Impaired brain plasticity as a potential therapeutic target for treatment and prevention of dementia.

INTRODUCTION: In 2017, it was estimated that close to 50 million people were living with dementia worldwide and this number is expected to double every 20 years. No effective treatment exists yet probably because by the time Alzheimer's dementia (AD) has developed it is too late to intervene. Areas covered: Mild cognitive impairment (MCI) is a clinical state that typically precedes AD. In MCI, the prefrontal cortex supports compensatory mechanisms that depend on robust synaptic plasticity and that delay progression to AD. This review focuses on novel neurostimulation approaches that could enhance prefrontal cortical plasticity in vivo by enhancing prefrontal cortical plasticity and function in patients with MCI or AD. It also describes novel neurophysiological markers that could function as targets for such approaches. Expert commentary: Targeting synaptic plasticity in patients with early AD or at risk of developing AD could be a promising approach to slow progression or prevent AD.