Potential use of accessible and cost-effective biomarkers in primary care

Today, CSF and PET measurements of Aß and tau pathology are valuable tools to aid the understanding of AD, and can be used to improve the accuracy of clinical AD diagnosis.¹ However, the availability of PET and CSF AD biomarkers is limited and can be very costly (PET) or invasive (CSF).¹ As a result, their use in clinical practice is likely to be restricted to more specialized centres.¹ The development of blood-based biomarkers offers potential benefit over those currently available.⁵ Before these biomarkers are implemented in the clinic, several steps such as development of automated assays and establishment of universal cut-offs for abnormality are required.⁵ Additionally, optimization of diagnostic algorithms that combine different blood-based biomarkers and other easily accessible and cost-effective tools will allow individualized prediction of AD dementia in patients with mild cognitive symptoms.¹ For patients with lower probability of neurodegenerative disease, follow-up in primary care may monitor the progression or improvement of symptoms, and consider alternative treatable conditions that may be contributing to symptoms.¹ For patients with higher probability of neurodegenerative disease, more advanced clinical assessments may be carried out to determine the most probable neurodegenerative disease diagnosis.¹ This would then allow the initiation of appropriate treatment and care.¹

References:
1.Hansson O. Biomarkers for neurodegenerative diseases. Nat Med  2021; 27 (6): 954–963.

2.Shaw LM, Arias J, Blennow K, et al. Appropriate use criteria for lumbar puncture and cerebrospinal fluid testing in the diagnosis of Alzheimer’s disease. Alzheimers Dement 2018; 14 (11): 1505–1521.

3.Johnson KA, Minoshima S, Bohnen NI, et al. Appropriate use criteria for amyloid PET: a report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer’s Association. Alzheimers Dement 2013; 9 (1): e1–e16.

4.Jie CVML, Treyer V, Schibli R, Mu L. Tauvid™: The first FDA-Approved PET Tracer for imaging tau pathology in Alzheimer’s disease. Pharmaceuticals (Basel) 2021; 14 (2): 110.

5.Hansson O, Edelmayer RM, Boxer AL, et al. The Alzheimer’s Association appropriate use recommendations for blood biomarkers in Alzheimer’s disease. Alzheimers Dement 2022; 18 (12): 2669–2686.