Early Detection of Incipient Alzheimer Pathology Time Is of the Essence

摘要

With the possible advent of disease-modifying treatments by targeting β-amyloid metabolism or deposition, it becomes crucial to identify individuals at risk for Alzheimer dementia as early as possible, preferably before the onset of overt cognitive impairment. Accessibility of screening tools in underserved areas will be important, despite a lack of neurologic or neuropsychological expertise. Long wait times, which are now common for dementia specialist care, will become even more unacceptable if the wait means delaying a disease-modifying treatment. Given the prevalence of Alzheimer disease and related disorders, such screening is likely to place high demands on the medical system. New diagnostic developments continue to hold promise in expanding accessibility to early and accurate diagnosis of Alzheimer disease and related disorders. Biomarkers such as PET scans or amyloid levels in CSF or serum are increasingly required for a diagnosis of Alzheimer pathology. It is also necessary to screen for subtle cognitive changes because the pathologic changes indicated by physiologic biomarkers do not always produce limitations in cognition or function in the early stages of disease.2 Access to neurobehavioral status screening can be limited by geographic or other constraints. Digital testing may expand accessibility to cognitive assessment, especially if digital testing compares favorably to established tests and can predict the presence of underlying Alzheimer pathology without the need for invasive or costly biomarker testing.