1. Pharmacologic treatments had no impact on preventing late-life dementia in patients with normal cognition.
2. Adverse events were increased for several pharmacologic interventions aimed at reducing dementia risk.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Dementia is a significant clinical syndrome, which affects a large proportion of the aging population. Dementia may be caused by several factors, including Alzheimer disease and mild cognitive impairment (MCI). The authors of this study sought to evaluate the current landscape of pharmacologic interventions to prevent or delay cognitive decline in adults with normal cognition. It was observed that there are currently no interventions proven to prevent late-life dementia. This study has several limitations. Of note, the authors were unable to assess the root cause of the insufficient evidence for no treatment, such as whether it is due to inadequate pharmacologic intervention versus study design constraints. Published results of some of the studies may also have been subject to reporting bias.
In-Depth [systematic review]: In total, 51 trials were included in this systematic review. Two reviewers extracted data independently. The reviewers extracted variables related to several primary outcomes, such as cognitive diagnoses of MCI or dementia and cognitive performance assessed by validated instruments. Of the 51 trials included, 1 study suggested that estrogen and estrogen-progesterone treatments increased risk of dementia (low evidence). High-dose raloxifene, statins and cholinesterase inhibitors were not shown to have an effect on reducing the development of dementia in persons of normal cognition. The authors also assessed adverse effects in the trials included in this systematic review. Adverse effects consisted of stroke, coronary heart disease, invasive breast cancer, pulmonary embolism, and venous thromboembolism for various different pharmacologic treatments.
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