Rodríguez-Gómez Octavio, Palacio-Lacambra M Eugenia, Palasí Antoni, Ruiz-Laza Agustín, Boada-Rovira Mercè
Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain.
Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain Servei de Neurología, Hospital Universitari de la Vall d'Hebró, Barcelona, Spain.
J Alzheimers Dis. 2014;42 Suppl 4:S515-23. doi: 10.3233/JAD-141479.
The incidence of dementia is rapidly increasing in developed countries due to social and demographic changes. This trend is expected to worsen in the coming decades, with the number of cases possibly even tripling in the next 25 years. Therefore Alzheimer's disease (AD) prevention is becoming a global health priority. Our knowledge of the pathophysiological process leading to the development of pathological brain lesions that characterize AD has increased exponentially in recent years. However, the phenotypic expression of AD not only depends on the development of senile plaques and neurofibrillary tangles but other factors also play a role. Thus, over the last few decades, epidemiological studies have revealed several risk factors for developing AD, such as vascular or lifestyle related factors. Having the current knowledge on AD, two different strategies have been developed for the prevention of AD: one is based on primary prevention by acting on modifiable risk factors, the other is a pathophysiology-driven approach aimed to identify individuals in a preclinical stage of the disease and treating them with drugs purporting to act on molecular targets of the amyloid cascade. Several promising trials with these approaches are currently ongoing and results are expected in the next few years. The intrinsic limitations in the design of preventive trials should be overcome through a global effort involving healthy population, healthcare professionals, governments, industry, and scientific institutions. This exertion will be more than compensated if we can make AD a preventable disease.
由于社会和人口结构的变化，发达国家痴呆症的发病率正在迅速上升。预计这一趋势在未来几十年将恶化，未来25年病例数量可能甚至增至三倍。因此，阿尔茨海默病（AD）的预防正成为全球卫生重点。近年来，我们对导致AD特征性病理性脑病变发展的病理生理过程的了解呈指数级增长。然而，AD的表型表达不仅取决于老年斑和神经原纤维缠结的发展，其他因素也起作用。因此，在过去几十年中，流行病学研究揭示了几个患AD的风险因素，如血管或生活方式相关因素。基于对AD的现有认识，已制定了两种不同的AD预防策略：一种基于通过作用于可改变的风险因素进行一级预防，另一种是病理生理学驱动方法，旨在识别疾病临床前阶段的个体并用旨在作用于淀粉样蛋白级联反应分子靶点的药物对其进行治疗。目前正在进行几项采用这些方法的有前景的试验，预计未来几年会有结果。应通过包括健康人群、医疗保健专业人员、政府、企业和科研机构在内的全球努力来克服预防性试验设计中的固有局限性。如果我们能使AD成为一种可预防的疾病，这种努力将得到远超其付出代价的回报。
