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Individualized clinical management of patients at risk for Alzheimer's dementia
Author(s) -
Isaacson Richard S.,
Hristov Hollie,
Saif Nabeel,
Hackett Katherine,
Hendrix Suzanne,
Melendez Juan,
Safdieh Joseph,
Fink Matthew,
Thambisetty Madhav,
Sadek George,
Bellara Sonia,
Lee Paige,
Berkowitz Cara,
Rahman Aneela,
MeléndezCabrero Josefina,
Caesar Emily,
Cohen Randy,
Lu Peilin,
Dickson Samuel P.,
Hwang Mu Ji,
Scheyer Olivia,
Mureb Monica,
Schelke Matthew W.,
Niotis Kellyann,
Greer Christine E.,
Attia Peter,
Mosconi Lisa,
Krikorian Robert
Publication year - 2019
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.2019.08.198
Subject(s) - dementia , medicine , cognitive decline , psychological intervention , alzheimer's disease , cognition , disease , risk factor , physical therapy , psychiatry
Multidomain intervention for Alzheimer's disease (AD) risk reduction is an emerging therapeutic paradigm. Methods Patients were prescribed individually tailored interventions (education/pharmacologic/nonpharmacologic) and rated on compliance. Normal cognition/subjective cognitive decline/preclinical AD was classified as Prevention. Mild cognitive impairment due to AD/mild‐AD was classified as Early Treatment. Change from baseline to 18 months on the modified Alzheimer's Prevention Cognitive Composite (primary outcome) was compared against matched historical control cohorts. Cognitive aging composite (CogAging), AD/cardiovascular risk scales, and serum biomarkers were secondary outcomes. Results One hundred seventy‐four were assigned interventions (age 25–86). Higher‐compliance Prevention improved more than both historical cohorts ( P = .0012, P < .0001). Lower‐compliance Prevention also improved more than both historical cohorts ( P = .0088, P < .0055). Higher‐compliance Early Treatment improved more than lower compliance ( P = .0007). Higher‐compliance Early Treatment improved more than historical cohorts ( P < .0001, P = .0428). Lower‐compliance Early Treatment did not differ ( P = .9820, P = .1115). Similar effects occurred for CogAging. AD/cardiovascular risk scales and serum biomarkers improved. Discussion Individualized multidomain interventions may improve cognition and reduce AD/cardiovascular risk scores in patients at‐risk for AD dementia.