0
Editorial |

CSF Biomarkers for Secondary Prevention Trials:  Why Markers of Amyloid Deposition and Neurodegeneration Are Both Important

David M. Holtzman, MD
Arch Neurol. 2012;69(6):691-692. doi:10.1001/archneurol.2012.587.
Text Size: A A A
Published online

Extract

A major challenge in developing therapies for Alzheimer disease (AD) as well as most neurodegenerative diseases is that by the time even the earliest clinically detectable signs and symptoms of the disease are apparent, there is already substantial brain injury.13 Most therapeutic trials in AD that are intended to address fundamental molecules and mechanisms underlying the disease have been performed in individuals who have mild to moderate dementia. A few trials have targeted people with very mild dementia/mild cognitive impairment believed to be due to AD. However, recent studies suggest that the use of cerebrospinal fluid (CSF) and amyloid imaging can detect the presence of amyloid-β (Aβ) deposition beginning as early as 10 to 15 years prior to the onset of any clinically detectable cognitive decline owing to AD.1,2,49 In addition, evidence of neurodegeneration and tauopathy appear to begin approximately 5 years prior to the cognitive decline that characterizes early AD.1,2,49 If both academic groups and the pharmaceutical industry are going to move toward prevention trials to delay the onset of cognitive impairment and dementia, biomarkers will need to be used to select people who are clinically normal but at high risk for near-term cognitive decline. Without such an approach, trial size will be enormous and cost prohibitive, and individuals may be subjected to treatments that have the potential for toxicity with no clear benefit.

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

First Page Preview

View Large
/>
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
Jobs
brightcove.createExperiences();