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Cited by 482Dementia and Cognitive Impairment ResearchAlzheimer's disease research and treatmentsMenopause: Health Impacts and Treatments

Evidence-based prevention of Alzheimer's disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials

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Yu, Jin-Tai, Xu, Wei, Tan, Chen-Chen, Andrieu, Sandrine, Suckling, John, Evangelou, Evangelos, Pan, An, Zhang, Can +17 more·2020·Journal of Neurology, Neurosurgery & Psychiatry
DOI 10.1136/jnnp-2019-321913PMC PMC7569385
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Abstract

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.

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  • Lifestyle is an important risk factor, where intellectual, physical, and social activities, as well as diet, may help to prevent Alzheimer's disease.

    “Thus, lifestyle is also an important risk factor, where intellectual, physical, and social activities, as well as diet, may help to prevent AD [1,22,100,101,102,103].”

    From Alzheimer's Disease: Treatment Strategies and Their Limitations. (2022) · cites this paper as [102]

    The Results (Table 1; page not provided) recommend physical exercise and mentally stimulating activities for AD prevention, and the Discussion identifies healthy lifestyle as important. The paper mentions caloric intake for weight management and lists vitamin C among factors with weaker evidence, but it does not establish a general preventive benefit of diet. Its Future research section raises uncertainty about social isolation rather than recommending social activities to prevent AD. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Part of the risk factors for cardiovascular disease are in common with Alzheimer's disease, including hypertension, dyslipidemia, diabetes, obesity, dietary factors, smoking, and physical activity.

    “This could explain why part of the risk factors for cardiovascular disease are in common with AD, including hypertension, dyslipidemia, diabetes, obesity, dietary factors, smoking, and physical activity (Figure 1B).”

    From Alzheimer's Disease: Treatment Strategies and Their Limitations. (2022) · cites this paper as [102]

    The Results (Figure 5) identify hypertension, diabetes, midlife obesity, physical exercise, and smoking as factors relevant to Alzheimer’s disease prevention. The passages do not establish dyslipidemia or dietary factors as Alzheimer’s disease risk factors, so they do not support the full list of shared cardiovascular and Alzheimer’s risk factors. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • A history of head trauma and hearing loss may favor the onset of Alzheimer's disease.

    “A history of head trauma and hearing loss may favor the onset of AD [3,102,116].”

    From Alzheimer's Disease: Treatment Strategies and Their Limitations. (2022) · cites this paper as [102]

    The Results recommend protecting the head from injuries, and the Conclusions identify head trauma as an Alzheimer’s disease risk factor, supporting that part of the claim. The passages from our copy do not identify hearing loss as a risk factor; a search for hearing loss found no passage supporting that part. (LLM, conf=0.86)

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Cites

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Cited by

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Authors
Yu, J.-T., Xu, W., Tan, C.-C., Andrieu, S., Suckling, J., Evangelou, E., Pan, A., Zhang, C., Jia, J., Feng, L., Kua, E.-H., Wang, Y.-J., Wang, H.-F., Tan, M.-S., Li, J.-Q., Hou, X.-H., Wan, Y., Tan, L., Mok, V., Tan, L., Dong, Q., Touchon, J., Gauthier, S., Aisen, P. S., & Vellas, B.
Affiliations
  • Shanghai Medical College of Fudan University (CN)
  • Qingdao University (CN)
  • Université Toulouse III - Paul Sabatier (FR)
  • Huazhong University of Science and Technology (CN)
  • Harvard University (US)
  • Capital Medical University (CN)
  • National University of Singapore (SG)
  • Army Medical University (CN)
  • Chinese University of Hong Kong (HK)
  • Centre Hospitalier Universitaire de Montpellier (FR)
  • McGill University (CA)
  • University of Southern California (US)
  • Hôpital Purpan (FR)
Corresponding author
Yu, Jin-Tai
ORCID
Venue
Journal of Neurology, Neurosurgery & Psychiatry
Publisher
BMJ
Published
2020-07-20
Volume
91
Issue
11
Pages
1201-1209
ISSN
  • 0022-3050 (ISSN-L)
  • 1468-330X
DOI
10.1136/jnnp-2019-321913
PMC
PMC7569385
OpenAlex
W2974979378
Cited by
482
References
14
Citations by year
2026: 39 · 2025: 84 · 2024: 94 · 2023: 94 · 2022: 85 · 2021: 75 · 2020: 10
FWCI
11.01
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Neurology Neurosurgery & Psychiatry (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • HAL (submittedVersion, cc-by-nc)
  • HighWire Press Open Archive (submittedVersion)
  • Apollo (University of Cambridge) (submittedVersion, cc-by-nc)
  • Apollo
Funders
  • Alzheimer's Association
  • Eli Lilly and Company
  • Sanofi
  • Biogen
  • Les Laboratories Pierre Fabre
  • TauRx Pharmaceuticals
  • Eisai
  • Servier
  • H. Lundbeck A/S
  • Ipsen
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Menopause: Health Impacts and Treatments
Keywords
Alzheimer's disease, dementia prevention, modifiable risk factors, cognitive activity, hyperhomocysteinemia, depression, stress, diabetes mellitus, head trauma, hypertension, obesity, physical activity, smoking, sleep, cerebrovascular disease, frailty, atrial fibrillation, vitamin C, estrogen replacement therapy, acetylcholinesterase inhibitors, evidence-based recommendations
MeSH terms
Alzheimer Disease, Antihypertensive Agents, Cognition, Depression, Diabetes Mellitus, Education, Craniocerebral Trauma, Humans, Hypertension, Hypotension, Orthostatic, Life Style, Obesity, Stress, Psychological, Exercise, Randomized Controlled Trials as Topic, Evidence-Based Medicine, Hyperhomocysteinemia, Risk Reduction Behavior, Observational Studies as Topic

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