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Prevention of Dementia by Intensive Vascular Care - preDIVA-trial

Prevention of Dementia by Intensive Vascular Care - preDIVA-trial. Edo Richard Department of Neurology Academic Medical Centre University of Amsterdam The Netherlands. Academic Medical Centre. No conflict of interest. Alzheimer’s Disease International 2012 - London. Epidemiology.

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Prevention of Dementia by Intensive Vascular Care - preDIVA-trial

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  1. Prevention of Dementia by Intensive Vascular Care-preDIVA-trial Edo Richard Department of Neurology Academic Medical Centre University of Amsterdam The Netherlands Academic Medical Centre No conflict of interest Alzheimer’s Disease International 2012 - London

  2. Epidemiology hypertension DM adiposity Vascular factors and dementia • lipids • smoking • physical exercise • Radiology • Pathology + + Vascular lesions plaque tangle • Clinical trials hypertension

  3. no effect on: cognition disability mortality EVA-trialEvaluation of Vascular Care in Alzheimer Alzheimer with vascular lesions N=130 mean age 76 y standard care vascular care • 3-monthly visits • multicomponent • intervention • vascular risk factors 2-year follow-up p=0.03 Richard et al. Stroke 2010;41:554-556 Richard et al. J Am Geriatr Soc 2009;57:797-805

  4. Dementia prevention? Prevention of Dementia by Intensive Vascular Care Start in 2006

  5. Open, cluster-randomised trial 116 GP practices 3534 subjects 70-78 Y Dementia?  excluded Cluster randomisation Standard care Vascular care (nurse led) 4-monthly visits • Secondary outcomes: • stroke • myocardial infarction • depression • mortality 2 year: dementia / handicap 4 year: dementia / handicap 6 year: dementia / handicap Richard E. et al. Alzheimer Dis Assoc Disord 2009; 23:198-204

  6. 2-yearly assessments Clinical assessment Cardiovascular events Medication BP BMI Lifestyle advices Clinimetrics MMSE VAT GDS ALDS (AMC Linear Disability Scale) • Laboratory assessment • Lipids, glucose, HcY, CRP • DNA storage (baseline) Dementia diagnosticswhen indicated

  7. Baseline Systolic BP BMI Total cholesterol % % % 39% 21% 23% <120 140-160 >180 120-140 160-180 • lack of physical exercise 40% • smoking 12%

  8. Window of opportunity % 12% Number of vascular risk factors Richard E. et al. Alzheimer Dis Assoc Disord 2009; 23:198-204

  9. Methodological considerations • Timing of intervention • Target population • Outcome measures • Type of intervention (multi-component)

  10. Proceedings Last patient out 3534 2000 1000 Jan 2007 Jan 2009 Jan 2011 Jan 2013 Jan 2015 First patient out www.edpi.org

  11. Neurology: Pim van Gool, MD PhD Lisa Eurelings, MD General practice: Eric Moll van Charante, MD PhD Suzanne Ligthart, MD Clinical trials bureau dept of Neurology: Carin Miedema General practices: All participating GPs (n= 116) All practice nurses (n=25) Acknowledgements • Funding: • Dutch Ministry of health, Welfare and Sport • Dutch Innovation Fund Health Insurances • The Netherlands Organisation for Health Research • and Development Academic Medical Centre

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