Prevention of Alzheimer's disease and other dementias

Alzheimer's disease (AD) affects 150 000 Australians and prevention is a high priority. Approaches to reduce the risk of AD and other dementias can be based on the risk factors that have been suggested from case-control and longitudinal studies. There is some evidence of benefit from vitamin E supplements (and possibly also vitamin C), a well-balanced diet including adequate folate and vitamin B 12, keeping physically and mentally alert, avoiding head injury, continuing moderate alcohol intake, avoiding excess aluminium exposure, avoiding smoking, and keeping elevated blood pressure, diabetes and other vascular risk factors under control. There are currently insufficient data to support the use of cholesterol-lowering agents, anti-inflammatory agents, oestrogen, caffeine, or ginkgo biloba to prevent dementia, but large prospective randomised placebo-controlled prevention trials are in progress for some of these agents and may alter these recommendations. Approaches in the future which look very promising are anti-amyloid vaccination and gene therapy. Targeting high risk groups, such as those with mild cognitive impairment, may increase the benefit of preventative approaches.