Alzheimer’s disease risk reduction in clinical practice: a priority in the emerging field of preventive neurology

Alzheimer’s disease is increasing in prevalence disproportionately to longevity, placing enormous burden on individuals, families, healthcare systems and the economy. Pathological brain changes may occur decades before the symptoms of Alzheimer’s disease manifest. With new tools designed to identify at-risk individuals (for example, blood-based biomarkers and polygenic risk assessments), a focus on prevention could begin early and continue throughout life. Targetable risk factors associated mainly with cardiovascular and metabolic health have been established, while mental health factors are increasingly recognized. Given the heterogeneity of the risk and pathogenesis of Alzheimer’s disease, interventions for risk reduction are most effectively determined on an individualized basis. Here we review the evidence for a precision medicine approach to Alzheimer’s disease risk reduction that involves multidisciplinary expertise, with a new emphasis on novel genetic and biomarker advances, and psychological factors. We propose integration of this approach into routine clinical practice and acknowledge obstacles to the widespread practice of preventive neurology.