1
|
Veneziano M, Piazza MF, Palummeri E, Paganino C, Andreoli GB, Amicizia D, Ansaldi F. A Longitudinal Study on Cognitive Training for Cognitively Preserved Adults in Liguria, Italy. Healthcare (Basel) 2024; 12:393. [PMID: 38338278 PMCID: PMC10855271 DOI: 10.3390/healthcare12030393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 01/13/2024] [Accepted: 02/01/2024] [Indexed: 02/12/2024] Open
Abstract
In this study, we examined the effects of memory training on cognitive function and depressive symptoms in a cohort of 794 healthy adults aged 50 years or older. Participants were divided into an active intervention group and a passive intervention group, with various cognitive measures assessed over a one-year period. Univariate analysis revealed that the active intervention group consistently outperformed the passive group in measures of memory self-perception (Memory Complaint Questionnaire-MACQ), depressive symptoms (Geriatric Depression Scale-GDS-4), verbal memory and recall ability (A3LP), and verbal fluency (VF). Significant differences in MACQ scores were observed between the two groups at all time points, indicating enhanced memory self-perception in the active group. GDS-4 scores consistently favored the active group, suggesting a reduction in depressive symptoms. A3LP scores demonstrated that the active group had better verbal memory and recall abilities. VF scores consistently favored the active group, indicating superior language skills and cognitive flexibility. Linear regression model and mixed linear regression model reinforced these findings, with highly significant interaction effects observed between the active/passive group, gender, age, education, and time. These effects were particularly pronounced for MACQ and A3LP scores, indicating the combined impact of these factors on memory self-perception and verbal memory. This study highlights the positive impact of memory training intervention on cognitive function and depressive symptoms in older adults and underscores the importance of considering gender, age, and education in cognitive interventions. Notably, these benefits persist for up to six months from the end of the program. The results provide valuable insights into cognitive changes in aging populations and suggest that tailored memory training programs can yield significant improvements.
Collapse
Affiliation(s)
| | - Maria Francesca Piazza
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (E.P.); (G.B.A.); or (D.A.); or (F.A.)
| | - Ernesto Palummeri
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (E.P.); (G.B.A.); or (D.A.); or (F.A.)
| | - Chiara Paganino
- Local Health Unit 3 (ASL3), 16125 Genoa, Italy; (M.V.); (C.P.)
| | | | - Daniela Amicizia
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (E.P.); (G.B.A.); or (D.A.); or (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
| | - Filippo Ansaldi
- Regional Health Agency of Liguria (ALiSa), 16121 Genoa, Italy; (E.P.); (G.B.A.); or (D.A.); or (F.A.)
- Department of Health Sciences (DiSSal), University of Genoa, 16132 Genoa, Italy
| |
Collapse
|
2
|
Improving community health-care systems' early detection of cognitive decline and dementia. Alzheimers Dement 2022; 18:2375-2381. [PMID: 36314503 DOI: 10.1002/alz.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 11/11/2022]
Abstract
Preliminary estimates suggest that current global health-care systems lack the resource capacity to provide persons with dementia timely access to diagnosis, treatment, and care. There is an increasing need to improve timely identification of individuals who will likely progress to Alzheimer's disease (AD) dementia particularly among under-represented, underserved, and vulnerable populations. The rapidly evolving area of bioinformatics of health system data and the emergence of fluid-based biomarkers for pre-symptomatic AD may provide an innovative strategic option for health system planners. A think-tank style meeting entitled "The Campaign to Prevent Alzheimer's Disease Work Group on Community-Based Detection and Assessment of Cognitive Decline" developed recommendations to guide future sustainability activities, public policy campaigns, and implementation pilots. The group identified and explored different pathways of community-based detection using electronic health records, from different international health-care systems, to detect and surveil individuals with early possible cognitive impairment.
Collapse
|
3
|
Rossini PM, Cappa SF, Lattanzio F, Perani D, Spadin P, Tagliavini F, Vanacore N. The Italian INTERCEPTOR Project: From the Early Identification of Patients Eligible for Prescription of Antidementia Drugs to a Nationwide Organizational Model for Early Alzheimer's Disease Diagnosis. J Alzheimers Dis 2020; 72:373-388. [PMID: 31594234 DOI: 10.3233/jad-190670] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Alzheimer's disease is the most common age-related neurodegenerative disorder and its burden on patients, families, and society grows significantly with lifespan. Early modifications of risk-enhancing lifestyles and treatment initiation expand personal autonomy and reduce management costs. Many clinical trials with potentially disease-modifying drugs are devoted to mild cognitive impairment (MCI) prodromal-to-Alzheimer's disease. The identification of biomarkers for early diagnosis may thus be crucial for early intervention and identification of high-risk subjects, the most appropriate target of new drugs as soon as they will be discovered. INTERCEPTOR is a strategic project by the Italian Ministry of Health and the Italian Medicines Agency (AIFA), aiming to validate the best combination (highly accurate, non-invasive, available on the whole national territory and financially sustainable) of biomarkers and organizational model for early diagnosis. 500 MCI subjects will be enrolled at baseline and followed-up for 3 years for at least 400 of them in order to define a "hub & spoke" nationwide model with recruiting (spokes) centers for MCI identification and expert (hubs) centers for risk diagnosis.
