New diagnostic concepts in Alzheimer's disease

Watkin, Anna; Sikdar, Sudip; Majumdar, Biswadeep; Richman, Anna

doi:10.1192/apt.bp.112.010462

Cited by 4 publications

(5 citation statements)

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“…They describe prodromal Alzheimer's disease as ‘MCI of the Alzheimer type’ and advocate the use of CSF and imaging biomarkers to help make this distinction. For preclinical Alzheimer's disease, however, the NIA–AA guidelines only apply in a research setting (Watkin 2013). Research criteria for diagnosing preclinical states of Alzheimer's disease developed by the International Working Group (the IGW-2 criteria) require the individual to be asymptomatic, have a marker of Alzheimer's disease pathology or an Alzheimer's disease autosomal dominant mutation on chromosome 1, 14 or 21 (Dubois 2014).…”

Section: Diagnostic Criteriamentioning

confidence: 99%

Biomarkers and the diagnosis of preclinical dementia

Lilford¹,

Hughes²

2018

BJPsych advances

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SUMMARYAlzheimer's disease pathology accumulates years before the onset of clinical symptoms and has been termed ‘preclinical dementia’. Biomarkers have been developed to detect this pathology – namely, brain amyloid deposition and markers of neurodegeneration. In this article we describe these biomarkers and review the evidence for their clinical use in predicting risk both in the cognitively ‘normal’ and in those who already have established cognitive decline. We also discuss the limitations and ethical considerations of these tests and consider whether we should start incorporating Alzheimer's disease biomarkers into clinical practice. We find that, because many cognitively healthy people will have Alzheimer's pathology, and it is not clear whether this does help predict future risk of Alzheimer's disease, diagnosing preclinical dementia carries numerous ethical implications and is currently not being advocated outside research settings.LEARNING OBJECTIVES•Understand the concepts of preclinical and prodromal Alzheimer's disease and the use of biomarkers in this context•Analyse the supporting evidence for the use of biomarkers in prodromal and preclinical dementia•Apply this information to everyday clinical practiceDECLARATION OF INTERESTJ. C. H. works in the Research Institute for the Care of Older People (RICE), which undertakes clinical drug trials for drug companies. He is a sub-investigator on a number of trials (some of which involve neuroimaging and biomarkers) and principal investigator and chief investigator on two trials (neither of which involves biomarkers). All of these trials concern Alzheimer's disease or dementia. He does not receive any direct personal payment from the trials: the payment goes to RICE, which does, however, fund almost half of his post. RICE is an independent charity and separate from the University of Bristol.

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Section: Diagnostic Criteriamentioning

confidence: 99%

Biomarkers and the diagnosis of preclinical dementia

Lilford¹,

Hughes²

2018

BJPsych advances

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“…Dementia poses significant challenges to patients, caregivers, and healthcare systems due to its rising prevalence and socioeconomic burden [ 4 ]. Alzheimer disease (AD) is the prototype and accounts for approximately 50–60% of all dementias [ 5 ]. In helping meet these significant challenges, current research into better diagnostics and treatments continues to advance and has been very promising.…”

Section: Introductionmentioning

confidence: 99%

Googling Alzheimer Disease: An Infodemiological and Ecological Study

Piamonte

Anlacan

Jamora

et al. 2021

Dement Geriatr Cogn Disord Extra

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Introduction: Understanding the emergent role of the internet on the health-seeking behavior of people is critical not only in the areas of medicine and public health but also in the field of infodemiology. Methods: Using Google Trends, data on global search queries for Alzheimer disease (AD) between January 2004 and April 2021 were analyzed. The relationship between online interest, as reflected by search volume index (SVI), and measures of disease burden, namely prevalence, deaths, and disability-adjusted life years, was evaluated. Results: There was a reduction in the tendency to search for AD during the past two decades. SVI peaks corresponded to news of famous people with AD and awareness months. Symptoms, causes, and differences with the term dementia were central queries for persons interested in AD. No notable overall correlation between SVI and measures of disease burden was found due to competing results. Sub-group analyses, however, showed that these correlations may be influenced by socioeconomic development, with strong negative significant associations observed in lower middle-income countries. Conclusion: Online interest in AD may represent a more complex metric influenced by socioeconomic factors. Awareness of the impact of celebrity diagnosis and awareness months on online search behavior may prove useful in the planning of public health campaigns for AD.

