Preventing Alzheimer's Disease

Current drug treatments for Alzheimer's disease (AD) appear to be symptomatic. There is an increasing priority to find effective and safe disease-modifying and preventive treatment strategies for cognitive decline, AD, and dementia. Recent developments have allowed the identification of possible pathogenic processes and pathways, and potential targets for intervention. Cerebrospinal fluid (CSF) biomarkers of ß-amyloid and tau, and neuroimaging including amyloid PET tracer retention show that the pathogenic process begins many years before symptoms appear. A number of preventive trials have been completed but so far none has demonstrated significant benefits and some were potentially harmful. New preclinical treatment trials are underway in people at the highest risk of developing AD in the following few years. A US National Institutes of Health panel found no evidence of even moderate scientific quality to clearly support the association of any modifiable factors with a reduced risk of cognitive decline or AD. The best current evidence suggests that heart-healthy eating patterns such as the Mediterranean diet may help to protect the brain. Future preventive approaches will need to harness the increased technological advances concerning biomarkers with new hypotheses driven by a better understanding of the relevant risk factors.