In a recent study published within the journal Nature Aging, researchers highlighted the necessity to shift focus toward pre-dementia stages of Alzheimer’s disease (AD) to maneuver towards a future where personalized medicine for AD will turn out to be available.
Perspective: Towards a future where Alzheimer’s disease pathology is stopped before the onset of dementia. Image Credit: Orawan Pattarawimonchai / Shutterstock
Background
AD is probably the most common reason behind dementia and, subsequently, considered one of the key healthcare challenges of the twenty first century, for which, at present, there isn’t a curative treatment available.
Advancements in biomarkers for AD pathology have enabled estimating the number of individuals in pre-dementia stages of AD. Per some preliminary estimates, 69 million (M) patients suffer from mild cognitive impairment (MCI), and over 300M have preclinical AD.
The previous is a prodromal stage of AD where cognitive deficits manifest but remain inadequate for a dementia diagnosis. In preclinical AD, patients don’t experience any signs or symptoms of dementia. Nonetheless, there may be an apparent have to delineate the concepts of AD from dementia because late diagnosis substantially compromises the standard of lifetime of a patient and burdens the healthcare infrastructure and healthcare professionals (HCPs).
Therapeutic strategies that would even barely delay the onset of dementia and the progression of AD in a timely fashion could considerably reduce the socioeconomic burden of the disease by empowering patients and their families to self-manage the disease.
Most significantly, such therapies could help rescue the brain, which normally becomes unfeasible when AD manifests as dementia. Fortunately, the window of opportunity to take preventive motion is big because research has shown that AD takes 20 to 30 years to develop.
Concerning the study
In the current study, researchers outlined the importance of AD-modulating drugs, lifestyle interventions, molecular diagnosis of AD via blood-based biomarkers, and digital and genetic tools. Moreover, they highlighted the necessity to take a position in personalizing the danger profiles of patients to collect prognostic information on all relevant patient outcomes.
Moreover, they really helpful adopting an inclusionary approach where patients at high risk of developing AD remain engaged of their health and disease management journey, with easy and inexpensive access to healthcare facilities.
Overall, they described a futuristic approach wherein patient-orchestrated AD care would help achieve a timely and precise diagnosis for stopping dementia amongst AD patients.
From AD prevention to diagnosis, prediction, and personalized care
Complementing pharmacological and non-pharmacological strategies, which will not be mutually exclusive, can be found for the treatment of AD. The previous slows down the progression of symptoms effectively, but only when administered within the pre-dementia stages. As an illustration, aducanumab and lecanemab are two drugs with AD-modulating properties; nonetheless, several challenges hinder their integration into clinical care.
The broad portfolio of therapeutic targets for AD present in preclinical AD studies increasingly focuses on AD risk genes, including apolipoprotein E (ApoE). Studies have also identified 12 modifiable risk aspects accountable for 40% of dementia risk, which have turn out to be attractive targets for lifestyle interventions.
In the long run, with personalized medicine for AD, disease modulation will likely be related to a selected sort of pathology, and molecular diagnosis will likely be crucial. Nonetheless, currently, standard diagnostic workup encompasses neuropsychological investigations of day-to-day activities.
Cognitive screening tests can be found at memory clinics; as an illustration, Montreal Cognitive Assessment (MoCA) indicates cognitive functioning. As well as, data on the genetic determinants of AD is quickly increasing, suggesting that diagnostic workup of the long run will incorporate genomics.
Computer-adapted, digital versions of paper-and-pencil tests will allow the extraction of more data points, save costs, shorten the administration time, and make the patient journey more patient-friendly. Also, tailored prognostic information and individualized risk predictions will likely be available to assist discover patients who will profit most from a selected preventive strategy.
Nonetheless, the authors emphasized that each one these endeavors would require the lively involvement of patients from an early stage. They could begin dementia risk assessment at home; later, HCPs could accurately predict the disease stage and make a molecular diagnosis. Also, they may discover individuals who would profit from personalized prevention strategies.
Nonetheless, throughout the patient journey, educating HCPs to optimally navigate their patients and support a strategy of shared decision-making is a crucial pre-requisite. One other pre-requisite for patient-orchestrated personalized care is providing information to patients and their families about what to anticipate from diagnostic tests and the disease and disease trajectory.
Conclusions
In conclusion, the present study provides an outlook on a future with personalized medicine for AD where patients and HCPs could be actively involved in disease management through tailored mixtures of lifestyle interventions and disease-modulating therapies. It might help timely goal AD pathology that might delay or prevent the onset of dementia altogether.