Lotte Sophie Truin

Background: Individuals with subjective cognitive decline (SCD) and mild cognitive impairment (MCI) are at increased risk of dementia and may benefit from lifestyle-based strategies for secondary prevention in clinical practice. Objective: To examine risk awareness, needs and preferences for dementia risk reduction in individuals with self-reported SCD and MCI and memory clinic professionals. Methods: Using a mixed-methods approach, we conducted online surveys to examine risk awareness, needs and preferences, and semi-structured interviews to explore barriers and facilitators related to online dementia risk reduction. Results: 1167 individuals with SCD (n = 1092) and MCI (n = 75), predominantly community-based research volunteers and a smaller group recruited via memory clinics, and 58 professionals completed the survey. Among SCD/MCI individuals, 39.5% were unaware that dementia risk can be reduced through lifestyle changes, 97.5% were interested in obtaining such information, and 97.9% considered using an online dementia risk management tool. Among professionals, 10.3% were unaware of dementia risk reduction, and 87.0% considered using a tool on this topic during consultations. Cardiovascular risk factors were poorly recognized by SCD/MCI individuals and, though acknowledged by professionals, rarely discussed in consultations. Interviews with SCD/MCI individuals (n = 14) and professionals (n = 9) highlighted several areas supporting implementation of an online dementia risk management tool (e.g., personalization, up-to-date information, coaching). Conclusions: Dementia risk awareness was low among SCD/MCI individuals, and high among memory clinic professionals. Both groups showed strong interest in using an online dementia risk management tool, and specific content, design and delivery features may influence engagement. Findings should be interpreted recognizing the mostly online-recruited, higher-educated study sample.

Background: Brain-healthy lifestyle changes could help reduce dementia risk in individuals with subjective cognitive decline (SCD) or mild cognitive impairment (MCI), but patients and clinicians in memory clinics often lack practical tools to support this. Objective: To explore the acceptability and usability of BreinZorg (English: BrainCare) in a memory clinic setting. BreinZorg is a co-created prototype consisting of a self-management website and hardcopy conversation aid providing dementia risk reduction information. Methods: The website includes a lifestyle assessment, personalized module recommendations, practical information on 16 modifiable dementia risk and protective factors (e.g., smoking, sleep) and a goal-setting feature. The hardcopy conversation aid briefly outlines these factors to support clinical risk reduction discussions. This study used semi-structured interviews based on the Program Participation Questionnaire and think-aloud sessions, which were analyzed through thematic content analysis. Participants were individuals with self-reported SCD or MCI (n = 19) and memory clinic professionals (n = 9), i.e., nurses/nurse practitioners, physicians/medical specialists and neuropsychologists. Results: BreinZorg was generally considered useful, trustworthy, easy to use, and applicable in clinical contexts. The platform's accessible design, nonjudgmental tone, and personalization features were appreciated. Some participants with SCD or MCI, particularly those already interested in brain health, desired more in-depth information. A lack of follow-up on personal goals and misaligned module recommendations after the lifestyle assessment were identified as barriers to sustained engagement. Conclusions: Memory clinic patients and professionals evaluated BreinZorg as practical, useful, and acceptable for supporting dementia risk reduction in clinical care. Offering more detailed information, integrating tailored follow-up support, and enhancing personalization may strengthen long-term user engagement.

Background: High cognitive activity possibly reduces the risk of cognitive decline and dementia.Aims: To investigate associations between an individual's need to engage in cognitively stimulating activities (need for cognition, NFC) and structural brain damage and cognitive functioning in the Dutch general population with and without existing cognitive impairment.Method: Cross-sectional data were used from the population-based cohort of the Maastricht Study. NFC was measured using the Need For Cognition Scale. Cognitive functioning was tested in three domains: verbal memory, information processing speed, and executive functioning and attention. Values 1.5 s.d. below the mean were defined as cognitive impairment. Standardised volumes of white matter hyperintensities (WMH), cerebrospinal fluid (CSF) and presence of cerebral small vessel disease (CSVD) were derived from 3T magnetic resonance imaging. Multiple linear and binary logistic regression analyses were used adjusted for demographic, somatic and lifestyle factors.Results: Participants (n = 4209; mean age 59.06 years, s.d. = 8.58; 50.1% women) with higher NFC scores had higher overall cognition scores (B = 0.21, 95% CI 0.17–0.26, P < 0.001) and lower odds for CSVD (OR = 0.74, 95% CI 0.60–0.91, P = 0.005) and cognitive impairment (OR = 0.60, 95% CI 0.48–0.76, P < 0.001) after adjustment for demographic, somatic and lifestyle factors. The association between NFC score and cognitive functioning was similar for individuals with and without prevalent cognitive impairment. We found no significant association between NFC and WMH or CSF volumes.Conclusions: A high need to engage in cognitively stimulating activities is associated with better cognitive functioning and less presence of CSVD and cognitive impairment. This suggests that, in middle-aged individuals, motivation to engage in cognitively stimulating activities may be an opportunity to improve brain health.