| Summary: | Symptomatic treatments that work by enhancing neurotransmitter function have been available for several years, and are generally accepted as being modestly beneficial in about 50% of those for whom they are prescribed. Disease-modifying drugs that may prevent or retard neuronal deterioration are being developed and some are in early clinical trials. Primary prevention, rather than treatment of the established disease, must be of equal, if not greater, importance. Common sense suggests that attention to modifiable risk factors might be worth exploring as a means of reducing the impact of vascular dementia, as it has proved so effective for cardiovascular disease and stroke. However, the primary prevention of Alzheimer's disease has always appeared a more difficult target; surprisingly there is increasing evidence that it may share risk factors with vascular dementia. It is therefore possible that attention to lifestyle in mid-life or earlier may be important. Furthermore, observational studies over the last 10 years or so have indicated that a number of other factors may have a protective effect, including NSAIDs, hormone-replacement therapy (HRT), antioxidants (both medical and dietary) and the statins. The apparent benefit of some of these approaches has been challenged, however. Lifestyle factors in later life may also be important, such as regular exercise, psychological well-being and a significant level of social interaction. © 2004 Elsevier Ltd. All rights reserved.
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