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Overtreating Alzheimer’s Disease

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Abstract

The management of frailty in older persons is not easy, implying interventions beyond the simple prescription of medications. Biological complexity, multimorbidity, polypharmacy, and social issues often hamper the possibility to directly translate the evidence coming from research into clinical practice. Frailty indeed represents the most relevant cause of the “evidence-based medicine issue” influencing clinical decisions in geriatric care. Today, patients with Alzheimer’s disease (AD) are much older and frailer than some decades ago. They also tend to have more drugs prescribed. In parallel, research on AD has evolved over the years, hypothesizing that anticipating the interventions to the earliest stages of the disease may provide beneficial effects (to date, still lacking). In this article, we argue that, by focusing exclusively on “the disease” and pushing to anticipate its detection (sometimes even before the appareance of its clinical manifestations) may overshadow the person’s values and priorities. Research should be developed for better integrating the concept of aging and frailty in the design of clinical trials in order to provide results that can be implemented in real life. On the other hand, clinicians should be less prone to the easy (but unsupported by evidence) pharmacological prescription.

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Authors and Affiliations

  1. Sapienza University, Rome, Italy

    M. Canevelli & G. Bruno

  2. National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy

    N. Vanacore

  3. Department of Health Sciences and Technology, ETH Zürich, Zürich, Switzerland

    A. Blasimme

  4. Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, University of Milan, Via Camaldoli 64, 20138, Milan, Italy

    Matteo Cesari

Authors
  1. M. Canevelli
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  2. N. Vanacore
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  3. A. Blasimme
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  4. G. Bruno
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  5. Matteo Cesari
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Correspondence to Matteo Cesari.

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Conflicts of interest: Marco Canevelli is supported by a research grant of the Italian Ministry of Health (GR-2016-02364975) for the project “Dementia in immigrants and ethnic minorities living in Italy: clinical-epidemiological aspects and public health perspectives” (ImmiDem). Matteo Cesari has received honoraria for presentations at scientific meetings and/or research funding from Nestlé. No specific conflict of interest declared by the other authors.

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Canevelli, M., Vanacore, N., Blasimme, A. et al. Overtreating Alzheimer’s Disease. J Prev Alzheimers Dis 8, 234–236 (2021). https://doi.org/10.14283/jpad.2020.74

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