title: A call for comparative effectiveness research to learn whether routine clinical care decisions can protect from dementia and cognitive decline.
abstract: Common diseases like diabetes, hypertension, and atrial fibrillation are probable risk factors for dementia, suggesting that their treatments may influence the risk and rate of cognitive and functional decline. Moreover, specific therapies and medications may affect long-term brain health through mechanisms that are independent of their primary indication. While surgery, benzodiazepines, and anti-cholinergic drugs may accelerate decline or even raise the risk of dementia, other medications act directly on the brain to potentially slow the pathology that underlies Alzheimer's and other dementia. In other words, the functional and cognitive decline in vulnerable patients may be influenced by the choice of treatments for other medical conditions. Despite the importance of these questions, very little research is available. The Alzheimer's Drug Discovery Foundation convened an advisory panel to discuss the existing evidence and to recommend strategies to accelerate the development of comparative effectiveness research on how choices in the clinical care of common chronic diseases may protect from cognitive decline and dementia.
authors.affiliation: Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA. pdacks@alzdiscovery.org.
authors.forename: Penny A
authors.initials: PA
authors.lastname: Dacks
authors.affiliation: Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
authors.forename: Joshua J
authors.initials: JJ
authors.lastname: Armstrong
authors.affiliation: Takeda Pharmaceuticals, Deerfield, IL, USA.
authors.forename: Stephen K
authors.initials: SK
authors.lastname: Brannan
authors.affiliation: Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA.
authors.forename: Aaron J
authors.initials: AJ
authors.lastname: Carman
authors.affiliation: Attorney at Law, Cambridge, MA, USA.
authors.forename: Allan M
authors.initials: AM
authors.lastname: Green
authors.affiliation: Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
authors.forename: M Sue
authors.initials: MS
authors.lastname: Kirkman
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Lawrence R
authors.initials: LR
authors.lastname: Krakoff
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.affiliation: Intramural Research Program, National Institute on Aging, NIH, Bethesda, MD, USA.
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.affiliation: Department of Psychiatry, University of Oxford, Oxford, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Lovestone
authors.affiliation: Takeda Pharmaceuticals, Deerfield, IL, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Merikle
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, USA.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Neumann
authors.affiliation: Geriatric Medicine Research Unit, Department of Medicine, Dalhousie University, Halifax, NS, Canada.|DGI Clinical, Halifax, NS, Canada.|Nova Scotia Health Authority, Halifax, NS, Canada.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Rockwood
authors.affiliation: Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA.
authors.forename: Diana W
authors.initials: DW
authors.lastname: Shineman
authors.affiliation: Thomas Jefferson College of Population Health, The Access Group, Philadelphia, PA, USA.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Stefanacci
authors.affiliation: Scientific Affairs, Quintiles Real World Late Phase Research, Cambridge, MA, USA.
authors.forename: Priscilla
authors.initials: P
authors.lastname: Velentgas
authors.affiliation: Representative for the American Heart Association; Hemorrhagic Stroke Research Program, Department of Neurology, Massachusetts General Hospital Stroke Research Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Viswanathan
authors.affiliation: Kaiser Permanente Division of Research, Population Science and Brain Aging, Oakland, CA, USA.
authors.forename: Rachel A
authors.initials: RA
authors.lastname: Whitmer
authors.affiliation: Wake Forest University School of Medicine, Winston-Salem, NC, USA.
authors.forename: Jeff D
authors.initials: JD
authors.lastname: Williamson
authors.affiliation: Alzheimer's Drug Discovery Foundation, 57 West 57th St. Suite 901, New York, NY, 10019, USA.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Fillit
mesh_terms: D060825:Cognitive Dysfunction / Q000517:prevention & control*; D057186:Comparative Effectiveness Research; D003704:Dementia / Q000517:prevention & control*; D006801:Humans
keywords: Alzheimer’s; Cognitive aging; Cognitive decline; Comorbidity; Comparative effectiveness; Dementia; Diabetes; Hypertension; Prevention; Repurposing