BRESCIA, 10 MARZO Malattia di Alzheimer Aspetti diagnostici: Luci ed ombre
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1 BRESCIA, 10 MARZO 2018 Malattia di Alzheimer Aspetti diagnostici: Luci ed ombre
2 Summary History Numbers Prevention Diagnosis Therapy Care (long term care) Ethical issues Citizenschip
3 Summary History Numbers Prevention Diagnosis Therapy Care (long term care) Ethical issues Citizenschip
4 1997 The discover (1906)
5 THE NEW DISCOVER 1976
6 Summary History Numbers Prevention Diagnosis Therapy Care (long term care) Ethical issues Citizenschip
7 The good news
8
9 The bad news
10 The very bad news
11
12 April Volume 15, Issue 5
13
14 Total number of persons with dementia
15 COSTS
16 Summary History Numbers Prevention Diagnosis Therapy Care (long term care) Ethical issues Citizenschip
17
18 2014
19 Summary History Numbers Prevention Diagnosis Therapy Care (long term care) Ethical issues Citizenschip
20 La Commissione accelera gli interventi sul morbo di Alzheimer e altre malattie neurodegenerative Oggi (22 luglio 2009) la Commissione ha adottato proposte concrete per il morbo di Alzheimer e altre forme di demenza e malattie neurodegenerative. ( /alzheimer_en.htm) Quattro settori principali di intervento: 1) Interventi tempestivi per diagnosticare la demenza (e ridurne i rischi) 2) Migliore coordinamento delle attività di ricerca tra i paesi dell UE 3) Condivisione delle buone prassi 4) Creazione di un forum di riflessione sui diritti, l autonomia e la dignità dei pazienti. LA DIAGNOSI PRECOCE MIGLIORA GLI OUTCOME PER PAZIENTE E FAMIGLIA
21 World Alzheimer's Day - September 21, 2009 Diagnosi della Demenza: See It Sooner DIAGNOSI PRECOCE! The theme for World Alzheimer's Day 2009 is 'Diagnosing Dementia: See It Sooner'.
22 The range of cognitive impairment Normal MCI Dementia Asintomatic Preclinical phasepresintomatic Paucisintomatic Predementia phase Prodromal dementia Sintomatic Clear dementia
23 Bateman et al. N Engl J Med 2012;367: ; Jack et al. Lancet Neurol 2010;9:119-28
24 Jack et al. Lancet Neurol 2010;9:119-28
25 Jack et al. Lancet Neurol 2010;9:119-28
26
27 Three diagnostic pakages: 1. Alzheimer s disease (AD) 2. Prodromial AD (paucisintomatic)(mci due to AD) 3. Preclinical AD (asintomatic, only for reseach) Jack et al. Alzheimers Dement 2011;7:257-62
28 Alzheimer s & Dementia 2011; 7:
29
30
31 I
32 II
33
34 Albert al. Alzheimers Dement 2011;7:270-9
35 AD prodromal
36 Biomarkers (I)
37 Biomarkers (II)
38 June 2014
39 June 2014
40 June 2014
41 June 2014
42 June 2014
43 DIAGNOSTIC AND PROGRESSION MARKERS June 2014
44 DIAGNOSTIC AND PROGRESSION MARKERS June 2014
45 Patogenesis and clinical diagnostic aspects of AD Patogenesi Diagnosis Alzheimer s disease Clinical diagnosis i amiloid and tau deposition Minor neurocognitive disorder NO cognitive symptoms or Behavioural disturbances Only with i marker Impossible Years from diagnosis Age
46 Recommendations of the Italian Psychogeriatric Association (AIP) and Italian Society for the Study of Dementia (SINDEM) on Early Diagnosis of Alzheimer Disease Presidents: M. Trabucchi (AIP) A. Padovani (SinDem) May 2014
47 BIOMARKER VALIDITY IN THE DIAGNOSIS OF AD Recommendations (I) Structural imaging should be carried out at least once in the diagnostic work-up of patients with cognitive impairment MRI is currently the imaging modality of choice for assessing subjects with suspected dementia; however, where MRI is not available or contraindicated, CT scans can usefully exclude major space occupying lesions, large infarcts and hydrocephalus. The authors recommend to assess specific patterns of focal atrophy. The authors strongly encourage the utilisation of standardised software programs to quantitatively analyse brain MRI to aid visual analysis. AIP, SinDem, 2014
48 BIOMARKER VALIDITY IN THE DIAGNOSIS OF AD Recommendations (II) In persons with core clinical criteria for MCI and negative structural brain imaging a 18F-FDG PET scan can be considered for diagnosis purposes. The overall regional pattern of metabolic impairment of the posterior cingulate/precuneus and lateral temporoparietal cortices, more accentuated than frontal cortex deficits, together with the relative preservation of the primary sensorimotor and visual cortices, basal ganglia and cerebellum defines the distinct metabolic phenotype of typical AD. In persons with core clinical criteria for MCI the presence of an AD-like metabolic pattern at 18-FDG-PET is highly predictive of conversion to AD dementia within two years. AIP, SinDem, 2014
