Dementia risk factors and biomarkers in subjective cognitive decline: real world evidence from the monza brain health service

Abstract

Up to 45% of dementia can be prevented by addressing modifiable risk factors. Brain Health Services (BHS) are emerging across Europe, targeting individuals with subjective cognitive decline (SCD) to assess, communicate and reduce their risk of dementia. Our aim is to characterize our BHS cohort, and assess differences in clinical, biological, neuroimaging, and impact of biomarker disclosure based on plasma Lumipulse p-Tau217. We analyzed baseline data from 186 consecutive individuals seen at our BHS (132 SCD). Cumulative dementia risk was calculated using the total Lancet relative risk (RR). Participants were grouped in plasma Lumipulse p-Tau217 above and below 0.15 pg/mL (A + and A–). Cluster analysis was performed with k-means. The most prevalent potentially modifiable factors among participants with SCD were sleep impairment, smoking, physical inactivity, and hypertension. A + SCD subjects (32%) were older and showed worse performance on cognitive screening tests (PFDR < 0.05). A + SCD showed higher GFAP and neurodegeneration on visual scales (PFDR < 0.05). Two clusters were identified, one with low modifiable and biological risk and high cognition, and another with high risk and lower cognition. Disclosure was well accepted, with no differences between A– and A + in depression and anxiety. Our findings showed a high prevalence of modifiable risk factors in SCD. A+ individuals demonstrated biological and structural hallmarks of early neurodegeneration. Biomarker disclosure was feasible, reflecting the potential benefits of transparent risk communication. These findings support incorporating plasma biomarkers and structured disclosure protocols in BHS, complementing multimodal prevention strategies to delay dementia onset.