Primary and secondary prevention strategies for reducing population-level dementia burden: A microsimulation modeling study

BackgroundThe growing burden of dementia and Alzheimer's disease may be mitigated by a combination of primary and secondary preventive strategies, including lifestyle interventions and targeted disease-modifying therapy at the individual-level.ObjectiveOur aim is to estimate the effects of primary and secondary prevention on a population level in terms of life years lived with and without dementia.MethodsWe used the previously developed and validated microsimulation model MISCAN-Dementia, modified to evaluate the impact of individual-level primary and secondary preventative interventions in the Dutch population aged 55 years and older, between 2025 and 2050. We expanded this model with prevention-specific effectiveness and eligibility, based on observed trial effects (primary analysis) and assuming a range of combinations of eligibility and effects (secondary analyses).ResultsExtrapolating results from available randomized controlled trials, combined primary and secondary preventative interventions result in a 6.1% decrease of life years lived with moderate to severe dementia until 2050, compared to no additional prevention. Dementia-free life years increased by 3.1%. The magnitude of risk reduction was the primary driver of impact, with the most optimistic assumptions resulting in a stabilization of dementia prevalence by 2050.ConclusionsA combination of primary and secondary preventative strategies likely is needed to achieve optimal effects on the future burden of dementia. These approaches differ in the time needed to achieve maximal population-level impact, with the overall magnitude of effect primarily determined by the size of the intervention's impact.