Collapse
Affiliation(s)
- Paolo Maria Rossini
- Area of Neuroscience, University Policlinic A. Gemelli Foundation-IRCCS, Rome, Italy.,Institute of Neurology, Catholic University, Rome, Italy
| | - Stefano F Cappa
- University School for Advanced Studies IUSS Pavia, Pavia, Italy.,IRCCS St. John of God, Brescia, Italy
| | | | - Daniela Perani
- Nuclear Medicine Unit and Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Spadin
- President "Associazione Italiana Malattia di Alzheimer" - AIMA, Italy
| | | | - Nicola Vanacore
- National Center for Disease Prevention and Health Promotion, National Institute of Health, Rome, Italy
| |
Collapse
|
4
|
Khachaturian AS, Hayden KM, Mielke MM, Tang Y, Lutz MW, Gustafson DR, Kukull WA, Mohs R, Khachaturian ZS. Future prospects and challenges for Alzheimer's disease drug development in the era of the NIA‐AA Research Framework. Alzheimers Dement 2018; 14:532-534. [DOI: 10.1016/j.jalz.2018.03.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ara S. Khachaturian
- Alzheimer's & Dementia: The Journal of the Alzheimer's Association Rockville MD USA
| | - Kathleen M. Hayden
- Associate Professor, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Sticht Center for Healthy Aging and Alzheimer's Prevention Wake Forest School of Medicine Winston‐Salem NC USA
| | - Michelle M. Mielke
- Professor of Epidemiology, Department of Health Sciences Research Professor of Neurology, Mayo Clinic College of Medicine Rochester MN USA
| | - Yi Tang
- Associate Professor, Department of Neurology Xuan Wu Hospital Beijing China
| | - Michael W. Lutz
- Assistant Professor of Neurology, Department of Neurology Duke University School of Medicine Durham NC USA
| | - Deborah R. Gustafson
- Section for NeuroEpidemiology, Department of Neurology State University of New York–Downstate Medical Center Brooklyn NY USA
| | - Walter A. Kukull
- Department of Epidemiology, School of Public Health University of Washington Seattle WA USA
| | - Richard Mohs
- Senior Associate Editor Alzheimer's & Dementia: The Journal of the Alzheimer's Association Chicago IL USA
| | | |
Collapse
|
5
|
Yim SJ, Yi D, Byun MS, Choe YM, Choi HJ, Baek H, Sohn BK, Kim JW, Kim EJ, Lee DY. Screening Ability of Subjective Memory Complaints, Informant-Reports for Cognitive Decline, and Their Combination in Memory Clinic Setting. Psychiatry Investig 2017; 14:640-646. [PMID: 29042889 PMCID: PMC5639132 DOI: 10.4306/pi.2017.14.5.640] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 04/06/2017] [Accepted: 06/03/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE This study aimed to compare the accuracy of subjective memory complaints, informant-reports for cognitive declines, and their combination for screening cognitive disorders in memory clinic setting. METHODS One-hundred thirtytwo cognitively normal (CN), 136 mild cognitive impairment (MCI), and 546 dementia who visited the memory clinic in the Seoul National University Hospital underwent standardized clinical evaluation and comprehensive neuropsychological assessment. The Subjective Memory Complaints Questionnaire (SMCQ) and the Seoul Informant Report Questionnaire for Dementia (SIRQD) were used to assess subjective memory complaints and informant-reports for cognitive declines, respectively. RESULTS Both SMCQ and SIRQD showed significant screening ability for MCI, dementia, and overall cognitive disorder (CDall: MCI plus dementia) (screening accuracy: 60.1-94.6%). The combination of SMCQ and SIRQD (SMCQ+SIRQD) was found to have significantly better screening accuracy compared to SMCQ alone for any cognitive disorders. SMCQ+SIRQD also significantly improved screening accuracy of SIRQD alone for MCI and CDall, but not for dementia. CONCLUSION Our findings suggest that the combined information of both subjective memory complaints and informant-reports for cognitive declines can improve MCI screening by each individual information, while such combination appears not better than informant-reports in regard of dementia screening.
Collapse
Affiliation(s)
- Seon Jin Yim
- Department of Geriatric Psychiatry, National Center for Mental Health, Seoul, Republic of Korea
| | - Dahyun Yi
- Department of Psychiatry and Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
| | - Min Soo Byun
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young Min Choe
- Department of Neuropsychiatry, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Hyo Jung Choi
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyewon Baek
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Bo Kyung Sohn
- Department of Psychiatry, Inje University College of Medicine, Busan, Republic of Korea
| | - Jee Wook Kim
- Department of Neuropsychiatry, Hallym University Dongtan Sacred Heart Hospital, Hwaseong, Republic of Korea
| | - Eui-Jung Kim
- Department of Psychiatry, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Dong Young Lee
- Department of Psychiatry and Biomedical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
6
|
Knopman D, Alford E, Tate K, Long M, Khachaturian AS. Patients come from populations and populations contain patients. A two‐stage scientific and ethics review: The next adaptation for single institutional review boards. Alzheimers Dement 2017; 13:940-946. [DOI: 10.1016/j.jalz.2017.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Eli Alford
- Schulman IRB Research Triangle Park NC USA
| | | | - Mark Long
- Schulman IRB Research Triangle Park NC USA
| | | |
Collapse
|
7
|
Shah H, Albanese E, Duggan C, Rudan I, Langa KM, Carrillo MC, Chan KY, Joanette Y, Prince M, Rossor M, Saxena S, Snyder HM, Sperling R, Varghese M, Wang H, Wortmann M, Dua T. Research priorities to reduce the global burden of dementia by 2025. Lancet Neurol 2016; 15:1285-1294. [DOI: 10.1016/s1474-4422(16)30235-6] [Citation(s) in RCA: 189] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/04/2016] [Accepted: 08/28/2016] [Indexed: 10/20/2022]
|
8
|
Dadaiyn F, Farzami J, Pourabbasi A, Pourabbasi A. A Road Map for School Health Promotion, a Model for Cognitive-Oriented School Health Policy Making and Implementing Policies for Schools. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2015. [DOI: 10.17795/intjsh-30185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
9
|
Khachaturian ZS, Khachaturian AS. Politics of science: Progress toward prevention of the dementia-Alzheimer's syndrome. Mol Aspects Med 2015; 43-44:3-15. [PMID: 26054567 DOI: 10.1016/j.mam.2015.06.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 06/01/2015] [Indexed: 11/29/2022]
Abstract
There exist many challenges hampering the discovery and development of effective interventions to prevent dementia. Three major trends have now intersected to influence the emerging interest in disease modifying therapies that may delay or halt dementia. The three crucial factors shaping this current focus are: (1) the emergence of the longevity revolution and the impact of a aging society, (2) the effects of the US Federal investment in research in advancing knowledge about the neurobiology of aging and dementia, and (3) the problem of US legislators and health policy makers to balance the allocation of evermore scarce research funding resources. The purpose of this essay is to provide a survey of the politics of science and to describe efforts to correctly manage the high level of expectations of both the patient and research communities. The perspective offered reviews the history and evolution of the ideas to treat or prevent dementia and Alzheimer's disease as a national strategic goal. The aim is to evaluate the interplay between science and formulation of public policy for setting research priority. We use the history of developing US National Institute of Aging's extramural research programs on brain aging and Alzheimer's disease (Khachaturian, 2006; 2007) as an initial case study.
