Dementia (Including Alzheimer’s Disease)can be Prevented: Statement Supported byInternational ExpertsOn the occasion of the G8 dementia summit inLondon on 11 December 2013, we call upon the gov-ernments of the G8 countries to makeprevention ofdementiaone of their major health aims.•The commonest dementia (Alzheimer’s disease)is irreversible and develops slowly over manyyears.•So far drugs have only relieved symptoms,but have not been effective against diseaseprogression.•About half of the large decline in deaths from heartdisease and stroke over the past 50 years has beenthe result of public health measures to modify riskfactors.We are conﬁdent that the same approachwill work for dementia.•We propose that a concerted effort be made todiscover modiﬁable risk factors for dementia andto exploit those already identiﬁed.•International collaboration is needed on large-scale clinical trials to test whether modifying riskfactors will lead to prevention of dementia.•Health authorities should aim to identify high riskindividuals at an early stage, when intervention ismore likely to help.•There is already sufﬁcient evidence to justifyimmediate action.Trials in those at risk of devel-oping dementia should be done of the following:exercise; controlling blood sugar, including dia-betes treatment; depression treatment; high bloodpressure treatment; B vitamins; omega-3 fattyacids; cognitive training; and social activities.•Public health policies should encourage middle-aged people to stop smoking; exercise; eatdiets rich in fruit and vegetables and ﬁsh(Mediterranean foods); avoid becoming obese anddiabetic; avoid excessive alcohol intake; treat highblood pressure. In other words –tell people thatadopting a healthy lifestyle may help to ward offdementia as it does for other diseases.It is notable that the prevalence of dementia andcognitive impairment in some Western countriesis now less than anticipated, possibly as a resultof changes in lifestyle and the reduction in car-diovascular risk factors, although this may notnecessarily mean that worldwide trends in theburden of dementia will be substantially reduced.We estimate that about half of Alzheimer’s dis-ease cases worldwide might be attributable toknown risk factors. Taking immediate action onthe known risk factors could perhaps prevent upto one-ﬁfth of predicted new cases by 2025.The worldwide costs of dementia in 2010 havebeen estimated to be $604 billion, most of it in G8countries. Prevention of dementia would thus notonly prevent a lot of human suffering but wouldsave huge sums of money.We call upon the Health Ministers of the G8 coun-tries to greatly increase government funding forresearch on the prevention of dementia.

J Avila (Centro de Biologia Molecular Severo Ochoa,Madrid)S Banerjee (University of Sussex, Brighton)DE Barnes (University of California, San Francisco)MS Beeri (Mount Sinai School of Medicine,New York)DA Bennett (Rush University Medical Center,Chicago)S Black (University of Toronto)C Brayne (University of Cambridge)J Breitner (McGill University, Montreal)M Breteler (German Center for NeurodegenerativeDiseases, Bonn)H Brodaty (University of New South Wales, Sydney)C Chen (National University of Singapore)MJ Chiu (President Taiwan Alzheimer’s Association,National Taiwan University, Taipei)M Combrinck (University of Cape Town)CW Cotman (University of California, Irvine)P Davies (Feinstein Institute, New York)C deCarli (University of California Davis, Sacramento)IV Damulin (I.M. Sechenov First Moscow StateMedical University, Moscow)P Dal-Bianco (Medical University of Vienna)J de la Torre (University of Texas, Austin)A de Silva (University of Kelaniya, Colombo,Sri Lanka)B De Strooper (Catholic University of Leuven)B Dubois (University of Paris VI)K Engedal (University of Oslo)S Engelborghs (University of Antwerp)MM Esiri (University of Oxford)RM Faull (University of Auckland)AM Fjell (University of Oslo)L Flicker (University of Western Australia, Perth)A Fl� el (Charit´ -Universit� tsmedizin, Berlin)oeaO Forlenza (University of Sao Paulo, Brazil)L Fratiglioni (Karolinska Institute, Stockholm)GB Frisoni (University of Geneva and IRCCSFatebenefratelli, Brescia)S Gauthier (McGill University, Montreal)S.I. Gavrilova (Mental Health Research Center RAMS,Moscow)H Hampel (Pierre and Marie Curie University, Paris)H Hendrie (Indiana University, Indianapolis)T Iwatsubo (University of Tokyo)R Jacoby (University of Oxford)J Jia (Beijing Capital Medical University)KA Jellinger (Medical University of Vienna)RN Kalaria (University of Newcastle, UK)ZS Khachaturian (The Campaign to PreventAlzheimer’s Disease by 2020, Potomac, MD)

