Table 1

Principles of secondary preventive approach as applied to Alzheimer’s disease (AD) and the role of predictive modelling in this setting

CriteriaPrerequisites for a preventive approachAD-specific contextRole of predictive modelling
Importance and public consensusLarge unmet public health causing a public concern.Yes: there is a public consensus around the unmet need and its criticality.
Further to that, prevention might be the only feasible intervention in AD (speculative).
CostsPrevention is more cost effective than treatment over the lifetime of the patient.Likely the case, given the AD burden, but not conclusive (until a specific intervention is evaluated).Health-economic modelling with a long-term horizon depending on long-term scenario.
MechanismThe natural course of disease is well understood.The role of a myloid βeta (targeted by the currently developed drugs) for disease progression is only partially understood, therefore reducing its levels might not translate to improvement in clinical outcomes.
Selection of the population to receive interventionIntervention is offered to all demographic segments in the population or specific screening procedure exists.Population-wide treatment might not be appropriate (side effects, budget impact). Targeting a segment might be necessary but difficult to establish which one (only a partial match between the asymptomatic stage and AD, genetic markers not conclusive).Identification of ‘at-risk’ patients from a general population or a predefined population with individual factors (eg, with genetic predisposition, family history, subjective memory complaint, etc.)
Efficacy of the treatmentA disease-modifying treatment exists.Future phase three trials will conclude on some but not all meaningful outcomes.Prediction of clinical outcomes and long-term based on biomarker status and its trajectory
(eg, cognition vs function and dependency).
Access to treatmentEfficacious treatment is accessible and affordable.Not possible to conclude until a specific intervention is known.Identification of patient subgroups most likely to benefit from the treatment.
  • Source, criteria and prerequisites adapted from Khoury et al 36 and Wilson and Jungner13