The prediction and prevention of Alzheimer's disease - towards a research agenda

This paper sets a research agenda for the prediction and prevention of futu re onset of Alzheimer's disease (AD). From a MEDLINE review of the literatu re, the authors found age to be a predictor of AD. The literature also indi cates that memory and attentional impairments predict AD, although the rela tive risk is relatively low. Late-onset depression may also predict AD, but these data are limited by a lack of cohort studies. Studying cognitively i mpaired subjects with late-onset depression may identify a high-risk group, facilitating prevention trials. Characteristics of an "ideal" preventive a gent are suggested. There is a biologic rationale, and preliminary evidence , that nan-steroidal anti-inflammatory drugs (including ASA), estrogen and vitamin E may play a preventive role in AD. Other compounds (such as acetyl cholinesterase inhibitors) are also promising, but costs, side effects, and lack of other health benefits may preclude their use in all but very high- risk groups.