Martha L. Daviglus
National Institutes of Health State-of-the-Science Conference Statement: Preventing Alzheimer Disease and Cognitive Decline
Vanderbilt University Medical Center|Nevada System of Higher Education|University of Nevada Reno|Georgetown University Medical Center|Columbia University Irving Medical Center|New York Hospital Queens|NewYork–Presbyterian Hospital|Northwestern University|University of Illinois at Chicago|University of Chicago|George Washington University|University of Pittsburgh|University of Pennsylvania|University of California, Los Angeles|National Blood Clot Alliance
nih conferences3 august 2010national institutes health stateofthescience conference statement preventing alzheimer disease cognitive declinefreemartha l daviglus md phd mph carl c bell md wade berrettini md phd phyllis e bowen phd e sander connolly jr md nancy jean cox phd jacqueline dunbarjacob phd rn evelyn c granieri md mph msed gail hunt ba kathleen mcgarry phd dinesh patel md arnold l potosky phd elaine sandersbush phd donald silberberg md maurizio trevisan md msmartha l daviglus md phd mphfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author carl c bell mdfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author wade berrettini md phdfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author phyllis e bowen phdfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author e sander connolly jr mdfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author nancy jean cox phdfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author jacqueline dunbarjacob phd rnfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author evelyn c granieri md mph msedfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author gail hunt bafrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author kathleen mcgarry phdfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author dinesh patel mdfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author arnold l potosky phdfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author elaine sandersbush phdfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author donald silberberg mdfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers author maurizio trevisan md msfrom feinberg school medicine northwestern university institute juvenile research university illinois chicago community mental health council university chicago chicago illinois center neurobiology behavior university pennsylvania university pennsylvania medical center philadelphia pennsylvania columbia university medical center new yorkpresbyterian hospital columbia university new york new york school nursing university pittsburgh pittsburgh pennsylvania national alliance caregiving bethesda maryland university california los angeles los angeles california george washington university school medicine rockville maryland georgetown university medical center lombardi comprehensive cancer center washington dc vanderbilt university medical center nashville tennessee nevada system higher education university nevada school medicine las vegas nevadasearch papers authorauthor article disclosure informationhttpsdoiorg10732600034819153320100803000260 sectionsaboutvisual abstractpdf toolsadd favoritesdownload citationstrack citationspermissions sharefacebooktwitterlinkedinredditemail national institutes health nih consensus stateofthescience statements prepared independent panels health professionals public representatives basis 1 results systematic literature review prepared contract agency healthcare research quality 2 presentations investigators working areas relevant conference questions 2day public session 3 questions statements conference attendees open discussion periods part public session 4 closed deliberations panel remainder second day morning third statement independent report panel policy statement nih us government following statement abridged version panels report available full atconsensusnihgov2010alzstatementhtmalzheimer disease common cause dementia first described 1906 german psychiatrist neuropathologist alois alzheimer observed pathologic hallmarks diseaseabnormal clumps protein amyloid plaques tangled bundles protein fibers neurofibrillary tanglesin brain woman experienced memory loss language problems unpredictable behavior important breakthrough invention photomicrograph early 1900s psychiatrist solomon carter fuller key innovation provided method taking photographs lens microscope allowing visualization amyloid plaques neurofibrillary tanglessince first description alzheimer disease gone rarely reported disorder one common disabling diseases among older adults increasing proportion older adults us population reinforces urgent need prevention treatment chronic diseases including alzheimer disease people cognitive health performance remain stable lifetime gradual decline shortterm memory processing speed others however decline cognitive function progresses serious state cognitive impairment various forms dementia mild cognitive impairment characterized problems memory language essential cognitive functions severe enough noticed others reflected cognitive tests severe enough interfere daily life dementia characterized progressive global deterioration cognitive abilities multiple domains including memory least 1 additional arealearning orientation language comprehension judgmentsevere enough interfere daily lifethe diagnosis alzheimer disease difficult often imprecise importance without question depending diagnostic pathologic criteria used alzheimer disease accounts 60 80 dementia cases many 51 million americans may currently disease prevalence mild cognitive impairment even higher furthermore number persons affected alzheimer disease mild cognitive impairment expected increase considerably aging babyboom generation alzheimer disease forms dementia cost 148 billion united states annually conditions also exact substantial toll patients caregivers terms financial costs stress anguishto date numerous studies attempted describe causes factors associated risk development progression mild cognitive impairment alzheimer disease generating abundance theories potential risk factors therapies age strongest known risk factor alzheimer disease people lateonset form receive diagnosis age 60 years earlyonset familial form also occurs rare genetic cardiovascular lifestyle factors also implicatedthe national institute aging office medical applications research nih convened stateofthescience conference 2628 april 2010 assess available scientific evidence first 2 days conference experts presented information 6 key questions weighing scientific evidenceincluding data presented speakers formal evidence report evidencebased practice center duke universitys clinical research