Office of Disease Prevention, National Institutes of Health

Objective To determine the effectiveness of adding a brief psychological eating‐disorder treatment (CBT) to weight management for addressing DSM‐5 binge‐eating disorder (BED) in US military Veterans with high weight. Method One hundred and nine Veterans, with DSM‐5 BED, seeking weight management services were randomly assigned to VA's Weight Management Program (MOVE!), or MOVE! plus a brief, clinician‐led cognitive‐behavioral therapy (MOVE! + CBT). Primary (eating disorder psychopathology and binge eating), secondary (mental health, quality of life, and eating‐ and appearance‐related), and exploratory (weight) outcomes were analyzed with mixed‐effects models for four timepoints (baseline, 3‐month [post‐treatment], and 9‐ and 15‐month follow‐ups). Results MOVE! + CBT reported significantly less overall eating disorder psychopathology compared to MOVE! at all post‐randomization timepoints: difference at 3 months −0.18 (−0.3, −0.06, p = 0.003), 9 months −0.15 (−0.3, 0, p = 0.05), and 15 months −0.27 (−0.42, −0.12, p < 0.001). There were no differences between groups in binge‐eating frequency. MOVE! + CBT remission rates were 28% at 3 months, 42% at 9 months, and 27% at 15 months. MOVE! remission rates were 22% at 3 months, 26% at 9 months, and 20% at 15 months. MOVE! + CBT was superior at post‐treatment through 15 months on eating‐, weight‐, and shape‐related (p's < 0.05), but few other, secondary outcomes. A 5% weight loss ranged from 26% to 38% for MOVE! + CBT, and 17% to 33% for MOVE!. Discussion Weight management alone and with concurrent CBT resulted in significant improvements in BED. The addition of CBT enhanced some specific outcomes but not weight loss. Findings provide evidence‐based clinical guidance and population‐level impact for addressing BED in the context of high weight, especially among Veteran populations. Trial Registration: Clinical Trial Registry Number: NCT03234881(Weight Loss Treatment for Veterans with Binge Eating)

Background Job burnout is particularly prevalent within the healthcare sector, with public health practitioners (PHPs) being especially vulnerable. The global impact of the coronavirus disease 2019 (COVID-19) pandemic has been profound, yet the prevalent level of job burnout among PHPs following the crisis has been largely overlooked. This study aims to assess the prevalence and determinants of job burnout among PHPs in the post-COVID-19 era, thereby providing a theoretical foundation for the development of targeted interventions. Methods This cross-sectional survey was conducted from July to October 2023, targeting members of the Center for Disease Control and Prevention and the Public Health Service Center in Baoan District, Shenzhen. A non-random convenience sampling was employed to recruit 222 participants. Demographic and work-related information was compiled. Job burnout was assessed with Chinese revised version of the Maslach Burnout Inventory-General Survey. Binary logistic regression analysis was employed to identify factors influencing job burnout among participants. The mediation effect was tested using the bias-corrected percentile Bootstrap method with 5,000 resamples. Results The prevalence of job burnout among the PHPs was found to be 50.90%, with rates of mild, moderate, and severe burnout at 27.03, 15.32, and 8.56%, respectively. Multivariable analysis indicated that self-rated mental health (OR = 0.436, 95% CI: 0.230, 0.827), workload intensity (OR = 5.183, 95% CI: 1.751, 15.340), and the family support for work (OR = 3.313, 95% CI: 1.335, 8.222) were significantly associated with burnout (p < 0.05). The PHPs exhibiting poorer self-rated mental health, higher workload, and lower family support for work were at greater risk of job burnout. The mediation analysis revealed that elevated workload indirectly increased the likelihood of burnout (indirect effect = 2.931, 95% CI: 1.111, 4.750), exhaustion dimension (indirect effect = 2.801, 95% CI: 1.115, 4.486) and cynicism dimension (indirect effect = 2.977, 95% CI: 1.127, 4.826) by exacerbating mental health deterioration. Conclusion Job burnout has emerged as a common concern among the PHPs in the aftermath of the COVID-19 pandemic. To effectively address burnout, it is crucial to develop effective intervention measures aimed at mitigating risk factors, ultimately enhancing the well-being of the PHPs.

