The National Academies Press

Currently Skimming:

1 Introduction
Pages 17-36

The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.

From page 17... ... initiated this study with the National Academies of Sciences, Engineering, and Medicine to take stock of the current state of knowledge on interventions for preventing cognitive decline and dementia, to help shape the messages NIA conveys to the broader public about these conditions, and to inform future actions and research in this area. The task for the committee charged with carrying out this study was to evaluate the existing evidence on interventions for preventing cognitive decline and dementia and, based on this evidence, to recommend the appropriate content for inclusion in public health messages, as well as priorities for future prevention research. Read the entire page →
From page 18... ... An earlier AHRQ systematic review on this subject (Williams et al., 2010) , published in 2010, concluded that there was insufficient evidence to make recommendations about interventions to prevent cognitive decline and dementia. Read the entire page →
From page 19... ... . This report incorporates the most recent evidence from a rapidly evolving field and stands out as uniquely focused on applying AHRQ's highly refined systematic review process to assess what evidence is available on the effectiveness of interventions themselves -- as opposed to focusing on potentially modifiable risk factors -- and examining how that evidence might serve as a basis for public health messaging. Read the entire page →
From page 20... ... Furthermore, the committee's task was to offer recommendations as to what can appropriately be communicated to members of the public, who generally are interested in staying cognitively healthy as they age and are unlikely to make the distinctions that are used in research. When describing the overall goal addressed by this study, instead of specifying particular conditions or listing all relevant conditions repeatedly, the committee uses the shorthand umbrella term preventing cognitive decline and dementia. Read the entire page →
From page 21... ... Finally, the term observational study refers to a nonexperi mental study design, that is, a design that does not use random assignment to an intervention (Concato et al., 2000) Read the entire page →
From page 22... ... . Similarly, the Framingham Heart Study, a longitudinal cohort study, reported a 20 percent decline in dementia incidence between 1997 and 2008 even as body mass index, diabetes prevalence, and population age increased (Satizabal et al., 2016) Read the entire page →
From page 23... ... . Population-based estimates of the percentage of Alzheimer's cases attributable to a given factor suggest that seven potentially modifiable risk factors -- diabetes, midlife hypertension, midlife obesity, insufficient physical activity, depression, smoking, and low educational attainment -- may account for about one-third of cases in the United States and Europe. Read the entire page →
From page 24... ... Also in accordance with the statement of task, interventions targeting stroke risk factors were given particular attention since they may contribute to CATD, and conditions that coexist with CATD as components of mixed dementia, such as vascular contributions to dementia, were included within the study scope. However, cognitive impairment that is likely to be caused solely by vascular disease (pure vascular dementia) Read the entire page →
From page 25... ... Based on the AHRQ systematic review and additional expert and public input, the committee will assess the quality of existing evidence and develop a short report that makes recommendations to inform the development of public health strategies and messaging (i.e., which preventive factors and inter ventions are supported by sufficient evidence to be incorporated into public health strategies and messages) and recommendations for future research. Read the entire page →
From page 26... ... AHRQ Systematic Review Design The AHRQ systematic review represents the most up-to-date and thorough review of the RCT evidence available. The review relied primarily on RCTs with a minimum 6-month follow-up period for intermediate outcomes; large prospective quasi-experimental cohort studies with comparator arms (n ≥250 per arm) Read the entire page →
From page 27... ... Examples of challenges that limit the strength of the evidence generated by existing studies include initiation of interventions at later life stages that may be 2 More detailed information on the instrument used to assess risk of bias can be found in Appendix B of the 2017 AHRQ systematic review, Interventions to prevent age-related cognitive decline, mild cognitive impairment, and clinical Alzheimer's-type dementia (Kane et al., 2017) (see Appendix A) Read the entire page →
From page 28... ... Eligible studies included randomized and non randomized controlled trials and quasi-experimental observational studies published to September 2016, enrolling people with normal cognition and/or MCI. The Evidence-based Practice Center extracted data, assessed risk of bias, summarized results for studies without high risk of bias, and evaluated the strength of evidence for studies with sufficient sample size. Read the entire page →
From page 29... ... For KQ3: Adults with normal or abnormal cog nition who have had testing such as cognitive tests, blood/CSF testing, or brain imaging used in intervention studies in KQ1 or KQ2. Study Objective For KQ1: To test the efficacy, comparative effec tiveness, and harms of interventions to prevent, delay, or slow cognitive decline, onset of MCI, or clinical Alzheimer's-type dementia. Read the entire page →
From page 30... ... . Use of Supplemental Evidence Acknowledging the limitations of the evidence examined in the AHRQ systematic review, the committee supplemented that evidence by applying the judgment and expertise of its members to incorporate, when appropriate, information from a variety of other sources in developing the recommendations presented in this report. Read the entire page →
From page 31... ... , but this lack may never be remedied by studies that meet the evidence criteria of the AHRQ systematic review. REPORT ORGANIZATION This report is divided into four chapters. Read the entire page →
From page 32... ... 2015. Target risk factors for dementia prevention: A systematic review and Delphi consensus study on the evidence from observational studies. Read the entire page →
From page 33... ... 2017. Interventions to prevent age-related cognitive decline, mild cognitive impairment, and clinical Alzheimer's-type dementia. Read the entire page →
From page 34... ... 2015. 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. Read the entire page →
From page 35... ... 2012. Assessing the risk of bias of individual studies in systematic reviews of health care inter ventions. Read the entire page →

From page 17...

... initiated this study with the National Academies of Sciences, Engineering, and Medicine to take stock of the current state of knowledge on interventions for preventing cognitive decline and dementia, to help shape the messages NIA conveys to the broader public about these conditions, and to inform future actions and research in this area. The task for the committee charged with carrying out this study was to evaluate the existing evidence on interventions for preventing cognitive decline and dementia and, based on this evidence, to recommend the appropriate content for inclusion in public health messages, as well as priorities for future prevention research.

1 Introduction Pages 17-36

1 Introduction
Pages 17-36