Collapse
Affiliation(s)
- Zaven S Khachaturian
- Campaign to Prevent Alzheimer's Disease by 2020, 451 Hungerford Drive 119-344, Rockville, MD 20850, USA.
| | - Ara S Khachaturian
- Campaign to Prevent Alzheimer's Disease by 2020, 451 Hungerford Drive 119-344, Rockville, MD 20850, USA
| |
Collapse
|
10
|
Iliffe S, Wilcock J, Drennan V, Goodman C, Griffin M, Knapp M, Lowery D, Manthorpe J, Rait G, Warner J. Changing practice in dementia care in the community: developing and testing evidence-based interventions, from timely diagnosis to end of life (EVIDEM). PROGRAMME GRANTS FOR APPLIED RESEARCH 2015. [DOI: 10.3310/pgfar03030] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BackgroundThe needs of people with dementia and their carers are inadequately addressed at all key points in the illness trajectory, from diagnosis through to end-of-life care. The EVIDEM (Evidence-based Interventions in Dementia) research and development programme (2007–12) was designed to help change this situation within real-life settings.ObjectivesThe EVIDEM projects were (1) evaluation of an educational package designed to enhance general practitioners’ (GPs’) diagnostic and management skills; (2) evaluation of exercise as therapy for behavioural and psychological symptoms of dementia (BPSD); (3) development of a toolkit for managing incontinence in people with dementia living at home; (4) development of a toolkit for palliative care for people with dementia; and (5) development of practice guidance on the use of the Mental Capacity Act (MCA) 2005.DesignMixed quantitative and qualitative methods from case studies to large database analyses, including longitudinal surveys, randomised controlled trials and research register development, with patient and public involvement built into all projects.SettingGeneral practices, community services, third-sector organisations and care homes in the area of the North Thames Dementia and Neurodegenerative Diseases Research Network local research network.ParticipantsPeople with dementia, their family and professional carers, GPs and community mental health team members, staff in local authority social services and third-sector bodies, and care home staff.Main outcome measuresDementia management reviews and case identification in general practice; changes in behavioural and psychological symptoms measured with the Neuropsychiatric Inventory (NPI); extent and impact of incontinence in community-dwelling people with dementia; mapping of pathways to death of people with dementia in care homes, and testing of a model of collaborative working between primary care and care homes; and understandings of the MCA 2005 among practitioners working with people with dementia.ResultsAn educational intervention in general practice did not alter management or case identification. Exercise as a therapy for BPSD did not reduce NPI scores significantly, but had a significant positive effect on carer burden. Incontinence is twice as common in community-dwelling people with dementia than their peers, and is a hidden taboo within a stigma. Distinct trajectories of dying were identified (anticipated, unexpected and uncertain), and collaboration between NHS primary care and care homes was improved, with cost savings. The MCA 2005 legislation provided a useful working framework for practitioners working with people with dementia.ConclusionsA tailored educational intervention for general practice does not change practice, even when incentives, policy pressure and consumer demand create a favourable environment for change; exercise has potential as a therapy for BPSD and deserves further investigation; incontinence is a common but unrecognised problem for people with dementia in the community; changes in relationships between care homes and general practice can be achieved, with benefits for people with dementia at the end of life and for the UK NHS; application of the MCA 2005 will continue to improve but educational reinforcements will help this. Increased research capacity in dementia in the community was achieved. This study suggests that further work is required to enhance clinical practice around dementia in general practice; investigate the apparent beneficial effect of physical activity on BPSD and carer well-being; develop case-finding methods for incontinence in people with dementia; optimise working relationships between NHS staff and care homes; and reinforce practitioner understanding of the MCA 2005.Trial registrationEVIDEM: ED-NCT00866099; EVIDEM: E-ISRCTN01423159.FundingThis project was funded by the Programme Grants for Applied Research programme of the National Institute for Health Research.
