The road ahead to cure Alzheimer’s disease: development of biological markers and neuroimaging methods for prevention trials across all stages and target populations
Open accessAbstract
Alzheimer's disease (AD) is a slowly progressing non-linear dynamic brain disease in which pathophysiological abnormalities, detectable in vivo by biological markers, precede overt clinical symptoms by many years to decades. Use of these biomarkers for the detection of early and preclinical AD has become of central importance following publication of two international expert working group's revised criteria for the diagnosis of AD dementia, mild cognitive impairment (MCI) due to AD, prodromal AD and preclinical AD. As a consequence of matured research evidence six AD biomarkers are sufficiently validated and partly qualified to be incorporated into operationalized clinical diagnostic criteria and use in primary and secondary prevention trials. These biomarkers fall into two molecular categories: biomarkers of amyloid-beta (Aβ) deposition and plaque formation as well as of tau-protein related hyperphosphorylation and neurodegeneration. Three of the six gold-standard ("core feasible) biomarkers are neuroimaging measures and three are cerebrospinal fluid (CSF) analytes. CSF Aβ 1-42 (Aβ1-42), also expressed as Aβ1-42 : Aβ1- 40 ratio, T-tau, and P-tau Thr181 & Thr231 proteins have proven diagnostic accuracy and risk enhancement in prodromal MCI and AD dementia. Conversely, having all three biomarkers in the normal range rules out AD. Intermediate conditions require further patient follow-up. Magnetic resonance imaging (MRI) at increasing field strength and resolution allows detecting the evolution of distinct types of structural and functional abnormality pattern throughout early to late AD stages. Anatomical or volumetric MRI is the most widely used technique and provides local and global measures of atrophy. The revised diagnostic criteria for “prodromal AD” and "mild cognitive impairment due to AD" include hippocampal atrophy (as the fourth validated biomarker), which is considered an indicator of regional neuronal injury. Advanced image analysis techniques generate automatic and reproducible measures both in regions of interest, such as the hippocampus and in an exploratory fashion, observer and hypothesis-indedendent, throughout the entire brain. Evolving modalities such as diffusion-tensor imaging (DTI) and advanced tractography as well as resting-state functional MRI provide useful additionally useful measures indicating the degree of fiber tract and neural network disintegration (structural, effective and functional connectivity) that may substantially contribute to early detection and the mapping of progression. These modalities require further standardization and validation. The use of molecular in vivo amyloid imaging agents (the fifth validated biomarker), such as the Pittsburgh Compound-B and markers of neurodegeneration, such as fluoro-2-deoxy-D-glucose (FDG) (as the sixth validated biomarker) support the detection of early AD pathological processes and associated neurodegeneration. How to use, interpret, and disclose biomarker results drives the need for optimized standardization. Multimodal AD biomarkers do not evolve in an identical manner but rather in a sequential but temporally overlapping fashion. Models of the temporal evolution of AD biomarkers can take the form of plots of biomarker severity (degree of abnormality) versus time. AD biomarkers can be combined to increase accuracy or risk. A list of genetic risk factors is increasingly included in secondary prevention trials to stratify and select individuals at genetic risk of AD. Although most of these biomarker candidates are not yet qualified and approved by regulatory authorities for their intended use in drug trials, they are nonetheless applied in ongoing clinical studies for the following functions: (i) inclusion/exclusion criteria, (ii) patient stratification, (iii) evaluation of treatment effect, (iv) drug target engagement, and (v) safety. Moreover, novel promising hypothesis-driven, as well as exploratory biochemical, genetic, electrophysiological, and neuroimaging markers for use in clinical trials are being developed. The current state-of-the-art and future perspectives on both biological and neuroimaging derived biomarker discovery and development as well as the intended application in prevention trials is outlined in the present publication.
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There exists no effective diagnostic biomarker that can detect the prodromal features of AD before the emergence of cognitive alterations.
“there exists no effective diagnostic biomarker that can detect the prodromal features of AD before the emergence of cognitive alterations (Cavedo et al., 2014).”
From Early stage alterations in white matter and decreased functional interhemispheric hippocampal connectivity in the 3xTg mouse model of Alzheimer’s disease. (2019) · cites this paper as Cavedo et al., 2014
The Abstract says biological markers can detect AD-related abnormalities years before overt clinical symptoms and that six biomarkers are sufficiently validated for inclusion in diagnostic criteria. The ‘Value of multimodal imaging in prevention trials’ section qualifies this: reliable staging before clinical onset may require a combination of biomarkers. That qualification does not support the categorical claim that no effective diagnostic biomarker exists. (LLM, conf=0.88)
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- Authors
- Cavedo, E., Lista, S., Khachaturian, Z., Aisen, P., Amouyel, P., Herholz, K., Jack Jr, C. R., Sperling, R., Cummings, J., Blennow, K., O’Bryant, S., Frisoni, G. B., Khachaturian, A., Kivipelto, M., Klunk, W., Broich, K., Andrieu, S., Thiebaut de Schotten, M., Mangin, J.-F., Lammertsma, A. A., Johnson, K., Teipel, S., Drzezga, A., Bokde, A., Colliot, O., Bakardjian, H., Zetterberg, H., Dubois, B., Vellas, B., Schneider, L. S., & Hampel, H.
