title: Prevention of sporadic Alzheimer's disease: lessons learned from clinical trials and future directions.
abstract: Interventions that have even quite modest effects at the individual level could drastically reduce the future burden of dementia associated with Alzheimer's disease at the population level. In the past three decades, both pharmacological and lifestyle interventions have been studied for the prevention of cognitive decline or dementia in randomised controlled trials of individuals mostly aged older than 50-55 years with or without risk factors for Alzheimer's disease. Several trials testing the effects of physical activity, cognitive training, or antihypertensive interventions showed some evidence of efficacy on a primary cognitive endpoint. However, most of these trials had short follow-up periods, and further evidence is needed to confirm effectiveness and establish the optimum design or dose of interventions and ideal target populations. Important innovations in ongoing trials include the development of multidomain interventions, and the use of biomarker or genetic inclusion criteria. Challenges include the use of adaptive trial designs, the development of standardised, sensitive outcome measures, and the need for interventions that can be implemented in resource-poor settings.
authors.affiliation: Inserm UMR1027, F-31073, Toulouse, France; University Toulouse III, Toulouse, France; Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France. Electronic address: sandrine.andrieu@univ-tlse3.fr.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Andrieu
authors.affiliation: Inserm UMR1027, F-31073, Toulouse, France; University Toulouse III, Toulouse, France; Department of Epidemiology and Public Health, CHU Toulouse, Toulouse, France.
authors.forename: Nicola
authors.initials: N
authors.lastname: Coley
authors.affiliation: Department of Psychiatry, University of Oxford, Oxford, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Lovestone
authors.affiliation: Alzheimer's Therapeutic Research Institute, University of Southern California, San Diego, CA, USA.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Aisen
authors.affiliation: Inserm UMR1027, F-31073, Toulouse, France; University Toulouse III, Toulouse, France; Department of Geriatric Medicine, CHU Toulouse, Toulouse, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vellas
mesh_terms: D000544:Alzheimer Disease / Q000517:prevention & control* / Q000628:therapy*; D000975:Antioxidants / Q000008:administration & dosage; D002986:Clinical Trials as Topic / Q000639:trends*; D005544:Forecasting; D006801:Humans; D007858:Learning; D012307:Risk Factors; D040242:Risk Reduction Behavior
chemical_list: D000975:Antioxidants