Outline Facts and figures Action plans Early / correct diagnosis Conclusions
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
% of total population Population Projections and Ageing 30 More developed regions 30 Less developed regions 20 60 + 20 10 70 + 80 + 0 1950 1970 1990 2010 2030 Calendar year 10 60 + 70 + 80 + 0 1950 1970 1990 2010 2030 Calendar year
Prevalence of Neurodegenerative Diseases Cases / 100 40 30 Dementia 20 10 Stroke Parkinson 0 60 70 80 90 100 Age (years) From Rocca W et al, Eurodem
Incidence and prevalence
Action plans France: Plan Alzheimer (2008-2012) UK: National Dementia Strategy (2009- ) Germany : DZDNE (2009-2018) Netherlands: Dutch Deltaplan Dementie (2013-2021)..
Key challenges Improvements in health and care Raising awareness and supporting dementia friendly communities Better research
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 26 2012: Prime Minister s Challenge on Dementia: Delivering major improvements in dementia care and research by 2015
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
Dutch National Plan Combining Innovative power NL Public Together we build the dyke Private
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
Towards a busines case Assumptions Volume growth 20% lower (= 2,24% instead of 2,8%) Effects notable from 2014 Berekening PGGM DB x millon 2020 2012-2020 Less formal costs 620 2.350 Less pressure on caregivers, less informal care 190 720 Economic growth PM PM TOTAL 810 +PM 3.070 +PM
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)
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
Evidence of AD before dementia? AD does not develop overnight.. Pathology accumulates gradually Nestor, Hodges, ScheltensNat Med 2004
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;6:239-246. Time
Predicting AD in MCI Hansson, Lancet Neurol 2006 CSF biomarkers 137 MCI 4-6 yrs follow-up HR for abeta + tau : 17.7
Predicting AD in Subjective complaints Aβ42 AD profile tau HR 14.9 (3.8-58.9) 6.8 (1.7-27.3) 3.0 (0.9-9.5) Van Harten et al. 2012
In vivo detection of amyloid
BP ND PIB-PET predictive in MCI Tolboom, J Nucl Med 2009 1,20 1,00 0,80 0,60 0,40 AD 0,20 0,00-0,20 Controls Milde cognitive impairment
Flutemetamol [ 18 F]flutemetamol is being investigated clinically as an amyloid imaging agent and has not yet been approved by any regulatory authorities.
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
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
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 -
The projected effect of risk factor reduction on Alzheimer's disease prevalence
VUmc Alzheimer Center