Considerations for the Design of a Systematic Review of Interventions for Preventing Clinical Alzheimer's-Type Dementia, Mild Cognitive Impairment, and Age-Related Cognitive Decline Letter Report (2015) / Chapter Skim
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The Academi committe held a meeting on Dec T ies ee cember 15 a 16, 2015 to provide and 5, input on the prelimin nary key questions and a draft study design prepa ared by the M Minnesota Evidence e-based Prac ctice Center (EPC) , whic AHRQ co ( ch ontracted to cconduct the systematic review.1,2 During the meeting, th committee met in open session wi representatives from N 2 e he e n ith NIA, AHRQ, and the EPC to discuss th committe task and the design o the system a he ee's d of matic review w.
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PUTATIVE INTERVENTION TARGETS During the December 15 meeting, the EPC asked the Academies committee for advice on intervention targets to include in the search strategy. Box 1 provides a list of putative intervention target categories, along with specific examples.
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Provided below are framing remarks that inform the overall design of the KQs, followed by specific edits and comments on each question. The natural history that leads to Alzheimer's-type dementia could be summarized as follows: persons with normal cognition start developing deterioration in their cognitive performance of slow onset and progression.
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changes in cognitive performance and incident dementia. Search terms could include cognition, cognitive, dementia, Alzheimer's, age associated cognitive decline, age associated cognitive impairment, subjective cognitive decline, cognitive impairment no dementia, cognitive impairment without dementia.
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We expect that few studies have attempted this, but believe it is a design issue worth noting. 3 The underlined text is used to indicate additions to the preliminary key questions provided by the Evidence-based Practice Center and strikethrough is used to indicate deletions.
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Response: Yes, that would be important to report when available. Regarding baseline values, it would be good to include the studies, describe the population, and code in a manner relevant to the risk factor (e.g., deficient or normal; sedentary, low physical activity, high physical activity; clinically diagnosed condition or not; never smokers, ex-smokers, current smokers)
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A common interaction that might be addressed in the literature is that of APOE e4 and a certain intervention. For example, a study found that cognitive and functional improvements in response to the drug rosiglitazone were only seen in patients with Alzheimer's disease who were APOE e4 negative.7 A pilot study reports preliminary data that metformin may be efficacious in preventing cognitive decline among persons who are also APOE e4 negative.8 Another recent study explores the interactions between APOE e4 status and a number of risk factors and interventions.9 7.
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This is consistent with our recommendation that KQ4 should not be a stand-alone emphasis of the report. A number of Phase III intervention studies, for example, used biomarkers as key secondary outcomes with respect to a health outcome, such as slowing of cognitive decline in MCI or mild Alzheimer's disease, and these will be informative.
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