Revising the Diagnostic Criteria for Alzheimer’s Disease: The Use of Biomarkers and Attendant Ethical Implications

By Antoine Leuzy, Pedro Rosa-Neto and Serge Gauthier.

Published by The International Journal of Science in Society

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“Alzheimer’s disease (AD) accounts for approximately 70 percent of dementia cases and is characterized by the need for specialized, high cost, long-term care. It is estimated that by the year 2050, AD will affect 13.5 million individuals within the US alone, a prevalence rate representing 10% of that predicted at the global level. As such, AD stands as one of the most important health challenges of the 21st century. While initially viewed as a distinct clinico-pathological entity — with the attendant implications of synonymity between AD pathology and the clinical symptoms of AD — advances in the neurobiology of AD have led to a revised conceptualization of AD in which the underlying pathophysiology is thought to precede the clinical diagnosis of AD by up to a decade. This has led to a growing consensus that the predementia phase of AD may represent a therapeutic window of opportunity — a period during which disease modifying drugs may prove effective — and has resulted in: 1) an increasing shift toward the use of biomarkers — measures that allow for in vivo detection of AD pathophysiology; and 2) the concept of early disease modifying interventions as a strategy to prevent or delay dementia onset. Collectively, these elements have found expression in the recent revisions to the diagnostic criteria for AD, namely those advanced by the National Institute of Aging and Alzheimer’s Association workgroups. While these developments signal progress in the fight against AD, they likewise bring to the fore ethical implications that merit careful consideration. These are the potential impact of a diagnosis of AD in its predementia stages and the implications of the new criteria on practicing physicians, those working in memory clinics, and society as a whole.”

Keywords: Alzheimer's Disease, Alzheimer's Diagnosis, Dementia, Global Health, Biomarkers, Disease Modifying Drugs, NIA-AA Criteria

The International Journal of Science in Society, Volume 4, Issue 2, pp.1-14. Article: Print (Spiral Bound). Article: Electronic (PDF File; 464.769KB).

Antoine Leuzy

Research Assistant and MSc Student, Alzheimer's Disease Research Unit, McGill Centre for Studies in Aging, Montreal, Quebec, Canada

After obtaining his undergraduate degree in Psychology from McGill University in December 2010, Antoine Leuzy began working as a Research Assistant at the McGill Center for Studies in Aging. He has since started his Masters of Science degree in the McGill Integrated Program in Neuroscience, under the supervision of Dr. Pedro Rosa-Neto and Dr. Serge Gauthier. His thesis project aims to investigate glutamatergic neurodegeneration in Alzheimer’s disease (AD) and frontotemporal lobar degeneration (FTLD) using [11C]ABP-688, a Positron Emission Tomography (PET) radioligand for the metabotropic glutamate receptor type 5 (mGLuR5). In addition to the science underlying biomarkers in dementia, Antoine is interested in the potential societal implications associated with the use of biomarkers for AD and the increasing emphasis on the predementia diagnosis of AD. Antoine is funded by the Canadian Institutes of Health Research Frederick Banting and Charles Best Canada Graduate Scholarship.

Dr Pedro Rosa-Neto

McGill University, Canada

Dr. Pedro Rosa-Neto received his MD from the Federal University Rio Grande do Sul, Brazil and his PhD from Aarhus University PET centre, Denmark. Dr. Rosa-Neto is an assistant professor of Neurology, Neurosurgery and Psychiatry at McGill University, which is affiliated with the Douglas Research Centre. He is a clinical neurologist with expertise in quantification of brain function using imaging techniques, in particular Positron Emission Tomography (PET). Dr. Rosa-Neto's research interests focus on imaging biomarkers for neurodegenerative diseases. He directs the laboratory for translational and integrative neuroimaging, which aims to use imaging techniques to advance the diagnosis of AD to a preclinical stage. Dr. Rosa-Neto’s research is funded by Alzheimer's Association USA (Alzheimer's Association Young Investigator), Canadian Foundation for innervation, Fonds de la recherche en santé du Québec (FRSQ), Canadian Institutes of Health Research (CIHR) and Nussia & André Aisenstadt Foundation. Dr. Rosa-Neto also conducts research on new treatments to prevent and treat dementia symptoms at the McGill Alzheimer's disease research Unit.

Serge Gauthier

McGill University, Canada

Dr. Gauthier completed his Medical studies at the Université de Montréal and received specialty training in Neurology at McGill University, followed by a Medical Research Council of Canada Fellowship in Neurochemistry at Professor Ted Sourkes' laboratory. Dr. Gauthier was a full-time Geographic at the Montréal Neurological Hospital and Institute from 1976 to 1985, the Director of the McGill Centre for Studies in Aging, from 1986 to 1997, and is currently the Senior Scientist of the Medical Research Council/Pharmaceutical Manufacturers Association of Canada Health Program. Dr. Gauthier is a Professor in the Department of Neurology & Neurosurgery, Psychiatry, Medicine; an Associate Member School of Physical & Occupational Therapy, in the Department of Pharmacology & Therapeutics, McGill University. Dr. Gauthier’s research interests include the etiology and treatment of Alzheimer's disease and other related diagnosis and development of consensus guidelines on approval and use of antidementia drugs, and on the rights of persons with dementia to participate in research. Dr. Gauthier is the recipient of the Galien Award 1997; the Canadian College of Neuropsychopharmacology Innovations in Neuropsychopharmacology Award 1998 with Doctors Judes Poirier and Rémi Quirion; and the 2005 Prix pour carrière scientifique de l'Association des médecins de langue française du Canada (2005 Award for scientific career of the Association of French-speaking doctors in Canada). From 2002 to 2007, Dr. Gauthier served as Rx&D Research Chair for the Canadian Institutes for Health Research.