NIH state-of-the-science conference statement: Preventing Alzheimer's disease and cognitive decline.
OBJECTIVE
To provide health care providers, patients, and the general public with a responsible assessment of currently available data on prevention of Alzheimer's disease and cognitive decline.


METHODS
A non-Department of Health and Human Services, nonadvocate 15-member panel representing the fields of preventive medicine, geriatrics, internal medicine, neurology, neurological surgery, psychiatry, mental health, human nutrition, pharmacology, genetic medicine, nursing, health economics, health services research, family caregiving, and a public representative. In addition, 20 experts from pertinent fields presented data to the panel and conference audience.


METHODS
Presentations by experts and a systematic review of the literature prepared by the Duke University Evidence-based Practice Center, through the Agency for Healthcare Research and Quality. Scientific evidence was given precedence over anecdotal experience.


METHODS
The panel drafted its statement based on scientific evidence presented in open forum and on published scientific literature. The draft statement was presented on the final day of the conference and circulated to the audience for comment. The panel released a revised statement later that day at http://consensus.nih.gov. This statement is an independent report of the panel and is not a policy statement of the NIH or the Federal Government.


CONCLUSIONS
Cognitive decline and Alzheimer’s disease are major causes of morbidity and mortality worldwide and are substantially burdensome to the affected persons, their caregivers, and society in general. Extensive research over the past 20 years has provided important insights on the nature of Alzheimer’s disease and cognitive decline and the magnitude of the problem. Nevertheless, there remain important and formidable challenges in conducting research on these diseases, particularly in the area of prevention. Currently, firm conclusions cannot be drawn about the association of any modifiable risk factor with cognitive decline or Alzheimer’s disease. Highly reliable consensus-based diagnostic criteria for cognitive decline, mild cognitive impairment, and Alzheimer’s disease are lacking, and available criteria have not been uniformly applied. Evidence is insufficient to support the use of pharmaceutical agents or dietary supplements to prevent cognitive decline or Alzheimer’s disease. We recognize that a large amount of promising research is under way; these efforts need to be increased and added to by new understandings and innovations (as noted in our recommendations for future research). For example, ongoing studies including (but not limited to) studies on antihypertensive medications, omega-3 fatty acids, physical activity, and cognitive engagement may provide new insights into the prevention or delay of cognitive decline or Alzheimer’s disease. This important research needs to be supplemented by further studies. Large-scale population-based studies and randomized controlled trials (RCTs) are critically needed to investigate strategies to maintain cognitive function in individuals at risk for decline, to identify factors that may delay the onset of Alzheimer’s disease among persons at risk, and to identify factors that may slow the progression of Alzheimer’s disease among persons in whom the condition is already diagnosed.
Daviglus
Martha L
ML
Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Bell
Carl C
CC
Berrettini
Wade
W
Bowen
Phyllis E
PE
Connolly
E Sander
ES
Cox
Nancy Jean
NJ
Dunbar-Jacob
Jacqueline M
JM
Granieri
Evelyn C
EC
Hunt
Gail
G
McGarry
Kathleen
K
Patel
Dinesh
D
Potosky
Arnold L
AL
Sanders-Bush
Elaine
E
Silberberg
Donald
D
Trevisan
Maurizio
M
D000544:Alzheimer Disease / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003071:Cognition / Q000187:drug effects*; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D019587:Dietary Supplements; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D015444:Exercise; D015525:Fatty Acids, Omega-3 / Q000627:therapeutic use; D005247:Feeding Behavior; D014943:Global Health; D006801:Humans; D009316:National Institutes of Health (U.S.); D015995:Prevalence; D011322:Primary Prevention / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents; D002800:Cholinesterase Inhibitors; D015525:Fatty Acids, Omega-3