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Posted by on Apr 19, 2011 in Neurology, Neuropsychiatry

Panel: AD Biomarkers Should Be Reserved for Clinical Trials

Panel: AD Biomarkers Should Be Reserved for Clinical Trials

Alzheimers_brain.jpg

Guidelines for the diagnosis of Alzheimer disease and its early companions MCI and preclinical dementia have been revamped for the first time in 27 years, reports the National Institute on Aging (NIA). And a quick scan of the online documents, offered freely at the site of the journal Alzheimer’s & Dementia, reveals that a lot of thought and ink has been devoted to the burgeoning area of biomarkersmeaning the use of brain imaging, like MRI or PET, or assays of tell-tale molecules, like beta amyloid and tau, in spinal fluid (CSF).

The overriding admonishment, at least for now, is that these biomarkers aren’t ready for routine practicewhich is not necessarily something unexpected by practicing neurologists, but which may dampen the otherwise-unbridled enthusiasm of industry (eg, Lilly), venture capitalists, and some journalists. One big caveat offered by the members of the NIA- and Alzheimer’s Association-sponsored panel, which revamped the moldy guidelines,* is that there is currently little standardization of these biomarkers to ensure their proper use and interpretation in routine practice. Consequently it is recommended that they be incorporated only into clinical trials and accompany other, conventional measures of the dementing process.

Another thought here is that CSF assays won’t really take off in routine practice until somebody invents a quick-and-easy method for obtaining the fluid. As far as I can tell, the bedside/office procedurewhich, although generally benign, is still a somewhat clunky process*hasn’t changed in more than 100 years. And much like the guy who (by legend) made money selling mining utensils during the various gold rushes, the guy or gal who revolutionizes our antiquated method for obtaining spinal fluid will profit the most when CSF biomarkers are (probably inevitably) incorporated into routine practice.

MCI = mild cognitive impairment.

* But the fact that the need to change these guidelines hasn’t been acutely felt since 1984 shows just how little progress we’ve made in understanding this illness. Sigh.

** And without significant reimbursement.

Photograph of atrophied brain from person with AD: National Institute on Alcohol Abuse and Alcoholism.

bmartin (1127 Posts)

A native East Tennessean, Barbara Martin is a formerly practicing, board-certified neurologist who received her BS (psychology, summa cum laude) and MD from Duke University before completing her postgraduate training (internship, residency, fellowship) at the Hospital of the University of Pennsylvania in Philadelphia. She has worked in academia, private practice, medical publishing, drug market research, and continuing medical education (CME). For the last 3 years, she has worked in a freelance capacity as a medical writer, analyst, and consultant. Follow Dr. Barbara Martin on and Twitter.