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Special Article
May 9, 2011

Risk Factors and Preventive Interventions for Alzheimer Disease: State of the Science

Author Affiliations

Author Affiliations: Northwestern University Feinberg School of Medicine (Drs Daviglus and Pirzada), Community Mental Health Council, Inc (Dr Bell), and College of Medicine (Dr Bell) and College of Applied Health Sciences (Dr Bowen), University of Illinois at Chicago, Chicago; Duke University Medical Center (Drs Plassman, Burke, and Williams) and Duke Evidence-based Practice Center (Dr Williams), Duke University, and Durham Veterans Affairs Medical Center (Dr Williams), Durham, North Carolina; Columbia University Medical Center (Dr Connolly) and College of Physicians and Surgeons (Dr Granieri), Columbia University, New York, New York; School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Dunbar-Jacob); University of California, Los Angeles (Dr McGarry); Charles E. Smith Life Community Hebrew Home of Greater Washington, Rockville, Maryland (Dr Patel); and Health Sciences System of the Nevada System of Higher Education, Las Vegas (Dr Trevisan).

Arch Neurol. 2011;68(9):1185-1190. doi:10.1001/archneurol.2011.100

Background  Numerous studies have investigated risk factors for Alzheimer disease (AD). However, at a recent National Institutes of Health State-of-the-Science Conference, an independent panel found insufficient evidence to support the association of any modifiable factor with risk of cognitive decline or AD.

Objective  To present key findings for selected factors and AD risk that led the panel to their conclusion.

Data Sources  An evidence report was commissioned by the Agency for Healthcare Research and Quality. It included English-language publications in MEDLINE and the Cochrane Database of Systematic Reviews from 1984 through October 27, 2009. Expert presentations and public discussions were considered.

Study Selection  Study inclusion criteria for the evidence report were participants aged 50 years and older from general populations in developed countries; minimum sample sizes of 300 for cohort studies and 50 for randomized controlled trials; at least 2 years between exposure and outcome assessment; and use of well-accepted diagnostic criteria for AD.

Data Extraction  Included studies were evaluated for eligibility and data were abstracted. Quality of overall evidence for each factor was summarized as low, moderate, or high.

Data Synthesis  Diabetes mellitus, hyperlipidemia in midlife, and current tobacco use were associated with increased risk of AD, and Mediterranean-type diet, folic acid intake, low or moderate alcohol intake, cognitive activities, and physical activity were associated with decreased risk. The quality of evidence was low for all of these associations.

Conclusion  Currently, insufficient evidence exists to draw firm conclusions on the association of any modifiable factors with risk of AD.

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