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In the field of Alzheimer's disease (<jats:styled-content style=\"fixed-case\">AD<\/jats:styled-content>) research, it has taken almost three decades for diagnostic nomenclature to undergo major re\u2010examination. The shift towards presymptomatic and pre\u2010dementia stages of <jats:styled-content style=\"fixed-case\">AD<\/jats:styled-content> has brought prevention and treatment trials much closer to each other than before.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Here we discuss: (i) the impact of diagnostic reliability on the possibilities for developing preventive strategies for <jats:styled-content style=\"fixed-case\">AD<\/jats:styled-content>; (ii) the scientific evidence to support moving from observation to action; (iii) ongoing intervention studies; and (iv) the methodological issues and prospects for balancing strategies for high\u2010risk individuals with those for broad population\u2010based prevention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The associations between neuropathology and cognition are still not entirely clear. In addition, the risk factors for <jats:styled-content style=\"fixed-case\">AD<\/jats:styled-content> dementia and the neuropathological hallmarks of <jats:styled-content style=\"fixed-case\">AD<\/jats:styled-content> may not necessarily be the same. Cognitive impairment has a clearer clinical significance and should therefore remain the main focus of prevention. Risk\/protective factors for dementia\/<jats:styled-content style=\"fixed-case\">AD<\/jats:styled-content> need to be studied from a life\u2010course perspective. New approaches in prevention trials include enrichment strategies based on genetic risk factors or beta\u2010amyloid biomarkers (at least four ongoing pharmacological trials), and multidomain interventions simultaneously targeting various vascular and lifestyle\u2010related risk factors (at least three ongoing trials). Experience from prevention programmes in other chronic diseases can provide additional methodological improvements.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Building infrastructures for international collaborations is necessary for managing the worldwide public health problem of <jats:styled-content style=\"fixed-case\">AD<\/jats:styled-content> and dementia. 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