Translating lifestyle interventions for optimal brain health in Africa.

<p dir="ltr">Specific cardiometabolic diseases (CMDs) - including type 2 diabetes, heart disease, and stroke - have been individually linked to increased risk of dementia. With population aging, a growing number of older adults are living with cardiometabolic multimorbidity - i.e., the presence of multiple, co-occurring CMDs. However, the role of cardiometabolic multimorbidity in the development of dementia is not well-understood. This thesis aimed to explore the complex interplay between cardiometabolic multimorbidity, cognitive decline, and dementia, and to identify possible compensatory factors that may attenuate the detrimental influence of CMDs on cognitive and brain health. This was carried out using data from three longitudinal studies: the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), the Screening Across the Lifespan Twin (SALT) study, and the UK Biobank (UKB).</p><p dir="ltr">Study I. The relationship between CMDs and cognitive phenotypes in the preclinical/prodromal phase of dementia was examined using 12y follow-up data from SNAC-K (n=2,577). Cardiometabolic multimorbidity was associated with accelerated cognitive decline (ß -0.03 [-0.04, -0.02]) and a significantly increased risk of both cognitive impairment (HR 1.73 [1.23, 2.44]) and its progression to dementia (HR 1.86 [1.17, 2.97]).</p><p dir="ltr">Study II. The association between cardiometabolic multimorbidity and dementia was assessed using 18y follow-up data from 17,913 twin individuals from SALT. Cardiometabolic multimorbidity was associated with a significantly increased risk of all-cause dementia (HR 1.42 [1.31, 1.53), Alzheimer's disease (HR 1.26 [1.10, 1.45]) and vascular dementia (HR 1.64 [1.42, 1.88]). Comparison of monozygotic and dizygotic twin pairs further indicated that genetic factors may underlie the association between CMDs and dementia.</p><p dir="ltr">Study III. Cognitive reserve (characterized by higher educational and occupational attainment, social stimulation, and engagement in leisure activities) was explored as a potential compensatory factor that might attenuate the association between CMDs and dementia using 15y follow-up data from UKB (n=216,178). People with CMDs and moderate-to-high compared to low levels of cognitive reserve had 17% lower risk of dementia (HR 0.83 [0.77, 0.91]) and significantly larger volumes of gray matter and hippocampus on brain MRI.</p><p dir="ltr">Study IV. The compensatory role of anti-inflammatory diet in the CMD-dementia association was examined using 15y follow-up data from UKB (n=84,342). People with CMDs and an anti-inflammatory compared to pro- inflammatory diet had 31% lower risk of dementia (HR 0.69 [0.55, 0.88]) as well as a significantly larger volume of gray matter and significantly smaller volume of white matter hyperintensities on brain MRI.</p><p dir="ltr">Conclusions. Together, the findings highlight cardiometabolic multimorbidity as an especially high-risk state for a continuum of cognitive phenotypes spanning from accelerated cognitive decline to cognitive impairment and dementia. This appears to involve both neurodegenerative and vascular processes in the brain. Further, genetic background may underpin the CMD-dementia association. However, modifiable factors including high levels of cognitive reserve and adherence to an anti-inflammatory diet appear to attenuate the association between CMDs, brain pathologies, and dementia.</p><p dir="ltr">Keywords: Cardiometabolic disease, dementia, Alzheimer's disease, vascular dementia, cognitive decline, brain MRI, cognitive reserve, anti-inflammatory diet, population-based study, twin study</p><h3>List of scientific papers</h3><p dir="ltr">This thesis is based on the following original papers, which will be referred to in the text as Studies I, II, III, and IV.</p><p dir="ltr">I. <b>Dove A,</b> Marseglia A, Shang Y, Vetrano DL, Grande G, Laukka EJ, Fratiglioni L, Xu W. Cardiometabolic multimorbidity accelerates cognitive decline and dementia progression. Alzheimer's & Dementia. 2022 Jun 16; 19(3): 821-830. <br><a href="https://doi.org/10.1002/alz.12708">https://doi.org/10.1002/alz.12708</a><br></p><p dir="ltr"><br></p><p dir="ltr">II. <b>Dove A,</b> Guo J, Marseglia A, Fastbom J, Vetrano DL, Fratiglioni L, Pedersen N, Xu W. Cardiometabolic multimorbidity and incident dementia: the Swedish twin registry. European Heart Journal. 2023 Feb 14; 44(7): 573-582.<br><a href="https://doi.org/10.1093/eurheartj/ehac744">https://doi.org/10.1093/eurheartj/ehac744</a><br></p><p dir="ltr"><br></p><p dir="ltr">III. <b>Dove A,</b> Yang W, Dekhtyar S, Guo J, Wang J, Marseglia A, Vetrano DL, Whitmer RA, Xu W. High cognitive reserve attenuates the risk of dementia associated with cardiometabolic diseases. Alzheimer's Research & <a href="https://doi.org/10.1186/s13195-024-01528-2" rel="noreferrer" target="_blank">https://doi.org/10.1186/s13195-024-01528-2</a><br></p><p dir="ltr"><br></p><p dir="ltr">IV. <b>Dove A,</b> Dunk MM, Wang J, Guo J, Whitmer RA, Xu W. Anti- inflammatory diet and dementia in older adults with cardiometabolic diseases. JAMA Network Open. 2024 Aug 12; 7(8): e2427125. <br><a href="https://doi.org/10.1001/jamanetworkopen.2024.27125">https://doi.org/10.1001/jamanetworkopen.2024.27125</a><br></p><p dir="ltr"><br></p>