Purpose This systematic review aimed to summarize the evidence on the association between multimorbidity and fluid biomarkers of Alzheimer’s disease (AD). Methods We systematically searched PubMed, Web of Science, and Embase for studies investigating the association between multimorbidity—defined as the co-occurrence of multiple chronic conditions in the same individual—and levels of cerebrospinal fluid (CSF) or blood biomarkers of AD, focusing on the most established AD biomarkers (amyloid-beta, phosphorylated-tau, total-tau, neurofilament light chain, and glial fibrillary acidic protein). Studies were selected following PRISMA guidelines. Results Out of 3,104 records, we identified 10 cross-sectional studies. Four studies assessed CSF biomarkers in dementia-free participants with mean age between 61.8 and 66.6 years, yielding mixed findings with no consistent association between multimorbidity and CSF biomarkers. Six studies focused on blood biomarkers in participants with mean age ranging from 66.5 to 76.4 years, five of which included individuals with dementia. Most of these studies reported an association between multimorbidity and elevated blood biomarker levels. Conclusions This review suggests a significant association between multimorbidity and AD blood biomarkers in older populations, while the results on CSF are mixed and inconsistent. Further research is needed, particularly longitudinal studies assessing both CSF and blood biomarkers within the same populations.

A fundamental phase in the life of new Guidelines is the implementation, which responds to the need to facilitate their adoption with interventions and procedures of proven effectiveness to increase their impact on public health. The implementation should follow a scientific method, and therefore shares many characteristics and the rigorous approach of clinical research. However, it differs in purposes, methods, and aims by addressing factors that include identifying and resolving barriers and facilitators in the adoption of evidence-based clinical innovations. The use of comprehensive geriatric assessment (CGA) can be facilitated by technological tools, with the possibility of early diagnosis of several chronic conditions, monitoring and management of the diseases typical of older people and, finally, to personalized care and optimization of healthcare resources. However, remote CGA also has limitations, including technology requirements, data security/privacy, and the need for comprehensive evaluation and simplicity. In this document we present the history and the model of implementation of the Italian guidelines on CGA in older persons. The standardization of CGA in older adults across different settings is particularly important in countries like Italy, that have among the oldest world population and where broader implementation of CGA, also outside traditional geriatric settings, has become a health priority that cannot longer be delayed.

Background For the public health community, monitoring recently published articles is crucial for staying informed about the latest research developments. However, identifying publications about studies with specific research designs from the extensive body of public health publications is a challenge with the currently available methods. Objective Our objective is to develop a fine-tuned pretrained language model that can accurately identify publications from clinical trials that use a group- or cluster-randomized trial (GRT), individually randomized group-treatment trial (IRGT), or stepped wedge group- or cluster-randomized trial (SWGRT) design within the biomedical literature. Methods We fine-tuned the BioMedBERT language model using a dataset of biomedical literature from the Office of Disease Prevention at the National Institute of Health. The model was trained to classify publications into three categories of clinical trials that use nested designs. The model performance was evaluated on unseen data and demonstrated high sensitivity and specificity for each class. Results When our proposed model was tested for generalizability with unseen data, it delivered high sensitivity and specificity for each class as follows: negatives (0.95 and 0.93), GRTs (0.94 and 0.90), IRGTs (0.81 and 0.97), and SWGRTs (0.96 and 0.99), respectively. Conclusions Our work demonstrates the potential of fine-tuned, domain-specific language models to accurately identify publications reporting on complex and specialized study designs, addressing a critical need in the public health research community. This model offers a valuable tool for the public health community to directly identify publications from clinical trials that use one of the three classes of nested designs.

