Public Health Promotion Unit, National Institute for Health and Welfare (THL), Helsinki, Finland.
Division of Clinical Geriatrics, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Nat Rev Neurol. 2018 Nov;14(11):653-666. doi: 10.1038/s41582-018-0070-3.
Research into dementia prevention is of paramount importance if the dementia epidemic is to be halted. Observational studies have identified several potentially modifiable risk factors for dementia, including hypertension, dyslipidaemia and obesity at midlife, diabetes mellitus, smoking, physical inactivity, depression and low levels of education. Randomized clinical trials are needed that investigate whether interventions targeting these risk factors can reduce the risk of cognitive decline and dementia in elderly adults, but such trials are methodologically challenging. To date, most preventive interventions have been tested in small groups, have focused on a single lifestyle factor and have yielded negative or modest results. Given the multifactorial aetiology of dementia and late-onset Alzheimer disease, multidomain interventions that target several risk factors and mechanisms simultaneously might be necessary for an optimal preventive effect. In the past few years, three large multidomain trials (FINGER, MAPT and PreDIVA) have been completed. The FINGER trial showed that a multidomain lifestyle intervention can benefit cognition in elderly people with an elevated risk of dementia. The primary results from the other trials did not show a statistically significant benefit of preventive interventions, but additional analyses among participants at risk of dementia showed beneficial effects of intervention. Overall, results from these three trials suggest that targeting of preventive interventions to at-risk individuals is an effective strategy. This Review discusses the current knowledge of lifestyle-related risk factors and results from novel trials aiming to prevent cognitive decline and dementia. Global initiatives are presented, including the World Wide FINGERS network, which aims to harmonize studies on dementia prevention, generate high-quality scientific evidence and promote its implementation.
如果要阻止痴呆症的流行，那么对痴呆症预防的研究至关重要。观察性研究已经确定了一些潜在可改变的痴呆症风险因素，包括中年时的高血压、血脂异常和肥胖、糖尿病、吸烟、缺乏身体活动、抑郁和低教育水平。需要进行随机临床试验，以研究针对这些风险因素的干预措施是否可以降低老年人认知能力下降和痴呆症的风险，但此类试验在方法学上具有挑战性。迄今为止，大多数预防干预措施都在小群体中进行了测试，仅针对单一的生活方式因素，结果为阴性或效果不大。鉴于痴呆症和迟发性阿尔茨海默病的多因素病因，同时针对多个风险因素和机制的多领域干预措施可能对于最佳预防效果是必要的。在过去几年中，已经完成了三项大型多领域试验（FINGER、MAPT 和 PreDIVA）。FINGER 试验表明，多领域生活方式干预可以使认知能力处于痴呆症高发风险的老年人受益。其他两项试验的主要结果并未显示预防干预具有统计学上的显著益处，但对痴呆症高危参与者的进一步分析显示干预具有有益效果。总体而言，这三项试验的结果表明，针对高危个体的预防干预是一种有效的策略。这篇综述讨论了与生活方式相关的风险因素的现有知识，以及旨在预防认知能力下降和痴呆症的新试验的结果。本文还介绍了全球倡议，包括全球 FINGER 网络，旨在协调痴呆症预防研究，生成高质量的科学证据，并促进其实施。