The rising burden of non-communicable diseases in sub-Saharan Africa

The convergence of climate change, adverse environmental exposures, and rapid population aging necessitates an equity-based paradigm shift in safeguarding brain health across the life course. Older adults, especially those in marginalized and low-resource settings, face disproportionate exposure to air pollution, toxicants, and climate-related hazards. Emerging evidence links these biophysical, social, and cultural vulnerabilities to cognitive decline and a heightened risk of developing Alzheimer's disease and related dementias (ADRDs), underscoring the need to examine cumulative exposures across the life course. Exposome-informed research integrating magnetic resonance imaging biomarkers with socioenvironmental contexts remains limited in underrepresented populations but offers opportunities to detect subclinical markers of environmental harm and illuminate mechanistic pathways of ADRDs. Thus, future studies must adopt equity-centered approaches, inclusive recruitment, and community-driven interventions to address systemic inequities and cumulative exposures. Embedding environmental justice within neuroscience will advance preventative public health policies that mitigate inequities and protect brain health during climate change. HIGHLIGHTS: Marginalized communities remain underrepresented in brain health/ Alzheimer's disease and related dementias (ADRDs) research. Toxic environmental exposures worsen inequities in brain health across the life course. Exposome-informed neuroimaging may detect early neural markers of cognitive decline. Future equity-centered exposome/neuroimaging work will inform brain health policy. Need for life course interventions to mitigate environmental risk factors of ADRDs.

Human Immunodeficiency Virus (HIV) and Non Communicable Diseases (NCD) are now the major chronic diseases of public health concern, especially in low- and middle-income countries. This joint burden has major adverse effects on the quality of life of an affected individual; causes premature death; creates adverse economic effects on families in general. The purpose of this paper is to highlight extent of the problem and various approaches that can address the threat posed by NCD among people living with HIV based on evidence and best practices in health interventions. The paper is based on the non-systematic review of policies, programs, health interventions and published research articles. In addition, recommendations of expert consultations and workshops organized in various countries were also reviewed. Review indicates that there are emerging developments to bridge the gap between the NCD and HIV, however, no focused strategy is available to address NCD in PLHIV. Some of the key suggested approaches are; build evidence for planning and management of NCD in PLHIV, increase allocation of financial resources for investigation and treatment of common NCDs in PLHIV, strengthening governance structure for improved efficiency and effectiveness of systems to address NCD in HIV and non-HIV services, reconfiguration of primary health care, routine screening of PLHIV for NCD and promoting healthy lifestyle to reduce PLHIV’s susceptibility to NCD, multi-/ inter-sectoral cooperation, public private partnership and community participation for sustained efforts. Although context-specific factors vary from place to place, the feasibility and cost-effectiveness of different approaches tackling NCD in PLHIV is needed.

HIV infection, a communicable disease, and noncommunicable diseases (NCDs) are among the major health concerns worldwide. An estimated 33 million people live with HIV, two-thirds of them in sub-Saharan Africa, where three-fourths of all AIDS-related deaths occur.

