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CONy 2021 | Opportunities of early diagnosis in Alzheimer’s disease

Richard Pither, PhD, Cytox Ltd, Oxford, UK, discusses the opportunities that arise from diagnosing Alzheimer’s disease (AD) in the early stages. It is known that the process in the brain that leads to the clinical symptoms of AD may be active for 20 or 25 years before clinical symptoms. Therefore, it’s crucial to identify patients in the early stages of the disease to have the opportunity to intervene. A growing body of evidence supports the potentially modifiable risk factors for dementia, which include lifestyle changes and risk-avoiding strategies that have been shown to be effective in delaying the time of disease onset or even avoiding symptoms. In high-risk individuals, management of those modifiable risk factors could reduce the risk of developing the disease. Additionally, an early diagnosis allows patients to receive disease-modifying therapies and participate in clinical trials. This interview was conducted during the virtual 2021 World Congress on Controversies in Neurology (CONy) meeting.

Transcript (edited for clarity)

Well, we we’ve known for some time now that the process in the brain that leads ultimately to the clinical symptoms of Alzheimer’s disease may be active for 20 or 25 years before we see clinical symptoms. And we know that because we can see pathology in the form of amyloid plaques and neurofibrillary tangles building up in the brain slowly before clinical symptoms. So the question is, how do you find those people before they develop symptoms relatively simply without expensive and invasive testing...

Well, we we’ve known for some time now that the process in the brain that leads ultimately to the clinical symptoms of Alzheimer’s disease may be active for 20 or 25 years before we see clinical symptoms. And we know that because we can see pathology in the form of amyloid plaques and neurofibrillary tangles building up in the brain slowly before clinical symptoms. So the question is, how do you find those people before they develop symptoms relatively simply without expensive and invasive testing. And then what can you do if you do find them? So our genetic test can be run at any age. Anything from young adult, 18 years of age upwards. And if you find you’re at high risk, there’s lots you can do. So first off, and I think most excitingly really is that the lifestyle changes and risk avoidance strategies have been shown to be very effective in maybe more than 40% of cases to either push back the time at which the disease becomes problematic, or maybe even avoid symptoms altogether.

And there was a very interesting, comprehensive report published last year by the Lancet Commission showing exactly these sort of 12 sorts of interventions that would in a high-risk individual be managed to reduce overall likelihood of developing the disease. So that’s the first thing you could do. The second thing of course, is that somewhat controversially, Biogen’s new treatment called Aduhelm, previously known as aducanumab, has now been approved for use by the FDA in early Alzheimer cases, early symptomatic disease. So if you were to find you were at high risk, with or without symptoms, you may be eligible for treatment with this anti-amyloid targeted drug.

Now I don’t think the drug will be for everyone, but it will benefit some people, and I think that’s been shown in the clinical trials and that’s why the FDA approved it. It’s not without its detractors, this drug, so it’s important that it’s only targeted in those really most likely to respond, and genuine Alzheimer at risk individuals, but I think that is another opportunity. As well, as of course, even becoming yourself, as a high-risk individual, a candidate for future clinical trials, be that with a Biogen drug or with other drugs that are being developed by other pharmaceutical companies.

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Disclosures

Dr Pither is an employee of Cytox Ltd