Early risk assessment for Alzheimer's disease

Abstract

The purpose of the Alzheimer's Association Research Roundtable meeting was to discuss the potential of finding diagnostic tools to determine the earliest risk factors for Alzheimer's disease (AD). Currently, drugs approved for AD address symptoms which are generally manifest after the disease is already well-established, but there is a growing pipeline of drugs that may alter the underlying pathology and therefore slow or halt progression of the disease. As these drugs become available, it will become increasingly imperative that those at risk for AD be detected and possibly treated early, especially given recent indications that the disease process may start decades before the first clinical symptoms are recognized. Early detection must go hand-in-hand with qualified tools to determine the efficacy of drugs in people who may be asymptomatic or who have only very mild symptoms of the disease. Devising strategies and screening tools to identify and monitor those at risk in order to perform "prevention" trials is seen by many as a top public-health priority, made all the more urgent by an impending growth in the elderly population worldwide.

A Naturalistic Study of Driving Behavior in Older Adults and Preclinical Alzheimer Disease: A Pilot Study

“…By 2050, one million persons will be newly diagnosed and living with symptomatic AD every year (Alzheimer's Association, 2016). Preclinical AD is defined as cognitive normality with biomarker evidence (e.g., brain imaging and cerebrospinal fluid [CSF] assays) that the disease process has begun (Carrillo et al, 2009; Clark et al, 2011; Fagan et al, 2009; Klunk et al, 2004). Individuals with preclinical AD eventually progress to symptomatic AD and will develop cognitive and functional impairments that affect complex activities such as driving (Fagan et al, 2007; Morris et al, 2009; Roe et al, 2016).…”

Preclinical Alzheimer's disease and longitudinal driving decline

“…CSF biomarkers are based on assays of proteins that are pathologically misfolded, and in addition to Aβ 42 , include tau and phosphorylated tau (ptau 181 ), the principal components of neurofibrillary tangles. 11 Our prior study results have indicated that road test performance, 8 and self-reports of previous involvement in crashes, 12 are cross-sectionally associated with abnormality of these biomarker levels among persons who are cognitively normal.…”

Episodic memory of odors stratifies Alzheimer biomarkers in normal elderly

“…The validation of indices to identify cognitively healthy individuals at risk for developing the progressive memory symptoms of AD, and to follow these individuals over time is essential for conducting therapeutic trials in this preclinical phase (2). Biomarkers that detect evidence of pathology and are verified for the dementia and MCI phases of AD, e.g., volumetric MRI (3), PET imaging (4) and CSF (5), are under examination in preclinical populations.…”