Brescia, Italy – 27 February 2025 – A major new project - DORIAN GRAY - funded by the European Union (EU) and led by the University of Brescia and partners including the European Society of Cardiology (ESC) – aims to uncover the links between cardiovascular disease (CVD) and mild cognitive impairment (MCI). The ambition of the DORIAN GRAY project aligns with the EU’s Horizon Europe strategic plan for 2021-2024, emphasising a holistic approach for disease prevention and promotion of physical and mental health. 

DORIAN GRAY will last five years (with the official start date 1 January 2025) have a budget of 11 million Euros distributed across 24 partners. It will be formally launched with an event at the University of Brescia, Italy, on February 27. 

Around one third of people living with CVD also have MCI, yet MCI is undiagnosed in an estimated 50-80% of these cases. This association between the two conditions extends beyond merely sharing well-established risk factors; and implies that CVD itself can potentially contribute to MCI, which refers to a stage of decline in cognitive function greater than normal for a person’s age and education, but not severe enough to impair daily function. Conversely dementia is characterised by a progressive decline in cognitive abilities and independent living.

The overarching ambition of DORIAN GRAY  is to uncover the mechanisms bridging MCI with CVD, and develop an integrated approach, which aims to promote resilience and improve overall health in the ageing population. It will start with the analysis of data available in patients with CVD, such as heart failure (HF), in which mechanisms leading to MCI are enhanced, and thereafter the factors aggravating the onset and progression of cognitive impairment in the general population with cardiovascular risk factors (CVRF) will be defined.

"For years, Alzheimer’s Disease (AD) and cerebrovascular dementia were viewed as separate entities. Recent research suggests they may represent a continuum, with overlapping pathways favouring either vascular or parenchymal β-amyloid deposition,” explains DORIAN GRAY co-coordinator Dr Riccardo Proietti of the University of Liverpool, UK. “CVD not only shares risk factors with cognitive impairment (CI) but may also contribute to it, through mechanisms like chronic hypoperfusion, infarcts, and arterial stiffness. However, a unifying theory remains elusive, due to the lack of reliable biomarkers for early diagnosis and risk stratification in MCI patients with CVD. The goal of DORIAN GRAY is to develop a neurobiology-based hypothesis linking MCI to CVD, using biomarkers for clinical assessment to inform joint health policies for prevention, while also developing an innovative digital tool that can be used for cognitive enhancement."

The project will integrate real-world data from multiple sources (i.e smartwatch, smartphones, tablets) and employ artificial intelligence (AI) and integrate it with clinical variables to enable risk stratification and personalised treatment that can be applied for primary (risk stratification for MCI), secondary (reducing the progression towards dementia), and tertiary (reducing the severity of MCI) prevention.

This will in turn allow early identification of patterns or ‘fingerprints’ of potential MCI progression, and introduces a paradigm shift in healthcare, applicable to other non-communicable diseases. A ground-breaking feature of the project is the use of a medical avatar, which has vast potential in healthcare yet to be fully explored. In the DORIAN GRAY an avatar-based coaching exergaming (ABCE) (technology driven physical activity) will act as both a cognitive enhancement tool in the exergame component and a lifestyle intervention in the coaching system. Instead of just offering explicit behavioural instructions, the ABCE shapes all aspects of a user’s life comprehensively increasing their awareness on physical and mental well-being, positively impacting healthy ageing.

Key parts of the project include:

·       Use of data from more than 300,000 people in 6 countries to develop an AI model for predicting MCI risk and predisposition

·       Co-design and development of an effective digital coaching system (CS), to facilitate, the adoption of healthy lifestyle changes

·       Co-design and development of the avatar-based exergaming (ABE) solution, including structured physical and cognitive exercises, provided through a role-playing game-like environment

·       Delivery of a pilot randomised-controlled (RCT) trial in patients with heart failure and MCI to test the feasibility and the effectiveness of the avatar-based coaching exergaming (ABCE) intervention

·       Generation of a Health Technology Assessment (HTA) report based on the results of an implementation clinical study in 4 clinical centres across Europe

·       Communication of the outcomes of the project to patients, HCPs and policy health makers, including the dissemination of the research outcomes to the scientific community and other stakeholders. 

DORIAN GRAY will have a substantial impact on various subgroups of the European population, including patients with CVD and general population at high risk of MCI. It will address needs for primary, secondary or tertiary prevention.

Assuming that DORIAN GRAY intervention will lead to 5-10% reduction in prevalence of dementia risk factors (namely diabetes, hypertension, obesity, physical inactivity but also depression, smoking and low educational attainment), model projected impacts in the year 2050 in the EU countries are estimated to be 1 – 2 million fewer cases of dementia in the EU population (1 million fewer cases with 5% and 2 million fewer cases with 10% of risk factor prevalence reduction).

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Notes to editors 

Funding: This project has received funding from the European Union’s Horizon Europe research and innovation programme under Grant Agreement number 101156266