Abstract

As the number of people with dementia continues to grow, and we are still making limited headway in the development of disease modifying therapies, the potential role of prevention is becoming increasingly important. Our understanding of key factors associated with increased and reduced risk of dementia has become increasingly clear through recent meta-analysis and there is some evidence that prevention measures are already beginning to mitigate incident rates of dementia within each age group. To maximize potential benefits for public health however, we need to have mechanisms to evaluate and implement evidence based approaches in a cost-effective way. To this end we have developed the PROTECT platform – an on-line cohort study in people without dementia over the age of 50, running in the UK, US, Norway and Hong Kong. We currently have 25,000 UK participants with serial neuropsychology, mental health assessments, lifestyle and medical information and DNA - and the cohort will grow to over 100,000 people over the next year with the international federation. So far, we have been able to confirm the increased risk of hearing loss and depression as risk factors for cognitive decline, highlight the importance of mild behavioural impairment as a key risk factor for progressive decline and begin to identify potential genetic mechanisms and produce evidence demonstrating the benefit of cognitive training in 2 large RCTs using different training approaches, with ongoing trials of vitamin D, physical exercise and nutritional interventions.