Semin Neurol 2022; 42(05): 525-548
DOI: 10.1055/s-0042-1759580
Review Article

Dementia Prevention in Clinical Practice

Kellyann Niotis
1   Department of Neurology, Weill Cornell Medicine and New York - Presbyterian, New York, New York
,
Kiarra Akiyoshi
1   Department of Neurology, Weill Cornell Medicine and New York - Presbyterian, New York, New York
,
Caroline Carlton
1   Department of Neurology, Weill Cornell Medicine and New York - Presbyterian, New York, New York
,
Richard Isaacson
1   Department of Neurology, Weill Cornell Medicine and New York - Presbyterian, New York, New York
2   Department of Neurology, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton, Florida
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Abstract

Over 55 million people globally are living with dementia and, by 2050, this number is projected to increase to 131 million. This poses immeasurable challenges for patients and their families and a significant threat to domestic and global economies. Given this public health crisis and disappointing results from disease-modifying trials, there has been a recent shift in focus toward primary and secondary prevention strategies. Approximately 40% of Alzheimer's disease (AD) cases, which is the most common form of dementia, may be prevented or at least delayed. Success of risk reduction studies through addressing modifiable risk factors, in addition to the failure of most drug trials, lends support for personalized multidomain interventions rather than a “one-size-fits-all” approach. Evolving evidence supports early intervention in at-risk patients using individualized interventions directed at modifiable risk factors. Comprehensive risk stratification can be informed by emerging principals of precision medicine, and include expanded clinical and family history, anthropometric measurements, blood biomarkers, neurocognitive evaluation, and genetic information. Risk stratification is key in differentiating subtypes of dementia and identifies targetable areas for intervention. This article reviews a clinical approach toward dementia risk stratification and evidence-based prevention strategies, with a primary focus on AD.

Keywords

Alzheimer's disease prevention - dementia prevention - precision medicine


Publication History

Article published online:
28 November 2022

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