M Kivipelto (Karolinska Institute, Stockholm)D Knopman (Mayo Clinic, Rochester, MN)T Kwok (Chinese University, Hong Kong)K Langa (University of Michigan, Ann Arbor)EB Larson (University of Washington, Seattle)L Launer (National Institute on Aging, Bethesda, MD)N Lautenschlager (University of Melbourne)BA Lawlor (Trinity College, Dublin)J Lindesay (University of Leicester, UK)A Lobo (University of Zaragoza, Spain)J L� kk (Karolinska Institute, Stockholm)oO Makeeva (Russian Academy of Medical Sciences,Tomsk)J Marksteiner (President, Austrian AlzheimerSociety)A McCaddon (Cardiff University Medical School)K Meguro (Tohoku University, Sendai, Japan)LT Middleton (Imperial College, London)MC Morris (Rush University, Chicago)DL Na (Sungkyunkwan University School ofMedicine, Seoul)MWS Nasrun (Indonesian Alzheimer Association,Universitas Indonesia, Jakarta)A Ogunniyi (University College Hospital, Ibadan,NigeriaS Pendelbury (Oxford NIHR Biomedical ResearchCentre)G Perry (University of Texas, San Antonio)RC Petersen (Mayo Clinic, Rochester, MN)VP Puzyrev (Institute of Medical Genetics, SB RAMS,Tomsk, Russia)G Rebok (Johns Hopkins University, Baltimore, MD)G Rees (CEO, Alzheimer’s Australia)H Refsum (University of Oslo)E Reynolds (King’s College, London)E Richard (University of Amsterdam)J Rinne (University of Turku, Finland)K Ritchie (INSERM, Montpellier)WA Rocca (Mayo Clinic, Rochester, MN)IH Rosenberg (Tufts University, Boston)PS Sachdev (University of New South Wales)N Scarmeas (Columbia University New York andUniversity of Athens)S Scarpa (University of Rome La Sapienza)R Schmidt (Medical University, Graz, Austria)P Scheltens (VU University Medical Center,Amsterdam)S Seshadri (Boston University)A Singh-Manoux (INSERM, Villejuif)I Skoog (University of Gothenburg)T Sobow (Medical University of Lodz, Poland)R Sperling (Harvard University, Boston)

P Srisuwan (Phramongkutklao Hospital and Collegeof Medicine, Bangkok)R Stewart (Institute of Psychiatry, London)DY Suharya (Executive Director, Alzheimer’sIndonesia)M Tripathi (All India Institute of Medical Sciences,New Delhi)AM Troen (Hebrew University of Jerusalem, Israel)J Trojanowski (University of Pennsylvania,Philadelphia)SJ van Rensburg (University of Stellenbosch,South Africa)B Vellas (University of Toulouse)G Waldemar (Director, Danish Dementia ResearchCentre, University of Copenhagen)H Wang (Peking University Institute of Mental Health)JZ Wang (Tongji Medical College, HUST, Wuhan,P.R. China)M Weiner (University of California, San Francisco)LJ Whalley (University Aberdeen, Scotland)LR White (Honolulu-Asia Aging Study, ChaminadeUniversity, Hawaii)PJ Whitehouse (Case Western Reserve University,Cleveland, OH)R Whitmer (Kaiser Permanente, Oakland, California)A Wimo (Karolinska Institute, Stockholm)R Wurtman (MIT, Cambridge, Mass)S-Y Yoon (University of Ulsan College of Medicine,Seoul)VV Zakharov (I.M. Sechenov First Moscow StateMedical University, Moscow)NG Zhukova (Siberian State Medical University,Tomsk)IA Zhukova (Siberian State Medical University,Tomsk)Some selected references to recent relevant literatureare:

