Prevention of Alzheimer's disease: where we stand

Alzheimer's disease has been recognized as a major public health issue that will grow in prominence as life expectancy increases and as the shape of population demographics shifts toward expansion in the older age ranges with contraction in younger ages. The magnitude of the problem can be expressed in incidence, prevalence economics, and quality of life. Great strides have been made in understanding and treating this disease, but current clinical management is far from satisfactory and progression seems inevitable once the disease is diagnosed. Such forces in any disease encourage intervention strategies to move from treatment to prevention. However, this vision can only be met with reasonable success when pathology is understood and there is evidence that manipulation of that pathology leads to clinical benefit. This is the challenge that lies ahead to achieve the goal of prevention of Alzheimer's disease. This review begins by examining the progress that has been made in this disease. Current efforts to develop prevention strategies are described and possible agents for future evaluation are discussed.