Dementia (including Alzheimer's disease) can be prevented:
Statement from international experts
A group of 112 international scientific and medical dementia experts from 36 countries have issued a statement today to the G8 dementia summit saying that effectively tackling known risk factors for dementia could perhaps prevent up to one-fifth of new cases by 2025. The experts call upon governments urgently to support more research into prevention and to adopt public health policies that arise from the outcomes of this research. They say that prevention is a powerful additional approach to the development of drugs for treating dementia. Drug development has so far cost around $40 billion without any benefit in slowing disease progression. The statement follows.
We call upon the governments of the G8 countries to make prevention of dementia one of their major health aims.
• The commonest dementia (Alzheimer’s disease) is irreversible, and develops slowly over many years.
• So far drugs have only relieved symptoms, but have not been effective against disease progression.
• About half of the large decline in deaths from heart disease and stroke over the past 50 years has been the result of public health measures to modify risk factors. We are confident that the same approach will work for dementia.
• We propose that a concerted effort be made to discover modifiable risk factors for dementia and to exploit those already identified.
• International collaboration is needed on large-scale clinical trials to test whether modifying risk factors will lead to prevention of dementia.
• Health authorities should aim to identify high risk individuals at an early stage, when intervention is more likely to help.
• There is already sufficient evidence to justify immediate action. Trials in those at risk of developing dementia should be done of the following: exercise; controlling blood sugar, including diabetes treatment; depression treatment; high blood pressure treatment; B vitamins; omega-3 fatty acids; cognitive training and social activities.
• Public health policies should encourage middle-aged people to stop smoking; exercise; eat diets rich in fruit and vegetables and fish (Mediterranean foods); avoid becoming obese and diabetic; avoid excessive alcohol intake; treat high blood pressure. In other words – tell people that adopting a healthy life-style may help to ward off dementia as it does for other diseases.
• It is notable that the prevalence of dementia and cognitive impairment in some Western countries is now less than anticipated, possibly as a result of changes in life-style and the reduction in cardiovascular risk factors, although this may not necessarily mean that worldwide trends in in the burden of dementia will be substantially reduced.
• We estimate that about half of Alzheimer disease cases world-wide might be attributable to known risk factors. Taking immediate action on the known risk factors could perhaps prevent up to one-fifth of predicted new cases by 2025.
• The world-wide costs of dementia in 2010 have been estimated to be $604 billion, most of it in G8 countries. Prevention of dementia would thus not only prevent a lot of human suffering but would save huge sums of money.
• We call upon the Health Ministers of the G8 countries to greatly increase government funding for research on the prevention of dementia.
The following have signed:
P Aisen (University of California, San Diego)
M Albert (Johns Hopkins University, Baltimore, MD)
K Anstey (Australian National University, Canberra)
J Avila (Centro de Biologia Molecular Severo Ochoa, Madrid)
S Banerjee (University of Sussex, Brighton)
DE Barnes (University of California, San Francisco)