Background/Aim Information on the long-term frequency of recurrence is of paramount importance for the increasing number of women living several years after breast cancer (BC) diagnosis and for their caregivers. The study aims to estimate the cumulative incidence of recurrence until 10 years after diagnosis in Italian women diagnosed with BC using population-based cancer registries. Methods Women diagnosed with stage I to III BC during 2004–2010 from Friuli Venezia Giulia and Veneto (Italy) cancer registries were included (n = 5825). Recurrence status after a disease-free period was ascertained through individual-level linked databases using treatment or procedure codes from claims. Cumulative incidence of recurrence was calculated in the presence of competing risks (second cancer or death). Results During a median follow-up of 13.5 years, 1522 out of 5825 women experienced a recurrence with an estimated 10-years cumulative incidence of 20.8 % (95 %CI:19.7–21.8 %), decreasing from 23.7 % in 2004–2006 to 18.5 % in 2007–2010. Women younger than 40 years (40.5 %), with stage III (41.8 %) and triple-negative BC (32.5 %) showed a higher 10-year incidence of recurrence. At 10 years after a BC diagnosis, 83.9 % of women were alive: 67.5 % without any cancer-related events, 12.4 % after recurrence and 4.0 % after second primary cancer. 10-years survival was higher than 90 % for women with stage I BC and 58.1 % for those with stage III (3.2 % and 27.3 % deaths after recurrence, respectively). Discussion This Italian study provide detailed population-based information on the incidence of recurrence and other outcomes after BC and may be replicated in other Italian and European areas.

Background Visual dysfunctions in Parkinson's disease (PD) patients suggest a possible degeneration of dopaminergic retinal layers, This study aimed to investigate macular retinal thickness in PD patients versus healthy controls using Optical Coherence Tomography (OCT), a non-invasive technique for in vivo retinal imaging. The role of the Val66Met polymorphism in the BDNF gene in relation to retinal degeneration and clinical features of PD was also explored. Methods This case-control study included 26 patients with idiopathic PD and 78 age- and sex-matched healthy controls, for a total of 208 eyes. All subjects underwent a 512 × 496-line OCT volumetric scan centred on the macular region. Results Macular thickness was measured in each sector and as an average across 360°. Significant differences were found in the superior sector of the left eye (OS2) (increase of 3 units in PD), the inferior sector of the left eye (OS2) (decrease of 3 units in PD), and the total volume of both eyes (decrease of 0.13 units in PD). An inverse correlation between retinal thickness and age at onset was observed in the temporal and inferior sectors of both eyes. The Val/Met heterozygous polymorphism was identified in 30.7% of PD patients. Conclusions The study confirms that thinning of the inner retinal layers is associated with PD. OCT provides a rapid, non-invasive, repeatable, and cost-effective method for in vivo assessment of retinal layers, supporting its potential as an early biomarker for PD. Further longitudinal studies with larger samples are needed to clarify the role of the BDNF polymorphism in retinal degeneration in PD.