Collapse
Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Jane Wilcock
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Vari Drennan
- Centre for Health and Social Care Research, The Faculty of Health, Social Care and Education at Kingston University London & St George’s University of London (previously at University College London), London, UK
| | - Claire Goodman
- Centre for Research in Primary and Community Care, School of Health and Social Work, University of Hertfordshire, Hertfordshire, UK
| | - Mark Griffin
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - Martin Knapp
- Personal Social Services Research Unit (PSSRU), Department of Social Policy, London School of Economics and Political Science, London, UK
| | - David Lowery
- Older Peoples Mental Health Services, Central and North West London NHS Foundation Trust (previously known as Central & NW London Mental Health NHS Trust), London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, Policy Institute at King’s, King’s College London, London, UK
| | - Greta Rait
- Research Department of Primary Care & Population Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | - James Warner
- Older Peoples Mental Health Services, Central and North West London NHS Foundation Trust (previously known as Central & NW London Mental Health NHS Trust), London, UK, Department of Psychiatry, Faculty of Medicine, Imperial College London, London, UK
| |
Collapse
|
11
|
Abstract
Abstract:Introduction:In parallel with robust efforts world-wide to develop effective neuroprotection for established disease, resources are being mobilized to delineate risk factors and implement preventive measures in a concerted effort to forestall the anticipated Alzheimer disease (AD) epidemic. A review of heritable and ‘acquired’ dementia risk factors, many operating at midlife, is presented in a companion paper.Objectives:In 2009, an Alzheimer Risk Assessment Clinic (ARAC) was established at the Jewish General Hospital (Montreal) to address the concerns increasingly being voiced by active middle-aged individuals at risk for AD. A positive family history of AD and/or perceived changes in personal cognitive function (predominantly short-term memory) are main reasons for referral. The primary objectives of ARAC are to (i) ascertain, inform and mitigate the risks of developing AD in cognitively-healthy persons aged 40-65 based on best available medical and epidemiological evidence, (ii) conduct scientific research on midlife dementia risk and prevention in this population and (iii) provide instruction in dementia risk assessment and management to health professionals, clinical/research fellows, medical residents and students. ARAC infrastructure, evaluation protocol, risk profile classification scheme, interventions, knowledge dissemination program, case vignettes, and seminal research projects are described.Conclusions:It is hoped that ARAC and similar initiatives will help prevent or delay dementia by innovating effective interventions based on increasingly nuanced estimation of modifiable AD risk in presymptomatic persons.
Collapse
|
12
|
Abstract
Alzheimer disease (AD) is a dementing, neurodegenerative disorder that affects approximately 500,000 Canadians and its prevalence is expected to double over the next 30 years. Although several medications may temporarily augment cognitive abilities in AD, there presently exists no proven method to avoid the inevitable clinical deterioration in this devastating condition. The delineation of risk factors for the development of AD offers hope for the advent of effective prevention or interventions that might retard the onset of symptoms. In this article, we provide a comprehensive review of midlife risk factors implicated in the etiopathogenesis of sporadic AD. Although some risk factors are heritable and largely beyond our control, others are determined by lifestyle or environment and are potentially modifiable. In a companion paper, we introduce the concept of an Alzheimer Risk Assessment Clinic for ascertainment and mitigation of these and other putative dementia risk factors in middle-aged adults.
Collapse
|
13
|
Zhu CW, Sano M, Ferris SH, Whitehouse PJ, Patterson MB, Galasko D, Schneider LS, Aisen PS. Alzheimer's Disease Cooperative Study Prevention Instrument Project assessing resource use and volunteer and paid work in healthy elders: a longitudinal study. J Am Geriatr Soc 2014; 62:985-8. [PMID: 24828933 DOI: 10.1111/jgs.12816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Carolyn W Zhu
- Department of Geriatrics and Palliative Medicine, Mount Sinai School of Medicine, New York, New York
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Scott TJ, O'Connor AC, Link AN, Beaulieu TJ. Economic analysis of opportunities to accelerate Alzheimer's disease research and development. Ann N Y Acad Sci 2014; 1313:17-34. [PMID: 24673372 PMCID: PMC4285871 DOI: 10.1111/nyas.12417] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The development of disease-modifying treatments for Alzheimer's disease (AD) faces a number of barriers. Among these are the lack of surrogate biomarkers, the exceptional size and duration of clinical trials, difficulties in identifying appropriate populations for clinical trials, and the limitations of monotherapies in addressing such a complex multifactorial disease. This study sets out to first estimate the consequent impact on the expected cost of developing disease-modifying treatments for AD and then to estimate the potential benefits of bringing together industry, academic, and government stakeholders to co-invest in, for example, developing better biomarkers and cognitive assessment tools, building out advanced registries and clinical trial-readiness cohorts, and establishing clinical trial platforms to investigate combinations of candidate drugs and biomarkers from the portfolios of multiple companies. Estimates based on interviews with experts on AD research and development suggest that the cost of one new drug is now $5.7 billion (95% confidence interval (CI) $3.7-9.5 billion) and could be reduced to $2.0 billion (95% CI $1.5-2.9 billion). The associated acceleration in the arrival of disease-modifying treatments could reduce the number of case years of dementia by 7.0 million (95% CI 4.4-9.4 million) in the United States from 2025 through 2040.
