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A Northumbria University-led team developed and tested a five-factor score to estimate dementia risk among older adults in low- and middle-income countries. The tool is intended to support research recruitment, not routine screening, and needs testing in regions absent from the study.
A Northumbria University-led international team has developed and validated a five-factor score to estimate dementia risk in older adults in low- and middle-income countries, where the researchers say about 60% of people with dementia live, using a simple conversational tool. Published in the American Journal of Epidemiology, the tool uses information gathered through conversation and is intended to help research studies and clinical trials identify people at higher risk—not to serve as a routine screening test.
The researchers built and tested the model using data from more than 11,000 older adults at seven sites in China, Cuba, the Dominican Republic, Puerto Rico, Venezuela, Mexico and Peru. Its five factors are age, social engagement, physical activity, high blood pressure and difficulty managing money. The last factor is assessed by asking a family member or carer about a noticeable change in the person’s ability to handle finances, one of several modifiable dementia risk factors.
Each factor contributes to a total score from 0 to 9. The report says a score of 0 corresponds to about a 1% chance of developing dementia within three years; a score of 9 corresponds to nearly 19%. The model achieved an accuracy score of 0.75, which the researchers describe as above the 0.70 threshold generally regarded as clinically useful.
The score requires no blood tests, brain scans or specialist equipment. The study was funded by the UK National Institute for Health and Care Research using UK Government international development funding, with additional support from Dementia Australia. The team’s stated focus is research use: providing a practical way to identify and recruit people for studies in settings where existing prediction tools may not apply well, particularly given evidence that memory problems may matter for dementia risk.
A Research Tool for Underrepresented Settings
Most dementia prediction tools were developed using data from high-income countries. According to the study report, those tools have transferred poorly to other settings, leaving researchers in many lower-income countries with fewer ways to identify people who may be at elevated risk. A locally relevant, conversation-based score could help research teams recruit participants without relying on costly tests or specialist equipment.
That could support prevention research and clinical trials in populations that make up a large share of the global dementia burden. It does not, by itself, show that using the score will prevent dementia or improve clinical outcomes. Its reported performance is a measure from the study, not proof that it will work equally well in every country or population.
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Why Existing Risk Models Fell Short
Dementia affects more than 57 million people worldwide, with around 60% living in low- and middle-income countries across Latin America, the Caribbean, Asia and Africa, according to the report. The research team says the geographic distribution of dementia has not been matched by the populations used to build many risk prediction tools.
The new score draws on everyday information: a person’s age and activity, contact with other people, blood-pressure status and changes in managing money. The researchers describe these factors as assessable in a straightforward conversation with an older adult and, where relevant, a relative or carer. The tool’s simplicity is intended to make it useful for research in settings with limited access to specialist testing.
“This model is a step towards changing that. It is simple, it is built for the settings where it is needed most, and it gives researchers a practical way to find the people who should be the focus of future studies and trials.”
— Dr. Eduwin Pakpahan, Northumbria University
Where the Score Still Needs Testing
The model was tested at seven sites, but the study does not cover every region where dementia is common. The researchers specifically call for validation in South Asia, the Middle East and North Africa, and Sub-Saharan Africa. Its accuracy and estimated risks may not carry over unchanged to populations with different circumstances or patterns of health care.
The score is described as a research tool, not a routine screening test for the general population. The available report does not establish how it should be used to guide individual clinical decisions, nor does it show that a particular score predicts with certainty whether a person will develop dementia. The three-year percentages are estimates associated with score levels, not guarantees for individuals.
Validation Beyond the Seven Sites
The researchers are calling for studies to test the score in additional regions, particularly those not represented in the current analysis. Such work would help establish whether the model performs reliably across different populations and local settings. The team also presents the score as a way to support future research studies and trials, which may use it to identify and recruit participants at elevated risk.
No timetable for further validation or plans for routine clinical rollout were provided in the report. Until more regional evidence is available, the score’s demonstrated reach remains limited to the seven study sites.
Key Questions
What does the new dementia risk score measure?
It estimates the chance of developing dementia within three years using five factors: age, social engagement, physical activity, high blood pressure and difficulty managing money.
Is the score intended for routine screening?
No. The researchers say it is primarily a research tool to help identify and recruit people for studies and clinical trials, rather than a routine test for the general population.
How was the score tested?
The team used data from more than 11,000 older adults at seven sites in China, Cuba, the Dominican Republic, Puerto Rico, Venezuela, Mexico and Peru. The model’s reported accuracy score was 0.75.
Can someone’s score determine whether they will develop dementia?
No. The score gives an estimated risk, not a certain prediction. The report says a score of 0 is associated with about a 1% three-year risk and a score of 9 with nearly 19%; individual outcomes can differ.
Which areas still need validation?
The researchers call for further testing in South Asia, the Middle East and North Africa, and Sub-Saharan Africa, regions not covered by the seven-site analysis.
Source: news-medical.net