MS Beeri (Mount Sinai School of Medicine, New York)
DA Bennett (Rush University Medical Center, Chicago)
S Black (University of Toronto)
C Brayne (University of Cambridge)
J Breitner (McGill University, Montreal)
M Breteler (German Center for Neurodegenerative Diseases, Bonn)
H Brodaty (University of New South Wales, Sydney)
C Chen (National University of Singapore)
MJ Chiu (President Taiwan Alzheimer’s Association, National Taiwan University, Taipei)
M Combrinck (University of Cape Town)
CW Cotman (University of California, Irvine)
P Davies (Feinstein Institute, New York)
C deCarli (University of California Davis, Sacramento)
IV Damulin (I.M. Sechenov First Moscow State Medical University, Moscow)
P Dal-Bianco (Medical University of Vienna)
J de la Torre (University of Texas, Austin)
A de Silva (University of Kelaniya, Colombo, Sri Lanka)
B De Strooper (Catholic University of Leuven)
B Dubois (University of Paris VI)
K Engedal (University of Oslo)
S Engelborghs (University of Antwerp)
MM Esiri (University of Oxford)
RM Faull (University of Auckland)
H Feldman (University of British Columbia)
AM Fjell (University of Oslo)
L Flicker (University of Western Australia, Perth)
A Flöel (Charité-Universitätsmedizin, Berlin)
O Forlenza (University of Sao Paulo, Brazil)
L Fratiglioni (Karolinska Institute, Stockholm)
GB Frisoni (University of Geneva and IRCCS Fatebenefratelli, Brescia)
S Gauthier (McGill University, Montreal)
S.I. Gavrilova (Mental Health Research Center RAMS, Moscow)
H Hampel (Pierre and Marie Curie University, Paris)
H Hendrie (Indiana University, Indianapolis)
T Iwatsubo (University of Tokyo)
R Jacoby (University of Oxford)
J Jia (Beijing Capital Medical University)
KA Jellinger (Medical University of Vienna)
RN Kalaria (University of Newcastle. UK)
ZS Khachaturian (The Campaign to Prevent Alzheimer's Disease by 2020, Potomac. MD)
M Kivipelto (Karolinska Institute, Stockholm)
D Knopman (Mayo Clinic, Rochester, MN)
T Kwok (Chinese University, Hongkong)
K Langa (University of Michigan, Ann Arbor)
EB Larson (University of Washington, Seattle)
L Launer (National Institute on Aging, Bethesda, MD)
N Lautenschlager (University of Melbourne)
BA Lawlor (Trinity College, Dublin)
J Lindesay (University of Leicester, UK)
A Lobo (University of Zaragoza, Spain)
J Lökk (Karolinska Institute, Stockholm)
O Makeeva (Institute of Medical Genetics, SB RAMS, Tomsk, Russia)
J Marksteiner (President, Austrian Alzheimer Society)
A McCaddon (Cardiff University Medical School)
K Meguro (Tohoku University, Sendai, Japan)
LT Middleton (Imperial College, London)
MC Morris (Rush University, Chicago)
DL Na (Sungkyunkwan University School of Medicine, Seoul)
MWS Nasrun (Indonesian Alzheimer Association, Universitas Indonesia, Jakarta)
A Ogunniyi (University College Hospital, Ibadan, Nigeria)
S Pendelbury (Oxford NIHR Biomedical Research Centre)
G Perry (University of Texas, San Antonio)
RC Petersen (Mayo Clinic, Rochester, MN)
VP Puzyrev (Institute of Medical Genetics, SB RAMS, Tomsk, Russia)
G Rebok (Johns Hopkins University, Baltimore, MD)
G Rees (CEO, Alzheimer’s Australia)
H Refsum (University of Oslo)
E Reynolds (King’s College, London)
E Richard (University of Amsterdam)
J Rinne (University of Turku, Finland)
K Ritchie (INSERM, Montpellier)
WA Rocca (Mayo Clinic, Rochester, MN)
IH Rosenberg (Tufts University, Boston)
PS Sachdev (University of New South Wales)
N Scarmeas (Columbia University New York and University of Athens)
S Scarpa (University of Rome La Sapienza)
R Schmidt (Medical University, Graz, Austria)
P Scheltens (VU University Medical Center, Amsterdam)
S Seshadri (Boston University)
A Singh-Manoux (INSERM, Villejuif)
I Skoog (University of Gothenburg)
