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Preclinical Alzheimer disease—the challenges ahead

Nature Reviews Neurology volume 9, pages 54–58 (2013)Cite this article

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Abstract

There is growing recognition that the pathophysiological process of Alzheimer disease (AD) begins many years prior to clinically obvious symptoms, and the concept of a presymptomatic or preclinical stage of AD is becoming more widely accepted. Advances in biomarker studies have enabled detection of AD pathology in vivo in clinically normal older individuals. The predictive value of these biomarkers at the individual patient level, however, remains to be elucidated. The ultimate goal of identifying individuals in the preclinical stages of AD is to facilitate early intervention to delay and perhaps even prevent emergence of the clinical syndrome. A number of challenges remain to be overcome before this concept can be validated and translated into clinical practice.

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Article 13 May 2021

David S. Knopman, Helene Amieva, … David T. Jones

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Acknowledgements

The work of R. A. Sperling and K. A. Johnson is supported in part by the National Institute on Aging (P01 AG036694; P50 AG005134; R01 AG027435; R01 AG037497), the American Health Assistance Foundation, and the Alzheimer's Association. J. Karlawish's work is supported by a Robert Wood Johnson Investigator Award in Health Policy Research. The authors thank N. Arzoumanian for her assistance with preparation of this manuscript before submission.

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Authors and Affiliations

  1. Departments of Neurology, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, 02115, MA, USA

    Reisa A. Sperling

  2. Departments of Medicine and Medical Ethics and Health Policy, University of Pennsylvania, 3615 Chestnut Street, Philadelphia, 19104, PA, USA

    Jason Karlawish

  3. Departments of Radiology and Neurology, Massachusetts General Hospital, Harvard Medical School, 33 Fruit Street, Boston, 02114, MA, USA

    Keith A. Johnson

Authors
  1. Reisa A. Sperling
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Correspondence to Reisa A. Sperling.

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Competing interests

R. A. Sperling has served as a site investigator for: Pfizer, Janssen, Avid/Lilly, and Bristol-Myers Squibb. She has served as a consultant to Roche, Janssen, Pfizer, Bayer, Satori, Biogen/IDEC, Merck, and Eisai. J. Karlawish serves on the professional advisory board for SeniorBridge and also has shares in this company. He is a co-holder of a licence on the University of Pennsylvania Integrated Neurodegenerative Disease database. K. A. Johnson has served as a site investigator and/or consultant for: General Electric Health Care, Pfizer, Janssen, Bristol-Myers Squibb, Elan, Bayer, Avid/Lilly, Siemens, and Genzyme.

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Sperling, R., Karlawish, J. & Johnson, K. Preclinical Alzheimer disease—the challenges ahead. Nat Rev Neurol 9, 54–58 (2013). https://doi.org/10.1038/nrneurol.2012.241

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