Background and objectives: Exerkines are signalling factors that are released from organs throughout the body during physical exercise (El-Sayes et al., 2019). Some of these exerkines are thought to contribute to the well-documented benefits of exercise on brain health and cognitive function, potentially delaying age-related cognitive decline (Erickson et al., 2011). However, research is still far from establishing a mechanism-based, evidence-driven exercise programme to prevent such decline. To date, most studies have focused on endurance training, leaving other training modalities underexplored. Moreover, few studies have simultaneously examined exercise-induced effects on blood, brain, and cognitive domains, limiting more holistic understanding of the underlying mechanisms. Research has also primarily involved healthy adults, whereas older adults at risk of Mild Cognitive Impairment (MCI) are less frequently studied. Importantly, the effects of exercise on cognition have never been investigated in persons with Spinal Cord Injury (SCI), a population with an elevated risk of age-related cognitive decline and dementia. The primary objective of the dissertation was therefore to gain a more comprehensive understanding of the mechanisms underlying the beneficial effects of exercise training, specifically resistance exercise in older adults and Neuromuscular Electrical Stimulation (NMES) in individuals with SCI, on brain health and cognitive function, with a particular focus on the role of exerkines in (exercise-induced) neuroplasticity. Methods: Eleven studies were conducted. Study 1 was a literature review describing exerkine release following acute and chronic endurance or resistance exercise and their effects on neuroplasticity via long-term synaptic potentiation. Study 2 summarised the findings from transcriptome and secretome studies identifying muscle-derived exerkines (myokines). Studies 3 and 4 were cross-sectional studies in older adults (n = 74) investigating the relationships between participant characteristics, blood (inflammatory and neurotrophic) and brain biomarkers (neurometabolites, regional grey matter volumes), and cognitive function. Studies 5–8 evaluated the effect of a single bout (n = 37) and a 12-week resistance exercise programme (n = 74) on blood and brain biomarkers and cognitive function in older adults. Studies 6 and 7 further compared outcomes between cognitively healthy older adults and those at elevated risk of MCI (based on the Montreal Cognitive Assessment). Study 9 systematically reviewed evidence on the effects of exercise interventions on cognitive performance in individuals with SCI and highlighted factors underlying their elevated risk of cognitive decline. Study 10 tested the effect of a single bout of NMES on exerkines and cognitive performance in persons with SCI. Study 11 described the protocol of a 12-week NMES intervention in individuals with SCI to examine the effect on exerkines and cognitive outcomes. Results: Study 1 identified 16 exerkines with known (in)direct effects on long-term synaptic potentiation. Study 2 reported 1,126 putative myokines, most with still unknown effects on the brain and body. Study 3 found associations between the circulating inflammatory marker kynurenine and signs of neuroinflammation and neurodegeneration in older adults. Study 4 showed that older adults with normal-to-slightly-elevated body weight and greater handgrip strength maintained larger brain volumes. Study 5 demonstrated improved working memory performance in older adults immediately after a single session of resistance exercise training compared to control group. Study 6 suggested hippocampal volume preservation over time in the resistance exercise group, and Study 7 revealed executive function improvements in older adults at elevated risk of MCI after 12 weeks of resistance training compared with control group. Study 8 demonstrated neurometabolic changes in older adults who contracted COVID-19 during participation. Study 9 confirmed that no prior studies have investigated exercise effects on cognitive function in individuals with SCI. Study 10 found increases in lactate levels, but no changes in cognitive performance after a single NMES session in persons with SCI. Study 11 described the design for a future 12-week NMES intervention study for individuals with SCI. Conclusions: The dissertation advances the understanding of exercise effects on brain health and cognition in older adults and individuals with SCI, providing a neurobiological basis for future research. Kynurenine levels, handgrip strength, and a healthy body weight emerged as potential biomarkers of brain health for older adults. The findings underscore the importance of monitoring cognitive functioning in persons with SCI. Although further research is needed to clarify the effect of different exercise modalities across populations with varying cognitive risk profiles, the present evidence reinforces the notion that physical exercise benefits brain function. A multimodal, enjoyable, and sustainable exercise programme maintained throughout life is likely to be the most effective strategy to mitigate or delay age-related cognitive decline. Keywords: aging, cognition, myokines, exercise, spinal cord injury

