There is a big push right now to identify individuals early on in Alzheimer’s disease, showing signs of pathology before clinical symptoms. And the question we had is, how do we better identify those at highest risk for cognitive decline? We know that being amyloid positive isn’t a perfect predictor of who will decline, and we need scalable tools that can be used in a clinical setting to better enable risk stratification...
There is a big push right now to identify individuals early on in Alzheimer’s disease, showing signs of pathology before clinical symptoms. And the question we had is, how do we better identify those at highest risk for cognitive decline? We know that being amyloid positive isn’t a perfect predictor of who will decline, and we need scalable tools that can be used in a clinical setting to better enable risk stratification. So in our study, we use a short digital memory assessment, one that can be self-administered, even done at home, along with a blood test for ptau217 to better identify individuals at high risk. We found that individuals with elevated ptau217 and deficits on our short memory assessment show faster decline over the next five years. These individuals are five times more likely to progress and develop symptoms, and if we use these filters as tools in clinical trials, we would reduce the number of people needed to power these secondary prevention trials by over 70%, greatly reducing burden and cost for trial sponsors. In the future with a diagnostic pathway, we’re going to need more scalable tools. There are so many people affected by Alzheimer’s disease, the numbers are only going up. So incorporating digital memory assessments and blood tests can really enhance our ability to better screen in areas like primary care. Using these digital assessments to screen for impairment are going to be critical. We need to better identify those who are eligible for treatment to get them treatment earlier and not delay treatment initiation. And so in the future, I see digital assessments and blood tests being used frequently, ideally used before primary care physicians, maybe as like an early tool to give before they come in for their annual visit. In the future, we need to incorporate these digital assessments to better identify those at highest risk for decline and those most likely to benefit from treatment. So we hope that blood tests and digital memory assessments will soon be integrated into diagnostic workflows. Yeah, so all of our research is really done in highly educated populations. We need to expand our work to include more data in underrepresented groups to make sure that our tests are still valid and reliable in these individuals. Our goal is to make scalable tools that are accessible to everybody because everyone’s at risk for Alzheimer’s disease. And so in the future, we need to design tasks that work in different languages, that can be done at home easier, are easily administered, and reliable. We still need to further demonstrate how well we can use this as a predictor on the individual level because population averages aren’t necessarily enough to really be able to implement this. We need to identify an individual’s risk to enhance early diagnosis and prognosis.
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