Primary and Secondary Prevention Trials in Alzheimer Disease: Looking Back, Moving Forward

Abstract

The field of Alzheimer disease (AD) prevention has been a culmination of basic science, clinical, and translational research. In the past three years since the new 2011 AD diagnostic guidelines, large-scale collaborative efforts have embarked on new clinical trials with the hope of someday preventing AD. This review will shed light on the historical and scientific contexts in which these trials were based on, as well as discuss potential challenges these trials may face in the coming years. Primary preventive measures, such as lifestyle, multidomain, medication, and supplemental interventions, will be analyzed. Secondary prevention as represented by disease-modifying interventions, such as anti-amyloid therapy and pioglitazone, will also be reviewed. Finally, hypotheses on future directions for AD prevention trials will be proposed.

Lifestyle Modifications and Nutritional Interventions in Aging-Associated Cognitive Decline and Alzheimer’s Disease

“…Many experimental treatments currently undergoing clinical trials are targeting the molecular mechanisms of AD, including Aβ plaques, tau hyperphosphorylation, oxidative damage, mitochondrial dysfunction, neurotransmission, calcium homeostasis, cell signaling, and anti-inflammatory pathways (Arvanitakis et al, 2008;Leoutsakos et al, 2012;Latta et al, 2015;Bhatti et al, 2017a;Hsu and Marshall, 2017). However, effective pharmacologic treatment strategies for cognitive decline, mild cognitive impairment (MCI), or dementia are not available to date.…”

Public awareness and knowledge of factors associated with dementia in China

“…The factors that are associated with dementia and were used as response options in the present study can be divided into two categories: lifestyle factors and medical factors [30]. Most of the respondents correctly recognized the relationship between lifestyle factors (e.g., alcohol use, smoking, and leisure activities) and dementia, but they often misunderstood the contribution of medical conditions and certain medications to the development of dementia.…”

Alzheimer’s Disease: New Diagnostic Criteria and Therapeutic Aspects Depending on the Stage of the Disease

“…В насто-ящее время в России для лечения БА применяются три препарата ИАХЭ: галантамин (обратимый ингибитор аце-тилхолинэстеразы и агонист никотиновых рецепторов), ривастигмин (ингибитор ацетил-и бутирил-холинэстера-зы), донепезил (обратимый ингибитор ацетилхолинэсте-разы). Терапевтический эффект ИАХЭ является дозозави-симым и в наибольшей степени проявляется при приме-нении максимальных доз препаратов этой группы [1,10,15,17]. На фоне приема ИАХЭ отмечается уменьшение выраженности когнитивных расстройств, в частности нарушений памяти, дисрегуляторных расстройств.…”