Preclinical Alzheimer Disease—Early Diagnosis or Overdiagnosis?

Langa, Kenneth M.; Burke, James F.

doi:10.1001/jamainternmed.2019.2629

Cited by 23 publications

(22 citation statements)

References 9 publications

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“…Moreover, our results were partially consistent with previous findings, showing that amyloid accumulation alone cannot predict the cognitive decline or disease progression, whereas the amyloid accumulation combined with tau or atrophy of some groups can predict the further cognitive decline [31][32][33] or disease progression in the normal adults [34][35][36] . These results support the recent idea about the combination therapies for future AD treatment strategies 37 and the widespread concern about overdiagnosis in the preclinical AD 38 .…”

Section: Discussionsupporting

confidence: 86%

Clinical and biomarker changes in sporadic Alzheimer’s disease

Zhuo

Zhang

Liu

et al. 2020

Preprint

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32The failure of all anti-amyloid-β (Aβ) drugs has led to a debate about the central role of amyloid 33 in sporadic Alzheimer's disease (SAD). In order to resolve this issue, it is necessary to evaluate 34 the impact of Aβ biomarkers on SAD by measuring the dynamic changes in biomarkers and 35 clinical profiles in the progression of SAD. We identified a clearer picture of the clinical and 36 biomarker changes in the progression of SAD by aligning the clinical diagnosis of mild cognitive 37 impairment (MCI) or AD onset. We found that changes in hippocampal volume and FDG, rather 38 than Aβ biomarkers, were associated with the changes in clinical measures in the progression of 39 SAD. In addition, cognitively normal people with elevated and with normal amyloid showed no 40 significant differences in clinical measures, hippocampal volume, or FDG. This study reveals 41 that Aβ is not a useful biomarker for predicting the clinical progression of patients who develop 42 SAD. 43 44

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Section: Discussionsupporting

confidence: 86%

Clinical and biomarker changes in sporadic Alzheimer’s disease

Zhuo

Zhang

Liu

et al. 2020

Preprint

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“…For example, a 60-year-old woman with preclinical AD has only a 30% risk of developing AD, that is, 70% die of other causes before symptoms appear. 10 In other words, the proportion of overtreated people would probably far exceed those who are correctly identified by means of early screening at the age of 65 and who would have a treatment advantage from the screening.…”

Section: Feature Articlementioning

confidence: 99%

Novel drug candidates targeting Alzheimer’s disease: ethical challenges with identifying the relevant patient population

et al. 2021

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Intensive research is carried out to develop a disease-modifying drug for Alzheimer’s disease (AD). The development of drug candidates that reduce Aß or tau in the brain seems particularly promising. However, these drugs target people at risk for AD, who must be identified before they have any, or only moderate, symptoms associated with the disease. There are different strategies that may be used to identify these individuals (eg, population screening, cascade screening, etc). Each of these strategies raises different ethical challenges. In this paper, we analyse these challenges in relation to the risk stratification for AD necessary for using these drugs. We conclude that the new drugs must generate large health benefits for people at risk of developing AD to justify the ethical costs associated with current risk stratification methods, benefits much larger than current drug candidates have. This conclusion raises a new set of ethical questions that should be further discussed.

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“…33 Labelling healthy individuals with AD pathology as having the disease even though they may never develop cognitive impairment 33 would significantly raise healthcare expenses, expose individuals to adverse effects of treatment and have important legal implications. 34 The Brazilian protocol for diagnosis of dementia 14 suggests that the basic evaluation of patients with memory complaints should include neuroimaging -either computed tomography (CT) scan or MRI -and blood tests for exclusion of reversible dementias. Nevertheless, it may take several months for patients in public health to get a simple brain CT scan and even longer to get an MRI.…”

Section: Clinical Vs Biological Approach Of Dementiamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Challenges in the diagnosis of dementia: insights from the United Kingdom-Brazil Dementia Workshop

Calil

Elliott

Borelli

et al. 2020

Dement. neuropsychol.

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ABSTRACT. In July 2019, a group of multidisciplinary dementia researchers from Brazil and the United Kingdom (UK) met in the city of Belo Horizonte, Minas Gerais, Brazil, to discuss and propose solutions to current challenges faced in the diagnosis, public perception and care of dementia. Here we summarize the outcomes from the workshop addressing challenges in diagnosis. Brazil faces a major problem in dementia underdiagnosis, particularly involving the population in an adverse socioeconomic context. There is poor availability of resources and specialists, and the knowledge of general practitioners and other healthcare professionals is far from satisfactory. Low education level is a further obstacle in diagnosing dementia, as the most commonly used screening tests are not designed to evaluate this population. Patients and their families must overcome the stigma of a diagnosis of dementia, which is still prevalent in Brazil and increases the burden of this condition. Whilst the UK has greater resources, dedicated memory services and a National Dementia Strategy plan, the National Health Service (NHS) has limited funding. Therefore, some challenges regarding diagnosis are common across both countries. The authors suggest possible solutions to confront these, with the goal of improving assessment and recognition of dementia and reducing misdiagnosis.

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Preclinical Alzheimer Disease—Early Diagnosis or Overdiagnosis?

Cited by 23 publications

References 9 publications

Clinical and biomarker changes in sporadic Alzheimer’s disease

Clinical and biomarker changes in sporadic Alzheimer’s disease

Novel drug candidates targeting Alzheimer’s disease: ethical challenges with identifying the relevant patient population

Challenges in the diagnosis of dementia: insights from the United Kingdom-Brazil Dementia Workshop

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