iCal
Raum:
Channel 3
Topic:
Wissenschaftliches Programm
Topic 01: Neurokognitive Erkrankungen, organische psychische Störungen, Demenz, F0
English programme
Format:
State-of-the-Art-Symposium
Dauer:
75 Minuten
17:30 Uhr
Diagnosis of Alzheimer’s disease – focus on the development of new biomarkers
Frank Jessen, Köln (Germany)
Details anzeigen
Autor:in:
Frank Jessen, Köln (Germany)
The early detection and aetiological differential diagnosis of dementia is growing in importance. An increasing number of people with mild memory disorders or the first symptoms of dementia are turning to general practitioners, specialists and specialised outpatient clinics to ask for diagnostic clarification and an evaluation of their future prognosis. Besides a differentiated clinical and neuropsychological examination, biomarkers play an important role in the aetiological diagnosis of dementia.
Cerebrospinal fluid (CSF) and imaging biomarkers have been established for the amyloid pathology, tau deposition and neurodegeneration of Alzheimer’s disease. On the technical level, in recent years progress could be made in the standardisation and reproducibility of measurements across laboratories. On the conceptual level, researchers have proposed dividing biomarkers into the categories A (amyloid), T (tau) and N (neurodegeneration), which will allow individual patients to be classified. In principle, the A/T/N system is open to the addition of further biomarkers. Possible current candidates are markers for synaptic integrity and inflammation.
On the basis of this system, individual risk scores for developing dementia have been developed for patients with mild cognitive impairment (MCI) and are being scientifically evaluated. In the next few years, such biomarker-based dementia risk scores for MCI are very likely to enter clinical practice.
The development of blood-based biomarkers for the above-mentioned pathologies is also of considerable clinical relevance. Until recently, the prevailing opinion was that blood-based biomarkers could not be developed for Alzheimer’s disease because of the blood-brain barrier and the insufficient concentration in plasma. However, advances in detection technology have allowed very low concentrations of the respective markers to be detected in blood. These new blood markers show high correlations with CSF biomarkers and promising diagnostic characteristics. We can assume that in a few years blood markers will be available as routine diagnostic tests for the main core pathologies of Alzheimer’s disease (A/T/N). This progress will result not only in great opportunities, but also in challenges, in particular in the area of consultations on early diagnosis and prediction, which can then also be implemented in non-specialised settings.
The lecture will present an overview of the current developments of new concepts and new markers and the associated ethical challenges.
18:00 Uhr
Treatment of dementias – focus on prevention
Lutz Frölich, Mannheim (Germany)
Details anzeigen
Autor:in:
Lutz Frölich, Mannheim (Germany)
The treatment of dementia syndromes, in particular Alzheimer’s disease, continues to focus on three areas: stabilisation of cognitive disorders, stabilisation of everyday skills, and treatment of behavioural disorders. The overall therapeutic concept always includes pharmacological measures and psychosocial interventions for those affected and their relatives as part of an overall treatment plan. Prevention strategies are increasingly attracting the public’s attention because of the moderate effect sizes of the currently available antidementia drugs, the importance of the long asymptomatic or prodromal interval of neurodegenerative diseases and the general attractiveness of the concept. These strategies stem from epidemiological findings on the reduced incidence of dementia in various countries over the past decades. Approx. 40% of the risk of dementia can be explained by a complex life span-dependent model that includes the duration and timing of 12 risk factors that in principle are modifiable. These factors are as follows (presented in order of decreasing risk level): sensory impairments, especially hearing loss; lower lifelong cognitive stimulation in terms of education; smoking; depression; social isolation; traumatic brain damage; physical inactivity; high blood pressure; air pollution; excessive alcohol use; overweight; and diabetes. The concept of lifestyle-dependent risk factors indicates that interventions that build on these factors at a suitable point in time and over a sufficiently long period can actually reduce the risk of dementia.
In fact, in the past 10 years 8 long, complex intervention studies were performed. Four of these studies focussed on the treatment of hypertension: Although 3 earlier studies did not show that antihypertensive treatment reduced the risk of dementia, the current SPRINT-MIND study (an intensified hypertension treatment) shows a reduction in the risk of mild cognitive impairment and a trend for a reduced risk of dementia. Of the 4 studies with multidomain interventions (FINGER, MAPT, PreDIVA and HATICE), 2 showed small effects on cognition in primary analyses or in subgroups at special risk, for example in amyloid-positive people. In addition, the studies showed the particular methodological difficulties of this type of study (e.g. with regard to duration, study adherence and selection of the study population). The consequences for future studies are that, as a matter of principle, dementia prevention should be understood in the sense of a risk reduction, and only minor effects are to be expected because of the nature of the disease. Furthermore, targeted intervention in people with an individualised risk profile is probably the most useful prevention strategy. Although convincing evidence is still lacking, individual lifestyle modification measures should already be part of the recommendations for non-pharmacological measures in patients in prodromal and early stages of dementia in clinical practice.