This will help planning larger, international prevention trials able to provide robust evidence on dementia/AD prevention. Conclusions Although the pathogenesis of dementia is not fully elucidated, selleckbio primary prevention seems possible as most factors involved in dementia onset and progression are modifiable or amenable to management. The recent AHRQ/NIH report shows that development of successful preventive strategies requires a more refined knowledge of risk and protective factors for dementia and AD as well as a validation of the observational studies with large intervention studies . AD and VaD share several risk factors, and most dementia cases are attributable to both vascular and neurodegenerative brain damage.
Furthermore, population-based neuropathological studies have shown that both subclinical neurodegenerative (amyloid plaques, neurofibrillary tangles, and Lewy bodies) and vascular lesions (and their co-occurrence) are common in the brains of cognitively normal older individuals . In light of this, preventive strategies aiming to postpone the onset of dementia syndrome have great potential. Epidemiological research suggests that the most effective strategy may be to encourage the implementation of multiple preventive measures throughout the life course, including high educational attainment in childhood and early adulthood, active control of vascular factors and disorders over adulthood, and maintenance of mentally, physically, and socially active lifestyles during middle age and later in life.
It has been estimated that half of AD cases worldwide are potentially attributable Dacomitinib to modifiable risk factors, and a 10% to 25% reduction in these factors could potentially prevent 3 million AD cases worldwide, and a reduction in all risk factors would have the greatest impact on dementia prevalence . However, RCTs are indispensable to confirm protein inhibitor the effect of risk reduction strategies targeting multiple risk factors. Multidomain interventional RCTs are ongoing and will provide new insights into prevention of cognitive impairment and dementia. Full implementation of the lifecourse approach is more challenging because of the difficulties of carrying out RCTs over many decades. Such long-term studies would require very large sample sizes and huge financial resources, and a pragmatic way to assess the effect of long-term interventions within an RCT has not yet been established. Furthermore, for ethical reasons, several risk and protective factors are not appropriate for intervention trials.