IntroductionSubjects exhibiting subjective cognitive decline (SCD) are at an increased risk for mild cognitive impairment and dementia. Given the delay between risk exposure and disease onset, SCD individuals are increasingly considered a good target population for cost‐effective lifestyle‐based Alzheimer's disease prevention trials.MethodsThe PENSA study is a randomized, double‐blind, controlled clinical trial that aims to evaluate the efficacy of a personalized multimodal intervention in lifestyle (diet counseling, physical activity, cognitive training, and social engagement) combined with the use of epigallocatechin gallate (EGCG) over 12 months, in slowing down cognitive decline and improving brain connectivity. The study population includes 200 individuals meeting SCD criteria and carrying the apolipoprotein E ε4 allele, who will be randomized into four treatment arms (multimodal intervention + EGCG/placebo, or lifestyle recommendations + EGCG/placebo). The primary efficacy outcome is change in the composite score for cognitive performance measured with the Alzheimer's Disease Cooperative Study Preclinical Alzheimer Cognitive Composite (ADCS‐PACC‐like) adding to the original version the Interference score from the Stroop Color and Word Test and the Five Digit Test. Secondary efficacy outcomes are (1) change in functional magnetic resonance imaging (fMRI) and structural neuronal connectivity (structural MRI) and (2) the safety assessment of the EGCG compound. This study is framed within the WW‐FINGERS consortium.DiscussionThe use of new technologies (i.e., mobile ecological momentary assessments [EMAs], activity tracker) in the PENSA study allows the collection of continuous data on lifestyle behaviors (diet and physical activity) and mood, enabling a personalized design as well as an intensive follow‐up of participants. These data will be used to give feedback to participants about their own performance along the intervention, promoting their involvement and adherence. The results of the study may aid researchers on the design of future clinical trials involving preventive lifestyle multicomponent interventions.

INTRODUCTION Non-communicable diseases (NCDs) are increasingly becoming important causes of illness and premature deaths globally, causing up to 41 million deaths annually, mostly occurring in Low and Middle-Income Countries. However, NCD treatment is lengthy and expensive forcing households to incur catastrophic expenditure. Thus, NCDs deepen inequality and are major drivers of unending poverty due to their lengthy treatment. Kenya successively reformed the National Health Insurance Fund to include a package that covers the plight of NCDs and transform it into a primary enabler for achieving Universal Health Coverage. This study examined whether health insurance affects catastrophic health expenditure among households of people with NCDs. METHODOLOGY A quasi-experimental design was conducted among eligible households with health insurance and those without, involving a representative sample of 350 households. Trained interviewers conducted interviews at baseline and after one year with household heads. RESULTS Households without cover spent a higher proportion of their total income (23%) on NCD care compared to households with insurance (11.7%). The mean total expenditure on NCD care for insured households was Ksh. 8,657.37 (95% CI 7,061.6 - 10,253.1) while that for non-insured was Ksh. 16,851.20 (95% CI 15,255.4 - 18,445.0), p = 0.000. Although the proportion of un-insured households that incurred catastrophic health expenditure (CHE) was higher than that of insured households, the study failed to establish that the incidence of CHE was different for non-insured and insured households (χ2= 33.89, df =1, p = 0.062). CONCLUSION NHIF cover was unable to protect Households of People with NCDs from CHE. The study recommends that NHIF's benefits package be further reformed to adequately cover all NCD's care needs. County government to strengthen the health system and boost capacity at lower levels of care to enhance NHIF coverage.

BackgroundDementia prevention is a global public health priority. The FINGER multimodal lifestyle intervention is the only intervention model so far that has demonstrated significant cognitive and other health benefits in at‐risk older adults. LETHE proposes a new multimodal precision prevention approach where FINGER intervention is complemented with digital tools to optimize intervention delivery, personalize recommendations based on individual risk profile, and support risk factor self‐management. The multinational 2‐year randomized controlled LETHE pilot trial aims to test the feasibility of a digitally supported, adapted FINGER intervention among older adults at risk of cognitive decline and dementia.MethodA total of 160 individuals aged 60‐77 years and with risk factors for dementia but no substantial cognitive impairment are recruited at four sites (Austria, Finland, Italy, Sweden; N = 40 per country). Digital readiness and experience with smart devices are required. Participants are randomized 1:1 to 1) structured multimodal lifestyle intervention (dietary guidance, exercise, cognitive training, vascular/metabolic risk management, social stimulation, sleep/stress management) where in‐person individual and group‐based activities are supported with the LETHE smartphone app developed in the project; or 2) self‐guided lifestyle intervention (regular health advice and access to a simplified app with no personalized/interactive content). Both groups wear a smartwatch to gather passive data (e.g., activity, sleep). Primary outcomes are retention rate, adherence to intervention and engagement with the app, and change in dementia risk based on validated risk scores (CAIDE, LIBRA). Secondary outcomes are lifestyle changes and changes in cognition, stress‐related symptoms, sleep, health‐related quality of life, and health literacy. Participant experiences will also be explored. The LETHE Advisory Board (members of the public) provided feedback on the trial protocol.ResultTrial is registered at ClinicalTrials.gov (NCT05565170), and ethical approval has been obtained in each country. Recruitment started in September 2022 and will be completed in Spring 2023. Updates and results on study progress will be presented.ConclusionLETHE pilot trial will inform about the feasibility of technological solutions and a digitally assisted lifestyle program to support brain health among older adults. If proved to induce sustained behavioural changes, digital tools could offer potential for large‐scale, cost‐effective dementia prevention programs.

