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O4‐04‐06: Prevention of dementia by intensive vascular care: PreDIVA
Author(s) -
Richard Edo,
Moll van Charante Eric P.,
Achthoven Lenny,
Vermeulen Marinus,
Van Gool Willem A.
Publication year - 2009
Publication title -
alzheimer's and dementia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 6.713
H-Index - 118
eISSN - 1552-5279
pISSN - 1552-5260
DOI - 10.1016/j.jalz.2009.05.545
Subject(s) - medicine , dementia , overweight , vascular dementia , incidence (geometry) , diabetes mellitus , blood pressure , physical therapy , obesity , physics , disease , optics , endocrinology
Background: Cardiovascular risk factors are associated with an increased risk of dementia. Treatment of hypertension and hypercholesterolemia is associated with a decreased incidence of dementia. Whether interventions aimed at cardiovascular risk factors in elderly reduce dementia risk is currently unknown. Prospective studies investigating whether thorough, multi-component vascular care in the elderly can decrease incident dementia are lacking so far. Methods: This study is designed as a large cluster-randomized trial with a 6-year follow-up in 3700 non-demented elderly subjects (70 to 78 y) to assess whether nurse-led intensive vascular care in primary care decreases the incidence of dementia and reduces disability. Primary outcomes are incident dementia and disability measured with the AMC Linear Disability Scale (ALDS). Secondary outcome parameters are mortality, incidence of vascular events, and cognitive functioning. Intensive vascular care comprises treatment of hypertension, hypercholesterolemia and diabetes according to strict guidelines and reducing overweight, smoking cessation, and stimulating physical exercise, in 4-monthly visits to a practice nurse. Statistical analysis is based on estimates of cumulative dementia incidence according to the Kaplan-Meier method. Results: Inclusion of 3700 patients was finished in early 2009. Baseline data show that 87% of the community-dwelling elderly have 1 or more cardiovascular risk factors and 44% have even 2 or more risk factors amenable to treatment. Systolic hypertension is present in 75% of the subjects and 79% of the subjects receiving antihypertensive medication still have a systolic pressure of >140 mm Hg, illustrating insufficient treatment. Hypercholesterolemia is present in more than 25%, as is serious overweight. Conclusions: In community-dwelling non-demented elderly patients, a very high percentage of subjects with cardiovascular risk factors are undertreated, in spite of clear guidelines for vascular risk management. This illustrates the large window of opportunity for the multi-component intervention aimed at cardiovascular risk factors as performed in this trial, which will hopefully lead to a decrease of incident dementia, in addition to the decrease in cardiovascular events. The execution of the trial in primary care according to cardiovascular management guidelines of primary care will lead to a high external validity of the results of this trial.