Background/Objectives: The increasing incidence of cancer during pregnancy is a growing public health concern, driven by delayed parenthood and rising maternal age. Pregnancy-associated cancer (PAC) presents complex clinical challenges, necessitating a balance between maternal cancer treatment and fetal safety. Historically considered incompatible with favorable pregnancy outcomes, evidence now suggests that pregnancy can often proceed without affecting cancer prognosis. A 2022 study in Italy provided the first population-based PAC estimates by linking cancer registries (CRs) and hospital discharge records (HDRs). This study aimed to update PAC estimates to 2019, covering 30% of the Italian population and addressing prior data limitations. Methods: A retrospective longitudinal analysis was conducted on women aged 15–49 diagnosed with malignant cancers between 2003 and 2019. Data from 21 Italian CRs were linked with HDRs to identify PAC cases, defined as obstetric hospitalizations occurring for women diagnosed with cancer in our study cohort in the period spanning from one year before to two years after a cancer diagnosis. All malignant cancers, excluding non-melanoma skin cancers, were analyzed. PAC rates were calculated per 1000 pregnancies, and trends were assessed using log-linear and JoinPoint regression models. Results: Among 131,774 women diagnosed with cancer, 6329 PAC cases were identified, with a PAC rate of 1.43 per 1000 pregnancies, consistent with global estimates. Thyroid (24.4%) and breast cancer (23.2%) were the most common. Analyzing the PAC rate by pregnancy outcome, in the period 2015–2019, this increased for both childbirths and miscarriages but decreased for voluntary terminations. Most hospitalizations (54%) occurred pre-diagnosis, peaking at diagnosis, especially for breast cancer (69%). Conclusions: PAC incidence is rising, particularly for live births and miscarriages, underscoring the need for multidisciplinary care and robust epidemiological insights to guide clinical management.

Patients with neurological disorders, particularly those who are chronologically and biologically older, may display highly varied clinical courses and trajectories. The present study explored the association between frailty and hospital outcomes among patients with acute neurological presentations admitted to an Italian university hospital. A cross-sectional study considered all patients consecutively admitted to the Neurology Unit of the Policlinico Umberto I University Hospital of Rome (Italy). A 40-item Frailty Index (FI) was retrospectively developed based on the clinical information collected in the Emergency Department (ED). Data on hospitalization outcomes were prospectively collected during the patient’s stay at the Neurology Unit. Linear and logistic regression models were conducted to test the association between FI and hospital outcomes. Overall, 185 participants (women 50.3%; mean age 68.6, SD 18.6 years) were included. FI scores ranged between 0 and 0.43, with a median value of 0.15 [IQR 0.10], and were positively correlated with age (Spearman’s rho 0.55, p < 0.001). In a linear regression model adjusted by age, sex, and diagnosis, FI was significantly associated with the number of days spent in the Neurology Unit (B 2.18, 95%CI 0.25–4.11, per 0.1 increase; p = 0.03). In bivariate logistic regression models adjusted by age, sex, and diagnosis, increasing FI scores were significantly associated with a lower likelihood of being discharged at home (OR 0.37, 95%CI 0.20–0.63, per 0.1 increase; p < 0.001), with higher odds of nosocomial infections (OR 1.67, 95%CI 1.05–2.73 per 0.1 increase; p = 0.03), and prescription of antibiotics (OR 1.77, 95%CI 1.11–2.92, per 0.1 increase; p = 0.02). Frailty is adversely associated with hospital outcomes in patients with acute neurological disorders. Assessing frailty could improve patient stratification, prognostication, and care planning, with a relevant impact on healthcare resources.

Background With the changing demographic landscape in most countries worldwide, accurate and brief culture-sensitive case-finding instruments are needed to identify patients with possible cognitive disorders. Objective To investigate the discriminative validity of the Brief Assessment of Impaired Cognition (BASIC) and BASIC Questionnaire (BASIC-Q) in a multicultural memory clinic sample across six European countries. Methods The study was a European cross-sectional multi-center study. Receiver operating characteristic curve analysis was used to examine discriminative validity of BASIC and BASIC-Q in identifying cognitive impairment (mild cognitive impairment (MCI) or dementia) as compared to specialist diagnosis. Regression analysis was used to assess the influence of sociodemographic variables and assessment in a second language on scores. Results The study included a total of 479 participants of which 169 (36%) had immigrant background. BASIC and BASIC-Q had high diagnostic accuracy for cognitive impairment (MCI or dementia) with areas under the curve (AUC) of 0.93 and 0.92, respectively. Age had a significant, but small effect on BASIC, while both BASIC and BASIC-Q were unaffected by sex, education, immigrant status, and assessment in a second language. Among patients with affective/anxiety disorder, 80% scored below cutoff for cognitive impairment on BASIC and 94% on BASIC-Q. However, applying an Objective Performance vs. Subjective Complaints ratio to differentiate between patients with cognitive impairment and affective/anxiety disorder resulted in high overall classification accuracies, with AUC values of 0.80 and 0.74, respectively. Conclusions The present study suggests that BASIC and BASIC-Q are valid brief case-finding instruments for cognitive impairment in a multicultural setting.

