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From: NIH news releases and news items [mailto:[log in to unmask]] On
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Sent: Wednesday, April 28, 2010 3:07 PM
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Subject: INDEPENDENT PANEL FINDS INSUFFICIENT EVIDENCE TO SUPPORT PREVENTIVE
MEASURES FOR ALZHEIMER'S DISEASE
U.S. Department of Health and Human Services
NATIONAL INSTITUTES OF HEALTH NIH News
NIH Office of the Director (OD) <http://www.nih.gov/icd/od/>
Office of Medical Applications of Research (OMAR)
<http://prevention.nih.gov/omar/>
For Immediate Release: Wednesday, April 28, 2010
CONTACT: Lisa Ahramjian, 301-496-4999, <e-mail: [log in to unmask]>
INDEPENDENT PANEL FINDS INSUFFICIENT EVIDENCE TO SUPPORT PREVENTIVE MEASURES
FOR ALZHEIMER'S DISEASE
Many preventive measures for cognitive decline and for preventing
Alzheimer's disease -- mental stimulation, exercise, and a variety of
dietary supplements -- have been studied over the years. However, an
independent panel convened this week by the National Institutes of Health
determined that the value of these strategies for delaying the onset and/or
reducing the severity of decline or disease hasn't been demonstrated in
rigorous studies.
"Alzheimer's disease is a feared and heart-breaking disease," said Dr.
Martha L. Daviglus, conference panel chair and professor of preventive
medicine and medicine at Northwestern University, Chicago. "We wish we
could tell people that taking a pill or doing a puzzle every day would
prevent this terrible disease, but current evidence doesn't support this."
The panel's assessment of the available evidence revealed that progress to
understand how the onset of these conditions might be delayed or prevented
is limited by inconsistent definitions of what constitutes Alzheimer's
disease and cognitive decline. Other factors include incomplete
understanding of the natural history of the disease and limited
understanding of the aging process in general. The panel recommended that
the research community and clinicians collaborate to develop, test, and
uniformly adopt objective measures of baseline cognitive function and
changes over time.
Although many non-modifiable risk factors have been examined, age is the
strongest known risk factor for Alzheimer's disease. Additionally, a genetic
variant of a cholesterol-ferrying protein (apolipoprotein E), has strong
evidence of association with the risk for developing Alzheimer's disease.
Although it is hoped that improved understanding of genetic risk factors may
ultimately lead to effective therapies, currently these associations are
primarily useful in the clinical research setting.
The panel determined that there is currently no evidence of even moderate
scientific quality supporting the association of any modifiable
factor-dietary supplement intake, use of prescription or non-prescription
drugs, diet, exercise, and social engagement-with reduced risk of
Alzheimer's disease. The evidence surrounding risk reduction for cognitive
decline is similarly limited. Low-grade evidence shows weak associations
between many lifestyle choices and reduced risk of Alzheimer's disease and
cognitive decline.
Although there is little evidence that these interventions lessen cognitive
decline, some are not necessarily harmful and may confer other benefits.
However, the panel also emphasized the need for enhanced public
understanding that these proposed prevention strategies are currently, at
best, only loosely associated with improved outcomes. This means that
carefully-designed randomized studies may reveal that these modifiable
factors enhance, detract, or have no effect on preventing Alzheimer's
disease and cognitive decline.
"These associations are examples of the classic chicken or the egg quandary.
Are people able to stay mentally sharp over time because they are physically
active and socially engaged or are they simply more likely to stay
physically active and socially engaged because they are mentally sharp?"
added Dr. Daviglus. "An association only tells us that these things are
related, not that one causes the other."
The panel found that certain chronic diseases, such as diabetes and
depression, and risk factors such as smoking are associated with increased
risk of both Alzheimer's disease and cognitive decline. However, studies
have not yet demonstrated that these medical or lifestyle factors actually
cause or prevent Alzheimer's disease or cognitive decline, only that they
are related.
There is insufficient evidence to support the use of pharmaceuticals or
dietary supplements to prevent Alzheimer's disease or cognitive decline.
Ongoing studies exploring factors including but not limited to physical
activity, omega-3 fatty acids (typically found in fish), antihypertensive
medications, and cognitive engagement may provide new insight into
Alzheimer's disease and cognitive decline prevention.
