In multifactorial conditions, a small reduction in multiple risk factors can substantially decrease overall risk. In summary, despite the discrepancies between findings of observational and interventional studies and the disappointing results of intervention studies on dementia and AD, methodological issues of the RCTs carried out thus far suggest selleck products that a valid evaluation of the efficacy of preventive measures has yet to be undertaken. Prevention of dementia: ongoing multidomain intervention studies The knowledge derived from the previously described observational and interventional studies paved the way for some ongoing RCTs on the prevention of cognitive decline and dementia.
In Europe, there are three large ongoing RCTs: the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), the Multidomain Alzheimer Preventive Trial (MAPT), and the Prevention of Dementia by Intensive Vascular Care (PreDIVA) study [48,49]. The common denominator of these studies is the multidomain approach, which aims to simultaneously target several risk factors for dementia in older adults, mainly by promoting lifestyle changes and adherence to medical treatments for vascular risk factors and vascular diseases. All RCTs exclude individuals with dementia and use clinical evaluation and neuropsychological tests to detect cognitive changes and dementia incidence as main outcomes. Furthermore, secondary outcomes include functional status, mood disorders, quality of life, adherence to the intervention programs, and utilization of health resources.
The latter two aspects are essential Anacetrapib from a public health perspective since they provide information on feasibility and cost-effectiveness of prevention strategies. Additionally, both FINGER and MAPT include ancillary studies on neuroimaging (morphological and functional), cerebrospinal fluid, and blood markers related to AD pathophysiology in order to investigate the effect of the interventions on brain morphology and metabolism, clarify mechanisms underlying preventive measures, and identify biomarkers that can be used to monitor effects of interventions. FINGER (ClinicalTrials.gov identifier NCT01041989) is a multicenter RCT aiming to prevent cognitive impairment, dementia, and disability in 60- to 77-year-olds.
The study population is represented by 1,200 individuals who are at increased risk of dementia and who were selected according to the CAIDE Dementia Risk Score and the CERAD neuropsychological test battery [32,48]. The 2-year multidomain intervention includes nutritional inhibitor Ceritinib guidance, physical activity, cognitive training, increased social activity, and intensive monitoring and management of metabolic and vascular risk factors (hypertension, dyslipidemia, obesity, and impaired glucose tolerance). Individuals in the reference group are given general public health advice on lifestyle and vascular risk factors.