Olga Koblova
Department of Psychiatry and Behavioral Sciences, University of Washington,
USA
Abstract Title:
Reframing dementia prevention: integrating all levels of prevention into clinical practice (literature review).
Biography:
Olga Koblova , MD is an assistant professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington and a fellowship-trained, board-certified geriatric psychiatrist. Her current clinical practice includes inpatient geriatric psychiatry, long-term civil commitment, consultation-liaison psychiatry, and collaborative care. She is passionate about dementia prevention and improving access to evidence-based dementia care.
Research Interests:
Dementia affects over 55 million people worldwide, with projections exceeding 150 million by 2050.⁹ The 2024 Lancet Standing Commission identified 14 modifiable risk factors (adding untreated vision loss and elevated LDL cholesterol), estimating that up to 45% of cases could be prevented or delayed.²³ Epigenetic research provides a mechanistic basis: modifiable exposures alter gene expression through reversible modifications,²⁷ and the Latent Early-life Associated Regulation (LEARn) model reframes neurodegeneration as a progressive, potentially modifiable process.²⁰˒²⁵ This review integrates recent evidence to propose a framework spanning all five levels of prevention.³⁸ Methods: PubMed and Cochrane Library were searched using the keywords listed below. Sources included landmark RCTs (FINGER, US POINTER, SMARRT, Maintain Your Brain, ACHIEVE, SPRINT MIND, CLARITY-AD, TRAILBLAZER-ALZ 2), systematic reviews and meta-analyses (2013–2025), clinical practice guidelines, consensus statements, and narrative reviews (2017–2026). Results: Primordial prevention targets upstream determinants before risk factors emerge (e.g., educational policies, helmet mandates, noise protection). Primary prevention through multidomain lifestyle interventions demonstrates the most consistent evidence, with antihypertensive treatment providing the strongest pharmacologic signal (OR 0.87; 95% CI 0.75–0.99). Secondary prevention is advancing through plasma p-tau217 (AUROC 91.1%) and precision approaches (MET-FINGER, epigenetic clocks). Disease-modifying therapies (lecanemab, donanemab) slow CDR-SB decline by ~27–36%, with small effect sizes. Emerging strategies explore next-generation agents (trontinemab, tau immunotherapies) and epigenetic therapeutics. Tertiary prevention relies on cognitive stimulation therapy (SMD = 0.43), multicomponent exercise (g = 0.40), stepwise BPSD management, fall prevention, advance care planning, and palliative care integration. Quaternary prevention addresses iatrogenic harm through deprescribing, avoiding deliriogenic medications, and preventing hospital-acquired cognitive decline. Conclusions: Dementia prevention is transitioning from concept to implementable clinical practice. Cardiovascular risk management remains the strongest modifiable target, and multidomain interventions provide the most robust evidence. The integration of validated risk scores, blood-based biomarkers, digital monitoring tools, and precision prevention now enables a comparable personalized approach for brain health. Prevention should span the life course, integrating all five levels into routine clinical practice to reduce the projected global burden of dementia. Keywords: Dementia prevention, dementia risk reduction, cognitive decline prevention, modifiable risk factors, precision prevention, dementia risk score, dementia prediction, dementia biomarkers, digital biomarkers.
