William N Whiteley et al. | Are large simple trials for dementia prevention possible? | Age and Ageing | published 12th December 2019
- Large simple trials have transformed care for heart attack and stroke. Lessons from these trials may be applicable to dementia prevention.
- The size of the population and duration of follow-up needed for dementia prevention trials will be a major challenge. The reliable identification of higher risk populations is difficult but will be important.
- Patients and families prioritise loss of function. Loss of functional abilities or clinical dementia are infrequent, but might be measured with lower variability than cognitive scores.
New trials of dementia prevention are needed to test novel strategies and agents. Large, simple, cardiovascular trials have successfully discovered treatments with moderate but worthwhile effects to prevent heart attack and stroke. The design of these trials may hold lessons for the dementia prevention.Here we outline suitable populations, interventions and outcomes for large simple trials in dementia prevention. We consider what features are needed to maximise efficiency. Populations could be selected by age, clinical or genetic risk factors or clinical presentation. Patients and their families prioritise functional and clinical outcomes over cognitive scores and levels of biomarkers. Loss of particular functions or dementia diagnoses therefore are most meaningful to participants and potential patients and can be measured in large trials.
The size of the population and duration of follow-up needed for dementia prevention trials will be a major challenge and will need collaboration between many clinical investigators, funders and patient organisations.
Full article: Are large simple trials for dementia prevention possible?