One of the most frightening aspects of a diagnosis of Alzheimer’s disease is the lack of knowledge about what lies ahead. Both patients and caregivers face the uncertainty of the disease’s progress, but a new study brings hope by demystifying the prognosis. A team of experts has developed an innovative tool capable of predicting cognitive decline over the next five years for patients with early signs of Alzheimer’s.
Development of the Tool
A team led by physician-researcher Pieter van der Veere, from the University of Amsterdam in the Netherlands, created a prediction model based on a meticulous study of real patients. The research involved 961 patients with an average age of 65, including 651 with mild dementia and 310 with mild cognitive impairment, all of whom had beta amyloid plaques in the brain, a characteristic marker of Alzheimer’s disease.
The researchers analyzed MRI scans, cerebrospinal fluid biomarkers, age, gender, medical history and cognitive test scores over time, graded in 30-point intervals.
“People are very interested in knowing what to expect from the disease in themselves or their loved ones, so better prediction models are urgently needed,” explains Pieter van der Veere.
Research Results
The results showed that patients with mild cognitive impairment began with an average score of 26.4 on the cognitive tests, falling to 21 after five years. Patients with mild dementia, on the other hand, showed a steeper drop, from 22.4 to 7.8 over the same period. This data allowed the researchers to outline a predictive model that takes into account the individual progression of the disease.
Impact of medication
The researchers also evaluated the effects of medication on the progression of Alzheimer’s. For example, a patient with mild cognitive impairment and an initial score of 28 could reach moderate impairment after six years. However, with a medication that reduces the rate of decline by 30%, this stage would only be reached after 8.6 years. For patients with mild dementia and an initial score of 21, progression to moderate impairment would take 2.3 years without medication, and 3.3 years with medication.
“In the future, this will become even more important if we can treat Alzheimer’s disease,” says neuroscientist Wiesje van der Flier. “This could be a starting point for conversations between the doctor, the patient and the family about the pros and cons of treatments, so that they can come to an appropriate decision together.”
Limitations and Future of Research
Although the models have shown promise, accurate prediction still faces challenges. Only half of the patients with cognitive impairment scored within two points of the prediction, and half of the patients with dementia scored within three points. This indicates that, despite the usefulness of the models, obtaining a totally reliable prognosis is still difficult.
The researchers are optimistic about the future. By including as many parameters as possible, the model can offer personalized results, giving patients and their families a clearer idea of what to expect as the disease progresses. However, it is essential that doctors clearly communicate the limitations and uncertainties involved.
“We understand that people with cognitive problems and their care partners are most interested in answers to questions such as ‘How long can I drive a car?’ or ‘How long can I continue practicing my hobby?’,” says Van der Veere. “In the future, we hope that the models will help make predictions about these quality of life issues and daily functioning. But until then, we hope that these models will help doctors translate these predicted scores into answers to people’s questions.”
The development of this new predictive tool marks a significant advance in the understanding and management of Alzheimer’s disease. As stated by neuroscientist Wiesje van der Flier, this tool could become a crucial starting point for conversations between doctors, patients and their families about the pros and cons of available treatments.
The scientists hope to further refine their research to produce more accurate prediction models in the future, allowing for predictions on quality of life issues and daily functioning. Until then, this tool represents an important step towards providing valuable, personalized information to those affected by Alzheimer’s disease.
The research has been published in Neurology.
