40th Anniversary: Review Neuroepidemiology From Dementia to Eumentia: A New Approach to Dementia Prevention Vladimir Hachinski a, b, c Abolfazl Avan d, e a Robarts Research Institute, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; b Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; c Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; d Department of Public Health, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; e Department of Family Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Received: March 2, 2022 Accepted: May 22, 2022 Published online: May 25, 2022 Correspondence to: Vladimir Hachinski, vladimir.hachinski @lhsc.on.ca © 2022 S. Karger AG, Basel Karger@karger.com www.karger.com/ned DOI: 10.1159/000525219 Keywords Dementia · Eumentia · Approach · Paradigm · Prevention Abstract Background: During the past 40 years, dementia prevention approaches have ranged from searching for a drug to pre- vent progression to Alzheimer’s disease to preventing de- mentia through multidomain lifestyle interventions. Cur- rent Approaches: The search for a silver bullet has yielded good science but no clinical results. The multi-model life- style intervention approach has shown encouraging results. The largest proportion of resources in prevention have been devoted to finding a drug to prevent, mitigate, or delay what is being called “Alzheimer’s disease of late onset.” The reality is that Alzheimer’s pathology is common among the elderly, but it seldom only occurs alone. The only treatable and pre- ventable pathology currently is vascular. Hence arose the concept of “vascular cognitive impairment” meaning any vascular cause or risk factor associated with cognitive im- pairment. The majority of cases of cognitive impairment in the elderly have a vascular component that is treatable and preventable and identifiable by several means, including a simple ischemic score. Conclusion: Since environmental, so- cioeconomic, and individual risk factors contribute to de- mentia, we proposed a Comprehensive, Customized, Cost- effective APProach (the CCC-APP) implemented in action- able units with the focus on promoting brain health (eumentia). Key Messages: We should implement dementia prevention approaches in actionable units around optimal brain health or eumentia. Heart disease, stroke, and demen- tia share mostly the same risk and protective factors; thus, their joint prevention is desirable. We need a comprehen- sive, customized, and cost-effective approach to joint pre- vention of stroke, heart disease, and dementia. We call for literal and virtual meetings of researchers of all the relevant disciplines to work on operational definitions and interdisci- plinary collaborations. © 2022 S. Karger AG, Basel Some Milestones from the Past 40 Years Dementia prevention has been characterized by scien- tific advances and conceptual confusion. Nevertheless, some milestones from the past 40 years can be highlight- ed: