Cognitive health cross-cutting theme

Life expectancy continues to increase in the UK and it is important that people have the opportunity to spend these extra years enjoying healthy, independent lives. To help achieve this, the aim of this cross-cutting theme was to contribute to the development and evaluation of preventive interventions for good brain health. The research focused on summarising the evidence to 1) determine the effectiveness of preventive interventions (including lifestyle and diet modification, improving cardiovascular health, social isolation, etc.) and 2) identify whether specific interventions work better depending on an individuals’ level of risk of developing dementia. The team also prioritised practice-focused activities that led to direct influence on policy at the national level. To kick start this work, the team was commissioned to conduct three rapid evidence reviews to inform the development of NICE public health guidance on mid-life interventions that could prevent or delay the onset of disability, dementia, and frailty in later life. We first looked at the association between risk behaviours in mid-life and late life outcomes such as mortality, disability, dementia, frailty. The second review summarized the effectiveness of interventions to promote healthy behaviours in mid-life. Finally, the third sought to inform the design of tailored interventions for people in mid-life by identifying issues that prevent or limit the uptake and maintenance of healthy behaviours. The reviews identified specific risk behaviours that can be changed to reduce the risk of dementia, disability and frailty for many people. These include smoking, lack of physical activity, alcohol consumption, poor diet and being overweight. For example, the provision of a structured exercise programme (such as stretching, aerobic exercise, walking, weight training, yoga) can build resolve to start and maintain physical activity. The NICE guidance implements this by recommending local authorities “provide supervised activities and exercise classes”. Similar recommendations are made for other risk behaviours. Building on that work, the team conducted three additional systematic reviews of studies of older populations living in the community. Two assessed the effectiveness of interventions that promote healthy behaviours and brain health. The third identified barriers and facilitators of behaviour change in these populations. At Public Health England’s request, the team developed an evidence-based resource for commissioners and local authorities based on the reviews’ key findings. It provides a steer to promote healthy behaviours and cognitive health, and for the development of a stronger evidence base.