Designing prevention programmes to reduce inci-

dence of dementia: Prospective cohort study of

modiﬁable risk factors.

Ritchie, K., I. Carriere, C. W. Ritchie, C. Berr, S.Artero and M. L. Ancelin.Bmj(2010) 341: c3885.

The projected effect of risk factor reduction on

Alzheimer’s disease prevalence.

Barnes, D. E. and K. Yaffe.Lancet Neurol(2011)10:819-828.

Creating a transatlantic research enterprise for

preventing Alzheimer’s disease.

Khachaturian, Z. S., et al.Alzheimers Dement(2009) 5:361-366.

Prevent Alzheimer’s disease by 2020: A national

strategic goal.

Khachaturian, Z. S. and A. S. Khachaturian.Alzheimers Dement(2009) 5:81-84.

Developing a global strategy to prevent Alzheimer’s

disease: Leon Thal Symposium 2010.

Khachaturian, Z. S., et al.Alzheimers Dement(2011) 7:127-132.

Efﬁcacy of Souvenaid in mild Alzheimer’s disease:

Results from a randomized, controlled trial.

Scheltens, P., et al.J Alzheimers Dis(2012)31:225-236.

Mediterranean diet, cognitive function, and demen-

tia: A systematic review.

Lourida, I., M. Soni, J. Thompson-Coon, N.Purandare, I. A. Lang, O. C. Ukoumunne and D. J.Llewellyn.Epidemiology(2013) 24:479-489.

Can we prevent Alzheimer’s disease? Secondary

“prevention” trials in Alzheimer’s disease.

Carrillo, M. C., H. R. Brashear, V. Logovinsky, J.M. Ryan, H. H. Feldman, E. R. Siemers, S. Abushakra,D. M. Hartley, R. C. Petersen, A. S. Khachaturianand R. A. Sperling.Alzheimer’s Dementia(2013)9:123-131.e121.

Midlife risk score for the prediction of dementia

four decades later.

Exalto, L. G., C. P. Quesenberry, D. Barnes,M. Kivipelto, G. J. Biessels and R. A. Whitmer.Alzheimers Dement(2013), doi: 10.1016/j.jalz.2013.05.1772

Long-chain omega-3 fatty acids improve brain

function and structure in older adults.

Witte, A. V., L. Kerti, H. M. Hermannstadter, J. B.Fiebach, S. J. Schreiber, J. P. Schuchardt, A. Hahnand A. Floel.Cereb Cortex(2013), doi: 10.1093/cer-cor/bht163.

Preventing Alzheimer’s disease-related gray mat-

ter atrophy by B-vitamin treatment.

Douaud, G., H. Refsum, C. A. de Jager, R.Jacoby, T. E. Nichols, S. M. Smith and A. D.Smith.Proc Natl Acad Sci U S A(2013) 110:9523-9528.

Nonpharmacologic treatment and prevention

strategies for dementia.

Yaffe, K. and T. Hoang.Continuum (MinneapMinn)(2013) 19:372-381.

Trends in the prevalence and mortality of cognitive

impairment in the United States: is there evidence

of a compression of cognitive morbidity?

Langa, K. M., E. B. Larson, J. H. Karlawish, D. M.Cutler, M. U. Kabeto, S. Y. Kim and A. B. Rosen.Alzheimers Dement(2008) 4:134-144.

