Toward to a pre-Toward to a pre-symptomatic diagnosis symptomatic diagnosis

of Alzheimer’sof Alzheimer’s

Marcos Díaz Díaz

Salamanca 2013

Index Alzheimer’s Disease

Epidemiology and costs

Limitations of diagnosis criteria

Neuroimaging

Biomarkers

Current treatment for AE

Redefinition of disease

Alheimer’s Disease Neurodegenerative disease

Unknown etiology

Etiopathogenic puzzle

Neurofibrillary tangles

Neuritic plaques (APP)

“Amyloid cascade”

ApoE

Epidemiology & costs 2010: more than half a million in Spain 2050: 1.5 million in Spain 2050: 115 million in the world WHO: 215 thousand million €/year in dementia Spain: 24.000€ / Europe: 54.000€ 286h/month – 70h/week Studies-researches:

Winsconsin United Biosource

Limitations of diagnosis criteria

Screening tests in primary attention

DSM-IV

CIE-10

Mild cognitive impairment –MCI-

Cognitive reserve theory

Too late

Neuroimaging Computerized Tomography (CT)

Magnetic Resonance Imaging (MRI)

Single-Photon Emission Computed Tomography (SPECT)

Positron Emission Tomography (PET) FDG

FDDNP

PIB

F-BAY94-9172

Florbetapir-F-18

Biomarkers Genetic biomarkers

CSF biomarkers

-amiloide peptideβ

Tau protein T-tau

P-tau

-amiloide & tau proteins combinedβ

-amiloide & tau proteins in MCIβ

Concomitant use of different biomarkers

Biomarkers

Current treatment for AE Non-pharmacological therapy & concomitant therapy AchE-Inhibitors & memantine Monoclonal antibody (mab)

Bapineuzumab Scarlet Road Study

Gantenerumab Washington University Study

Gantenerumab Solanezumab LY2886721

Redefinition of disease

Clinical-biological model:

Alzheimer’s Disease

Alzheimer’s Dementia

Dubois criteriaDubois criteriaMCI or episodic memory debts for more than 6 months

+

CSF (P-tau o A42)βor

MRI (entorhinal atrophy/amygdala)

or

PET (bilateral temporal hypometabolism or PET-PIB)

or

ApoE (4-4)

Toward to a pre-Toward to a pre-symptomatic diagnosis symptomatic diagnosis

of Alzheimer’sof Alzheimer’s

Marcos Díaz Diaz

Salamanca 2013