INTRODUCTION Knowledge gaps remain about the prognosis of mild cognitive impairment (MCI). Conversion rates to dementia vary widely, and reversion to normal cognition has gained attention. This review updates evidence on MCI conversion risk and probability of stability and reversion. METHODS We searched databases for studies on MCI prognosis with ≥3 years of follow‐up, established criteria for MCI and dementia, and performed a meta‐analysis using a random‐effects model to assess conversion risk, reversion, and stability probability. Meta‐regressions identified sources of heterogeneity and guided subgroup analysis. RESULTS From 89 studies (mean follow‐up: 5.2 years), conversion risk was 41.5% (38.3%–44.7%) in clinical and 27.0% (22.0%–32.0%) in population‐based studies, with Alzheimer's dementia as the most common outcome. Stability rates were 49.3% (clinical) and 49.8% (population). Reversion was 8.7% (clinical) and 28.2% (population). DISCUSSION Our findings highlight higher conversion in clinical settings and 30% reversion in population studies, calling for sustainable care pathway development. Highlights Prognosis for mild cognitive impairment (MCI) varies by setting; dementia risk is higher and the probability of reversion is lower in clinical‐based studies. In both clinical and population settings, cognitive stability is ≈50%. A reorganization of health services could ensure sustainable care for individuals with MCI. Significant heterogeneity in MCI studies impacts data interpretation; follow‐up length is crucial. Long‐term prognosis studies on MCI in low‐ and middle‐income countries are urgently needed.

Background Complementary feeding is a critical period for child development and normal nutritional status, playing a vital role in the prevention of malnutrition and related health issues. However, poor hygiene practices during this phase can lead to foodborne diseases and inadequate nutrient intake. Objective To assess poor hygienic practice related to complementary feeding and associated factors among mothers of children aged 6–23 months in Lemo District, 2023. Methods A community-based cross-sectional study was conducted from September to November 2023, utilizing a systematic sampling technique. A total of 402 mother–child pairs were randomly selected for participation. Data were collected using a pretested and structured questionnaire and then entered into Epi-Data version 4.6. The data were subsequently exported to SPSS version 26 for analysis. In the multivariable binary logistic regression analysis, variables with a p-value less than 0.05 were deemed to be statistically significant. Results The prevalence of poor hygienic practices related to complementary feeding among mothers of children aged 6–23 months was found to be 65%. Factors significantly associated with poor hygienic practices of complementary feeding was the absence of a separate kitchen [AOR = 3.17, 95% CI: (1.32, 7.59)], lack of access to a protected source of drinking water [AOR = 8.17, 95% CI: (3.06, 18.7)], and lack of access to media [AOR = 2.12, 95% CI: (1.25, 3.6)]. Conclusion The study revealed a significant prevalence of inadequate hygienic practices in the context of complementary feeding among mothers. Factors that were identified as significant contributors to the observed poor hygienic practices includes the absence of separate kitchen, unprotected source of drinking water, and a lack of exposure to media.

