What have clinical trials taught us about brain health?

• Published in: Cerebral circulation - cognition and behavior Vol. 6; p. 100199
• Main Authors: Lee, Keon-Joo, Bae, Hee-Joon
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2024; Elsevier
• Subjects: Brain health; Cerebral small vessel disease; Clinical trials; Mendelian randomization; Multidomain approach; Clinical trials; Brain health; Mendelian randomization; Cerebral small vessel disease; Multidomain approach
• ISSN: 2666-2450; 2666-2450
• DOI: 10.1016/j.cccb.2023.100199

•While many interventions aimed at improving or maintaining brain health faced challenges in demonstrating benefits, some recent trials such as SPRINT MIND and LACI-2 have shown promising results.•Inspired by the FINGER trial, multidomain approaches are now recognized as a viable strategy for preserving cognitive functions.•Employing image markers of cerebral small vessel disease in clinical trials can bolster statistical power and provide deeper insights into the disease's underlying mechanisms.•The Mendelian randomization approach stands as a potent tool in pinpointing intervention targets for clinical trials focused on brain health. The Global Burden of Disease Study projects an almost tripling of dementia cases worldwide in the next 30 years making it important to recognize and understand modifiable risks and preventatives for cognitive impairment. Recent studies suggest that prevention or treatment of cardiovascular risks may be an important strategy to prevent or slow the progression of cognitive impairment. In 2017, the American Heart Association and American Stroke Association introduced metrics for "optimal brain health". These metrics defined brain health in terms of ideal health behaviors and factors. Since then and leading up to 2017, a number of clinical trials have been conducted to investigate the potential of modification of cardiovascular risks on prevention of dementia or cognitive impairment and thus, enhancement of brain health. This discussion is a review of findings from clinical trials focusing on interventions, including antihypertensive agents, glycemic control and lipid-lowering therapies, multidomain approaches, and antithrombotic medications. Notably, the results highlight the promise of intensive blood pressure lowering strategies and multidomain approaches, as evidenced by the FINGER trial. The review also discusses the potential of treatment or prevention of cerebral small vessel disease (cSVD) and the application of Mendelian randomization as a strategy to preserve brain structure and function.