Methodological alternatives to RCTs have been proposed to obtain robust evidence on AD and dementia prevention [11,53]. The ongoing RTCs on dementia prevention will have to take into account the ‘window of opportunity hypothesis’ when evaluating the results selleck chemicals of interventions. In fact, efficacy of preventive actions may vary by age. Thus, implementation of interventions at the appropriate time in the life course is crucial for successful prevention. Refining of prognostic tools, which can be used for early detection of subjects at risk of dementia in the general population, will also help to better plan intervention studies. Also, when older individuals are targeted, the frequent coexistence of chronic diseases needs to be considered since it can negatively impact cognitive performance and limit adherence to preventive interventions.
On the other hand, appropriate management of morbidity can help improve cognitive performance and delay dementia onset. For instance, although stroke is a known risk factor for dementia, it has been recently reported that about 25% of stroke patients discontinued one or more of their prescribed secondary prevention medications within 3 months of hospitalization for acute stroke [54-56]. Improving long-term adherence to poststroke treatment can prevent recurrent cerebrovascular diseases and contribute to preventing or delaying clinical expression of dementia syndrome. Additionally, there is evidence of inadequate management of hypertension and hypercholesterolemia in older adults [49].
Similar situations exist for heart failure, which increases the risk of dementia among older adults [56], and diabetes mellitus, which accelerates the progression from mild cognitive impairment to dementia by more than 3 years [57]. Preliminary results from the PreDIVA study showed that 87% of the study participants have at least one modifiable risk factor amenable to intervention, proving the presence of a window of opportunity for improved risk management [49]. In conclusion, prevention of dementia is now moving from observational to interventional studies to verify hypotheses and define tools that can be applied in the general population. Epidemiological and preclinical studies will continue to provide new information on risk/protective factors and pathological mechanisms.
The international collaboration among research teams involved in ongoing multidomain RCTs will allow the sharing of experiences and discussions on methodological aspects of these studies. This can help in interpretation of results, identification and solution of problems related to intervention strategies, Entinostat and refinement of preventative approaches. Since a cure for dementia is not yet available, finding effective preventive strategies is essential for LB42708? a sustainable society in an aging world.