AD Smith (University of Oxford)
T Sobow (Medical University of Lodz, Poland)
R Sperling (Harvard University, Boston)
P Srisuwan (Phramongkutklao Hospital and College of Medicine, Bangkok)
R Stewart (Institute of Psychiatry, London)
DY Suharya (Executive Director, Alzheimer’s Indonesia)
M Tripathi (All India Institute of Medical Sciences, New Delhi)
AM Troen (Hebrew University of Jerusalem, Israel)
J Trojanowski (University of Pennsylvania, Philadelphia)
SJ van Rensburg (University of Stellenbosch, South Africa)
B Vellas (University of Toulouse)
G Waldemar (Director, Danish Dementia Research Centre, University of Copenhagen)
H Wang (Peking University Institute of Mental Health)
JZ Wang (Tongji Medical College, HUST, Wuhan, P.R. China)
M Weiner (University of California, San Francisco)
LJ Whalley (University Aberdeen, Scotland)
LR White (Honolulu-Asia Aging Study, Chaminade University, Hawaii)
PJ Whitehouse (Case Western Reserve University, Cleveland, OH)
R Whitmer (Kaiser Permanente, Oakland, California)
A Wimo (Karolinska Institute, Stockholm)
R Wurtman (MIT, Cambridge, Mass)
K Yaffe (University of California, San Francisco)
S-Y Yoon (University of Ulsan College of Medicine, Seoul)
VV Zakharov (I.M. Sechenov First Moscow State Medical University, Moscow)
NG Zhukova (Siberian State Medical University, Tomsk)
IA Zhukova (Siberian State Medical University, Tomsk)
Some selected references to recent relevant literature are:
Designing prevention programmes to reduce incidence of dementia: prospective cohort study of modifiable risk factors.
Ritchie, K., I. Carriere, C. W. Ritchie, C. Berr, S. Artero and M. L. Ancelin. Bmj (2010) 341: c3885.
The projected effect of risk factor reduction on Alzheimer's disease prevalence.
Barnes, D. E. and K. Yaffe. Lancet Neurol (2011) 10: 819-828.
Creating a transatlantic research enterprise for preventing Alzheimer's disease.
Khachaturian, Z. S., et al. Alzheimers Dement (2009) 5: 361-366.
Prevent Alzheimer's disease by 2020: a national strategic goal.
Khachaturian, Z. S. and A. S. Khachaturian. Alzheimers Dement (2009) 5: 81-84.
Developing a global strategy to prevent Alzheimer's disease: Leon Thal Symposium 2010.
Khachaturian, Z. S., et al. Alzheimers Dement (2011) 7: 127-132.
Efficacy of Souvenaid in mild Alzheimer's disease: results from a randomized, controlled trial.
Scheltens, P., et al. J Alzheimers Dis (2012) 31: 225-236.
Mediterranean diet, cognitive function, and dementia: a systematic review.
Lourida, I., M. Soni, J. Thompson-Coon, N. Purandare, I. A. Lang, O. C. Ukoumunne and D. J. Llewellyn. Epidemiology (2013) 24: 479-489.
Can we prevent Alzheimer's disease? Secondary “prevention” trials in Alzheimer's disease.
Carrillo, M. C., H. R. Brashear, V. Logovinsky, J. M. Ryan, H. H. Feldman, E. R. Siemers, S. Abushakra, D. M. Hartley, R. C. Petersen, A. S. Khachaturian and R. A. Sperling. Alzheimer's Dementia (2013) 9: 123-131.e121.
Midlife risk score for the prediction of dementia four decades later.
Exalto, L. G., C. P. Quesenberry, D. Barnes, M. Kivipelto, G. J. Biessels and R. A. Whitmer. Alzheimers Dement (2013) EPubahead of print.10.1016/j.jalz.2013.05.1772
Long-chain omega-3 fatty acids improve brain function and structure in older adults.
Witte, A. V., L. Kerti, H. M. Hermannstadter, J. B. Fiebach, S. J. Schreiber, J. P. Schuchardt, A. Hahn and A. Floel. Cereb Cortex (2013) June, Epubahead of print.
Preventing Alzheimer's disease-related gray matter atrophy by B-vitamin treatment.
Douaud, G., H. Refsum, C. A. de Jager, R. Jacoby, T. E. Nichols, S. M. Smith and A. D. Smith. Proc Natl Acad Sci U S A (2013) 110: 9523-9528.
Nonpharmacologic treatment and prevention strategies for dementia.