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“…23 However, these rates vary by subtype of disease. The variation in the conversion rates could be explained by the differing disease processes 13,24 and the heterogeneity which comes from different populations being studied. 25 In epidemiological samples, MCI has often been classified by applying a psychometric cut-off point to a proportion of cases without in-depth clinical examination, and a large proportion of these cases subsequently revert to normality.…”

Section: Mild Cognitive Impairmentmentioning

confidence: 99%

“…11 Extensive research has been devoted to identifying the characteristics of incipient dementia, which presents before the onset of the full dementia syndrome. 12,13 This research has given rise to the concept of MCI, which is the state between the cognitive changes of normal ageing and very early dementia. 14,15 The transitional period has been described using a variety of terms such as MCI, dementia prodrome, incipient dementia, isolated memory impairment 16 and, more recently, mild neurocognitive disorder.…”

Section: Mild Cognitive Impairmentmentioning

confidence: 99%

“…For example, guidelines suggest that the decision of whether or not to investigate for possible mild cognitive impairment or dementia is influenced by cognitive test scores (e.g. in the Mini-Mental State Examination, the threshold for mild Alzheimer's disease is a score of 21-26, whereas the threshold for moderate Alzheimer's disease is a score of [10][11][12][13][14][15][16][17][18][19][20].…”

Section: National Institute Of Neurological and Communicative Disordementioning

confidence: 99%

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Automated tests for diagnosing and monitoring cognitive impairment: a diagnostic accuracy review

Aslam

Bates

Dündar

et al. 2016

Health Technol Assess

Self Cite

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BackgroundCognitive impairment is a growing public health concern, and is one of the most distinctive characteristics of all dementias. The timely recognition of dementia syndromes can be beneficial, as some causes of dementia are treatable and are fully or partially reversible. Several automated cognitive assessment tools for assessing mild cognitive impairment (MCI) and early dementia are now available. Proponents of these tests cite as benefits the tests’ repeatability and robustness and the saving of clinicians’ time. However, the use of these tools to diagnose and/or monitor progressive cognitive impairment or response to treatment has not yet been evaluated.ObjectivesThe aim of this review was to determine whether or not automated computerised tests could accurately identify patients with progressive cognitive impairment in MCI and dementia and, if so, to investigate their role in monitoring disease progression and/or response to treatment.Data sourcesFive electronic databases (MEDLINE, EMBASE, The Cochrane Library, ISI Web of Science and PsycINFO), plus ProQuest, were searched from 2005 to August 2015. The bibliographies of retrieved citations were also examined. Trial and research registers were searched for ongoing studies and reviews. A second search was run to identify individual test costs and acquisition costs for the various tools identified in the review.Review methodsTwo reviewers independently screened all titles and abstracts to identify potentially relevant studies for inclusion in the review. Full-text copies were assessed independently by two reviewers. Data were extracted and assessed for risk of bias by one reviewer and independently checked for accuracy by a second. The results of the data extraction and quality assessment for each study are presented in structured tables and as a narrative summary.ResultsThe electronic searching of databases, including ProQuest, resulted in 13,542 unique citations. The titles and abstracts of these were screened and 399 articles were shortlisted for full-text assessment. Sixteen studies were included in the diagnostic accuracy review. No studies were eligible for inclusion in the review of tools for monitoring progressive disease. Eleven automated computerised tests were assessed in the 16 included studies. The overall quality of the studies was good; however, the wide range of tests assessed and the non-standardised reporting of diagnostic accuracy outcomes meant that meaningful synthesis or statistical analysis was not possible.LimitationsThe main limitation of this review is the substantial heterogeneity of the tests assessed in the included studies. As a result, no meta-analyses could be undertaken.ConclusionThe quantity of information available is insufficient to be able to make recommendations on the clinical use of the computerised tests for diagnosing and monitoring MCI and early dementia progression. The value of these tests also depends on the costs of acquisition, training, administration and scoring.Future workResearch is required to establish stable cut-off points for automated computerised tests that are used to diagnose patients with MCI or early dementia. Additionally, the costs associated with acquiring and using these tests in clinical practice should be estimated.Study registrationThe study is registered as PROSPERO CRD42015025410.FundingThe National Institute for Health Research Health Technology Assessment programme.

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New diagnostic concepts in Alzheimer's disease

Cited by 4 publications

References 30 publications

Biomarkers and the diagnosis of preclinical dementia

Biomarkers and the diagnosis of preclinical dementia

Googling Alzheimer Disease: An Infodemiological and Ecological Study

Automated tests for diagnosing and monitoring cognitive impairment: a diagnostic accuracy review

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