The reasons or optimism are excerpted below, with specific messages to primary care docs (highlighted by me.)
Maybe preventing all AD won't happen in my lifetime, but I'd like to believe that I'll see a day when ALL people have access to universal, functional, personalized medicine--because that will be how ALL primary care medicine is practiced.The following brief primer highlights useful new information to the PCP in their interactions with AD patients.
One important new fact about AD is that ...there is enormous variation among people with the disease in...clinical [behavioral] and neuropathological features of the disease... emphasizing the need for focusing on more individualized assessment and case management.
Another important new finding about the disease is that... we are dealing with a complex brain disorder which represents the culmination of intricate connections among multiple pathogenic factors. The complexity of the underlying biology of AD explains not only the failure of some trials in the past but also indicates the need for novel drug development paradigms that take into account the prospects of testing multiple therapeutic targets or agents.
The third significant feature of AD is that...an asymptomatic or preclinical stage may actually precede by nearly two decades the next stages...the prolonged intricate mechanisms in progression of neurodegeneration will have profound impact...[on] a PCP who now must pay more careful attention to the complaints of older or at-risk patients' subjective feelings of memory loss.
The final area of new information, with important ramification for the design of future clinical studies, as well as PCP practices, is the discovery of... predisposing factors [which] include several potential susceptibility genes (e.g., ApoE), lifestyle and some co-morbid conditions such as CVD, diabetes, hypertension, obesity, etc. ...these preliminary findings have begun to provide some promising potential strategies for reducing the risks AD.
In conclusion, the good news for the PCP is that... nonpharmacological multidomain interventions have some significant beneficial effects such as reducing the decline in cognitive function or delaying the onset of disabling symptoms. These multidomain interventions, as the name implies, require changes in the "behavior habits" of patients in several aspects of their lifestyle, e.g., diets, physical, and mental exercises...studies also have found that management of comorbid or known risk factors, e.g., vascular disorders, diabetes, hypertension, obesity, etc., have beneficial effects.
