title: Dementia Prevention: optimizing the use of observational data for personal, clinical, and public health decision-making.
abstract: Worldwide, over 35 million people suffer from Alzheimer's disease and related dementias. This number is expected to triple over the next 40 years. How can we improve the evidence supporting strategies to reduce the rate of dementia in future generations? The risk of dementia is likely influenced by modifiable factors such as exercise, cognitive activity, and the clinical management of diabetes and hypertension. However, the quality of evidence is limited and it remains unclear whether specific interventions to reduce these modifiable risk factors can, in turn, reduce the risk of dementia. Although randomized controlled trials are the gold-standard for causality, the majority of evidence for long-term dementia prevention derives from, and will likely continue to derive from, observational studies. Although observational research has some unavoidable limitations, its utility for dementia prevention might be improved by, for example, better distinction between confirmatory and exploratory research, higher reporting standards, investment in effectiveness research enabled by increased data-pooling, and standardized exposure and outcome measures. Informed decision-making by the general public on low-risk health choices that could have broad potential benefits could be enabled by internet-based tools and decision-aids to communicate the evidence, its quality, and the estimated magnitude of effect.
authors.affiliation: Alzheimer's Drug Discovery Foundation, New York, NY.
authors.forename: Penny A
authors.initials: PA
authors.lastname: Dacks
authors.affiliation: UMR 1027 INSERM-University Toulouse III, CHU Toulouse, Toulouse, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Andrieu
authors.affiliation: Gerontology Research Unit, Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health, Boston, MA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Blacker
authors.affiliation: Alzheimer's Drug Discovery Foundation, New York, NY.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Carman
authors.affiliation: MD PhD JD, Attorney at Law, Cambridge, MA.
authors.forename: Allan M
authors.initials: AM
authors.lastname: Green
authors.affiliation: Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Francine
authors.initials: F
authors.lastname: Grodstein
authors.affiliation: Department of Health Research & Policy (Epidemiology); Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA.
authors.forename: Victor W
authors.initials: VW
authors.lastname: Henderson
authors.affiliation: Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.
authors.forename: Bryan D
authors.initials: BD
authors.lastname: James
authors.affiliation: Alzheimer's Drug Discovery Foundation, New York, NY.
authors.forename: Rachel F
authors.initials: RF
authors.lastname: Lane
authors.affiliation: Center for Evidence-based Medicine, School of Public Health, Brown University, Providence, RI.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lau
authors.affiliation: Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA.
authors.forename: Pei-Jung
authors.initials: PJ
authors.lastname: Lin
authors.affiliation: Clinical Trials and Evaluation Unit, School of Clinical Sciences, University of Bristol, UK.
authors.forename: Barnaby C
authors.initials: BC
authors.lastname: Reeves
authors.affiliation: Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.
authors.forename: Raj C
authors.initials: RC
authors.lastname: Shah
authors.affiliation: UMR 1027 INSERM-University Toulouse III, CHU Toulouse, Toulouse, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
authors.affiliation: School of Medicine, University of California San Francisco, San Francisco, CA.
authors.forename: Kristine
authors.initials: K
authors.lastname: Yaffe
authors.affiliation: DSM Nutritional Products.
authors.forename: Karin
authors.initials: K
authors.lastname: Yurko-Mauro
authors.affiliation: Alzheimer's Drug Discovery Foundation, New York, NY.
authors.forename: Diana W
authors.initials: DW
authors.lastname: Shineman
authors.affiliation: Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL.
authors.forename: David A
authors.initials: DA
authors.lastname: Bennett
authors.affiliation: Alzheimer's Drug Discovery Foundation, New York, NY.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Fillit
keywords: Alzheimer’s; communication; low-risk; non-randomized studies; primary prevention