The prevalence of Alzheimer disease (AD) and related dementia is expected to triple over the next 30 years in the United States and worldwide.1 Alzheimer disease drug development during the past 2 decades has met with disappointment. The last drug approved for this disease by the US Food and Drug Administration was in 2003 and was a drug with symptomatic, not disease-modifying, benefit. The challenges of drug development have been somewhat mitigated by advances in the determination of disease mechanisms, the identification of biomarkers and of genetic and nongenetic risk factors, and an updated conceptual framework for clinical development. In particular, an understanding that most neurodegenerative diseases take many years, if not decades, to develop and thus have a long preclinical phase has spurred interest in prevention. The identification of preclinical or early clinical phases, such as mild cognitive impairment (MCI), is critical for these primary and secondary prevention approaches.
Yaffe K. Prevention of Cognitive Impairment With Intensive Systolic Blood Pressure Control. JAMA. 2019;321(6):548–549. doi:10.1001/jama.2019.0008
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