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Toward to a pre-symptomatic diagnosis ofToward to a pre-symptomatic diagnosis of
Alzheimer’sAlzheimer’s
Marcos Díaz Díaz
Salamanca 2013
Index
 Alzheimer’s Disease
 Epidemiology and costs
 Limitations of diagnosis criteria
 Neuroimaging
 Biomarkers
 Current treatment for AE
 Redefinition of disease
Alheimer’s Disease
 Neurodegenerative disease
 Unknown etiology
 Etiopathogenic puzzle
 Neurofibrillary tangles
 Neuritic plaques (APP)
 “Amyloid cascade”
 ApoE
Epidemiology & costs
 2010: more than half a million in Spain
 2050: 1.5 million in Spain
 2050: 115 million in the world
 WHO: 215 thousand million €/year in dementia
 Spain: 24.000€ / Europe: 54.000€
 286h/month – 70h/week
 Studies-researches:
 Winsconsin
 United Biosource
Limitations of diagnosis criteria
 Screening tests in primary attention
 DSM-IV
 CIE-10
 Mild cognitive impairment –MCI-
 Cognitive reserve theory
Too late
Neuroimaging
 Computerized Tomography (CT)
 Magnetic Resonance Imaging (MRI)
 Single-Photon Emission Computed Tomography (SPECT)
 Positron Emission Tomography (PET)
 FDG
 FDDNP
 PIB
 F-BAY94-9172
 Florbetapir-F-18
Biomarkers
 Genetic biomarkers
 CSF biomarkers
 β-amiloide peptide
 Tau protein
 T-tau
 P-tau
 β-amiloide & tau proteins combined
 β-amiloide & tau proteins in MCI
 Concomitant use of different biomarkers
Biomarkers
Current treatment for AE
 Non-pharmacological therapy & concomitant therapy
 AchE-Inhibitors & memantine
 Monoclonal antibody (mab)
 Bapineuzumab
 Scarlet Road Study
 Gantenerumab
 Washington University Study
 Gantenerumab
 Solanezumab
 LY2886721
Redefinition of disease
 Clinical-biological model:
 Alzheimer’s Disease
 Alzheimer’s Dementia
Dubois criteriaDubois criteria
MCI or episodic memory debts for more than 6 months
+
CSF (P-tau o βA42)
or
MRI (entorhinal atrophy/amygdala)
or
PET (bilateral temporal hypometabolism or PET-PIB)
or
ApoE (4-4)
Toward to a pre-symptomatic diagnosis ofToward to a pre-symptomatic diagnosis of
Alzheimer’sAlzheimer’s
Marcos Díaz Diaz
Salamanca 2013

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Toward to a pre-symptomatic diagnosis of Alzheimer's

  • 1. Toward to a pre-symptomatic diagnosis ofToward to a pre-symptomatic diagnosis of Alzheimer’sAlzheimer’s Marcos Díaz Díaz Salamanca 2013
  • 2. Index  Alzheimer’s Disease  Epidemiology and costs  Limitations of diagnosis criteria  Neuroimaging  Biomarkers  Current treatment for AE  Redefinition of disease
  • 3. Alheimer’s Disease  Neurodegenerative disease  Unknown etiology  Etiopathogenic puzzle  Neurofibrillary tangles  Neuritic plaques (APP)  “Amyloid cascade”  ApoE
  • 4. Epidemiology & costs  2010: more than half a million in Spain  2050: 1.5 million in Spain  2050: 115 million in the world  WHO: 215 thousand million €/year in dementia  Spain: 24.000€ / Europe: 54.000€  286h/month – 70h/week  Studies-researches:  Winsconsin  United Biosource
  • 5. Limitations of diagnosis criteria  Screening tests in primary attention  DSM-IV  CIE-10  Mild cognitive impairment –MCI-  Cognitive reserve theory Too late
  • 6. Neuroimaging  Computerized Tomography (CT)  Magnetic Resonance Imaging (MRI)  Single-Photon Emission Computed Tomography (SPECT)  Positron Emission Tomography (PET)  FDG  FDDNP  PIB  F-BAY94-9172  Florbetapir-F-18
  • 7. Biomarkers  Genetic biomarkers  CSF biomarkers  β-amiloide peptide  Tau protein  T-tau  P-tau  β-amiloide & tau proteins combined  β-amiloide & tau proteins in MCI  Concomitant use of different biomarkers
  • 9. Current treatment for AE  Non-pharmacological therapy & concomitant therapy  AchE-Inhibitors & memantine  Monoclonal antibody (mab)  Bapineuzumab  Scarlet Road Study  Gantenerumab  Washington University Study  Gantenerumab  Solanezumab  LY2886721
  • 10. Redefinition of disease  Clinical-biological model:  Alzheimer’s Disease  Alzheimer’s Dementia Dubois criteriaDubois criteria MCI or episodic memory debts for more than 6 months + CSF (P-tau o βA42) or MRI (entorhinal atrophy/amygdala) or PET (bilateral temporal hypometabolism or PET-PIB) or ApoE (4-4)
  • 11. Toward to a pre-symptomatic diagnosis ofToward to a pre-symptomatic diagnosis of Alzheimer’sAlzheimer’s Marcos Díaz Diaz Salamanca 2013