Abstract
The terms “prevention” and “risk reduction” are often used interchangeably in medicine. There is considerable debate, however, over the use of these terms in describing interventions that aim to preserve cognitive health and/or delay disease progression of Alzheimer's disease (AD) for patients seeking clinical care. Furthermore, it is important to distinguish between Alzheimer's disease prevention and Alzheimer's dementia prevention when using these terms. While prior studies have codified research-based criteria for the progressive stages of AD, there are no clear clinical consensus criteria to guide the use of these terms for physicians in practice. A clear understanding of the implications of each term will help guide clinical practice and clinical research. The authors explore the semantics and appropriate use of the terms “prevention” and “risk reduction” as they relate to AD in clinical practice.
Highlights
The terms “prevention” and “risk reduction” often are used interchangeably in medicine when referring to clinical interventions that aim to delay or prevent the onset of a disease
The purpose of this paper is to explore the semantics and most appropriate use of the terms “prevention” and “risk reduction” as they relate to the clinical practice of preventing or delaying the pathophysiologic state of Alzheimer’s disease (AD), the end stage of AD dementia, and related cognitive decline
The cumulative data in this study suggested that when these seven factors were adequately addressed, a 30% reduction in the incidence of dementia could be achieved [11]
Summary
The terms “prevention” and “risk reduction” often are used interchangeably in medicine when referring to clinical interventions that aim to delay or prevent the onset of a disease. There has been an exponential increase in the number of studies investigating the impact of modifiable risk factor reduction on brain health, cognition, and dementia risk Many of these demonstrate that secondary prevention strategies to reduce modifiable risk factors correlate with a decrease in the rate of progression to MCI and symptomatic AD [11, 20], suggesting “prevention,” as defined by WHO, is achievable. Consensus among experts may not yet be within reach, it is worthwhile to discuss and explore these definitions To this end, a structured clinical approach of targeted intervention may aim to delay onset (and/or reduce risk) in the area of primary AD prevention, yet for secondary and tertiary prevention, may instead seek to delay onset (and/or possibly prevent) the progression from a prodromal stage to dementia. Emerging computation methods imposed upon serial collection of agreed upon set of biomarkers and other available lifestyle factor has promise in the AD field and already has precedent in the literature [40, 41]
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