71 year old male presents with abnormal neurologic findings | Figure 1

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71 year old male presents with abnormal neurologic findings and this is his MRI. What findings would you expect to find on physical exam?

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What tools exist to assess the presence of multiple risk factors for dementia in middle‐aged people, and can they correctly predict future dementia?
Key messages
• We found 14 tools used in middle‐aged people to predict future dementia.
• Seven studies tested a prediction tool named Cardiovascular Risk Factors, Ageing, and Dementia (CAIDE).
• The benefits of using these tools to predict dementia later in life are unclear, because the studies provided little high‐quality evidence.

What did we want to find out?
We wanted to find out what tools are available for middle‐aged adults (aged 45 to 65 years), and how well they predict dementia later in life (at least five years after the initial assessment). We looked for tools that included risk factors widely accepted to be linked to dementia onset.

What did we do?
We searched for studies that evaluated tools used in middle‐aged adults to identify those at high risk of dementia later in life. We investigated how well these tools predicted future dementia based on an accuracy value. If the accuracy value is more than a recommended standard of 0.75, we can say that the tool is accurate at predicting future dementia. It is also important to establish that a tool developed in one group of people (in the original development study) can accurately predict dementia in another group of people (in validation studies); only then can it be applied in routine healthcare practice. We compared and summarised the results of the studies.

What did we find?
We found 20 studies that described 14 different tools for dementia prediction. The tools included between two and 11 modifiable risk factors for dementia. Seven of the tools featured in two or more studies and were considered validated. Seven studies used a tool called Cardiovascular Risk Factors, Ageing, and Dementia (CAIDE). The CAIDE tool included current measures of a person's blood pressure, weight and height, cholesterol level, and frequency of exercise to predict future dementia. The combined accuracy value across the studies was 0.71, not high enough for us to consider CAIDE a reliable tool for predicting future dementia.

What are the limitations of the evidence?
Half (seven) of the tools were used in a single study, so we were unable to measure how well they predicted future dementia. Most studies provided too little information for us to assess accuracy values.