The past tendency in Alzheimer’s disease has been for clinicians to manage it by doing a diagnosis of exclusion. This phenotypic-driven approach has poor accuracy, but with the rise of screening tools and blood biomarkers, the illness is increasingly being managed by a diagnosis of inclusion.
Charlotte Teunissen, head of the Neurochemistry Laboratory at Amsterdam University Medical Centers (AUMC), reflected on the growing potential of blood biomarkers in Alzheimer’s during a symposium at the 2024 Alzheimer’s Association International Conference (AAIC), running from 28 July to 1 August in Philadelphia, US.
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Teunissen recently headed a European Academy of Neurology (EAN) workshop among neurologists in training on the opportunities for the adoption of biomarkers into clinical practice for Alzheimer’s, finding that they are cost-effective, non-invasive, and would result in better communication with families due to there being an objective disease diagnosis.
While challenges to this adoption were acknowledged, including standardisation, infrastructure and logistics, Teunissen believes these factors can be overcome in time.
The neurologist also shared the outcome of a formal study by the AUMC neurochemistry lab to gain perspective on whether patients would want a blood test for Alzheimer’s.
Informal care partners were presented with the statement: a blood test indicates that you do not have Alzheimer’s. Many respondents expressed that they would have a lot of confidence in the results if symptoms were mild, but less so with severe symptoms.
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By GlobalData“That’s understandable, because if you have experience of severe symptoms, yet the test is negative, then you don’t understand what’s going on,” said Teunissen.
“So, there’s clearly also a need for additional blood-based biomarkers for other types of dementia.”
Teunissen went on to note that the biological diagnosis of Alzheimer’s is important because there is a long preclinical phase until clinical symptoms appear.
This is thought to be around a 20-year period for the development of the pathology until symptoms of Alzheimer’s appear.
“This gives us a time window for intervention, but we also need to rely on biomarkers because the clinical symptoms are not yet accurate enough,” Teunissen added.
The four main biomarkers for Alzheimer’s are amyloid-beta A, tau τ, neuronal degeneration N, and cognitive decline C, and glial fibrillary acidic protein (GFAP) is used as a biomarker for inflammation.
“We want to capture them all in our biomarker analysis,” said Teunissen.
“We’re able to measure these biomarkers in CSF, but really surprisingly, and that’s the revolution, nowadays we can also measure those biomarkers in blood, in lower concentrations, but due to technical improvements, we’re able to measure them very accurately.”
On the future development of biomarkers, there is a need for a panel of biomarkers that can be utilised in diagnosis staging and as a measure of treatment effects, Teunissen said.
In concluding remarks, Teunissen said there is the anticipation of a multi-tiered process – starting with a blood test in primary care that will allow earlier, more timely diagnosis of Alzheimer’s and increased access to disease-modifying therapies.
