1 / 11

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.

regina-acosta
Télécharger la présentation

Prevention of Dementia by Intensive Vascular Care - preDIVA-trial

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related