The effect of dementia trends and treatments on

longevity and disability: A simulation model based

on the MRC Cognitive Function and Ageing Study

(MRC CFAS).

Jagger, C., R. Matthews, J. Lindesay, T. Robinson,P. Croft and C. Brayne.Age Ageing(2009) 38:319-325.

Methodological challenges in designing dementia

prevention trials - the European Dementia Preven-

tion Initiative (EDPI).

Richard, E., S. Andrieu, A. Solomon, F. Man-gialasche, S. Ahtiluoto, E. P. Moll van Charante, N.Coley, L. Fratiglioni, A. S. Neely, B. Vellas, W. A. vanGool and M. Kivipelto.J Neurol Sci(2012) 322:64-70.

Trends in the incidence and prevalence of

Alzheimer’s disease, dementia, and cognitive

impairment in the United States.

Rocca, W. A., R. C. Petersen, D. Knopman, S.,L. E. Hebert, D. A. Evans, K. S. Hall, S. Gao, F. W.Unverzagt, K. M. Langa, E. B. Larson and L. White,R.Alzheimers Dement(2011) 7:80-93.

Is dementia incidence declining?: Trends in demen-

tia incidence since 1990 in the Rotterdam Study.

Schrijvers, E. M., B. F. Verhaaren, P. J. Koudstaal,A. Hofman, M. A. Ikram and M. M. Breteler.Neurol-ogy(2012) 78:1456-1463.

Twenty-year changes in dementia occurrence sug-

gest decreasing incidence in central Stockholm,

Sweden.

Qiu, C., E. von Strauss, L. Backman, B. Win-blad and L. Fratiglioni.Neurology(2013) 80:1888-1894.

A two-decade comparison of prevalence of demen-

tia in individuals aged 65 years and older from three

geographical areas of England: Results of the Cog-

nitive Function and Ageing Study I and II.

Matthews, F. E., A. Arthur, L. E. Barnes, J. Bond,C. Jagger, L. Robinson, C. Brayne, on behalf of theMedical Research Council Cognitive Function andAgeing Study.Lancet(2013) 382:1405-1412.

The worldwide economic impact of dementia 2010.

Wimo, A., L. Jonsson, J. Bond, M. Prince, B.Winblad.Alzheimers Dement(2013) 9:1-11 e13.

The global prevalence of dementia: A systematic

review and metaanalysis.

Prince, M., R. Bryce, E. Albanese, A. Wimo, W.Ribeiro and C. P. Ferri.Alzheimers Dement(2013)9:63-75 e62.

New insights into the dementia epidemic.

Larson, E. B., K. Yaffe and K. M. Langa.New EnglJ Med(2013), doi: 10.1056/NEJMp1311405.Some international and national initiatives

European Dementia Prevention Initiative:

http://www.edpi.org/

The Healthy Brain Initiative (CDC and

Alzheimer’s Association, USA):

http://www.cdc.gov/aging/healthybrain/roadmap.htm

OECD Global Challenge of Alzheimer’s disease:

http://www.oecd-ilibrary.org/science-and-technology/emerging-trends-in-biomedicine-and-health-technology-innovation 5k44zcpt65vc-en

A National Alzheimer’s Strategic Plan (Alzhei-

mer’s Association, 2009):

http://www.alz.org/documents/national/report asg alzplan.pdf

National Plan to Address Alzheimer’s Disease: 2013

update:

http://aspe.hhs.gov/daltcp/napa/NatlPlan2013.pdf

National dementia strategies for the UK

(Alzheimer’s Society):

http://www.alzheimers.org.uk/ndstrategies

UK Department of Health statement (Septem-

ber 2013):

http://dementiachallenge.dh.gov.uk/2013/09/25/on-the-road-to-the-g8-dementia-summit/

CONFLICT OF INTEREST STATEMENT

ADS is named as inventor on patents held bythe University of Oxford for the use of B vitamins