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Alzheimers Dement. 2018 Dec;14(12):1663-1673. doi: 10.1016/j.jalz.2018.08.004. Epub 2018 Nov 13.

The clinical practice of risk reduction for Alzheimer's disease: A precision medicine approach.

Author information

1
Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA. Electronic address: rii9004@med.cornell.edu.
2
School of Nursing, Hunter College, City University of New York, New York, NY, USA.
3
Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA.
4
Department of Psychology, Temple University, Philadelphia, PA, USA.
5
Loyola School of Medicine, Chicago, IL, USA.
6
Department of Cardiology, Crystal Run Healthcare, Middletown, NY, USA.
7
Inner Source Health, New York, NY, USA.
8
Department of Neurology, Weill Cornell Medicine, San Juan, PR, USA.
9
Weill Cornell Medicine-Qatar, Doha, Qatar.
10
Weill Cornell Medicine, New York, NY, USA.
11
Biostatistics, Pentara Corporation, Salt Lake City, UT, USA.
12
Department of Neurology, Columbia University College of Physicians & Surgeons, New York, NY, USA.
13
Compass Health Systems, Miami, FL, USA.
14
Department of Psychiatry & Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA.

Abstract

Like virtually all age-related chronic diseases, late-onset Alzheimer's disease (AD) develops over an extended preclinical period and is associated with modifiable lifestyle and environmental factors. We hypothesize that multimodal interventions that address many risk factors simultaneously and are individually tailored to patients may help reduce AD risk. We describe a novel clinical methodology used to evaluate and treat patients at two Alzheimer's Prevention Clinics. The framework applies evidence-based principles of clinical precision medicine to tailor individualized recommendations, follow patients longitudinally to continually refine the interventions, and evaluate N-of-1 effectiveness (trial registered at ClinicalTrials.gov NCT03687710). Prior preliminary results suggest that the clinical practice of AD risk reduction is feasible, with measurable improvements in cognition and biomarkers of AD risk. We propose using these early findings as a foundation to evaluate the comparative effectiveness of personalized risk management within an international network of clinician researchers in a cohort study possibly leading to a randomized controlled trial.

KEYWORDS:

APOE; Alzheimer’s Prevention Clinic; Alzheimer’s disease prevention; Alzheimer’s precision medicine; Clinical precision medicine; Multidomain interventions; Personalized medicine; Preclinical Alzheimer’s disease

PMID:
30446421
PMCID:
PMC6373477
[Available on 2019-12-01]
DOI:
10.1016/j.jalz.2018.08.004
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