Collapse
Affiliation(s)
- Troy J Scott
- RTI International, Research Triangle Park, North Carolina
| | | | | | | |
Collapse
|
15
|
Naylor MD, Karlawish JH, Arnold SE, Khachaturian AS, Khachaturian ZS, Lee VMY, Baumgart M, Banerjee S, Beck C, Blennow K, Brookmeyer R, Brunden KR, Buckwalter KC, Comer M, Covinsky K, Feinberg LF, Frisoni G, Green C, Guimaraes RM, Gwyther LP, Hefti FF, Hutton M, Kawas C, Kent DM, Kuller L, Langa KM, Mahley RW, Maslow K, Masters CL, Meier DE, Neumann PJ, Paul SM, Petersen RC, Sager MA, Sano M, Schenk D, Soares H, Sperling RA, Stahl SM, van Deerlin V, Stern Y, Weir D, Wolk DA, Trojanowski JQ. Advancing Alzheimer's disease diagnosis, treatment, and care: recommendations from the Ware Invitational Summit. Alzheimers Dement 2013; 8:445-52. [PMID: 22959699 DOI: 10.1016/j.jalz.2012.08.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 11/28/2022]
Abstract
To address the pending public health crisis due to Alzheimer's disease (AD) and related neurodegenerative disorders, the Marian S. Ware Alzheimer Program at the University of Pennsylvania held a meeting entitled "State of the Science Conference on the Advancement of Alzheimer's Diagnosis, Treatment and Care," on June 21-22, 2012. The meeting comprised four workgroups focusing on Biomarkers; Clinical Care and Health Services Research; Drug Development; and Health Economics, Policy, and Ethics. The workgroups shared, discussed, and compiled an integrated set of priorities, recommendations, and action plans, which are presented in this article.
Collapse
Affiliation(s)
- Mary D Naylor
- Institute on Aging, University of Pennsylvania, Philadelphia, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Trojanowski JQ, Arnold SE, Karlawish JH, Naylor M, Brunden KR, Lee VMY. A model for improving the treatment and care of Alzheimer's disease patients through interdisciplinary research. Alzheimers Dement 2012; 8:564-73. [PMID: 23102127 PMCID: PMC3643202 DOI: 10.1016/j.jalz.2011.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 08/22/2011] [Accepted: 08/24/2011] [Indexed: 12/31/2022]
Abstract
The emerging global epidemic of Alzheimer's disease (AD) demands novel paradigms to address the two unmet needs of the field: (a) cost-effective health care delivery programs/services, and (b) clinical and basic research to accelerate therapy discovery/development. This report outlines a model demonstration project, the Marian S. Ware Alzheimer Program at the University of Pennsylvania, which was designed to achieve four specific aims: (1) improve the integration and continuity of AD care; (2) identify biomarkers that detect the earliest presence of AD and related neurodegenerative cognitive disorders; (3) enhance both the design and conduct of clinical trials as well as review their results to more effectively test new AD therapies and translate valuable therapies into clinical practice; and (4) discover and develop novel disease-modifying small molecule treatments for AD. The "Ware-UPenn" program has been presented in this report as a useful prototype for partnerships between private philanthropy and academia in planning and developing programs to address a major national public health problem.
Collapse
|
17
|
|
18
|
Khachaturian ZS, Khachaturian AS, Thies W. The draft "National Plan" to address Alzheimer's disease - National Alzheimer's Project Act (NAPA). Alzheimers Dement 2012; 8:234-6. [PMID: 22546355 DOI: 10.1016/j.jalz.2012.04.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This perspective updates the status of the "National Plan to Address Alzheimer's Disease" and the recommendations of the NAPA Advisory Council's Sub-committee on Research. Here, we identify some of the critical issues the future reiterations of the National Plan should consider during implementation phase of the plan. The Journal invites the scientific community to contribute additional ideas and suggestions towards a national research initiative.
Collapse
|
19
|
Shelkovnikova TA, Kulikova AA, Tsvetkov PO, Peters O, Bachurin SO, Buchman VL, Ninkina NN. Proteinopathies, neurodegenerative disorders with protein aggregation-based pathology. Mol Biol 2012. [DOI: 10.1134/s0026893312020161] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
20
|
Abstract
There are no substantially effective treatments or preventatives for Alzheimer disease. The few prevention trials that were undertaken did not shown efficacy for the drugs tested; but, nevertheless, advanced prevention trials methods. We review past recruitment methods and discuss areas for improvement. Improvements in recruitment methods can enhance the likelihood for accurately demonstrating the efficacy of an effective drug. Effective therapeutics to prevent AD await discovery and proof.
Collapse
Affiliation(s)
- L S Schneider
- University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA.
| |
Collapse
|
21
|
Khachaturian ZS. Prospects for designating Alzheimer's disease research a national priority. Alzheimers Dement 2012; 7:557-61. [PMID: 22055971 DOI: 10.1016/j.jalz.2011.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
This editorial evaluates the prospects of the National Alzheimer's Project Act (NAPA) succeeding to shape public policies that would substantially increase national expenditures for research on Alzheimer's disease. The essay identifies, in the context of 30-year history, some of the difficult challenges the NAPA Advisory Council must address and offers specific recommendations for an action plan by the Secretary, Department of Health and Human Services (DHHS).
Collapse
|
22
|
Vellas B, Pesce A, Robert PH, Aisen PS, Ancoli-Israel S, Andrieu S, Cedarbaum J, Dubois B, Siemers E, Spire JP, Weiner MW, May TS. AMPA workshop on challenges faced by investigators conducting Alzheimer's disease clinical trials. Alzheimers Dement 2011; 7:e109-17. [PMID: 21784343 DOI: 10.1016/j.jalz.2010.05.2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2010] [Accepted: 05/24/2010] [Indexed: 01/25/2023]
Abstract
The recruitment and retention of patients are among the greatest challenges currently being faced by researchers who conduct Alzheimer's disease (AD) clinical trials. To discuss these challenges and other major issues associated with clinical research in AD, an international workshop was organized by the Association Monégasque pour la recherche sur la Maladie d'Alzheimer at Monte Carlo, Monaco, in February 2010, with the participation of leading research experts in the field of Alzheimer's. Key topics discussed were as follows: (1) the selection, recruitment, and retention of clinical trial subjects; (2) international co-operation among researchers; and (3) patient rights and informed consent for participants in clinical trials. This article highlights some of the challenges faced by investigators when conducting clinical trials in AD, and it also offers some recommendations aimed at overcoming these challenges.
