RT Journal Article
SR Electronic
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
FD BMJ Publishing Group Ltd
SP 1201
OP 1209
DO 10.1136/jnnp-2019-321913
VO 91
IS 11
A1 Yu, Jin-Tai
A1 Xu, Wei
A1 Tan, Chen-Chen
A1 Andrieu, Sandrine
A1 Suckling, John
A1 Evangelou, Evangelos
A1 Pan, An
A1 Zhang, Can
A1 Jia, Jianping
A1 Feng, Lei
A1 Kua, Ee-Heok
A1 Wang, Yan-Jiang
A1 Wang, Hui-Fu
A1 Tan, Meng-Shan
A1 Li, Jie-Qiong
A1 Hou, Xiao-He
A1 Wan, Yu
A1 Tan, Lin
A1 Mok, Vincent
A1 Tan, Lan
A1 Dong, Qiang
A1 Touchon, Jacques
A1 Gauthier, Serge
A1 Aisen, Paul S
A1 Vellas, Bruno
YR 2020
UL http://jnnp.bmj.com/content/91/11/1201.abstract
AB 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.