Outline. Facts and figures Action plans Early / correct diagnosis Conclusions

Transcription

1 Outline Facts and figures Action plans Early / correct diagnosis Conclusions

2 Dementia: the greatest chalenge. Time to act now Philip Scheltens Professor of Neurology VU University Medical Center Amsterdam Department of Neurology/Alzheimer Center Amsterdam, The Netherlands

3 % of total population Population Projections and Ageing 30 More developed regions 30 Less developed regions Calendar year Calendar year

4 Prevalence of Neurodegenerative Diseases Cases / Dementia Stroke Parkinson Age (years) From Rocca W et al, Eurodem

5 Incidence and prevalence

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7 Action plans France: Plan Alzheimer ( ) UK: National Dementia Strategy (2009- ) Germany : DZDNE ( ) Netherlands: Dutch Deltaplan Dementie ( )..

8 Key challenges Improvements in health and care Raising awareness and supporting dementia friendly communities Better research

9 We want more people into clinical trials; more people getting that cance to get the very latest drugs. Our ambition is this: at least 10 per cent of people with dementia should be able to take part in clinical trials up around ten times from today March : Prime Minister s Challenge on Dementia: Delivering major improvements in dementia care and research by 2015

10 The UK will use its Presidency of the G8 to identify and agree a new international approach on dementia research. The UK will use its Presidency of the G8 to identify and agree a new international approach on dementia research in recognition that the condition is fast becoming the biggest pressure on care systems around the world, Prime Minister David Cameron announced today. G8 dementia summit A specific G8 dementia summit will be held in London in September

11 Dutch National Plan Combining Innovative power NL Public Together we build the dyke Private

12 Structure Deltaplan 3 Pillars National e- health portal National registration Research programme 200 mln DB Health benefit Economic growth Less collective burden - costs - loss of productivity

13 Towards a busines case Assumptions Volume growth 20% lower (= 2,24% instead of 2,8%) Effects notable from 2014 Berekening PGGM DB x millon Less formal costs Less pressure on caregivers, less informal care Economic growth PM PM TOTAL 810 +PM PM

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15 The early days 1906: Alois Alzheimer Über eine eigenartige Erkrankung der Hirnrinde Auguste D 51 year old forgetfull, but also severe aphasia and behavioural changes Diagnosis: post mortem Senile plaques (amyloid-beta) Neurofibrillary tangles (tau)

16 From very late to earlier diagnosis 1984: NINCDS-ADRDA criteria Concept of probable AD during life (Senile) dementia is now disease Pathological characteristics far out of sight Diagnosis per exclusionem Memory impairment + Other cognitive impairment Decline from previous Impact on daily living Progressive Not due to other disorder

17 Evidence of AD before dementia? AD does not develop overnight.. Pathology accumulates gradually Nestor, Hodges, ScheltensNat Med 2004

18 Biomarkers for (Prodromal) AD Abnormal CSF Aβ 42 Amyloid imaging FDG-PET MRI hippocampal volume CSF Tau Cognitive performance Function (ADL) Amyloid imaging FDG-PET MRI hippocampal volume CSF Aβ 42 Cognitive performance Function (ADL) CSF Tau Normal Presymptomatic emci LMCI Dementia Aisen PS, Petersen RC, Donohue MC, et al. Alzheimers Dement. 2010;6: Time

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20 Predicting AD in MCI Hansson, Lancet Neurol 2006 CSF biomarkers 137 MCI 4-6 yrs follow-up HR for abeta + tau : 17.7

21 Predicting AD in Subjective complaints Aβ42 AD profile tau HR 14.9 ( ) 6.8 ( ) 3.0 ( ) Van Harten et al. 2012

22 In vivo detection of amyloid

23 BP ND PIB-PET predictive in MCI Tolboom, J Nucl Med ,20 1,00 0,80 0,60 0,40 AD 0,20 0,00-0,20 Controls Milde cognitive impairment

24 Flutemetamol [ 18 F]flutemetamol is being investigated clinically as an amyloid imaging agent and has not yet been approved by any regulatory authorities.

25 Future of diagnosis Combination of markers accurate + early diagnosis Abnormal CSF Aβ 42 Amyloid imaging FDG-PET MRI hippocampal volume CSF Tau Cognitive performance Function (ADL) Amyloid imaging FDG-PET MRI hippocampal volume CSF Aβ 42 Cognitive performance Function (ADL) CSF Tau Normal Preclinical Prodromal Dementia Clinical criteria allow diagnosis Time

26 Future of diagnosis Combination of markers accurate + early diagnosis Abnormal CSF Aβ 42 Amyloid imaging FDG-PET MRI hippocampal volume CSF Tau Cognitive performance Function (ADL) Amyloid imaging FDG-PET MRI hippocampal volume CSF Aβ 42 Cognitive performance Function (ADL) CSF Tau Normal Biomarkers allow diagnosis Preclinical Prodromal Dementia Time

27 Early diagnosis prerequisite for drug/therapy development Ongoing studies based on IWG criteria: - BMS (γ secretase inhibitor): FCSRT- CSF (until jan 13) - Affiris (immunotherapy): FCRST- MRI - Roche (immunotherapy): FCSRT- CSF - Lilly (BACE inhibitor): FCRST- CSF- PET amyloid ligand - Merck (BACE inhibitor): FCRST-PET amyloid - LipiDiDiet (EU funded; Souvenaid): FCRST-MRI or PET or CSF -

28 The projected effect of risk factor reduction on Alzheimer's disease prevalence

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30 VUmc Alzheimer Center