Individualized clinical management of patients at risk for Alzheimer's dementia

被引：57

作者：

Isaacson, Richard S. ^{[1
,2
]}

Hristov, Hollie ^{[1
,2
]}

Saif, Nabeel ^{[1
,2
]}

Hackett, Katherine ^{[3
]}

Hendrix, Suzanne ^{[4
]}

Melendez, Juan ^{[5
]}

Safdieh, Joseph ^{[1
,2
]}

Fink, Matthew ^{[1
,2
]}

Thambisetty, Madhav ^{[6
]}

Sadek, George ^{[1
,2
]}

Bellara, Sonia ^{[1
,2
]}

Lee, Paige ^{[7
]}

Berkowitz, Cara ^{[1
,2
]}

Rahman, Aneela ^{[1
,2
]}

Melendez-Cabrero, Josefina ^{[8
]}

Caesar, Emily ^{[9
]}

Cohen, Randy ^{[10
]}

Lu, Pei-Lin ^{[11
]}

Dickson, Samuel P. ^{[4
]}

Hwang, Mu Ji ^{[1
,2
]}

Scheyer, Olivia ^{[12
]}

Mureb, Monica ^{[1
,2
]}

Schelke, Matthew W. ^{[13
]}

Niotis, Kellyann ^{[1
,2
]}

Greer, Christine E. ^{[14
]}

Attia, Peter ^{[15
]}

Mosconi, Lisa ^{[1
,2
]}

Krikorian, Robert ^{[16
]}

机构：

[1] Weill Cornell Med, Dept Neurol, New York, NY 10065 USA

[2] NewYork Presbyterian, New York, NY 10021 USA

[3] Temple Univ, Dept Psychol, Philadelphia, PA 19122 USA

[4] Pentara Corp, Biostat, Salt Lake City, UT USA

[5] Hlth & Community Serv, Jersey Memory Assessment Serv, Jersey, England

[6] NIA, Clin & Translat Neurosci Sect, Lab Behav Neurosci, NIH, Baltimore, MD 21224 USA

[7] Univ Calif Los Angeles, Coll Letters & Sci, Los Angeles, CA USA

[8] Weill Cornell Med, Dept Neurol, San Juan, PR USA

[9] Loyola Sch Med, Chicago, IL USA

[10] Crystal Run Healthcare, Dept Cardiol, Middletown, NY USA

[11] Zhejiang Univ, Sir Run Run Shaw Hosp, Sch Med, Dept Neurol, Hangzhou, Zhejiang, Peoples R China

[12] Univ Calif Los Angeles, Sch Law, Los Angeles, CA 90024 USA

[13] Columbia Univ Coll Phys & Surg, Dept Neurol, New York, NY 10032 USA

[14] Univ Southern Calif, Keck Sch Med, Dept Ophthalmol, Los Angeles, CA 90007 USA

[15] Attia Med, New York, NY USA

[16] Univ Cincinnati, Coll Med, Dept Psychiat & Behav Neurosci, Cincinnati, OH USA

来源：

ALZHEIMERS & DEMENTIA | 2019年 / 15卷 / 12期

关键词：

Alzheimer's disease prevention; Multi-domain interventions; Alzheimer's prevention clinic; Personalized medicine; Preclinical Alzheimer's disease; ASSOCIATION WORKGROUPS; DIAGNOSTIC GUIDELINES; COGNITIVE IMPAIRMENT; NATIONAL INSTITUTE; HYPOTHETICAL MODEL; DISEASE; PREVENTION; RECOMMENDATIONS; INTERVENTION; VALIDATION;

D O I：

10.1016/j.jalz.2019.08.198

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Introduction: Multidomain intervention for Alzheimer's disease (AD) risk reduction is an emerging therapeutic paradigm. Methods: Patients were prescribed individually tailored interventions (education/pharmacologic/nonpharmacologic) and rated on compliance. Normal cognition/subjective cognitive decline/preclinical AD was classified as Prevention. Mild cognitive impairment due to AD/mild-AD was classified as Early Treatment. Change from baseline to 18 months on the modified Alzheimer's Prevention Cognitive Composite (primary outcome) was compared against matched historical control cohorts. Cognitive aging composite (CogAging), AD/cardiovascular risk scales, and serum biomarkers were secondary outcomes. Results: One hundred seventy-four were assigned interventions (age 25-86). Higher-compliance Prevention improved more than both historical cohorts (P = .0012, P < .0001). Lower-compliance Prevention also improved more than both historical cohorts (P = .0088, P < .0055). Higher-compliance Early Treatment improved more than lower compliance (P = .0007). Higher-compliance Early Treatment improved more than historical cohorts (P < .0001, P = .0428). Lower-compliance Early Treatment did not differ (P = .9820, P = .1115). Similar effects occurred for CogAging. AD/cardiovascular risk scales and serum biomarkers improved. Discussion: Individualized multidomain interventions may improve cognition and reduce AD/cardiovascular risk scores in patients at-risk for AD dementia. (C) 2019 The Authors. Published by Elsevier Inc. on behalf of the Alzheimer's Association.

引用

页码：1588 / 1602

页数：15

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