Diagnosing Alzheimer’s disease (AD) is a complex process, often relying on biomarkers—specific proteins or substances in the body linked to the disease.
However, experts now caution that solely using these biomarkers can lead to over-diagnosis, potentially causing undue stress for people who may never experience memory problems.
To address this issue, a team of international experts, led by the University of Geneva and the Salpêtrière Hospital in Paris, has proposed new recommendations that include both biomarkers and clinical symptoms, helping to ensure accurate diagnosis.
Alzheimer’s disease, a progressive brain disorder that affects memory and thinking skills, currently impacts many worldwide, with numbers expected to rise dramatically in the coming decades.
In Switzerland, for example, the number of people with Alzheimer’s and other forms of dementia could exceed 300,000 by 2050, twice as many as today.
Recently, a U.S. research group suggested that AD could be diagnosed solely based on biomarkers, such as amyloid β and tau proteins, found in cerebrospinal fluid, PET brain scans, or even blood tests.
These proteins are commonly associated with Alzheimer’s-related brain changes, but relying only on them for diagnosis risks labeling healthy people with Alzheimer’s if they show abnormal biomarkers without symptoms.
The expert panel, led by Professors Giovanni Frisoni of the University of Geneva and Bruno Dubois of Sorbonne University, suggests a more careful approach. They advocate a diagnosis that combines both biological markers and clinical assessments, such as memory and cognitive tests.
This approach helps avoid diagnosing Alzheimer’s in people who are at risk but show no symptoms, focusing instead on a tailored monitoring plan.
The team’s recommendations, published in JAMA Neurology, emphasize the importance of a “clinical and biological” definition of Alzheimer’s. While biomarkers can indicate the risk of Alzheimer’s, they should only be used with thorough medical assessments.
The presence of biomarkers alone, they argue, does not mean a person has Alzheimer’s disease.
For people in their 50s, only about 3% may show positive biomarkers without symptoms. However, this rate jumps to around 40% for those in their 80s. Many of these individuals will not develop Alzheimer’s, despite showing these biomarkers.
For them, a supportive approach that focuses on monitoring rather than an immediate diagnosis is advised. Prof. Frisoni explains, “Around 70% of people with these biomarkers will not develop AD. Why give them a distressing diagnosis?”
The new recommendations classify individuals with positive biomarkers into two categories: those with symptoms and those without. Those with symptoms would be diagnosed with Alzheimer’s, while those without symptoms would simply be considered at risk.
In Geneva, the Memory Center has already begun developing a new approach to care for those at risk. By early 2025, they plan to offer “patient journeys” that monitor risk factors such as biomarkers, depression, and social isolation to help manage potential health outcomes.
These categories will also aid future research, allowing scientists to better track and understand how various risk factors influence Alzheimer’s.
Researchers hope to create more effective, personalized treatment plans that might include lifestyle changes and nutritional interventions alongside anti-amyloid medications.
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Source: KSR.
