New Horizons in the Diagnosis and Management of Alzheimer Disease in Older Adults

Helena Dolphin*, Adam H Dyer, Laura Morrison, Susan Deborah Shenkin, Tomas Welsh, Sean P Kennelly

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

Alzheimer Disease (AD) is the most common cause of dementia and in addition to cognitive decline directly contributes to physical frailty, falls, incontinence, institutionalisation and polypharmacy in older adults. Increasing availability of clinically-validated biomarkers including Cerebrospinal Fluid (CSF) and Positron Emission Tomography (PET) to assess
both amyloid and tau pathology have led to a re-conceptualisation of AD as a clinical biological diagnosis, rather than one based purely on clinical phenotype. However, copathology is frequent in older adults which influences accuracy of biomarker interpretation. Importantly, some older adults with positive amyloid or tau pathological biomarkers may never experience cognitive impairment or dementia. These strides towards achieving an
accurate clinical-biological diagnosis are occurring alongside recent positive phase-3 trial results reporting statistically-significant effects of anti-amyloid Disease Modifying Therapies (DMTs) on disease severity in early AD. However, the real-world clinical benefit of these DMTs is not clear and concerns remain regarding how trial results will translate to real-world clinical populations, potential adverse effects (including Amyloid-Related Imaging Abnormalities), which can be severe, and healthcare-systems readiness to afford and deliver
potential DMTs to appropriate populations. Here, we review recent advances in both clinical biological diagnostic classification and future treatment in older adults living with AD. Advocating for access to both more accurate clinical-biological diagnosis and potential DMTs must be done so in a holistic and gerontologically-attuned fashion, with geriatricians advocating for enhanced multi-component and multi-disciplinary care for all older adults with AD. This includes those across the AD severity spectrum including older adults potentially ineligible for emerging DMTs.
Original languageEnglish
Article numberafae005
Number of pages12
JournalAge and Ageing
Volume53
Issue number2
DOIs
Publication statusPublished - 10 Feb 2024

Keywords / Materials (for Non-textual outputs)

  • Alzheimer Disease
  • Diagnosis
  • Biomarkers
  • Dementia

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