Alzheimer’s Disease Biomarkers, Not Cognition, Will Now Define Disorder
An interim analysis of 4,000 scans presented at the 2017 Alzheimer’s Association International Conference found that scan results changed patient management in 68% of cases, including by refining dementia diagnoses; adding, stopping, or switching medications; and altering patient counseling.
IDEAS uses an FDA-approved amyloid imaging agent. Tau PET ligands are in development, but have not been approved. However, other less invasive and less costly options may soon be developed, the committee noted. The search continues for a validated blood-based biomarker, including neurofilament light protein, plasma amyloid beta, and plasma tau.
“In the future, … blood-based biomarker tests—along with genetics, clinical, and demographic information—will likely play an important screening role in selecting individuals for more expensive or more invasive biomarker testing. This has been the history in other biologically defined diseases such as cardiovascular disease,” Dr. Jack and his colleagues noted.
In any case, without an effective treatment, much of the information conveyed by the biomarker profile paradigm remains academic, Dr. Jack said.
“If [the biomarker profile] were easy to determine and inexpensive, I imagine a lot of people would ask for it,” Dr. Jack said. “Certainly, many people would want to know, especially if they have a cognitive problem. People who have a family history, who may have Alzheimer’s pathology without the symptoms, might want to know. But the reality is that until there is a treatment that alters the course of this disease, finding out that you actually have Alzheimer’s disease is not going to enable you to change anything.”
Alzheimer’s & Dementia is the official journal of the Alzheimer’s Association. Dr. Jack has served on scientific advisory boards for Elan/Janssen AI, Bristol-Meyers Squibb, Eli Lilly, GE Healthcare, Siemens, and Eisai; received research support from Baxter International and Allon Therapeutics; and holds stock in Johnson & Johnson.
—Michele G. Sullivan
Suggested Reading
Jack CR Jr., Bennett DA, Blennow K, et al. NIA-AA Research Framework: toward a biological definition of Alzheimer’s disease. Alzheimers Dement. 2018;14(4):535-562.
Khachaturian AS, Hayden KM, Mielke MM, et al. Future prospects and challenges for Alzheimer’s disease drug development in the era of the NIA-AA Research Framework. Alzheimers Dement. 2018;14(4):532-534.
Silverberg N, Elliott C, Ryan L, et al. NIA commentary on the NIA-AA Research Framework: towards a biological definition of Alzheimer’s disease. Alzheimers Dement. 2018;14(4):576-578.
