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Preclinical Alzheimer disease: identification of cases at risk among cognitively intact older individuals.

Abstract

Since the first description of the case of Auguste Deter, presented in Tübingen in 1906 by Alois Alzheimer, there has been an exponential increase in our knowledge of the neuropathological, cellular, and molecular foundation of Alzheimer's disease (AD). The concept of AD pathogenesis has evolved from a static, binary view discriminating cognitive normality from dementia, towards a dynamic view that considers AD pathology as a long-lasting morbid process that takes place progressively over years, or even decades, before the first symptoms become apparent, and thus operating in a continuum between the two aforementioned extreme states. Several biomarkers have been proposed to predict AD-related cognitive decline, initially in cases with mild cognitive impairment, and more recently in cognitively intact individuals. These early markers define at-risk individuals thought to be in the preclinical phase of AD. However, the clinical relevance of this preclinical phase remains controversial. The fate of such individuals, who are cognitively intact, but positive for some early AD biomarkers, is currently uncertain at best. In this report, we advocate the point of view that although most of these preclinical cases will evolve to clinically overt AD, some appear to have efficient compensatory mechanisms and virtually never develop dementia. We critically review the currently available early AD markers, discuss their clinical relevance, and propose a novel classification of preclinical AD, designating these non-progressing cases as 'stable asymptomatic cerebral amyloidosis'.

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    • Authors

    Lazarczyk MJ, Hof PR, Bouras C, Giannakopoulos P

    Institution

    Department of Mental Health and Psychiatry, University Hospitals of Geneva and Faculty of Medicine of the University of Geneva, 1225 Geneva, Switzerland.

    Source

    BMC medicine 10: 2012 pg 127

    MeSH

    Alzheimer Disease
    Asymptomatic Diseases
    Biological Markers
    Cerebral Amyloid Angiopathy
    Dementia
    Humans
    Risk Assessment

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    23098093