- Affiliations
- Centro San Giovanni di Dio Fatebenefratelli (IT)
- Inserm (FR)
- Prevent Alzheimer’s Disease 2020 (US)
- University of California San Diego (US)
- University of Manchester (GB)
- Brigham and Women's Hospital (US)
- Cleveland Clinic (US)
- University of Gothenburg (SE)
- University of North Texas Health Science Center (US)
- University of Geneva (CH)
- Karolinska Institutet (SE)
- University of Pittsburgh (US)
- Federal Institute for Drugs and Medical Devices (DE)
- Université Toulouse III - Paul Sabatier (FR)
- Commissariat à l'Énergie Atomique et aux Énergies Alternatives (FR)
- Amsterdam University Medical Centers (NL)
- Harvard University (US)
- German Center for Neurodegenerative Diseases (DE)
- University Hospital Cologne (DE)
- Trinity College Dublin (IE)
- Centre National de la Recherche Scientifique (FR)
- Pitié-Salpêtrière Hospital (FR)
- National Hospital for Neurology and Neurosurgery (GB)
- University of Southern California (US)
- ORCID
- Cavedo, E.
- Lista, S.
- Aisen, P.
- Amouyel, P.
- Herholz, K.
- Sperling, R.
- Cummings, J.
- Blennow, K.
- O’Bryant, S.
- Frisoni, G.B.
- Khachaturian, A.
- Kivipelto, M.
- Klunk, W.
- Broich, K.
- Andrieu, S.
- Mangin, J.-F.
- Lammertsma, A.A.
- Teipel, S.
- Drzezga, A.
- Bokde, A.
- Colliot, O.
- Bakardjian, H.
- Zetterberg, H.
- Dubois, B.
- Vellas, B.
- Schneider, L.S.
- Hampel, H.
- Venue
- The Journal of Prevention of Alzheimer's Disease
- Publisher
- Elsevier BV
- Published
- 2014
- Volume
- 1
- Issue
- 3
- Pages
- 1-22
- ISSN
- 2274-5807 (ISSN-L)
- PMC
- PMC4606938
- OpenAlex
- W2157357845
- Cited by
- 67
- References
- 230
- Citations by year
- 2025: 3 · 2023: 5 · 2022: 3 · 2021: 3 · 2020: 4 · 2019: 8 · 2018: 10 · 2017: 18 · 2016: 10 · 2015: 2 · 2014: 1
- FWCI
- 7.36
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Prevention of Alzheimer s Disease (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Archive ouverte UNIGE (University of Geneva) (acceptedVersion)
- Arrow@dit (Dublin Institute of Technology) (submittedVersion, cc-by-nc-sa)
- HAL (submittedVersion, other-oa)
- UCL Discovery (University College London) (submittedVersion)
- DZNE Pub (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Alzheimer's Association
- Mayo Foundation for Medical Education and Research
- Development of Innovative Strategies for a Transdisciplinary approach to ALZheimer's disease
- Université de Lille
- Science Foundation Ireland (11/RFP.1/NES/3194)
- Deutsche Forschungsgemeinschaft
- Agence Nationale de la Recherche (ANR-10-IAIHU06, ANR-13-JSV4-0001, ANR-09-EMER, 10-IAIHU-06, ANR-09-EMER-006, ANR-10)
- Institut National de la Santé et de la Recherche Médicale (ANR-10-IAIHU-06)
- AXA Research Fund (ANR-10-IAIHU-06)
- Knut och Alice Wallenbergs Stiftelse
- Vetenskapsrådet
- Université Pierre et Marie Curie
- Centre hospitalier régional universitaire de Lille
- Fondation pour la Recherche sur Alzheimer
- National Institutes of Health (-0001, 5u01ag024904-10, AG12300, U01-AG024904, AG005133, AG024904, AG025204, AG025516, AG011378, ANR-10-IAIHU-06)
- National Institute on Aging (U01-AG-024904, R01AG043392, P01AG025204, P30AG012300, RF1AG025516, P50AG005133, U01AG006786, U01AG010483, R01AG011378, P50AG005142, R01AG037551, R01AG041851, R37AG025516, R01AG039389)
- National Heart, Lung, and Blood Institute (U01HL096917)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Keywords
- Alzheimer's disease, biomarkers, neuroimaging, preclinical Alzheimer's disease, prodromal Alzheimer's disease, mild cognitive impairment, amyloid-beta, tau protein, cerebrospinal fluid biomarkers, hippocampal atrophy, magnetic resonance imaging, diffusion tensor imaging, tractography, resting-state fMRI, neurodegeneration, prevention trials, diagnostic criteria, brain atrophy
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