P3‐624: PRIMARY DEMENTIA PREVENTION: RECOMMENDATIONS FOR FRENCH PUBLIC HEALTH POLICY

The French High Council of Public Health (HCSP) received a referral from the Directorate General of Health (DGS) to develop recommendations for the implementation of a prevention strategy for Alzheimer's disease and related diseases (ADRD) with 4 aims: 1) Synthesize the existing evidence and / or arguments in favor of preventive measures of ADRD by distinguishing as necessary the different etiologies; 2) Discuss the appropriateness and the possible risks of preventive intervention based on these data, in particular the therapeutic risk (antihypertensive treatment ...); 3) Propose and argue strategies for preventing or reducing modifiable risk factors; 4) Make recommendations to better structure the epidemiological surveillance of these diseases. The working group was multidisciplinary, involving: epidemiologists, a health economist, a geriatrician, a general practitioner and a nutritionist. Firstly, the group analyzed scientific reports on modifiable risk factors, studies on preventive interventions for dementia, in France and abroad, by assessing their benefit - risk ratio. Secondly, it investigated prevention programs and strategies implemented in other developed countries to analyses their target population, aims, contents, organization, and evaluation. Furthermore, it carried out auditions of different experts and prevention actors in France (Health policy organizations, family and patient associations, institutions) and discussed conclusions and recommendations with DGS and experts from HCSP. Recent publications on a possible decrease of dementia incidence in some western countries could be considered as a real-life demonstration of the effectiveness of prevention. A potential explanation of this decrease could be an overall improvement in the level of education, living conditions, lifestyle, and nutrition, and in the management of vascular risk factors, including hypertension. Despite various biases in observational studies or uncertainty on temporality and the lack of evidence supporting causality in most intervention studies, the HCSP proposes a series of recommendations and actions in response to the public health queries (Table 1). Our report was based on a broad approach of the prevention of chronic diseases and the proposed actions can be integrated mostly into existing programs. Recommendations must now be transformed into actions.