Leshner AI, Landis S, Stroud C, Downey A, Committee on Preventing Dementia and Cognitive Impairment; Board on Health Sciences Policy; Health and Medicine Division; National Academies of Sciences, Engineering, and Medicine. Preventing Cognitive Decline and Dementia: A Way Forward. Washington (DC): National Academies Press (US); 2017 Jun. The National Academies Collection: Reports funded by National Institutes of Health.
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University of Louisville School of Medicine
I am disturbed that this new report from the National Academies of Science, Engineering, and Medicine has concluded that an “assertive public health campaign” cannot yet be offered for dementia prevention. They are correct that definitive evidence is not currently available to document the value of preventive measures in preventing late-life dementing illnesses. But the absence of evidence is not evidence of absence! We already know that hypertension is linked to stroke, and that stroke contributes to cognitive impairment in Alzheimer’s disease. We also know that periodontitis is a risk factor for heart disease and stroke (and perhaps AD). Low levels of physical activity and obesity are also risk factors for heart disease and stroke. Who exactly would be harmed by a public health campaign recommending high levels of physical and mental activity; dental care; avoidance of head injury, obesity, and smoking; control of diabetes and hypertension; and a low-fat, high–fiber diet?
References:
Friedland RP, Nandi S. A Modest Proposal for a Longitudinal Study of Dementia Prevention (with apologies to Jonathan Swift, 1729). J Alzheimers Dis. 2012 Sep 17; PubMed.
View all comments by Robert FriedlandUniversity of California-San Diego
There will never be the volume nor the quality of intervention studies that show main effects and complex interactions needed to “prove” that lifestyle factors affect the incidence of dementia/AD. Rather than dismiss observational research, we must recognize that longitudinal cohort studies may actually provide more evidence than traditionally thought, given the length of time it takes to develop AD (i.e., from conception on!). This thesis is fully developed in our book, "Alzheimer's Disease: Life Course Perspectives on Risk Reduction.”
Clinical trials also have a range of methodologic shortcomings that are not easily overcome, not the least of which is the relatively short follow-up time that most trials necessitate. Advancements in the U.S. in this field lag behind Europe and Scandinavia, where multi-armed prevention trials in populations are ongoing. In the U.S., there is little attention being focused on such prevention trials, with funding being tied up with expensive treatments and diagnostic techniques. There should be a marriage of these two approaches in order to maximize “going deep” with “going wide” and gaining external validity on a population level.
And I agree with Robert Friedland: What possible harm could be done by recommending heart- and brain-healthy lifestyles?
View all comments by Amy BorensteinMake a Comment
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