Collapse
Affiliation(s)
- Bruno Vellas
- Department of Geriatrics, INSERM U558, Toulouse University Hospital Center, Toulouse, France
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Using cognitive decline in novel trial designs for primary prevention and early disease-modifying therapy trials of Alzheimer's disease. Int Psychogeriatr 2011; 23:1376-85. [PMID: 21477408 DOI: 10.1017/s1041610211000354] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Ideally putative disease-modifying therapies for Alzheimer's disease (AD) should be tested in patients who have minimal morbidity. Current barriers to such trials in early disease include the lack of disease-specific early biomarkers, insensitivity of quantitative cognitive outcome measures, and expensive trial designs requiring large sample sizes and long duration. This paper describes principles and progress towards a novel trial design that overcomes these problems, utilizing wide-scale cognitive performance screening to define pre-trial cognitive decline trajectories which can serve as trial outcome measures to assess AD disease-modifying efficacy. METHODS Theoretical principles important for the detection of intra-individual cognitive decline and a practical example are described. RESULTS Serial evaluations of community-based volunteers demonstrate how a screening tool method to detect subtle cognitive decline can predict in vivo amyloid pathology as a trigger for etiological evaluation. Trajectories of decline appear consistent over at least two years, suggesting they could be used as a trial inclusion criterion and ameliorable outcome measure together with other AD biomarkers. Informative trial durations could be 6-12 months, or extend to incorporate staggered random withdrawal or start designs, with as few as 20 individuals per treatment arm. CONCLUSIONS This trial methodology offers significant advantages over current AD trial designs, including treatment at earlier stages of disease, shorter trial duration, obviation of informed consent difficulties, smaller sample sizes, reduced cost and--given adequate screening programs--sufficient subjects for multiple simultaneous trials. Importantly, it allows the rapid evaluation of putative treatments that may only be efficacious in pre-dementia states.
Collapse
|
24
|
Trojanowski JQ, Hampel H. Neurodegenerative disease biomarkers: guideposts for disease prevention through early diagnosis and intervention. Prog Neurobiol 2011; 95:491-5. [PMID: 21821094 DOI: 10.1016/j.pneurobio.2011.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
|
25
|
Schipper HM. Presymptomatic apolipoprotein E genotyping for Alzheimer's disease risk assessment and prevention. Alzheimers Dement 2011; 7:e118-23. [DOI: 10.1016/j.jalz.2010.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 05/25/2010] [Accepted: 06/03/2010] [Indexed: 11/26/2022]
Affiliation(s)
- Hyman M. Schipper
- Centre for Neurotranslational Research and Bloomfield Centre for Research in AgingLady Davis Institute for Medical ResearchJewish General HospitalMcGill UniversityMontrealQuebecCanada
| |
Collapse
|
26
|
|
27
|
Iliffe S, Curry L, Kharicha K, Rait G, Wilcock J, Lowery D, Tapuria A, Kalra D, Ritchie C. Developing a Dementia Research Registry: a descriptive case study from North Thames DeNDRoN and the EVIDEM programme. BMC Med Res Methodol 2011; 11:9. [PMID: 21272296 PMCID: PMC3038162 DOI: 10.1186/1471-2288-11-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 01/27/2011] [Indexed: 11/10/2022] Open
Abstract
AIM To describe the development of a dementia research registry, outlining the conceptual, practical and ethical challenges, and to report initial experiences of recruiting people with dementia to it from primary and secondary care. BACKGROUND Women, the oldest old and ethnic minorities have been under-represented in clinical trials in dementia. Such under-representation biases estimates of absolute effect, absolute harm and cost-effectiveness. Research on dementia should include patient populations that more exactly reflect the population at risk. One of the impediments to this is the lack of a suitable tool for identification of patients suitable for studies. CONSTRUCTION & CONTENTS: A technology development methodology was used to develop a registry of people with dementia and their carers. This involved phases of modelling and prototype creation, 'bench testing' the prototype with experts and then 'field testing' the refined prototype in exemplar sites. The evaluation of the field testing described here is based on a case study methodology. UTILITY: This case study suggests that construction and population of a dementia research registry is feasible, but initial development is complex because of the ethical and organisational difficulties. Recruitment from primary care is particularly costly in terms of staff time and only identifies a very small number of people with dementia who were not already known to specialist services. Recruiting people with dementia through secondary care is a resource intensive process that takes up to six months to complete. Identifying the components of a minimum dataset was easy but its usefulness for pre-screening potential research populations has yet to be established. Acceptance rates are very high in the first clinic to recruit to the registry, but this may reflect the efforts of registry 'champions'. DISCUSSION AND CONCLUSIONS Easier recruitment may perpetuate potential selection biases and we are not yet able to assess the representativeness of the research-ready population recruited to the registry. The need to recruit from wider populations, through primary and social care, remains. The success of this registry will be measured by the proportion of people from it who are recruited to research projects, and its impact on overall accrual to studies.
