Linus Mattias Jönsson

This study aims to prevent the development of dementia in individuals with mild cognitive impairment (MCI) through innovative solutions for early detection, precision diagnostics, and individualized evidence-based prevention and treatment.The epidemiological part will focus on two aspects: the impact of depression and sleep disturbances on cognitive impairment and dementia development and use register data and AI to develop a risk prediction model to identify people at risk for MCI, Alzheimer disease, and other dementia early in primary health care. Both risk factors and protective factors will be examined, thus the model will suggest individuals who should be further evaluated for MCI, Alzheimer´s, and other forms of dementia and provide support for preventive advice and interventions.The clinical part aims to determine the clinical and health economic value of a precision diagnostic algorithm based on a combination of digital cognitive tests and blood-based biomarkers in the assessment of subjective cognitive complaints (SCC) in primary care. The study will actively screen for SCC among individuals at increased risk of dementia, with risk factors including age, hypertension, and/or type II diabetes mellitus. Digital cognitive tests and blood-based biomarkers will be utilized to diagnose SCC, mild cognitive impairment (MCI), and dementia due to Alzheimer´s disease, as well as to examine how these biomarkers predict disease conversion after two years.

Research problem, specific questionsMaintaining cognitive and functional ability into late life is a lifelong process and health promotion/early intervention are the vital components of public health efforts to achieve healthy aging. The FINGER multidomain intervention trial, which integrates five healthy behaviour domains—nutrition, exercise, cognitive training, social activity, and vascular risk monitoring and management, was the first large-scale randomized controlled trial in the world showing evidence for cognitive benefit in older adults at-risk for dementia. The benefit was also extended to physical function, cardiovascular health, quality of life, and health economic aspects. Despite the compelling evidence, more questions remain to be answered: Are the findings from the FINGER trial generalizable to different settings in the Swedish context (e.g., memory clinic, primary care, and municipality)? Can the FINGER model contribute to additional parameters central for healthy aging? Is there an evidence-based need to further refine the FINGER model? How can the FINGER model be adapted and implemented across socioeconomically diverse populations? In this 6-year program, we address these questions by adapting and implementing the FINGER model in different settings and sociocultural contexts.Data and methodWe plan six interrelated work packages: a) Adapting and implementing the FINGER model across different settings in Swedish society

b) Testing the FINGER model for healthy aging

c) Refining the FINGER model with novel risk factors and sex differences in the response to lifestyle interventions

d) Adapting and implementing the FINGER model in sociocultural contexts

e) Health economic assessment, payment models and sustainment

and f) Knowledge dissemination, implementation of findings and public involvement. We use data from a) existing FINGER and FINGER-based trials in many countries (e.g., MIND-AD, MIND-China)

b) ongoing FINGER-based implementation studies in different contexts: specialist (Brain Health Clinic), primary care (STRONGER), and municipality (Train your Brain)

and c) pilot studies to capture younger people and family caregivers (Family FINGERS).Relevance and utilisationThe program will generate new knowledge on tailored intervention approaches at individual and population levels to support longer and healthier lives in different settings and sociocultural contexts. This knowledge is critical knowledge for the development of health policies to promote of healthy aging and equal health care.Plan for programme realisationThe program is carried out by an interdisciplinary team of experts with expertise in relevant disciplines, e.g., epidemiology, gerontology, clinical geriatrics, clinical trials, implementation research, psychology, health economics, biostatistics, and care science. The budget is used for supporting researchers to implement the study plan and collect new data. The applicant will coordinate all research activities.

Neurodegenerative diseases are one of the most important contributors to morbidity and mortality in the elderly. In Europe, over 14 million people are currently living with dementia, at a cost of over 400 billion EUR annually. Comorbidities with these conditions are frequent and a major obstacle to optimal diagnosis and management. Recent advances in diagnostic technologies and the advent of disease-modifying therapies (DMT) for Alzheimer’s disease (AD), the most common aetiology of dementia, heralds the beginning of precision medicine in this disease area. PROMINENT will develop a digital platform for precision medicine that will remove barriers that currently exists for leveraging these technological advancements in the routine care of patients with neurodegenerative disorders and co-morbidities. The platform gives clinicians access to prediction models leveraging multimodal diagnostic data automatically derived from multiple sources (imaging repositories, medical records, mobile devices), helping them choose optimal care pathways and improving diagnostic precision. It will provide personalized, relevant and meaningful information on diagnosis and prognosis in a format understandable by patients and care partners. Further, it will support the introduction of new health technologies such as DMT for AD, by ensuring adherence to appropriate use guidelines and facilitating the prospective collection of data on real-world usage, safety and effectiveness. The expected impact of the project is to increase diagnostic accuracy and optimized use of existing and new treatment options. It will empower patients and caregivers by engaging them in more person-centric health care decisions, leading to improved adherence and patient experience. Ultimately this is expected to lead to cost-effective care, improved health outcomes and quality of life.

Alzheimer´s disease and other dementias are among the biggest societal challenges of the coming decades. The innovation milieu PREDEM aims to prevent dementia disorders by developing and introducing new methods for early detection and investigation, accurate diagnostics and individualized prevention and treatment. The vision for PREDEM is that all people who are at risk of developing dementia are offered the best available preventive measures and treatments based on their individual circumstances.In the innovation milieu, we introduce digital tools and working methods for early detection and investigation of cognitive impairment. Moreover, we develop, validate and introduce new classes of biomarkers for precision diagnostics. We develop prediction models and decision support for individualized prevention and treatment and develop methods for evaluating cost-effectiveness of new diagnostic and treatment strategies as well as new payment models to ensure fast and equal access to cost-effective treatment.