NYC Healthcare News

Project ideas needed from worldwide Alzheimer Disease research community

October 01, 2015

The diagnosis of AD is based on the presence of the clinical syndrome of dementia. But evidence suggests that the neurobiological features of the disease, including plaque deposition, tangle accumulation, and synaptic loss, begin a decade or more before the onset of dementia. Indeed, the prevalence of amyloid deposition in brain as indicated by amyloid PET scanning or low A??42 in the cerebral spinal fluid of non-demented older individuals is 20-40 percent (Jack et al., 2010), indicating a huge population of individuals with a cardinal feature of AD pathology but without dementia. If amyloid dysregulation and other neurobiological abnormalities accumulate many years prior to dementia, it is reasonable to assume that the optimal time to change the disease course by interrupting the driving neurodegenerative processes is long before dementia onset. At the late stage of brain failure represented by dementia, attacking these processes may be minimally effective or even futile. If we think of AD neurodegeneration as a smoldering fire destroying the structural integrity of the brain, we must quench the flame before the damage is irreparable.

Clearly, we should seek the tools necessary to test putative disease modifiers in the pre-dementia population, presumably as early as feasible. We must identify individuals on the AD trajectory prior to significant brain dysfunction. And to indicate treatment effects in these individuals we require outcome measures that are dynamic indicators of disease (and treatment response) when there are little or no cognitive and clinical manifestations. In other words, we need surrogate outcome measures that are reasonably likely to predict long-term, clinically relevant benefits. Progress in the development of biochemical and neuroimaging biomarkers of AD suggests that the necessary tools may be close at hand."

Here is the full text of Dr. Aisen's remarks and a recording of the webinar with slides and audio, including of the Q&A session:alzforum/res/for/journal/detail.asp?liveID=180

SOURECE Alzheimer Research Forum