Commentary on “Lowering the risk of Alzheimer's disease: Evidence‐based practices emerge from new research.” Prevention of Alzheimer disease

s P s I s p g c t b a i r r o s i It has been an extraordinarily productive decade for lzheimer Disease (AD) research in many fields ranging rom molecular genetics, neurophysiology and brain imagng, to clinical and epidemiologic studies. In 1997, a review of the current state of the art concluded hat only age and family history could be considered as risk actors for AD with any degree of certainty [1]. Now, as the eview by Jedrziewski et al shows [2], many potential risk actors for AD have been identified, and at least some of hese could be the target for prevention strategies. Two articularly interesting areas not completely addressed in his survey are the rather remarkable and apparent associaion between well-known cardiovascular risk factors, hyperension, diabetes, the metabolic syndrome, and AD risk [3] nd newer studies suggesting a link between stress and AD 4]. Given the enormous and growing burden to society that D represents, both within United States as well as gloally, the idea that there may be available prevention stratgies is a very exciting one. The authors of this survey are, however, suitably cauious in their conclusions emphasizing the need for more esearch before identifying definitive prevention practices nd raise a number of methodologic issues. Some of the problems in interpretation and analysis are xemplified in the survey. For example, the review of indiidual risk factors includes results using different outcomes, e, AD, dementia, and cognitive decline. Although AD pahology is a major cause of dementia and cognitive decline, t is not the only one, particularly in the case of cognitive ecline. So grouping results using these outcomes may lead o somewhat erroneous conclusions regarding the strength f the association specifically with AD. The survey also