Previous findings on the link between metabolic syndrome (MetS) and the risk of all-cause dementia, Alzheimer's disease (AD), vascular dementia (VD), and cognitive decline are inconsistent. We systematically searched Embase, PubMed, Web of Science, the Cochrane Library, and Scopus up to June 2025 for prospective cohort studies conducted in community-based settings among adults aged 18years or older that reported risk estimates (e.g., relative risks, hazard ratios, or odds ratios) for the association between MetS and the risk of dementia or cognitive decline. Risk of bias for studies were assessed using ROBINS-I, and the Grading of Recommendation, Assessment, Development, and Evaluation (GRADE) approach was applied to evaluate the certainty of evidence. Relative risks (RR) with 95%CI were computed using a random-effects inverse-variance method. Twenty-eight cohorts involving 6,753,197 participants were examined. MetS was significantly associated with a higher risk of all-cause dementia (RR = 1.11, 95%CI: 1.07-1.14; absolute risk difference: 2 more cases per 1000 persons), VD (RR = 1.33, 95%CI: 1.21-1.46; absolute risk difference: 7 more per 1000), and cognitive decline (RR = 1.24, 95%CI: 1.10-1.40; absolute risk difference: 5 more per 1000), all based on low-certainty evidence. No significant association was found between MetS and AD, with very low certainty. MetS components of hypertension, hyperglycemia, and low HDL-C were key risk factors, with a dose-response relationship observed between the number of MetS components and dementia risk. Subgroup analyses indicated MetS increased all-cause dementia risk in individuals under 70 (p-value for interaction: 0.048). MetS was positively associated with increased risk of all-cause-dementia, VD, and cognitive decline, but not AD. However, the effect sizes were modest and the certainty of evidence was low. Further prospective cohort studies are needed to confirm the associations.

SummaryBackgroundDistressing dreams are associated with faster cognitive decline and increased dementia risk in people with Parkinson's disease (PD). Whether distressing dreams might be associated with cognitive decline and dementia in people without PD is unknown. This study investigated the association between self-reported distressing dream frequency and the risk of cognitive decline and incident dementia in community-dwelling men and women without cognitive impairment or PD.MethodsRisk of cognitive decline was evaluated in 605 middle-aged adults (mean age = 50 years [IQR 44–57]; 55·7% female) from the Midlife in the United States (MIDUS) study, who were cognitively normal at baseline, and were followed-up for a maximum of 13 years (IQR 9–10). Cognitive decline was defined as having an annual rate of decline in global cognitive function (measured using five cognitive tests) ≥ 1 standard deviation faster than the mean decline rate from baseline to follow-up. Risk of incident all-cause dementia was evaluated in 2600 older adults (mean age = 83 years [IQR 81–84]; 56·7% female) pooled from the Osteoporotic Fractures in Men Study (MrOS) and the Study of Osteoporotic Fractures (SOF), who were dementia-free at baseline, and were followed-up for up a maximum of 7 years (IQR 4–5). Incident dementia was based on doctor-diagnosis. Frequency of distressing dreams was assessed in all cohorts at baseline (January 2002 – March 2012) using item 5h of the Pittsburgh Sleep Quality Index. The association between self-reported distressing dream frequency (“never”, “less than weekly”, “weekly”) and later cognitive outcomes, was evaluated using multivariable logistic regression in both the middle-aged and pooled older adult cohorts.FindingsAfter adjustment for all covariates, a higher frequency of distressing dreams was linearly and statistically significantly associated with higher risk of cognitive decline amongst middle-aged adults (P for trend = 0·016), and higher risk of incident all-cause dementia amongst older adults (P for trend <0·001). Compared with middle-aged adults who reported having no distressing dreams at baseline, those who reported having weekly distressing dreams had a 4-fold risk of experiencing cognitive decline (adjusted odds ratio [aOR] = 3·99; 95% CI: 1·07, 14·85). Amongst older adults, the difference in dementia risk was 2·2-fold (aOR = 2·21; 95% CI: 1·35, 3·62). In sex-stratified analyses, the associations between distressing dreams and both cognitive outcomes were only statistically significant amongst men.InterpretationDistressing dreams predict cognitive decline and all-cause dementia in middle-aged and older adults without cognitive impairment or PD - especially amongst men. These findings may help to identify individuals at risk of dementia and could facilitate early prevention strategies.FundingThe study received no external funding.