institute commissioned agency healthcare research quality available wwwahrqgovclinictpalzcogtphtman independent panel prepared presented stateofthescience statement addressing conference questionsthe panel review included relevant studies relationship multiple factors including nutritional medical social economic behavioral environmental genetic mild cognitive impairment alzheimer disease scope review restricted human studies conducted developed countries sample sizes least 50 participants randomized controlled trials rcts 300 participants observational studies minimum duration exposure preventive interventions outcomes see full report details studies published english included participants 50 years older sexes diverse racial ethnic populations considered evidencebased practice center rated study quality using grade grading recommendations assessment development evaluation criteria panels charge confined answer questions related prevention established alzheimer disease cognitive declinequestion 1what factors associated reduction risk alzheimer diseasecurrently evidence even moderate scientific quality exists support association modifiable factor nutritional supplements herbal preparations dietary factors prescription nonprescription drugs social economic factors medical conditions toxins environmental exposures reduced risk alzheimer diseasewhat knowstrong evidence indicates genetic factors particularly apolipoprotein e apoe gene variation associated risk alzheimer disease although better understanding genetic risk factors alzheimer disease may ultimately lead effective therapies observed genetic associations currently relevant largely stratification factors studies designed identify additional risk factors clinical trials designed test effectiveness therapiesnumerous modifiable factors reported show association risk alzheimer disease across multiple studies overall scientific quality evidence low thus additional studies factors may change perhaps substantially magnitude direction observed associations chronic diseases conditions diabetes elevated blood cholesterol level midlife depression associated increased risk alzheimer disease several dietary lifestyle factors medications also linked decreased risk alzheimer disease include adequate folic acid intake low saturated fat consumption high fruit vegetable consumption use statins light moderate alcohol consumption educational attainment cognitive engagement participation physical activities current smoking never married low social support reported associated increased risk alzheimer disease however quality evidence association factors alzheimer disease low consistent associations found vitamins fatty acids metabolic syndrome blood pressure plasma homocysteine level obesity body mass index antihypertensive medications nonsteroidal antiinflammatory drugs gonadal steroids exposures solvents electromagnetic fields lead aluminumlimitationsone challenges interpreting findings existing studies risk factors alzheimer disease lack consistent uniformly applied definition alzheimer disease another key challenge distinguishing factors associated alzheimer disease factors associated lateonset disorders prevalent older adults example vascular disease lead dementia vascular disease common elderly persons may often present individuals alzheimer disease thus difficult differentiate factors associated alzheimer disease contribution vascular disease related dementias factors truly associated alzheimer disease similarly unclear whether observed associations depression might reflect early features alzheimer diseasethe primary limitation studies distinction association causality diseases complex determined shaped many variables associations often involve correlated factors example individuals higher levels education also likely greater cognitive engagement making difficult determine whether either factor factors causal rolequestion 2what factors associated reduction risk cognitive decline older adultscognition combination skills include attention learning memory language visuospatial skills executive function decision making goal setting planning judgment decline cognition ranges severe dementia alzheimer disease mild cognitive impairment agerelated cognitive decline cognitive decline multicausal mild cognitive impairment always progress dementia moreover functional cognitive decline moderately associated pathologic changes typical alzheimer disease idea cognitive reserve minds resilience neuropathologic damage brain explains variances ability cope physiologically mentally existing pathology despite hopeful insights provided concept issues complicate attempts design robust studies determine factors might prevent cognitive declinewhat knowfor factors existing studies either show association cognitive decline provide inconclusive evidence association seen overall quality evidence lownutritional dietary factorsthe available evidence support clear role nutritional dietary factors examined consistent evidence available longerchain 3 fatty acids often measured fish consumption several longitudinal studies showing association reduced risk cognitive decline factors evidence varies consistent association vitamin b vitamin e vitamin c folate carotene limited evidence suggesting possible protective effect low saturated fat high vegetable intakemedical factorsseveral cardiovascular risk factors consistently associated increased risk cognitive decline high blood pressure consistently associated cognitive decline particularly severe cognitive decline diabetes also associated increased risk cognitive decline association modest less consistent metabolic syndrome cluster metabolic abnormalities consistently associated modest risk cognitive decline medical factors goodquality studies lacking example sleep apnea traumatic brain injury findings inconclusive example obesitypsychological emotional healthdepression depressive symptoms consistently found associated mild cognitive impairment cognitive declinemedicationsno consistent epidemiologic evidence exists association statins antihypertensive medications antiinflammatory drugs data insufficient comment cholinesterase inhibitors existing reports difficult interpret variation formulations dosage duration route administration postmenopausal estrogens drug treatment effect example antihypertensive medicationssocioeconomic factorschildhood socioeconomic status cognitive milieu seem strongly influence cognitive decline later life evidence putative association years education cognitive decline inconsistentsocial cognitive engagementwhereas findings association cognitive decline living alone without partner inconsistent robust association exists loss spouse cognitive decline limited inconsistent evidence suggests