Given the unknown therapeutic value of targeting Alzheimer’s disease pathology and the discovery of robust risk factors for dementia, non-pharmacological risk reduction (RR) is increasingly offered as an alternative to targeting Alzheimer’s disease pathology. While RR will surely be a useful tool to make public health gains, we propose solutions to three possible issues with over-reliance on multi-domain interventions to achieve RR: limited individual impact, an exclusive focus on later life, and overlooking social determinants of dementia. We argue in favor of a broader debate within the research community and greater society about how different therapeutic avenues should be explored.
DalyT, MastroleoI, HenryV, BourdenxM (2022) An argument for simple tests of treatments of Alzheimer’s disease. J Alzheimers Dis, doi: 10.3233/JAD-215492.
3.
LeCouteur DG, HunterS, BrayneC (2016) Solanezumab and the amyloid hypothesis for Alzheimer’s disease. BMJ355, i6771.
DalyT, HouotM, BarberousseA, PetitA, EpelbaumS (2021) A proposal to make biomedical research into Alzheimer’s disease more democratic following an international survey with researchers. J Alzheimers Dis Rep5, 637–645.
6.
ShawJ (2018) Feyerabend’s well-ordered science: How an anarchist distributes funds. Synthese198, 419–449.
7.
HorstkötterD, DeckersK, KöhlerS (2021) Primary prevention of dementia: An ethical review. J Alzheimers Dis79, 467–476.
8.
NganduT, LehtisaloJ, SolomonA, LevälahtiE, AhtiluotoS, AntikainenR, BäckmanL, HänninenT, JulaA, LaatikainenT, LindströmJ, MangialascheF, PaajanenT, PajalaS, PeltonenM, RauramaaR, Stigsdotter-NeelyA, StrandbergT, TuomilehtoJ, SoininenH, KivipeltoM (2015) A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): A randomised controlled trial. Lancet385, 2255–2263.
9.
MigliaccioR, AgostaF, RascovskyK, KarydasA, BonaseraS, RabinoviciGD, MillerBL, Gorno-TempiniML (2009) Clinical syndromes associated with posterior atrophy: Early age at onset AD spectrum. Neurology73, 1571–1578.
10.
MillerZA, MandelliML, RankinKP, HenryML, BabiakMC, FrazierDT, LobachIV, BettcherBM, WuTQ, RabinoviciGD, Graff-RadfordNR, MillerBL, Gorno-TempiniML (2013) Handedness and language learning disability differentially distribute in progressive aphasia variants. Brain136, 3461–3473.
11.
van PraagH, KempermannG, GageFH (2000) Neural consequences of environmental enrichment. Nat Rev Neurosci1, 191–198.
BrownRCH, MaslenH, SavulescuH (2019) Against moral responsibilisation of health: Prudential responsibility and health promotion. Public Health Ethics12, 114–129.
14.
RöhrS (2021) Social determinants of brain health need to be addressed in risk reduction of cognitive decline and dementia. Int Psychogeriatr33, 1249–1251.
15.
NakahoriN, SekineM, YamadaM, TatsuseT, KidoH, SuzukiM (2018) A pathway from low socioeconomic status to dementia in Japan: Results from the Toyama dementia survey. BMC Geriatr18, 102.
16.
SeblovaD, FischerM, ForsS, JohnellK, KarlssonM, NilssonT, SvenssonAC, LövdénM, LagerA (2021) Does prolonged education causally affect dementia risk when adult socioeconomic status is not altered? A Swedish natural experiment in 1.3 million individuals. Am J Epidemiol190, 817–826.
17.
ColeyN, Coniasse-BrioudeD, IgierV, FournierT, PoulainJP, AndrieuS; ACCEPT study group (2021) Disparities in the participation and adherence of older adults in lifestyle based multidomain dementia prevention and the motivational role of perceived disease risk and intervention benefits: An observational ancillary study to a randomised controlled trial. Alzheimers Res Ther13, 157.
18.
DalyT (2022) Giving a fairer face to urban space: Progress on the long road to dementia prevention. Int J Geriatr Psychiatry37, doi: 10.1002/gps.5657
19.
MastroleoI, DalyT (2021) Avoiding exceptionalism and silver bullets: Lessons from public health ethics and Alzheimer’s disease. Am J Bioeth21, 25–28.
20.
WalshS, GoviaI, WallaceL, RichardE, PetersR, AnsteyKJ, BrayneC (2022) A whole-population approach is required for dementia risk reduction. Lancet Healthy Longev3, E6–E8.