Improving responsiveness of health systems to non-communicable diseases

Because of the urbanization, demographic transition and influence of globalization, the lifestyle of people in many of the low and middle income countries (LMIC) is changing; heading to unhealthy dietary habit, physical inactivity and use of cigarette and alcohol.The lifestyle changes on the background of earlier malnutrition, inevitably leads to central obesity.This with the stressful situation caused by the competitive environment catalyzes the surge of Non Communicable Diseases (NCDs).Reports showed that the burden of NCDs in LMICs is on the rise.As a result, NCDs are responsible for two-thirds of the world's deaths-80% in low-and middle-income countries.In sub-Saharan Africa, NCDs contribute a third of the disability-adjusted life year burden.However, resources allocated to prevent and treat NCDs in LMICs are none or little (1).Until recently, communicable diseases remained the sole priority for health policy though they do not constitute the major contributor to the burden of disease in terms of disability-adjusted life years or mortality in any region of the world apart from sub-Saharan Africa (2, 3).Though essential to reduce the future disease burden, prevention interventions will do little for those people who have already developed NCDs, and who are essentially being used to validate investments that will come too late to help them.While working on limiting the number of future NCD patients, an important duty is to ensure that people with NCDs receive quality care today.Investing to improve primary care to shoulder NCD services-the main entry point to health services for most people in resource-limited settingshas the potential to overcome some of these problems (4).From the successful experience gained in delivering interventions for communicable diseases such as HIV, tuberculosis

BackgroundPrior studies have reported that older adults can benefit from formal educational programs about dementia. Participating in an online educational program focusing on risk and protective factors could potentially increase participants’ dementia literacy, empowerment, and engagement in brain health promotion, which in turn could reduce their dementia risk. The goal is to develop a comprehensive, compelling, and evidence‐based online educational program on risk and protective factors for dementia.MethodThe Brain Health Support Program is being developed as part of the Canadian Consortium on Neurodegeneration in Aging CAN‐Thumbs‐Up initiative. The program is designed to improve dementia literacy, promote lifestyle changes in at‐risk individuals who are cognitively intact or have mild cognitive impairment, and evaluate its effectiveness.ResultsThe content is based on the epidemiological literature on risk and protective factors for dementia. The format is determined from a review of web‐based educational programs for older adults and is co‐created with experts, stakeholders and citizen advisors. The program contains eight interactive modules with new content provided weekly over a 12‐month period. The modules contain general information and tips on modifiable risk factors including diet, physical activity, cognitively stimulating activity, sleep, vascular health, social and psychological factors, vision and hearing, as well as information on dementia, stigma, and stereotypes. Participants have access to an individualized risk profile to determine personal goals and are given feedback on lifestyle changes. Content is available in French and English. Changes in dementia literacy, self‐efficacy, attitudes toward dementia and modifiable risk factors will be collected from the platform.ConclusionProviding access to scientifically validated education through an interactive web‐based platform is expected to have a positive effect on participants’ attitude, engagement in brain health behaviours and dementia literacy. It might also increase readiness to change and maintain positive lifestyle changes. The content and format are co‐created with users and stakeholders, which should increase its relevance and facilitate future implementation.

A – 89 The Impact of Physical Activity on Brain Health in APOE e4 Carriers and Non-Carriers: A Narrative Review