Alzheimer Scotland DAW Conference - 3 June 2016

1. Research: risk reduction &
prevention, cognitive testing and
dementia in the workplace
Prof Craig Ritchie
Centre for Dementia Prevention
University of Edinburgh
www.centrefordementiaprevention.com

2. Overview
• Why Prevention?
• What is secondary prevention?
• What is EPAD?

3. Why Prevention?
0
10
20
30
40
50
60
70
Age 60 65 70 75 80 85
Current Incidence
5-year delay
Ritchie et al. 2015
Lancet Psychiatry
(In Press)

4. Biomarkers and Alzheimer’s
Dementia
• Amyloid Pathology
• Tau Pathology
• Cerebrovascular Changes
• a-synuclein
• Blood Brain Barrier Integrity
• Glial activation and inflammation
• Oxidative stress
• Mitochondrial dysfunction
• Synaptic dysfunction
• Metal dyshomeostasis
• Apoptosis
• Insulin resistance
• mTOR signalling
• b-HSD function

6. SECONDARY PREVENTIONPRIMARY
PREVENTION
PREVENTION PREMISED ON UNDERSTANDING DISEASE BEFORE DEMENTIA

7. Risk factors
Dementia
Familial
aggregation
APOE,
other genes
Dyslipidemia
Hypertension
Obesity
Cognitive reserve
Neuronal damage
0 20
Adult life
60
Mid-life
75
Late-life
Acrossthelifespan
Vascular insults
Brain reserve
Education
Physical activity
Cognitive and
social activity
Unhealthy
diet
Alcohol
overuse
Smoking
Diabetes
Protective factors
Risk factors
Figure adapted from Sindi S , et al. F1000Prime Rep. 2015;7:50.

8. Secondary Prevention
The three steps to achieve secondary
prevention:
STEP 1: Identifying the ‘at risk’ person
1. Risk factors (fixed and modifiable)
2. Cognitive profile (not ‘symptoms’)
3. Biomarker evidence of disease
4. Changes in these over time
Can we develop an accurate prediction algorithm/score?

9. Secondary Prevention
The three steps to achieve secondary
prevention:
STEP 2: Tailoring treatment
1. Reducing modifiable risk factors
2. Enhancing resilience
3. Disease course modification through specific drug
intervention(s)

10. Secondary Prevention
The three steps to achieve secondary
prevention:
STEP 3: Measuring success
1. Individual’s risk status reduces
1. Cognition improves** (Karen Ritchie)
2. Biomarkers normalise
3. Risk of dementia decreases
2. Population level success
1. Incidence decreases
2. Trajectory of decline at early stage ameliorated

11. The European Prevention of Alzheimer's Dementia
(EPAD) project aims to develop an infrastructure that
efficiently enables the undertaking of adaptive, multi-arm
Proof of Concept studies for early and accurate
decisions on the ongoing development of drug
candidates or drug combinations for the prevention of AD
dementia.
European Prevention of
Alzheimer’s Dementia (EPAD) Goal

12. EPAD Consortium
Current Grant Funding from IMI = €64M until end 2019

13. EPAD funnell

14. The EPAD Longitudinal Cohort Study
14
Loss to Follow Up
Maintained at N=6,000
Data
EPAD Cohort Baseline
• Clinical
• Biomarker
• Imaging
Data
Data
1st Follow Up 2nd Follow Up
?
Enter Other Clinical Trial
Enter EPAD Trial
Replenishment from Virtual EPAD Register

15. The EPAD PoC Trial (n=1,500)
15
Allows early decisions on progression to longer term clinical outcomes by impact on
pre-defined and target-specific intermediary phenotype.

16. 2016 2023
Memantine, AChEIs, combination
Improved and earlier risk prediction
Precision Medicine
Other cognitive enhancers
Disease-modifying therapies
Community-wide prevention initiatives (diet, exercise…)
Alzheimer’s Disease treatment 2016
and beyond

17. 2016 2023
Memantine, AChEIs, combination
Improved and earlier risk prediction
Precision Medicine
Other cognitive enhancers
Secondary Prevention therapies
Community-wide prevention initiatives (diet, exercise…)
Alzheimer’s Disease treatment 2016
and beyond (with EPAD)

18. National Leads
Ritchie/Gallacher - UK & Ireland
Miia Kivipelto - Scandinavia
José Luis Molinuevo – Spain/Portugal
Philip Scheltens - Benelux
Giovanni Frisoni - Switzerland/Italy
Bruno Vellas - France
Acknowledgements
Work Package Leads
WP1
Simon Lovestone (UOXF)
Andrew Satlin (Eisai)
Gary Romano (JPNV)
WP2
Adrian Mander (MRC)
Shobha Dhadda (Eisai)
Scott Berry (BERRY)
Kristian Windfeld (Lundbeck)
WP3
Pieter Jelle Visser (VU-VUmc)
Gerald Luscan (Pfizer)
WP4
Craig Ritchie (UEDIN)
Catherine Debove (BI)
Miia Kivipelto (KI)
Mila Etropolski (JPNV)
WP5
Carlos Díaz (SYNAPSE)
Serge Van der Geyten (JPNV)
WP6
Jean Georges (AE)
Sean Knox (NOV)
WP7
José Luis Molinuevo (BBRC)
Frank Tennigkeit (UCB)
Saira Ramasastry (SYNAPSE)
WP8
Edo Richard (RUMC)
Luc Truyen (JPNV)
Carol Brayne (UCAM)
Shirlene Badger (UCAM
Executive Committee & PMO
Serge Van der Geyten (JPNV)
Luc Truyen (JPNV)
Andrew Satlin (Eisai)
Craig Ritchie (UEDIN)
Simon Lovestone (UOXF)
José Luis Molinuevo (BBRC)
Carlos Díaz (Project Manager)
Sandra Pla (member of PMO)
Lennert Steukers (member of PMO)
Mila Eltropolski (JPNV – member of PMO)
Judi Syson (UEDIN – member of PMO)

19. The research leading to these results has received support
from the Innovative Medicines Initiative Joint Undertaking
under grant agreement n° 115736, resources of which are
composed of financial contribution from the European
Union's Seventh Framework Programme (FP7/2007-2013)
and EFPIA companies’ in kind contribution.
Acknowledgment