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Review
. 2017;14(4):426-440.
doi: 10.2174/1567205013666160930112125.

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

David Hsu  1 , Gad A Marshall  2
Affiliations
Review

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

David Hsu et al. Curr Alzheimer Res. 2017.

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 antiamyloid therapy and pioglitazone, will also be reviewed. Finally, hypotheses on future directions for AD prevention trials will be proposed.

Keywords: Alzheimer disease; anxiety; hypertension.; neuropsychological; pathophysiology.

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Figures

Figure 1
Figure 1. Levels of Prevention
This model depicts the targeted approaches to AD prevention, from primary to secondary. The most direct approach to AD prevention is a disease-modifying agent; hence, it is at the center of the diagram. As the circle widens, the preventive approach becomes more indirect, ultimately landing on single lifestyle interventions as described in the text. A4 = Anti-Amyloid Treatment in Asymptomatic Alzheimer’s Disease; ADAPT = AD Anti-inflammatory Prevention Trial; API = Alzheimer’s Prevention Initiative; DIAN = Dominantly Inherited Alzheimer Network; FINGER = Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability; GEM = Ginkgo Evaluation of Memory; MAPT = Multidomain Alzheimer Preventive Trial; PreDIVA = Prevention of Dementia by Intensive Vascular Care study; WHIMS = Women’s Health Initiative Memory Study
Figure 2
Figure 2. Times for Prevention
This diagram illustrates potential future times of intervention for longitudinal prevention clinical trials that could yield the maximal benefit. The timeline may differ for autosomal-dominant AD versus late-onset/sporadic AD.
See this image and copyright information in PMC

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