49 BIOMARKER VALIDITY IN THE DIAGNOSIS OF AD Recommendation (III) Amyloid imaging should not be considered a routine test. The authors recommend that amyloid imaging can be considered for early diagnosis in individuals with core clinical criteria for MCI with a cognitive complaint objectively confirmed that is in persistent or progressive. These patients should satisfy the core clinical criteria for possible (not probable) AD. The authors recommend that amyloid imaging can be considered in patients with progressive dementia and atypically early age of onset (usually defined as 65 years or less in age). AIP, SinDem, 2014
50 BIOMARKER VALIDITY IN THE DIAGNOSIS OF AD Recommendations (IV) The combined pattern of low levels of Aβ42 together with high levels of T- tau and P-tau in CSF has been shown to be specific to patients with AD. CSF determinations of substances that may play a pathogenetic role in dementias (beta-amyloid, tau protein) should be performed within the framework of research protocols. The authors recommend to assess concurrently levels of Abeta 42, Total Tau and Phospho Tau and to utilize CSF biomarkers in the setting of the entire clinical and instrumental picture. AIP, SinDem, 2014
51 Diagnosi delle demenze MCI MMSE > 26; CDR 0.5 Demenza lieve-moderata MMSE > 16; CDR < 2 Demenza severa MMSE < 15; CDR > 3 Valutazione nps + RM cerebrale + PET cerebrale + Amy Pet + Rachicentesi Valutazione nps breve + TC encefalica con studio del lobo temporale mesiale e della vascolarità sottocorticale Valutazione nps di base + TC encefalica con studio della vascolarità sottocorticale Se sospetto di FTD: PET cerebrale Se sospetto di LBD: SPECT con DATSCAN
52 Summary History Numbers Prevention Diagnosis Therapy Care (long term care) Ethical issues Citizenschip
53 Stigma, no treatment, There is nothing to do
54
55 Alzheimer s Prevention Initiative: A Plan to Accelerate the Evaluation of Presymptomatic Treatments; Eric M. Reiman, MD, JessicaB.S. Langbaum, PhD, Adam S. Fleisher, MD,Richard J. Caselli, MD, Kewei Chen, PhD, Napatkamon Ayutyanont, PhD, Yakeel T.Quiroz, MA, Kenneth S. Kosik, MD, Francisco Lopera, MD, and Pierre N. Tariot, MD
56 Not all patients with MCI have AD pathology and progress to dementia. MCI negative to amyloidosis and/or neurodegeneration should not progress to dementia. Not all patients with AD pathology progress to dementia. [etical aspects]
57 1) Amyloid deposition 2) Neurodegeneration - synaptic dysfunction 3) Neuronal loss brain atrophy Not all patients with MCI have AD pathology and progress to dementia. MCI negative to amyloidosis and/or neurodegeneration should not progress to dementia. Not all patients with AD pathology progress to dementia.
58
59 Sapessi tu quanti mulini, a guardar meglio sono veramente giganti; quante lucciole sono veramente lanterne! G. Bufalino: Qui pro quo. Bompiani, Milano, 1991, p.48 IRCCS Centro San Giovanni di Dio - Fatebenefratelli
60 Uncertain progress on the fuzzy boundaries od AD Whitehouse P.J., George D.R. JAD, 2011;26:1-5 The myth of Alzheimer s What you aren t being told about today s most dreaded diagnosis (2008)
61 Summary History Numbers Prevention Diagnosis Therapy Care (long term care) Ethical issues Citizenschip
62 Jeanne Calment
63
64
65 "The diseases have symptoms: the symptoms suggest the organic foundation of all that we are. They make us think of the brain like a piece of meat. And where should I recognize that, yes, the brain is a piece of meat, I look instead to keep a blind spot where I put stories that emphasize the most soul-related aspects of the self " Jonathan Franzen: My father s brain.
66 Ferruccio Sangiacomo, 2008
Il processo diagnostico dell Alzheimer dalla clinica al neuroimaging Giovanni B. Frisoni M.D.
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