Alzheimer's disease: Only prevention makes sense

Abstract

Alzheimer's disease therapeutics is one of the most important endeavours in today's clinical investigation. Over more than 30 years of research, no disease-modifying treatment has been approved by either the FDA or the EMA to treat Alzheimer's disease. Recently, the evidence of pathological alterations in the brain tissue has been gathered showing that the signs of brain damage appear more than 20 years before the onset of Alzheimer's dementia. The major aim of this review is to underpin the idea that in Alzheimer's therapeutics, only prevention makes sense. It is difficult to visualise that would-be patients may be treated with endovenous administration of antibodies for several years to delay the onset of dementia. Rather, changes in lifestyle that should be specific, stratified and personalised are a likely alternative to delay the transition from asymptomatic Alzheimer's to minimal cognitive impairment and from there to dementia. These efforts are of the utmost importance. If we could delay the onset of full-blown dementia by 5 years, the number of demented patients would be almost halved. Thus, emphasis on preventive measures that can be implemented for decades must be supported. This approach, where even mild changes in cognition are of the greatest importance, cannot be underestimated in terms of both the individual and society's viewpoints.

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“…The number the AD patients in America is expected to increase from 5.7 million today to 13.8 million by 2050 according to the World Alzheimer report. However, there has been no effective therapy for AD currently (Vina and Sanz-Ros 2018). Therefore, it is important to develop effective agents to slow or halt the neurodegenerative process and alleviate pathology of AD.…”

Physical exercise in the prevention and treatment of Alzheimer's disease

“…Prevention through the promotion of changes in lifestyle in presymptomatic and predementia disease stages may have the potential for delaying one-third of dementias. 70 Engaging in physical exercise programs seems to be effective, but it is clearly not enough. Studies that examine multimodal interventions hypothesize that an integrated approach to addressing multiple risk factors for AD may be more successful than single-component interventions in producing benefits.…”

Retinal layer thickness in preclinical Alzheimer's disease

“…; Sun et al. ; Vina & Sanz‐Ros ). One of the most important reasons for these unsuccessful trials may have been the timing: most trials were focused on people already suffering from clinically evident dementia, where brain damage is in more advanced stages (Sun et al.…”

“…One of the most important reasons for these unsuccessful trials may have been the timing: most trials were focused on people already suffering from clinically evident dementia, where brain damage is in more advanced stages (Sun et al. ; Vina & Sanz‐Ros ). As reversing neuronal damage may be impossible, it may be more effective to start treatment before the onset of dementia (Kumar et al.…”

“…The development of a new non‐invasive, patient friendly and easily repeatable measurement of a biomarker for pre‐clinical AD patients is especially interesting, because it would allow for early interventions targeting the causes at a stage that neuronal damage could still be prevented (Sun et al. ; Vina & Sanz‐Ros ).…”