Collapse
Affiliation(s)
- Steve Iliffe
- Research Department of Primary Care & Population Health, University College London, Royal Free campus, Rowland Hill St., London NW3 2PF, UK.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Khachaturian ZS, Barnes D, Einstein R, Johnson S, Lee V, Roses A, Sager MA, Shankle WR, Snyder PJ, Petersen RC, Schellenberg G, Trojanowski J, Aisen P, Albert MS, Breitner JCS, Buckholtz N, Carrillo M, Ferris S, Greenberg BD, Grundman M, Khachaturian AS, Kuller LH, Lopez OL, Maruff P, Mohs RC, Morrison-Bogorad M, Phelps C, Reiman E, Sabbagh M, Sano M, Schneider LS, Siemers E, Tariot P, Touchon J, Vellas B, Bain LJ. Developing a national strategy to prevent dementia: Leon Thal Symposium 2009. Alzheimers Dement 2010; 6:89-97. [PMID: 20298968 DOI: 10.1016/j.jalz.2010.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Among the major impediments to the design of clinical trials for the prevention of Alzheimer's disease (AD), the most critical is the lack of validated biomarkers, assessment tools, and algorithms that would facilitate identification of asymptomatic individuals with elevated risk who might be recruited as study volunteers. Thus, the Leon Thal Symposium 2009 (LTS'09), on October 27-28, 2009 in Las Vegas, Nevada, was convened to explore strategies to surmount the barriers in designing a multisite, comparative study to evaluate and validate various approaches for detecting and selecting asymptomatic people at risk for cognitive disorders/dementia. The deliberations of LTS'09 included presentations and reviews of different approaches (algorithms, biomarkers, or measures) for identifying asymptomatic individuals at elevated risk for AD who would be candidates for longitudinal or prevention studies. The key nested recommendations of LTS'09 included: (1) establishment of a National Database for Longitudinal Studies as a shared research core resource; (2) launch of a large collaborative study that will compare multiple screening approaches and biomarkers to determine the best method for identifying asymptomatic people at risk for AD; (3) initiation of a Global Database that extends the concept of the National Database for Longitudinal Studies for longitudinal studies beyond the United States; and (4) development of an educational campaign that will address public misconceptions about AD and promote healthy brain aging.
Collapse
|
29
|
Trojanowski JQ, Arnold SE, Karlawish JH, Brunden K, Cary M, Davatzikos C, Detre J, Gaulton G, Grossman M, Hurtig H, Jedrziewski K, McCluskey L, Naylor M, Polsky D, Schellenberg GD, Siderowf A, Shaw LM, Van Deerlin V, Wang LS, Werner R, Xie SX, Lee VMY. Design of comprehensive Alzheimer's disease centers to address unmet national needs. Alzheimers Dement 2010; 6:150-5. [PMID: 20298979 DOI: 10.1016/j.jalz.2009.11.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 11/06/2009] [Indexed: 01/16/2023]
Abstract
The problem of Alzheimer's disease (AD) exemplifies the challenges of dealing with a broad range of aging-related chronic disorders that require long-term, labor-intensive, and expensive care. As the baby boom generation ages and brain diseases become more prevalent, the need to confront the pending health care crisis is more urgent than ever before. Indeed, there is now a critical need to expand significantly the national effort to solve the problem of AD, with special focus on prevention. The Campaign to Prevent Alzheimer's Disease by 2020 (PAD2020) aims to create a new paradigm for planning and supporting the organization of worldwide cooperative research networks to develop new technologies for early detection and treatments of aging-related memory and motor impairments. PAD 2020 is developing an implementation plan to justify (1) increasing the federal budget for research, (2) developing novel national resources to discover new interventions for memory and motor disorders, and (3) creating innovative and streamlined decision-making processes for selecting and supporting new ideas. Since 1978 the National Institute on Aging or National Institute of Health (NIH) established an extensive national network of AD research facilities at academic institutions including AD Centers (ADCs), Consortium to Establish a Registry for AD, AD Cooperative Study (ADCS), AD Drug Discovery Program, National Alzheimer's Coordinating Center, National Cell Repository for AD, and AD Neuroimaging Initiative. However, despite the success of these programs and their critical contributions, they are no longer adequate to meet the challenges presented by AD. PAD 2020 is designed to address these changes by improving the efficiency and effectiveness of these programs. For example, the ADCs (P30s and P50s) can be enhanced by converting some into Comprehensive Alzheimer's Disease Centers (CADCs) to support not only research, but also by being demonstration projects on care/treatment, clinical trials, and education as well as by seamlessly integrating multisite collaborative studies (ADCS, AD Neuroimaging Initiative, Patient Registries, Clinical Data Banks, etc) into a cohesive structure that further enhances the original mission of the National Institute on Aging ADCs. Regional CADCs offer greater efficiency and cost savings while serving as coordinating hubs of existing ADCs, thereby offering greater economies of scale and programmatic integration. The CADCs also broaden the scope of ADC activities to include research on interventions, diagnosis, imaging, prevention trials, and other longitudinal studies that require long-term support. Thus, CADCs can address the urgent need to identify subjects at high risk of AD for prevention trials and very early in the course of AD for clinical trials of disease modification. The enhanced CADCs will allow more flexibility among ADCs by supporting collaborative linkages with other institutions and drawing on a wider expertise from different locations. This perspective article describes the University of Pennsylvania (Penn) CADC Model as an illustrative example of how an existing ADC can be converted into a CADC by better utilization of Penn academic resources to address the wide range of problems concerning AD. The intent of this position paper is to stimulate thinking and foster the development of other or alternative models for a systematic approach to the study of dementia and movement disorders.
Collapse
|
30
|
Gauthier S, Garcia A, Sano M, Robert P, Senanarong V, Woodward M, Brodaty H. Priorities for research consortia on Alzheimer's disease. Alzheimers Dement 2010; 6:359-62. [PMID: 20630416 DOI: 10.1016/j.jalz.2010.05.2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coordination and harmonization of efforts between five major research consortia on Alzheimer's disease may increase our understanding of this condition and improve our therapeutic approaches. Specific opportunities include a registry for families with early onset dementia, a study registry, minimal data sets, validation of assessment tools and outcomes, update on ethical issues, resolution of methodological issues, new investigators training, longitudinal observation studies, prevention studies, and liaison with stakeholders such as Alzheimer Disease International.
