1. Prevention of Dementia by Intensive Vascular Care - preDIVA-trial
Edo Richard
Department of Neurology
Academic Medical Centre
University of Amsterdam
The Netherlands
Academic Medical Centre
No conflict of interest
Alzheimer’s Disease International London

2. Vascular factors and dementia
hypertension DM
adiposity
lipids
smoking
physical exercise
Epidemiology
Radiology
Pathology + +
Vascular lesions
plaque
tangle
Clinical trials
hypertension

3. EVA-trial Evaluation of Vascular Care in Alzheimer
Alzheimer with vascular lesions
N=130
mean age 76 y
no effect on:
cognition
disability
mortality
standard care
vascular care
3-monthly visits
multicomponent
intervention
vascular risk factors
2-year follow-up
p=0.03
Richard et al. J Am Geriatr Soc 2009;57:
Richard et al. Stroke 2010;41:

4. Dementia prevention? Prevention of Dementia by Intensive Vascular Care
Start in 2006

5. Open, cluster-randomised trial
116 GP practices
3534 subjects Y
Dementia?  excluded
Cluster randomisation
Standard care
Vascular care
(nurse led)
Component
intervention BP
lifestyle, medication
smoking
quit, counseling
exercise
advice, exercise program
overweight
BMI>25: advice; BMI>30: dietician
cholesterol
CVD: statin
no CVD: in case TC/HDL >5: statin
glucose
if > 6.1 mmol/l: stepped protocol
4-monthly visits
Secondary outcomes:
stroke
myocardial infarction
depression
mortality
2 year: dementia / handicap
4 year: dementia / handicap
6 year: dementia / handicap
Richard E. et al. Alzheimer Dis Assoc Disord 2009; 23:

6. 2-yearly assessments Clinical assessment Clinimetrics
Cardiovascular events
Medication BP
BMI
Lifestyle advices
Clinimetrics
MMSE
VAT
GDS
ALDS (AMC Linear Disability Scale)
Laboratory assessment
Lipids, glucose, HcY, CRP
DNA storage (baseline)
Dementia diagnostics when indicated

7. Baseline lack of physical exercise 40% smoking 12% Systolic BP BMI
Total cholesterol % % %
39%
21%
23%
<120
>180
lack of physical exercise 40%
smoking %

8. Window of opportunity Number of vascular risk factors % 12%
Richard E. et al. Alzheimer Dis Assoc Disord 2009; 23:

9. Methodological considerations
Timing of intervention
Target population
Outcome measures
Type of intervention (multi-component)

10. Proceedings www.edpi.org Last patient out 3534 2000 1000 Jan 2007 Jan
2009
Jan
2011
Jan
2013
Jan
2015
First patient out

11. Acknowledgements Academic Medical Centre Neurology:
Pim van Gool, MD PhD
Lisa Eurelings, MD
General practice:
Eric Moll van Charante, MD PhD
Suzanne Ligthart, MD
Clinical trials bureau dept of Neurology:
Carin Miedema
General practices:
All participating GPs (n= 116)
All practice nurses (n=25)
Funding:
Dutch Ministry of health, Welfare and Sport
Dutch Innovation Fund Health Insurances
The Netherlands Organisation for Health Research
and Development
Academic Medical Centre