title: Advances in the prevention of Alzheimer's Disease.
abstract: Alzheimer's disease (AD), the leading cause of dementia, has reached epidemic proportions, with major social, medical and economical burdens. With no currently available curative treatments, both the World Health Organization and the G8 Dementia Summit recently identified dementia and AD prevention as a major public health priority. Dementia and AD have a wide range of risk factors (genetic, vascular/metabolic and lifestyle-related), which often co-occur and thus interact with each other. Previous intervention efforts aimed at preventing dementia and AD focused on the management of single risk factors, with relatively modest findings. Also, the effect of risk factors depends on age at exposure, indicating that the timing of preventive interventions needs to be carefully considered. In view of the complex multifactorial nature of AD, as well as its long pre-clinical (asymptomatic) phase, interventions simultaneously targeting multiple risk factors and disease mechanisms at an early stage of the disease are most likely to be effective. Three large European multidomain prevention trials have been launched with the goal of preventing cognitive decline, dementia and AD in older adults with different risk profiles. Pharmacological trials are also shifting towards prevention of Alzheimer dementia, by targeting at-risk individuals prior to the onset of cognitive symptoms. The current review will summarize and discuss the evidence on risk and protective factors from observational studies, ongoing lifestyle-related and pharmacological randomized controlled trials (RCTs), as well as future directions for dementia and AD prevention.
authors.affiliation: Karolinska Institutet Center for Alzheimer Research Novum, 5th floor, 141 86 Huddinge Sweden ; Aging Research Center, Karolinska Institutet and Stockholm University Gävelagatan 16, 8th floor, 113 30 Stockholm Sweden.
authors.forename: Shireen
authors.initials: S
authors.lastname: Sindi
authors.affiliation: Karolinska Institutet Center for Alzheimer Research Novum, 5th floor, 141 86 Huddinge Sweden ; Aging Research Center, Karolinska Institutet and Stockholm University Gävelagatan 16, 8th floor, 113 30 Stockholm Sweden.
authors.forename: Francesca
authors.initials: F
authors.lastname: Mangialasche
authors.affiliation: Karolinska Institutet Center for Alzheimer Research Novum, 5th floor, 141 86 Huddinge Sweden ; Aging Research Center, Karolinska Institutet and Stockholm University Gävelagatan 16, 8th floor, 113 30 Stockholm Sweden ; Department of Neurology, University of Eastern Finland Yliopistonranta 1 B, 70211 Kuopio Finland.
authors.forename: Miia
authors.initials: M
authors.lastname: Kivipelto