MedicalResearch.com Interview with:
David A. Wolk, MD
Department of Neurology
Co-Director, Penn Memory Center
Associate Director, Alzheimer’s Disease Core Center
University of Pennsylvania
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Mild Cognitive Impairment (MCI) is a state when individuals have mild memory problems, but not enough to impact day-to-day function. Many patients with MCI are on the trajectory to developing Alzheimer’s Disease dementia, but about half will not and remain stable. As such, patients with MCI are often uncertain about the likelihood they should expect to decline in the future which obviously may be associated with considerable anxiety and this may delay opportunities for them to plan for the future or begin therapeutic interventions.
This study examined the degree to which amyloid PET, which detects the amyloid pathology of Alzheimer’s Disease, a measure of shrinkage of the hippocampus with MRI, and cognitive measures predicted development of dementia over 3 years. We found that each of these measures enhances prediction of whether an individual will or will not develop dementia in the future. If all of these measures are positive, one has a very high risk of progression whereas if amyloid PET and the MRI measurement are normal, there is very little risk of progression.
MedicalResearch.com: What should readers take away from your report?
Response: I think the primary message is that we can do much better with the tools that we have to prognosticate in patients with mild cognitive symptoms and that could potentially provide important benefits for them. While our medicines are limited currently, patients and families often want to know what to expect in the future. This can impact decisions about, for example, where to live or whether to investigate entering clinical trials. Awareness of a high likelihood of progression may also allow families to institute better monitoring of medicine taking and financial activities to avoid troubles in the future.
One other interesting finding is that in those patients who did not have evidence of underlying Alzheimer’s Disease pathology – the ones who had “normal” amyloid PET scans – but still progressed to dementia, tended to display a higher degree of cerebrovascular disease, emphasizing the importance of vascular disease to cognitive decline and the potential benefit of risk reduction.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: I think this study, and others, should compel our field to include these measures in patients who want to better understand their risk of progression. Future studies could examine implementation of these measures in clinical practice rather than the research cohort studied here.
MedicalResearch.com: Is there anything else you would like to add?
Response: I think this paper is an example of how the field is moving more towards “precision medicine” to better predict outcomes in individuals. While even with these tests, there are some individuals we still can only give probabilistic information as to risk (e.g. ~50%), a significant proportion we can provide much higher precision, such that we can say it is highly likely they will or will not develop dementia over a several year timeframe.
Disclosures: Dr. Wolk reports grants and personal fees for consultation from GE Healthcare, Merck, Eli Lilly, and Jannsen during the conduct of the study; grants from Avid Radiopharmaceuticals, Eli Lilly, Merck, Functional Neuromodulation, and Biogen outside the submitted work
Wolk DA, Sadowsky C, Safirstein B, et al. Use of Flutemetamol F 18–Labeled Positron Emission Tomography and Other Biomarkers to Assess Risk of Clinical Progression in Patients With Amnestic Mild Cognitive Impairment. JAMA Neurol. Published online May 14, 2018. doi:10.1001/jamaneurol.2018.0894
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