TY - JOUR T1 - Evidence-based prevention of Alzheimer's disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials JF - Journal of Neurology, Neurosurgery & Psychiatry JO - J Neurol Neurosurg Psychiatry DO - 10.1136/jnnp-2019-321913 SP - jnnp-2019-321913 AU - Jin-Tai Yu AU - Wei Xu AU - Chen-Chen Tan AU - Sandrine Andrieu AU - John Suckling AU - Evangelos Evangelou AU - An Pan AU - Can Zhang AU - Jianping Jia AU - Lei Feng AU - Ee-Heok Kua AU - Yan-Jiang Wang AU - Hui-Fu Wang AU - Meng-Shan Tan AU - Jie-Qiong Li AU - Xiao-He Hou AU - Yu Wan AU - Lin Tan AU - Vincent Mok AU - Lan Tan AU - Qiang Dong AU - Jacques Touchon AU - Serge Gauthier AU - Paul S Aisen AU - Bruno Vellas Y1 - 2020/07/20 UR - http://jnnp.bmj.com/content/early/2020/09/02/jnnp-2019-321913.abstract N2 - Background Evidence on preventing Alzheimer’s disease (AD) is challenging to interpret due to varying study designs with heterogeneous endpoints and credibility. We completed a systematic review and meta-analysis of current evidence with prospective designs to propose evidence-based suggestions on AD prevention.Methods Electronic databases and relevant websites were searched from inception to 1 March 2019. Both observational prospective studies (OPSs) and randomised controlled trials (RCTs) were included. The multivariable-adjusted effect estimates were pooled by random-effects models, with credibility assessment according to its risk of bias, inconsistency and imprecision. Levels of evidence and classes of suggestions were summarised.Results A total of 44 676 reports were identified, and 243 OPSs and 153 RCTs were eligible for analysis after exclusion based on pre-decided criteria, from which 104 modifiable factors and 11 interventions were included in the meta-analyses. Twenty-one suggestions are proposed based on the consolidated evidence, with Class I suggestions targeting 19 factors: 10 with Level A strong evidence (education, cognitive activity, high body mass index in latelife, hyperhomocysteinaemia, depression, stress, diabetes, head trauma, hypertension in midlife and orthostatic hypotension) and 9 with Level B weaker evidence (obesity in midlife, weight loss in late life, physical exercise, smoking, sleep, cerebrovascular disease, frailty, atrial fibrillation and vitamin C). In contrast, two interventions are not recommended: oestrogen replacement therapy (Level A2) and acetylcholinesterase inhibitors (Level B).Interpretation Evidence-based suggestions are proposed, offering clinicians and stakeholders current guidance for the prevention of AD. ER -