Objectives The study aims to analyze care and cost patterns in the Veneto region for cancer patients in the final phase of their disease. Methods The study cohort includes adult patients alive on 1.1.2018, which have been diagnosed with cancer at the age 15+ in a 28-years period, spanning from 1990 to 2017, and died within 12 months from prevalence date. The end-of-life (EOL) prevalent cases included in the study cohort are identified by the Veneto Tumor Registry. Primary tumors considered in the analysis are colon, rectum, skin melanoma, female breast, thyroid. Patient monthly average EOL costs, patient annual average EOL costs and total regional costs have been estimated separately for each cancer site/sex/age group/health care service database. Results The estimated EOL total cost, for the five analyzed cancer types in the Veneto Region, is approximately 53 million euros. Costs associated with cancer treatment tend to increase in the final phase of the disease. In general, Hospital Admission is the main driver cost in all types of cancer considered, with the only exception in melanoma, where Hospital Drugs features the highest contribution. Moreover, costs differ significantly depending on the type of cancer, gender, and age, revealing highest average costs associated with younger patients. Conclusions This study provides a comprehensive analysis of healthcare budget distribution in the last year of life, enabling healthcare planners to predict cancer burden in the future. This model can be applied to other Italian regions and countries with different healthcare systems.

Alzheimer’s disease (AD) can be identified through biomarkers of amyloid (A) and tau (T) pathology. Frailty, a measure of biological aging, could impact the association between AD neuropathology and its clinical manifestation. We aimed to investigate the relationship between frailty and AD biomarkers among people with mild cognitive impairment (MCI) attending a university memory clinic. Data were collected from a cohort of patients with MCI at the Memory Center of Geneva University Hospital (Switzerland). Frailty was assessed using a 35-item Frailty Index (FI). A and T positivity were determined through amyloid and tau PET or CSF analysis. Participants were divided into two subgroups: (i) A + T + (both amyloid and tau positive) and (ii) E/N (either A + or T + , neither A + nor T +), including all other combinations of A/T status. We first explored the correlation between FI, age, and education. Demographics, FI scores, and neuropsychological test results were then compared between these two groups. Logistic regression models, adjusted for age, sex, and education were used to examine the association between FI and AT positivity. One hundred twenty patients were included. FI was positively correlated with age and inversely with education. A + T + patients exhibited lower FI scores compared to E/N participants (0.13 ± 0.10 vs. 0.15 ± 0.08, p = 0.01). Logistic regressions found a negative association between FI and A + T + (OR 0.6, 95% CI 0.32–0.90; p = 0.02). Frailty is associated with a lower likelihood of AD biomarker positivity in patients with MCI. Frailty might reflect alternative pathophysiological mechanisms contributing to cognitive impairment.

Background In mouse models of amyloidosis, macrophage receptor 1 (MSR1) and neprilysin (NEP) have been shown to interact to reduce amyloid burden in the brain. Objective The purpose of this study is to analyze these two gene products in combination with apolipoproteins and Aβ1-42 in the cerebrospinal fluid (CSF) and plasma of individuals at different stages of Alzheimer’s disease (AD), as well as in autopsied brain samples from ROSMAP (Religious Orders Study and Memory and Aging Project). Methods CSF/plasma levels of MSR1 and NEP were measured using the sensitive primer extension assay technology. CSF Aβ1-42 was assessed with ELISA, while CSF ApoE and ApoJ were measured with the Luminex’s multiplex technology. Brain MSR1, APOE, and CLU (APOJ) mRNA levels were measured with RNA-Seq and contrasted to amyloid plaques pathology using CERAD staging. Results While plasma and CSF MSR1 levels are significantly correlated, this correlation was not observed for NEP. In addition to be highly correlated to one another, CSF levels of both MSR1 and NEP are strongly correlated with AD status and CSF Aβ1-42, ApoE, and ApoJ levels. In the cortical tissues of subjects from ROSMAP, MSR1 mRNA levels are correlated with CLU mRNA levels and the CERAD scores but not with APOE mRNA levels. Conclusion The discrepancies observed between CSF/plasma levels of MSR1 and NEP with CSF Aβ1-42 and ApoE concentrations can be explained by many factors, such as the disease stage or the involvement of the blood-brain barrier breakdown that leads to the infiltration of peripheral monocytes or macrophages.

