EFNS/ENS Joint Congress of European Neurology: 31 May – 3 June 2014, Istanbul
Every seven seconds someone in the world comes down with Alzheimer’s disease. Dementia disorders cost European economies more than EUR 100 billion euros annually. Progress has been made primarily in early detection and in the ever-improving diagnosis of the disease, especially through the identification of meaningful biomarkers, experts reported at the Joint Congress of European Neurology in Istanbul.
Istanbul, 2. Juni 2014 – “Dementia will be the fastest growing health problem over the next 30 years. This poses a challenge for all health systems in Europe and will affect neurology to a major extent, since dementia will be the most significant brain disease in the future,” Prof Philip Scheltens from the Free University in Amsterdam told the Joint Congress of European Neurology in Istanbul.
According to the WHO, 35.6 million people globally were suffering from some form of dementia in 2010 and the number is expected to increase three-fold by 2030. The latest data from the European Brain Council (EBC) indicates 6.3 million people in Europe alone are living with a dementia disorder. The costs arising from dementia in the 27 EU countries plus Switzerland, Norway and Iceland amount to about 105.2 billion Euros annually, the EBC estimates. Alzheimer’s disease is the most common form of dementia, responsible for 60 to 80 per cent of all dementia disorders. Every seven seconds a new case is registered worldwide and each year the number of people it affects increases by around 4.6 million.
Early detection and prevention of significant importance
A major focus of the scientific meeting in Istanbul is on the prevention and early detection of dementia, particularly Alzheimer’s disease (AD). “These are exciting but challenging times in Alzheimer’s disease research. At many levels, a more detailed picture of the disease is being refined and advanced. Long-hoped-for advances in the development of disease-modifying therapy remain unfulfilled. Prevention will therefore be given greater attention. In recent dementia research, important progress has been observed particularly in the diagnosis of the disorder,” Prof Scheltens said. As more biomarkers for the various forms of dementia become known, the differential diagnosis of Alzheimer and other forms of dementia is approaching early stages when cognitive impairments are still slight. Mild cognitive impairment (MCI) is considered a transitional stage of a normal aging process leading to AD. However, not all those affected by MCI develop Alzheimer’s disease. Prof Scheltens: “Prediction of conversion to AD at an early stage would enable an earlier, and potentially more effective, treatment of AD.”
Biomarker use for the etiologic diagnosis of MCI in Europe
The use of biomarkers for the etiological diagnosis of mild cognitive impairment (MCI) is widespread in the European academic research memory clinics, according to a study of the European Alzheimer’s Disease Consortium (EADC) presented in Istanbul. “The EADC centres participating in this survey currently use the core biomarkers for the etiological diagnosis of MCI. There is widespread agreement among those clinicians surveyed that a combination of amyloidosis and neuronal injury biomarkers was a strongly indicative signature of Alzheimer’s disease,” said study author Martina Bocchetta from IRCCS Fatebenefratelli Brescia, Italy.
The study suggests that the most frequently used biomarker for the etiological diagnosis of MCI was the visual reading of the atrophy of the medial temporal lobe on magnetic resonance imaging (75 per cent of the 37 responders using it “always/frequently”). Among surveyed centres, 22 per cent used measurements of tau protein and beta-amyloid levels in the cerebrospinal fluid (CSF markers) in the context of MCI evaluation.
Alzheimer’s diagnosis using microRNAs
Circulating microRNAs (miRNA) could offer great promise for the future diagnosis of AD, a Milan study presented at the Congress in Istanbul shows. MiRNAs are small molecules in the body involved in deactivating genes at different levels. „Our results suggest a potential use of circulating miRNAs, together with other markers, as non-invasive, relatively inexpensive and peripheral biomarkers for Alzheimer’s diagnosis,“ said study author Dr Daniela Galimberti. A specific PCR array with 84 miRNAs was used in the study to screen miRNA serum level in Alzheimer patients and control subjects. The Alzheimer patients showed significantly lower scores on a number of the tested RNAs, including miR-125b, miR-223, miR-23a and miR-26b.
FDG-PET recognising mild cognitive impairment progression
The use of FDG-PET as a biomarker for the progression of mild cognitive impairment (MCI), independent of an amyloidal deposition, was shown in another study in which Prof Scheltens participated and which was presented at the Joint Congress of European Neurology. Through the use of positron emission tomography (PET), three-dimensional distribution of radioactivity in tissue can be spatially detected, illustrated and quantified. With FDG-PET, a radiolabeled glucose analogue is used.
“A small portion of MCI-patients exhibit a neurodegeneration without it leading to amyloidal deposits typical of AD,” said Prof Scheltens. The aim of the study was to identify biomarker predictors for the prognosis of these “suspected non-AD pathophysiology” (SNAP). “The study suggests that SNAP is associated with a specific risk progression,” according to Prof Scheltens.
Sources:
Congress-Abstracts Bocchetta et al., The use of biomarkers for the etiologic diagnosis of mild cognitive impairment in Europe: a survey of the European Alzheimer’s disease consortium; Abstract Galimberti et al., Circulating and intrathecal miRNAs as potential biomarkers for Alzheimer’s disease; Abstract Frisoni et al., Mild cognitive impairment with suspected non AD pathology (SNAP): prediction of progression to dementia; Others: www.brainfacts.org/Policymakers/Brain-Disease-in-Europe; Olesen J et al.: The economic cost of brain disorders in Europe. European Journal of Neurology 2012, 19: 155-162
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