Population Dementia Risk Reduction
Background & Scientific Rationale
Maximising the potential of existing observational studies for targeted preventive interventional research is a high priority. Observational evidence from the population studies coordinated from Cambridge has shown that the prevalence of dementia in the population at particular ages has dropped, leading to stability in the estimates for total numbers of people with dementia despite considerable population ageing over the last two decades. These changes may be associated with dramatic reductions in vascular mortality and morbidity in most Western populations, thought to be due to a combination of improved risk profiles and medical management of vascular risks. Current cohorts offer the opportunity to extend what are currently observational cohorts to serve as a platform for intervention studies with extensively phenotyped samples.
This proposal seeks to strengthen at a local and study level the investment that will be made into an internationally unique dementia platform being developed. The local building blocks include earlier CLAHRC CP work: programmes of evidence synthesis and research priority setting conducted through the previous CLAHRC in collaboration with the Alzheimer’s Society, James Lind Alliance and the Cochrane Collaboration and MRC funded population research such that pilot trials of promising interventions can now be developed. Collaboration across the region enables cohorts spanning a wide age range to work together to identify samples of individuals characterised as at different life-course stages of risk to be invited for trial participation, thus allowing a spectrum of primary, secondary and tertiary prevention approaches to be tested in representative populations.
The project is also well aligned with the objectives of the NIHR School for Public Health Research’s Ageing Well programme. These cohorts are named in the Dementias Platform UK (DPUK) in which 22 UK based cohorts aim to support a step change in the potential for innovation and experimental medicine.
Aim and research questions
The key aim is to create the capacity to support pilots and trials of promising interventions for dementia that can be rigorously trialled in representative populations with specific targeting for the different types of prevention (primary, secondary and tertiary). The CLAHRC theme will concentrate on secondary and tertiary, the latter complementing the main thrust of the DPUK which will be towards early interventions. Specifically this proposal will strengthen our input into the DPUK as well as developing packages of intervention relevant to dementia, frailty and end of life which UKDP will be less well placed to implement. This will be developed in close collaboration with the relevant DPUK activities, which partially cover many of these elements.
The project integrates and builds on work to develop the MRC-CFAS cohort as a prevention platform already started with strong input from collaborators in multiple centres.
Expected Output of Research / Impact
We seek to contribute to the generation of generic flexible and transferable building blocks: relevant biostatistical methods across themes: multimodal enhancement principles for cohorts; identification of new measurements required, design and support measurement within cohorts; outputs covering trajectories of risk and cross sectional risk prediction; design and implementation of trials, pilots in the first instance. The developmental work is critical and will result in pilots and trials attracting the larger resources needed. UKDP will be creating the opportunities for inward investment from industry. The CLAHRC investment will position the Eastern Region well for attracting the consortia finance.