Abstract
Dementia can result from a number of distinct diseases with differing etiology and pathophysiology. Even within the same disease, there is considerable phenotypic heterogeneity with varying symptoms and disease trajectories. Dementia diagnosis is thus very complex, time-consuming, and expensive and can only be made definitively post-mortem with histopathological confirmation. These inherent difficulties combined with the overlap of some symptoms and even neuropathological features, present a challenging problem for research in the field. This has likely hampered progress in epidemiological studies of risk factors and preventative interventions, as well as genetic and biomarker research. Resource limitations in large epidemiologically studies mean that limited diagnostic criteria are often used, which can result in phenotypically heterogeneous disease states being grouped together, potentially resulting in misclassification bias. When biomarkers are identified for etiologically heterogeneous diseases, they will have low specificity for any utility in clinical practice, even if their sensitivity is high. We highlight several challenges in in the field which must be addressed for the success of future genetic and biomarker studies, and may be key to the development of the most effective treatments. As a step toward achieving this goal, defining the dementia as a biological construct based on the presence of specific pathological features, rather than clinical symptoms, will enable more precise predictive models. It has the potential to lead to the discovery of novel genetic variants, as well as the identification of individuals at heightened risk of the disease, even prior to the appearance of clinical symptoms.
Highlights
Dementia is a major public health problem, with enormous social and economic costs, and substantial burden for the individual, their caregiver and families [1]
The results of drug trials to slow or halt the progression of dementia have so far been unsuccessful [3]. This emphasizes the need for more research into the etiology of the diseases which cause dementia, with better characterization of genetic and environmental risk factors [4]
Dementia is an overarching term used to describe a group of symptoms that results in severe long-term decline in cognitive function that is significant enough to affect daily function [6]
Summary
Dementia is a major public health problem, with enormous social and economic costs, and substantial burden for the individual, their caregiver and families [1]. By 2050, it is estimated that over 130 million people will be living with dementia [2]. This sharp increase from the 2015 estimates of 48 million reflects the aging population worldwide, but the current lack of effective treatments or cures. The results of drug trials to slow or halt the progression of dementia have so far been unsuccessful [3]. This emphasizes the need for more research into the etiology of the diseases which cause dementia, with better characterization of genetic and environmental risk factors [4]. There is an increasing push to identify valid disease biomarkers, which would aid in diagnosis, and could be used to predict individuals at future risk [5]
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