Yaffe, K. and T. Hoang. Continuum (Minneap Minn) (2013) 19: 372-381.
Trends in the prevalence and mortality of cognitive impairment in the United States: is there evidence of a compression of cognitive morbidity?
Langa, K. M., E. B. Larson, J. H. Karlawish, D. M. Cutler, M. U. Kabeto, S. Y. Kim and A. B. Rosen. Alzheimers Dement (2008) 4: 134-144.
The effect of dementia trends and treatments on longevity and disability: a simulation model based on the MRC Cognitive Function and Ageing Study (MRC CFAS).
Jagger, C., R. Matthews, J. Lindesay, T. Robinson, P. Croft and C. Brayne. Age Ageing (2009) 38: 319-325;
Methodological challenges in designing dementia prevention trials - the European Dementia Prevention Initiative (EDPI).
Richard, E., S. Andrieu, A. Solomon, F. Mangialasche, S. Ahtiluoto, E. P. Moll van Charante, N. Coley, L. Fratiglioni, A. S. Neely, B. Vellas, W. A. van Gool and M. Kivipelto. J Neurol Sci (2012) 322: 64-70.
Trends in the incidence and prevalence of Alzheimer’s disease, dementia, and cognitive impairment in the United States.
Rocca, W. A., R. C. Petersen, D. Knopman, S. , L. E. Hebert, D. A. Evans, K. S. Hall, S. Gao, F. W. Unverzagt, K. M. Langa, E. B. Larson and L. White, R. Alzheimer's dementia (2011) 7: 80-93.
Is dementia incidence declining?: Trends in dementia incidence since 1990 in the Rotterdam Study.
Schrijvers, E. M., B. F. Verhaaren, P. J. Koudstaal, A. Hofman, M. A. Ikram and M. M. Breteler. Neurology (2012) 78: 1456-1463.
Twenty-year changes in dementia occurrence suggest decreasing incidence in central Stockholm, Sweden.
Qiu, C., E. von Strauss, L. Backman, B. Winblad and L. Fratiglioni. Neurology (2013) 80: 1888-1894.
A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II.
Matthews, F. E., A. Arthur, L. E. Barnes, J. Bond, C. Jagger, L. Robinson, C. Brayne, on behalf of the Medical Research Council Cognitive Function and Ageing Study. Lancet (2013). 10.1016/S0140-6736(13)61570-6. Epub ahead of print
The worldwide economic impact of dementia 2010.
Wimo, A., L. Jonsson, J. Bond, M. Prince, B. Winblad. Alzheimers Dement (2013) 9: 1-11 e13.
The global prevalence of dementia: a systematic review and metaanalysis.
Prince, M., R. Bryce, E. Albanese, A. Wimo, W. Ribeiro and C. P. Ferri. Alzheimers Dement (2013) 9: 63-75 e62.
A conceptual framework and ethics analysis for prevention trials of Alzheimer Disease.
Peters, K. R., B. Lynn Beattie, H. H. Feldman and J. Illes. Prog Neurobiol (2013) 110: 114-123.
New insights into the dementia epidemic.
Larson, E.B., Yaffe, K. and Langa, K.M. New Eng J Med (2013) on-line 27 November 2013
Some international and national initiatives:
European Dementia Prevention Initiative:
The Healthy Brain Initiative (CDC and Alzheimer’s Association, USA):
OECD Global Challenge of Alzheimer’s disease:
A National Alzheimer’s Strategic Plan (Alzheimer’s Association, 2009):
National Plan to Address Alzheimer’s Disease: 2013 update:
National dementia strategies for the UK (Alzheimer’s Society):
National Prevention Research Initiative (UK):
UK Department of Health statement (September 2013):
This statement will appear in an upcoming issue of Journal of Alzheimer’s Disease.
For further information, contact Professor David Smith, Department of Pharmacology, University of Oxford, Mansfield Rd., Oxford OX1 3QT, UK