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The clinical practice of risk reduction for Alzheimer's disease: A precision medicine approach
Author(s) -
Isaacson Richard S.,
Ganzer Christine A.,
Hristov Hollie,
Hackett Katherine,
Caesar Emily,
Cohen Randy,
Kachko Robert,
MeléndezCabrero Josefina,
Rahman Aneela,
Scheyer Olivia,
Hwang Mu Ji,
Berkowitz Cara,
Hendrix Suzanne,
Mureb Monica,
Schelke Matthew W.,
Mosconi Lisa,
Seifan Alon,
Krikorian Robert
Publication year - 2018
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.2018.08.004
Subject(s) - medicine , psychological intervention , disease , clinical trial , randomized controlled trial , precision medicine , clinical practice , alzheimer's disease , cohort , intensive care medicine , medline , physical therapy , pathology , psychiatry , political science , law
Like virtually all age‐related chronic diseases, late‐onset Alzheimer's disease (AD) develops over an extended preclinical period and is associated with modifiable lifestyle and environmental factors. We hypothesize that multimodal interventions that address many risk factors simultaneously and are individually tailored to patients may help reduce AD risk. We describe a novel clinical methodology used to evaluate and treat patients at two Alzheimer's Prevention Clinics. The framework applies evidence‐based principles of clinical precision medicine to tailor individualized recommendations, follow patients longitudinally to continually refine the interventions, and evaluate N‐of‐1 effectiveness (trial registered at ClinicalTrials.gov NCT03687710). Prior preliminary results suggest that the clinical practice of AD risk reduction is feasible, with measurable improvements in cognition and biomarkers of AD risk. We propose using these early findings as a foundation to evaluate the comparative effectiveness of personalized risk management within an international network of clinician researchers in a cohort study possibly leading to a randomized controlled trial.