pdp 2.0: Individually tailored dementia prevention

In Luxembourg, more people shall be able to reduce their risk of developing dementia

The Luxembourg Programme for Dementia Prevention (pdp) is entering a new funding period. It will continue to develop in the direction of personalised prevention and help to reduce the risk of dementia in Luxembourg for people with Mild Cognitive Impairment (MCI). MCI is a slight decrease in the performance of the brain that can lead to dementia in its further course. In pdp, risk factors are specifically targeted in people with MCI, thus significantly reducing the likelihood of developing dementia. "With the new phase of pdp we want to intensify our efforts to reach even more people with MCI in Luxembourg and offer more targeted measures for dementia prevention," says Health Minister Paulette Lenert. To this end, both the pdp team and the services offered for people with MCI will now be expanded. In addition, the accompanying research is being intensified to identify additional risk factors, which could lead to more personalised preventive measures.

Statistically, life expectancy in Europe, and thus also in Luxembourg, is increasing. This also means that the risk of developing dementia in old age increases. The aim of the Programme for Dementia Prevention (pdp) is to reduce this risk in as many people as possible. pdp is based on recent scientific findings¹ in which researchers have identified a dozen risk factors that can be influenced in a targeted manner to prevent dementia or at least delay it. These findings led the Luxembourg Ministry of Health, in cooperation with the Luxembourg Centre for Systems Biomedicine (LCSB) of the University of Luxembourg, to significantly increase the measures for dementia prevention through pdp in 2018.

MCI is reversible

Risk factors that favour dementia are obesity, high blood pressure, depression, hearing loss or poorly controlled diabetes. Moreover, smoking, social isolation or a lack of exercise can also promote the onset of dementia. In an early phase, these factors can lead to the development of MCI, thus partially decreasing the performance of the brain. However, this process may be reversed and this is where pdp intervenes. People who are suspected of having MCI and who show evidence of increased risk factors can be referred to the programme by their treating physician. Participants are then carefully examined in pdp to record their lifestyle habits and to create a cognitive profile based on memory, attention and language tests. This procedure determines an individual risk profile for each patient.

Based on the risk profile, pdp then suggest free personalised preventive measures. For example, for people who should increase their physical activity, the programme may suggest a sports course, while for those who need to reduce their weight, nutritional advice is offered. In other people, MCI can be countered with targeted memory training or a suitable hearing aid. "In the past two years, with the help of pdp, more than 180 people have had the chance to identify and reduce their dementia risk factors," says Rejko Krüger, Professor of Neuroscience and coordinator of pdp.

The basis for this success is the close cooperation with the treating physicians and health service providers in Luxembourg. The pdp team informs the physician about the nature and extent of the patients’ risks for dementia. Physicians are actively involved in pdp by closely monitoring patients’ therapy to for instance control diabetes or high blood pressure. "Only with this cooperative approach it is possible to develop an individual and effective prevention programme for each person affected," says Krüger. The pdp health service providers, which offer courses and social activities through a vouchers system, also play a key role. "They are in constant contact with the people affected by MCI", adds Krüger: "Their work with the patients is the basis for the success of pdp."

pdp goes digital

To support even more people in the fight against dementia, the pdp team and its network will be expanded in the new funding period of the programme. “We want as many people as possible in Luxembourg to benefit from pdp,” states Health Minister Lenert. For this reason, there are now contact points for pdp not only in Luxembourg City, but also in Ettelbrück and Esch / Belval. In addition, digital offers will be developed as part of the programme. They are very important, especially under the conditions of the current coronavirus pandemic, even though in person examinations at pdp locations meet the highest hygiene standards. "With digital offers, we will be able to reach even more people, especially those who are currently holding back and prefer staying in their homes," says Krüger.

The initiators of pdp have already developed the programme in the direction of a personalised prevention concept and they will now also accompany the measures with a new research project in Luxembourg: "We would like to investigate how the social environment, socio-economic factors, diet and the composition of microbes in the digestive tract influence the risk factors," explains Prof. Krüger: "Thereby we are aiming to identify further dementia risk factors, which we can then specifically address and reduce within the framework of pdp.” This is not only intended to reach more people, but also to continuously improve the quality of their treatment.

¹ Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., & Banerjee, S. et al. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396: 10248, 413-446. doi: 10.1016 / s0140-6736 (20) 30367-6

pdp is a member of the FINGER-Consortium, which connects all dementia prevention programmes worldwide.

Communicated by the Ministry of Health and the University of Luxembourg

Picture: ©Ministry of Health