Collapse
|
31
|
Commentary on “Developing a national strategy to prevent dementia: Leon Thal Symposium 2009.” The rationale for a National Institutional Review Board for neurodegenerative diseases. Alzheimers Dement 2010; 6:135-7. [DOI: 10.1016/j.jalz.2010.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 01/11/2010] [Indexed: 11/18/2022]
|
32
|
Simpkins JW. Commentary on "Alzheimer's Disease Drug Development and the Problem of the Blood-Brain Barrier". Alzheimers Dement 2009; 5:433-4. [PMID: 19751923 DOI: 10.1016/j.jalz.2009.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 06/26/2009] [Indexed: 10/20/2022]
Abstract
The perspective by Dr. William Pardridge entitled "Alzheimer's Disease Drug Discovery and the Problem of the Blood-Brain Barrier" makes a strong case for the imbalance in resource distribution to the drug-discovery and brain drug delivery processes, where the latter received less than 1% of the investment of the former. My own calculations are consistent with this striking imbalance. Dr. Pardridge predicts that current trials of passive immunity against beta-amyloid peptide will likely fail, whereas past trials of active immunization exhibited trial-ending side effects, in part because of disruption of the integrity of the blood-brain barrier. To bring an assessment of the physiology of the blood-brain barrier and the brain delivery of drugs to the fore, several changes are needed in the way we perceive the problem, train our young scientists, organize research efforts, and incentivize reaching our common goals of effective drug therapy for Alzheimer's disease.
Collapse
Affiliation(s)
- James W Simpkins
- Department of Pharmacology and Neuroscience, Institute for Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, TX, USA.
| |
Collapse
|
33
|
Golde TE, Petrucelli L, Lewis J. Targeting Abeta and tau in Alzheimer's disease, an early interim report. Exp Neurol 2009; 223:252-66. [PMID: 19716367 DOI: 10.1016/j.expneurol.2009.07.035] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Revised: 06/25/2009] [Accepted: 07/23/2009] [Indexed: 12/28/2022]
Abstract
The amyloid beta (Abeta) and tau proteins, which misfold, aggregate, and accumulate in the Alzheimer's disease (AD) brain, are implicated as central factors in a complex neurodegenerative cascade. Studies of mutations that cause early onset AD and promote Abeta accumulation in the brain strongly support the notion that inhibiting Abeta aggregation will prevent AD. Similarly, genetic studies of frontotemporal dementia with parkinsonism linked to chromosome 17 (FTDP-17 MAPT) showing that mutations in the MAPT gene encoding tau lead to abnormal tau accumulation and neurodegeneration. Such genetic studies clearly show that tau dysfunction and aggregation can be central to neurodegeneration, however, most likely in a secondary fashion in relation to AD. Additional pathologic, biochemical, and modeling studies further support the concept that Abeta and tau are prime targets for disease modifying therapies in AD. Treatment strategies aimed at preventing the aggregation and accumulation of Abeta, tau, or both proteins should therefore be theoretically possible, assuming that treatment can be initiated before either irreversible damage is present or downstream, self-sustaining, pathological cascades have been initiated. Herein, we will review recent advances and also potential setbacks with respect to the myriad of therapeutic strategies that are designed to slow down, prevent, or clear the accumulation of either "pathological" Abeta or tau. We will also discuss the need for thoughtful prioritization with respect to clinical development of the preclinically validated modifiers of Abeta and tau pathology. The current number of candidate therapies targeting Abeta is becoming so large that a triage process is clearly needed to insure that resources are invested in a way such that the best candidates for disease modifying therapy are rapidly moved toward clinical trials. Finally, we will discuss the challenges for an appropriate "triage" after potential disease modifying therapies targeting tau and Abeta have entered clinical trials.
Collapse
Affiliation(s)
- Todd E Golde
- Department of Neuroscience, College of Medicine, Mayo Clinic, 4500 San Pablo Rd., Jacksonville, FL 32224, USA.
| | | | | |
Collapse
|
34
|
Khachaturian ZS, Khachaturian AS. Prevent Alzheimer's disease by 2020: a national strategic goal. Alzheimers Dement 2009; 5:81-4. [PMID: 19328433 DOI: 10.1016/j.jalz.2009.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Sabbagh MN, Tariot PN. Commentary on "a roadmap for the prevention of dementia II. Leon Thal Symposium 2008." A national registry to identify a cohort for Alzheimer's disease prevention studies. Alzheimers Dement 2009; 5:128-9. [PMID: 19328441 PMCID: PMC2746079 DOI: 10.1016/j.jalz.2009.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 01/12/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Marwan N Sabbagh
- Cleo Roberts Center, Banner Sun Health Research Institute, Sun City, AZ, USA.
| | | |
Collapse
|
36
|
Schneider LS. Commentary on “A roadmap for the prevention of dementia II: Leon Thal Symposium 2008.” A federally funded corporation for the prevention and treatment of cognitive impairment and brain aging. Alzheimers Dement 2009; 5:172-9. [DOI: 10.1016/j.jalz.2009.01.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Lon S. Schneider
- Department of Psychiatry and Behavioral Sciences and Department of NeurologyKeck School of Medicine and the Leonard Davis School of GerontologyUniversity of Southern CaliforniaLos AngelesCAUSA
| |
Collapse
|