Targeting 10 risk factors may help prevent Alzheimer’s disease

Researchers have identified 10 risk factors for Alzheimer’s disease that clinicians can target with preventive measures, according to results of a systematic review and meta-analysis published in Journal of Neurology, Neurosurgery and Psychiatry.

“More and more evidence has shown that Alzheimer's disease, like other common chronic diseases, could be preventable as a result of increasing levels of education and improved control of relative modifiable risk factors,” Jin-Tai Yu, MD, PhD, executive vice director of the Institute of Neurology at Fudan University in China, told Healio Psychiatry. “However, currently, there still have been no evidence-based guidelines for prevention of Alzheimer's disease. Hence, we worked with an international team of researchers, including several renowned neurologists, geriatricians, psychiatrists, psychologists and epidemiologists, to review and analyze all current evidence in order to produce the first evidence-based guideline for Alzheimer’s disease prevention.”

Yu and colleagues searched relevant websites and electronic databases from inception to March 1, 2019, and included 243 observational prospective studies and 153 randomized controlled trials. From these studies, they analyzed 104 modifiable factors and 11 interventions. They pooled multivariable-adjusted effect estimates by random-effects models, with credibility assessment according to its risk for imprecision, inconsistency and bias, as well as summarized classes of suggestions and levels of evidence.

Based on the consolidated evidence, Yu and colleagues proposed 21 suggestions. Class I suggestions, which were those they strongly recommended, targeted 19 factors, 10 of which they termed as based on strong evidence. These were education, cognitive activity, high body mass index in late life, hyperhomocysteinaemia, depression, stress, diabetes, head trauma, hypertension in midlife and orthostatic hypotension. They also highlighted nine with weaker evidence, which were obesity in midlife, weight loss in late life, physical exercise, smoking, sleep, cerebrovascular disease, frailty, atrial fibrillation and vitamin C. However, they recommended against oestrogen replacement therapy and acetylcholinesterase inhibitors.

“The proposed evidence-based suggestions offer clinicians and stakeholders current guidance for the prevention of Alzheimer’s disease,” Yu told Healio Psychiatry. “Nearly two-thirds of these suggestions target vascular risk factors and lifestyle, strengthening the importance of keeping a good vascular condition and maintaining a healthy lifestyle for preventing Alzheimer’s disease.”