Alzheimer's Preventive Approaches and Cognitive Monitoring Must Be Integrated Into the Primary Care Setting

摘要

The world of Alzheimer's disease (AD) is moving to predinical AD and to prevention.1'2 This probably beneficial phenomenon will bring some new challenges. We will have to identify the patients who are most at risk to develop dementia for future targeted therapy and adapted intervention.3 Older adults are presently more educated, with better control of vascular and metabolic risk factors, and more elect to stay healthy. On the other hand, due to the augmentation of life expectancy, more and more persons reach 85+ years, and so some general health aspects, including comorbidities and frailty must be taken into consideration.4'5 Primary care settings (PCSs) are in the best position to give the more adapted response to this new challenge (Alzheimer prevention) because they know the patients, their family, living conditions, other morbidities, and have a prospective view. Primary care settings must be able to target 2 large categories of older adults at risk of cognitive decline, and give the more appropriate response: Older adults with subjective memory complaints6 in generally good health condition and the oldest old with both physical and cognitive frailty.7 We review in this editorial these 2 potential targets and how cognitive decline monitoring and prevention, including AD, could be integrated in the PCS.