From Genes to Prevention: Epidemiology of Alzheimer's Disease. Colloquium of IPSEN Foundation May 25, Paris, France

In the next 50 years, Alzheimer’s disease (AD) is likely to become one of the world’s largest public health problems, second only to cancer, unless ways of preventing the disease or treating its preclinical stages are found. Prevention requires the early identification of likely sufferers and determination of the risks that predispose them to AD, information that comes only from large-scale and long-term studies of populations. The progress made in such epidemiological studies and the questions that remain to be answered were the topic of this year’s colloquium on Alzheimer’s disease, organized for Foundation IPSEN by Richard Mayeux (Columbia Univ., New York) and Yves Christen (Foundation IPSEN, Paris) and held in Paris on May 25, 1998. Unlike most of the IPSEN Alzheimer’s colloquia, which concentrate on the details of the disease mechanism, the focus of this discussion was the people who have or may develop AD and other dementias. Because of the problems of establishing a clear diagnosis of AD during life, much of the discussion dealt with dementia rather than specifically with AD, although most speakers considered about 80% of the cases in their samples to be AD. Population studies are essential for determining how best to provide for and treat sufferers in the future, but are also providing valuable pointers to the causes of dementia and in some cases even to potential treatments. Results are now available from several large long-term studies of populations in the USA and Europe, as well as some smaller comparisons of groups with different ethnic or cultural backgrounds. Although these studies are not directly comparable because of differing designs and criteria, they point inescapably to a large increase in the number of people with the disease as the population ages. As important as it is to observe who has the disease (prevalence) and who is getting it (incidence), the work has now moved into a more sophisticated analytical phase (Mayeux), revealing indicators of early disease, and genetic and environmental risk and protective factors. Perhaps more significant in the long term, the ground is being prepared for the time when preventive measures become available by opening up a debate on both the practical and ethical issues surCNS Drug Reviews Vol. 4, No. 2, pp. 196–200 © 1998 Neva Press, Branford, Connecticut