In addition, preventing recurrent cerebrovascular disease and maintaining sufficient cerebral blood perfusion by adequately managing heart failure and avoiding very low blood pressure may help postpone clinical expression of the dementia syndrome, especially among very old people. The second strategy is to maintain the more active and socially integrated Inhibitors,research,lifescience,medical lifestyles by establishing extensive social networks and frequently participating in social, physical, and intellectually stimulating activities, which may reduce the risk or delay the onset of AD.38,132 Taken together, the most effective strategy may be to encourage, people implementing

Inhibitors,research,lifescience,medical multiple preventive measures throughout the life course, including

high selleck chemical educational attainment in childhood and early adulthood, active control of vascular factors and disorders over adulthood, and maintenance of mentally, physically, and socially active lifestyles during middle age and later in life. Intervention trials toward primary prevention The main clinical and intervention trials toward primary prevention by targeting the possible risk and protective Inhibitors,research,lifescience,medical factors for AD and dementia are summarized in Table II. 160,161,176-182 Antihypertensive treatments in reducing the risk of dementia and AD have been tested in a Inhibitors,research,lifescience,medical few clinical trials. The pooling analysis of the 2007 Cochrane review, based essentially on three clinical trials (SHEP,183 Syst-Eur,184 and SCOPE185),

found no convincing evidence that blood pressure-lowering therapy among elderly individuals with hypertension could prevent dementia. However, in this review the SCOPE trial, which did not show any effect of blood pressure-lowering treatment by candesartan on the risk of dementia, was Inhibitors,research,lifescience,medical actually not a placebo-controlled trial due to ethical considerations. By contrast, the placebo-controlled PROGRESS trial among individuals with cerebrovascular disease, (transient ischemic attacks and stroke), which did find a beneficial effect of antihypertensive therapy on cognitive function related to recurrent stroke, was not included.186 The cognition substudy of the double-blind placebo-controlled Hypertension in the Very the Elderly Trial (HYVET-COG) among people 80+ years found a nonsignificant reduction in the risk of dementia related to antihypertensive treatment. Encouragingly, when data from this clinical trial were pooled together with those from three other doubleblind placebo-controlled trials (SHEP, Syst-Eur, and PROGRESS), antihypertensive treatment could reduce the risk of dementia by 13 % (hazard ratio, 0.87; 95 % CI, 0.76-1.00; P=0.045).