcastle; iii) Alzheimer’s Australia NSW Community Centre, Port Macquarie) for detailed (face-to-face) neuropsychological, medical and psychological assessment (described in more detail below) within one month of when they completed the online assessments.. i) Medical assessment (duration: up to 1 hour): A medical professional will review the patient’s medical history with an emphasis on vascular risk factors and diabetes as well as details regarding family medical history. Biomedical measurements include height, weight, waist circumference, and blood pressure. Finally, in order to obtain objective markers of key health outcomes, a nurse or staff member trained in blood collection procedures will take a blood sample that will be tested for cardiovascular markers (e.g., HDL/LDL cholesterol). ii) Neuropsychological assessment (duration: 1 hour): The clinical neuropsychologist will conduct a brief clinical interview to collect details about the participant’s background, education and occupation, cognition and functional status. Participants will also complete approximately one hour of neuropsychological tests including Digit Span from the Wechsler Adult Intelligence Scale, Third Edition (WAIS-III), Logical Memory subtests from the Wechsler Memory Scale, Third Edition (WMS-III), Rey Auditory Verbal Learning Test (RAVLT), Rey-Osterrieth Complex Figure Test, Controlled Oral Word Association Test, Semantic Fluency, Trail Making Test A and B, Boston Naming Test, Clock Drawing Test, and the Delis-Kaplan Executive Functioning System (D-KEFS) Color-Word Interference subtest (D-KEFS). iii) Mood assessment (duration: up to 1 hour): To assess each participant’s mood and psychiatric history, the clinical neuropsychologist will ask semi-structured interview questions including the Structured Clinical Interview for the Hamilton Depression Scale and modules A (Major Depressive Episode), N (Generalized Anxiety Disorders), and O (Rule-Out Medical, Organic or Drug Causes for All Disorders) of the Mini International Neuropsychiatric Interview, Version 6.0. Both the online assessments and the face-to-face assessments will only occur one time.
Sponsors
The University of Sydney
Eligibility
Sex/Gender
All
Age
50 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
Adults between the ages of 50 and 70 who speak fluent English and who have concerns about their cognition (but not a formal diagnosis of dementia) or mood are eligible to participate in this study.
Exclusion criteria
Individuals will be excluded from the study if they are aged <50 years or >70 years, do not speak fluent English, have been diagnosed with dementia, or do not have concerns about their cognition or mood.
Outcome results
None listed