The panel made a variety of recommendations to shape the future research
agenda and fill identified gaps, while acknowledging that advancing our
understanding of these complex conditions in order to develop conclusive,
evidence-based prevention recommendations will require considerable time and
resources. For example, the panel advocated launching long-term,
longitudinal studies to better characterize the natural history and
progression of these diseases in the community. They also recommended the
establishment of registries for Alzheimer's disease and cognitive decline,
modeled on existing registries for cancer.
Extensive research over the past 20 years has provided important insights on
the nature of Alzheimer's disease and cognitive decline and the magnitude of
the problem. Nevertheless, there remain important and formidable challenges
in conducting research on these diseases, particularly in the area of
prevention. There are numerous ongoing or planned investigations which may
offer promising new insights regarding the causes and prevention of these
diseases.
An updated version of the panel's draft consensus statement, which
incorporates comments received during this morning's public session, will be
posted later today at <http://consensus.nih.gov>.
The panel will hold a press telebriefing to discuss their findings today at
2:00 p.m. EDT. To participate, call 1-888-428-7458 (US) or 201-604-1577
(International) and reference the NIH Alzheimer's conference. Audio playback
will be available shortly after conclusion of the telebriefing, by calling
1-888-632-8973 (U.S.) or 201-499-0429 (International) and entering replay
code 35986458.
The conference was sponsored by the NIH Office of Medical Applications of
Research and the National Institute on Aging, along with other NIH and
Department of Health and Human Services components. This conference was
conducted under the NIH Consensus Development Program, which convenes
conferences to assess the available scientific evidence and develop
objective statements on controversial medical issues.
The 15-member panel included experts in the fields of preventive medicine,
geriatrics, internal medicine, neurology, neurological surgery, psychiatry,
mental health, human nutrition, pharmacology, genetic medicine, nursing,
health economics, health services research, and family caregiving. A
complete listing of the panel members and their institutional affiliations
is included in the draft conference statement. Additional materials,
including panel bios, photos, and other related resources, are available at
<http://consensus.nih.gov/2010/alzmedia.htm>. Interviews with panel members
can be arranged by contacting Lisa Ahramjian at 301-496-4999 or <e-mail:
[log in to unmask]>.
The conference was webcast live and will be archived shortly. Links to the
archived webcast will be available at
<http://consensus.nih.gov/2010/alz.htm>.
Individuals interested in obtaining resources for patients and families
affected by Alzheimer's disease may wish to contact the National Institute
on Aging's Alzheimer's Disease Education and Referral Center at
1-800-438-4380 or <http://www.nia.nih.gov/alzheimers>.
In addition to the material presented at the conference by speakers and the
comments of conference participants presented during discussion periods, the
panel considered pertinent research from the published literature and the
results of a systematic review of the literature. The systematic review was
prepared through the Agency for Healthcare Research and Quality
Evidence-based Practice Centers (EPC) program, by the Duke University
Evidence-based Practice Center. The EPCs develop evidence reports and
technology assessments based on rigorous, comprehensive syntheses and
analyses of the scientific literature, emphasizing explicit and detailed
documentation of methods, rationale, and assumptions. The evidence report on
preventing Alzheimer's disease and cognitive decline is available at
<http://www.ahrq.gov/clinic/tp/alzcogtp.htm>.
The panel's statement is an independent report and is not a policy statement
of the NIH or the federal government. The NIH Consensus Development Program
was established in 1977 as a mechanism to judge controversial topics in
medicine and public health in an unbiased, impartial manner. NIH has
conducted 122 consensus development conferences, and 34 state-of-the-science
(formerly "technology assessment") conferences, addressing a wide range of
issues. A backgrounder on the NIH Consensus Development Program process is
available at <http://consensus.nih.gov/backgrounder.htm>.
The Office of the Director, the central office at NIH, is responsible for
setting policy for NIH, which includes 27 Institutes and Centers. This
involves planning, managing, and coordinating the programs and activities of
all NIH components. The Office of the Director also includes program offices
which are responsible for stimulating specific areas of research throughout
NIH. Additional information is available at <http://www.nih.gov/icd/od>.
The National Institutes of Health (NIH) -- The Nation's Medical Research
Agency -- includes 27 Institutes and Centers and is a component of the U.S.
Department of Health and Human Services. It is the primary federal agency
for conducting and supporting basic, clinical and translational medical
research, and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and its programs,
visit <www.nih.gov>.
##
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<http://www.nih.gov/news/health/apr2010/od-28.htm>.
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