title: Advances in the prevention of Alzheimer's disease and dementia.
abstract: BACKGROUND
  Definitions and diagnostic criteria for all medical conditions are regularly subjected to reviews and revisions as knowledge advances. In the field of Alzheimer's disease (AD) research, it has taken almost three decades for diagnostic nomenclature to undergo major re-examination. The shift towards presymptomatic and pre-dementia stages of AD has brought prevention and treatment trials much closer to each other than before.
  
  
  METHODS
  Here we discuss: (i) the impact of diagnostic reliability on the possibilities for developing preventive strategies for AD; (ii) the scientific evidence to support moving from observation to action; (iii) ongoing intervention studies; and (iv) the methodological issues and prospects for balancing strategies for high-risk individuals with those for broad population-based prevention.
  
  
  RESULTS
  The associations between neuropathology and cognition are still not entirely clear. In addition, the risk factors for AD dementia and the neuropathological hallmarks of AD may not necessarily be the same. Cognitive impairment has a clearer clinical significance and should therefore remain the main focus of prevention. Risk/protective factors for dementia/AD need to be studied from a life-course perspective. New approaches in prevention trials include enrichment strategies based on genetic risk factors or beta-amyloid biomarkers (at least four ongoing pharmacological trials), and multidomain interventions simultaneously targeting various vascular and lifestyle-related risk factors (at least three ongoing trials). Experience from prevention programmes in other chronic diseases can provide additional methodological improvements.
  
  
  CONCLUSIONS
  Building infrastructures for international collaborations is necessary for managing the worldwide public health problem of AD and dementia. The International Database on Aging and Dementia (IDAD) and the European Dementia Prevention Initiative (EDPI) are examples of ongoing international efforts aiming to improve the methodology of preventive studies and provide the basis for larger intervention trials.
authors.affiliation: Karolinska Institutet Alzheimer Disease Research Center (KI-ADRC), Stockholm, Sweden; Department of Neurology, University of Eastern Finland, Kuopio, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Solomon
authors.forename: F
authors.initials: F
authors.lastname: Mangialasche
authors.forename: E
authors.initials: E
authors.lastname: Richard
authors.forename: S
authors.initials: S
authors.lastname: Andrieu
authors.forename: D A
authors.initials: DA
authors.lastname: Bennett
authors.forename: M
authors.initials: M
authors.lastname: Breteler
authors.forename: L
authors.initials: L
authors.lastname: Fratiglioni
authors.forename: B
authors.initials: B
authors.lastname: Hooshmand
authors.forename: A S
authors.initials: AS
authors.lastname: Khachaturian
authors.forename: L S
authors.initials: LS
authors.lastname: Schneider
authors.forename: I
authors.initials: I
authors.lastname: Skoog
authors.forename: M
authors.initials: M
authors.lastname: Kivipelto
mesh_terms: D000375:Aging; D000544:Alzheimer Disease / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control; D015415:Biomarkers / Q000032:analysis; D002986:Clinical Trials as Topic; D003071:Cognition; D003704:Dementia / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control; D042241:Early Diagnosis; D006801:Humans; D008137:Longitudinal Studies; D011315:Preventive Medicine / Q000379:methods*; D062706:Prodromal Symptoms; D012307:Risk Factors
chemical_list: D015415:Biomarkers
keywords: Alzheimer's disease; biomarkers; clinical trials; dementia; prevention