Recommendations can be put into context by the US Alzheimer’s disease Association report, which explores the consequences of a hypothetical advance that could lead to a preventive intervention. It is estimated that 13.5 million US citizens aged 65 and older will have AD in 2050. Moreover, the annual costs for their care will increase from US$172 billion in 2010 to $1.08 trillion in 2050. A hypothetical breakthrough intervention that could become available in 2015 and would delay onset by 5 years could reduce the number of patients in 2050 by over 40%, to less than 8 million. The cost of their care would then be reduced to $631 billion. The AA report remarks that this hypothetical scenario is based on assumptions that have been translated into real achievements for other chronic disorders, such as heart disease and HIV/AIDS; hence, it provides an optimistic counterpoint to the down-to-earth conclusions of the NIH Conference Statement.

In crisis, Friedman thought, the actions taken depend on the ideas that are prevalent at the time. Both reports, released in the space of just a few weeks, have unambiguoushly exposed the crisis in AD prevention and laid down a useful set of ideas; now action must be taken (Reported in Lancet Neurol. 2010 Jul;9(7):643).