Remarkable protein identifies Alzheimer’s disease before symptoms appear

It is now also possible to predict who will get worse Alzheimer’s in the next few years.

A large study by Lund University in Sweden found that people with Alzheimer’s can now be identified before they develop any symptoms. It is now also possible to predict who will deteriorate over the next few years. The study, published in the journal Nature Medicine, is very timely in light of the recent development of new drugs for Alzheimer’s disease.

It has long been known that two proteins are associated with Alzheimer’s disease – beta-amyloid, which forms plaques in the brain, and tau, which later accumulates inside brain cells. Elevated levels of these proteins, combined with cognitive impairment, have previously formed the basis for the diagnosis of Alzheimer’s disease.

“Changes in the brain occur between ten and twenty years before the patient has any overt symptoms, and it is only when the tau begins to spread that the nerve cells die and the first cognitive problems occur in the person in question. This is why Alzheimer’s is so difficult to diagnose in its early stages,” explains Oskar Hansson, senior neurologist at Skåne University Hospital and professor at Lund University.

He is currently leading a major international study involving 1,325 people from Sweden, the US, the Netherlands and Australia. Participants had no cognitive impairment at the start of the study.

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Using a PET scan, it was possible to visualize the presence of tau and amyloid in the participants’ brains. It was found that people who were found to have two proteins had a 20-40 times higher risk of developing the disease at follow-up after several years compared to participants who did not have biological changes.

“When both beta-amyloid and tau are present in the brain, it is no longer considered a risk factor, but rather a diagnosis. A pathologist who studies brain samples in this way immediately diagnoses a patient with Alzheimer’s disease,” says Rick Ossenkoppele, first author of the study and senior research fellow at Lund University and the University of Amsterdam Medical Center.

He explains that Alzheimer’s disease researchers belong to two schools of thought: on the one hand, those who believe that Alzheimer’s disease cannot be diagnosed until cognitive impairment begins. There is also a group that he and his colleagues belong to that say the diagnosis can be based purely on biology and what can be seen in the brain.

Differences in the nomenclature of cognitively intact individuals with (+) or without (-) in vivo biomarkers indicative of Aβ (A) and tau (T) pathology in NIA-AA and IWG criteria for AD. Note that for the IWG criteria, the estimated level of “progression risk” is increased when the A and T biomarkers are positive. (CREDIT: Natural Medicine)

“You can, for example, compare our results with prostate cancer. If you take a biopsy and find cancer cells, the diagnosis is cancer, even if the person in question has not yet developed symptoms,” says Rick Ossenkoppele.

Recently, positive results have emerged from clinical trials of a new anti-Alzheimer drug, lekanemab, which has been evaluated in patients with Alzheimer’s disease. Based on this, the Lund University study is particularly interesting, the researchers say:

Oscar Hansson (LETTER: Kenneth Ruona)

“If we can diagnose a disease before cognitive problems appear, we may eventually be able to use a drug to slow the disease at a very early stage. When combined with physical activity and good nutrition, a person will have a better chance of preventing or slowing down future cognitive impairment.

However, more research is needed before treatment can be recommended for people who have not yet developed memory loss,” concludes Oscar Hansson.

Who has Alzheimer’s disease?

  • In 2020, 5.8 million Americans were living with Alzheimer’s disease.

  • Young people can develop Alzheimer’s disease, but it is less common.

  • The number of people living with the disease doubles every 5 years after they reach the age of 65.

  • By 2060, this number is predicted to nearly triple to 14 million people.

  • Symptoms of the disease may first appear after age 60, and the risk increases with age.

What is known about Alzheimer’s disease?

Scientists don’t yet fully understand what causes Alzheimer’s disease. There is probably not one cause, but several factors that can affect each person differently.

  • Age is the best known risk factor for developing Alzheimer’s disease.

  • Family history – Researchers believe that genetics may play a role in the development of Alzheimer’s disease. However, genes are not equal to fate. A healthy lifestyle can help reduce the risk of developing Alzheimer’s disease. Two large, long-term studies show that adequate physical activity, a nutritious diet, limiting alcohol intake, and not smoking can help people.

  • Changes in the brain can begin years before the onset of the first symptoms.

  • Researchers are studying whether education, diet and environment play a role in the development of Alzheimer’s disease.

  • There is growing scientific evidence that a healthy lifestyle, which has been shown to prevent cancer, diabetes, and heart disease, can also reduce the risk of subjective cognitive decline.

What is the burden of Alzheimer’s disease in the United States?

  • Alzheimer’s disease is one of the top ten causes of death in the US.

  • 6th leading cause of death among adults in the US.

  • Fifth leading cause of death among adults aged 65 and over.

  • In 2020, approximately 5.8 million Americans aged 65 and over had Alzheimer’s disease. By 2060, this number is predicted to nearly triple to 14 million people.

In 2010, spending on Alzheimer’s disease was predicted to fall from $159 billion to $215 billion. By 2040, these costs are projected to rise from $379 billion to more than $500 billion a year.

Alzheimer’s death rates are rising, in contrast to cardiovascular disease and cancer deaths, which are declining.

It has been shown that dementia, including Alzheimer’s disease, is underreported on death certificates and therefore the proportion of older people dying from Alzheimer’s disease may be significantly higher.

For more science news, visit our New Discoveries section at The bright side of the news.

Note. Materials provided above by Lund University. Content can be edited for style and length.

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