Single nucleotide polymorphisms (SNPs) found to be associated with Androgenetic Alopecia (AGA) to date, are characterized by an apparent reduced penetrance into the phenotype suggesting a role of other factors in the etiology of AGA. Objective: We conducted a study to investigate the role of specific allelic variants in AGA controlling for nutritional and lifestyle factors. Methods: Individual patterns of SNPs present in the baldness susceptibility locus at 20p11 (rs1160312 and rs6113491) or close to the androgen receptor (AR) gene in chromosome X (rs1041668) were investigated in 212 male subjects. Information on socio-demographic characteristics, medical history, smoking, and diet was also collected. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: After controlling for age, diet, BMI, family history of AGA, and smoking, an increased risk of AGA was found for subjects with [A] alleles for both rs1160312 (OR: 2.97; 95% CI: 1.34–6.62) and rs6113491 (OR: 2.99; 95% CI: 1.37–6.52), and for subjects with the TT genotype for rs1041668 (OR: 4.47; 95% CI: 1.60–12.5). Multivariate logistic regression indicates that diet, familiarity, and BMI, but not smoking, remain statistically significant despite the different SNP genotypes. Conclusions: To our knowledge, this is the first indication that the rs1160312, rs6113491, and rs1041668 polymorphisms are independent risk factors for AGA that can be modulated by diet.

Background: Dementia is a major global public health challenge, with over 50 million cases in 2020, projected to reach 152 million by 2050. Effective prevention strategies are needed to reduce the impact of modifiable risk factors associated with dementia, particularly in countries with ageing populations like Italy. The Population Attributable Fraction (PAF) and Potential Impact Fraction (PIF) are key metrics for understanding and reducing dementia cases through targeted interventions. Objectives: This study aimed to revise and expand PAF estimates for dementia in Italy, integrate them with PIF calculations, and assess the alignment of regional health policies with these risk factors. Additionally, the study explored regional variations in PAFs and evaluated the potential for reducing dementia incidence through feasible public health interventions. Design: A cross-sectional analysis was conducted using data from two national public health surveillance systems, PASSI and PASSI d'Argento (PdA), to estimate PAFs and PIFs for dementia at both national and regional levels. The study used data collected between 2017 and 2019. Setting: Data were drawn from 19 Italian regions and two autonomous provinces, providing national and subnational estimates of modifiable risk factors for dementia. Participants: The study population included a nationally representative sample of 86,494 individuals aged 18-64 (PASSI) and 48,516 individuals aged 65 and older (PdA). Measurements: PAFs were calculated for 11 of the 12 modifiable risk factors identified by the Lancet Commission in 2021, with data from the PASSI and PdA systems. PIFs were calculated to estimate the potential reduction in dementia cases under different intervention scenarios. Regional variations in PAFs were assessed and aligned with health policies outlined in the Regional Prevention Plans. Results: The national combined PAF for 11 modifiable risk factors was 39.6 % (95 % CI: 20.8-55.9). Midlife hypertension and physical inactivity were the most significant contributors, accounting for 12.3 % of the total PAF. Cardiovascular risk factors collectively explained over 50 % of preventable dementia cases. Regional PAFs ranged from 31.7 % to 47.5 %, with a clear north-south gradient; southern regions exhibited higher PAFs due to cardiovascular factors. Despite broad consistency between national and regional PAFs, significant variability was found in how regions addressed risk factors, particularly air pollution. At the national level, a 10 % reduction in risk factors would prevent 54,495 dementia cases, with subnational PIFs ranging from 3.7 % to 6.0 %. Conclusions: This study highlights the substantial potential for dementia prevention in Italy through targeted public health interventions. However, significant regional disparities in PAFs and the alignment of health policies underscore the need for a more nuanced, regionally tailored approach. Future strategies should integrate both PAF and PIF to maximize the impact of interventions, particularly in addressing cardiovascular risk factors. These findings can guide the development of evidence-based policies to reduce dementia incidence across Italy.