Latest advances on interventions that may prevent, delay or ameliorate dementia

Abstract

Abstract:Objectives: In this paper we aim to: (1) identify and review midlife risk factors that may contribute to the development of dementia and that may be amenable to intervention; (2) review advances made in our understanding of the most common cause of dementia, Alzheimer's disease (AD), where current pharmacological studies have aimed to modify the disease course; and (3) explore other interventions that may slow cognitive decline in those with AD. Methods: A review of the literature was conducted to look for interventions that may modify the risk of incident dementia or that may modify symptom progression in those with diagnosed dementia. Results: (1) Midlife risks identified as amenable to intervention include blood pressure, diabetes, elevated cholesterol, poor psychosocial and lifestyle factors. (2) The leading drugs in development can be grouped by their principal target: anti-amyloid, anti-tau and mitochondrial stability. However to date, there have been no successes in late stage Phase III trials of putative disease-modifying drugs for AD. (3) Once the diagnosis of dementia has been made there is little that can slow the rate of decline. Possible exceptions include the use of exercise and antihypertensive medication with some nootropic medication showing promise in small trials. Conclusion: (1) It is clear that there are several risk factors in midlife that may lead to a greater likelihood of developing dementia. However, there is no simple intervention to modify these risks. It seems sensible to conclude from the data that avoiding high blood pressure, controlling cholesterol and diabetes as well as maintaining a healthy diet and lifestyle may lower the risk of developing dementia. (2) The need for better outcome measures in clinical trials is evident and may, in part, explain the numerous failures in late-stage clinical trials of diseasemodifying drugs. Improved diagnostic test batteries to reduce population heterogeneity in early intervention studies will be required for robust clinical trials in the future. (3) Current research indicates that there is little that can delay decline; however, future trials may wish to focus on nootropics.

Rural‐Urban Differences in Alzheimer's Disease and Related Disorders Diagnostic Prevalence in Kentucky and West Virginia

“…Early diagnosis provides opportunities for symptomatic treatment, participation in clinical treatment trials, long‐term care planning, estate planning, and often provides the answer as to why a loved one has become forgetful, irritable, paranoid, anxious, or depressed. Further, early intervention to improve the general health of the patient through management of comorbidities and increasing physical activity, along with other lifestyle modifications, may delay the onset of more severe symptoms …”

“…Second, there are several symptomatic therapies that can help manage the symptoms of cognitive impairment due to ADRD, and there are many other treatment options that can address the behavioral and psychiatric symptoms of dementia effectively. Third, dementia patients’ quality of life may be enhanced by nonpharmacologic management of comorbidities and lifestyle modifications such as increasing physical activity . Additionally, the personality, behavioral, and functional changes that often accompany dementia may be less upsetting for caregivers if they are explained by a diagnosis.…”

Mild cognitive impairment and dementia in a heterogeneous elderly population: prevalence and risk profile

“…Optimum and aggressive control of hypertension, diabetes, weight, smoking, and vascular risk factors and the need for exercise have been identified as potential preventative strategies. 63,64 Vascular dementia accounts for about 30% of the total dementia prevalence. 3 Vascular risk factors were most prevalent in our study.…”

Antihypertensive Treatment in People With Dementia

“…cancer) and rarer forms of dementia (Korsakoff's syndrome, dementia due to HIV, normal pressure hydrocephalus, CADASIL); animal studies and non-English language articles. As effects of antihypertensive drugs on the progression of dementia have been reviewed elsewhere [8][9] , they were excluded from the literature analysis.…”

“…Previous reviews have proposed but not proven that such treatment might delay the onset of dementia [8][9] . Another review concluded that there is no convincing evidence of the effectiveness of antihypertensive therapy in the reduction of cardiovascular and cerebrovascular events in people with dementia 56 , which our review has confirmed.…”