Alzheimer's Association International Research Articles

Gaps in biomedical research in frontotemporal dementia: A call for diversity and disparities focused research.

Frontotemporal dementia (FTD) is one of the leading causes of young-onset dementia before age 65, typically manifesting as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). Although FTD affects all populations across the globe, knowledge regarding the pathophysiology and genetics derives primarily from studies conducted in North America and Western Europe. Globally, biomedical research for FTD is hindered by variable access to diagnosis, discussed in this group's earlier article, and by reduced access to expertise, funding, and infrastructure. This perspective paper was produced by two professional interest areas of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) and discusses the field's current status on the cross-cultural aspects of basic and translational research in FTD (including that focused on epidemiology, genetics, biomarkers, and treatment). It subsequently provides a summary of gaps and needs to address the disparities and advance global FTD biomedical research.

Advancements in dementia research, diagnostics, and care in Latin America: Highlights from the 2023 Alzheimer's Association International conference satellite symposium in Mexico City.

While Latin America (LatAm) is facing an increasing burden of dementia due to the rapid aging of the population, it remains underrepresented in dementia research, diagnostics, and care. In 2023, the Alzheimer's Association hosted its eighth satellite symposium in Mexico, highlighting emerging dementia research, priorities, and challenges within LatAm. Significant initiatives in the region, including intracountry support, showcased their efforts in fostering national and international collaborations; genetic studies unveiled the unique genetic admixture in LatAm; researchers conducting emerging clinical trials discussed ongoing culturally specific interventions; and the urgent need to harmonize practices and studies, improve diagnosis and care, and use affordable biomarkers in the region was highlighted. The myriad of topics discussed at the 2023 AAIC satellite symposium highlighted the growing research efforts in LatAm, providing valuable insights into dementia biology, genetics, epidemiology, treatment, and care.

Prevalence of mild behavioural impairment and its association with cognitive and functional impairment in normal cognition, mild cognitive impairment, and mild Alzheimer's dementia.

Mild behavioural impairment (MBI) is an emergent and persistent neuropsychiatric symptom (NPS) in subjects aged 50 and older who are at risk for cognitive decline. We examined the prevalence of MBI across the spectrum from cognitively normal (CN), mild cognitive impairment (MCI), to dementia, and further investigated the association between the MBI domain and cognitive and functional impairment. MBI was assessed in 2337 elderly patients in the Alzheimer's Disease Neuroimaging Initiative database (mean age, 73.04 years; 52.8% male). Among the subjects, 868 (37.1%) had normal cognition, 1066 (45.6%) had MCI, and 403 (17.2%) had mild Alzheimer's dementia (AD). MBI was evaluated in accordance with the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment diagnostic criteria for MBI, utilising the Neuropsychiatric Inventory. We compared the prevalence of the MBI domain with CN using multinominal logistic regression analysis and further quantified the magnitude of the association between MCI/AD and the MBI domains by calculating the population attributable risk (PAR). We assessed the association between the MBI domains and cognitive and functional impairment using simultaneous linear regression analysis. The most common MBI domains in each diagnostic group were affective dysregulation followed by impulse dyscontrol, decreased motivation, social inappropriateness, and abnormal perception or thought content. The PARs for MBI domains in subjects with MCI or AD were respectively: 16.60% and 24.34% for affective dysregulation; 3.72% and 18.06% for impulse dyscontrol; 4.78% and 14.13% for decreased motivation, 1.91% and 2.29% for social inappropriateness; and 0.68% and 3.85% for abnormal perception or thought content. All MBI domains except for social inappropriateness were significantly associated with a higher 11-item Alzheimer's Disease Assessment Scale-Cognitive Subscale total score. All MBI domains were significantly associated with a higher Functional Activities Questionnaire total score. Our findings show that MBI is highly prevalent across subjects with CN, MCI, and AD and is associated with cognitive and functional decline. MBI could be a crucial clinical phenotype relevant to the risk of cognitive and functional impairment, and provides a useful dimension pertinent to diagnostic approaches.

Clearance of interstitial fluid (ISF) and CSF (CLIC) group-part of Vascular Professional Interest Area (PIA), updates in 2022-2023. Cerebrovascular disease and the failure of elimination of Amyloid-β from the brain and retina with age and Alzheimer's disease: Opportunities for therapy.

This editorial summarizes advances from the Clearance of Interstitial Fluid and Cerebrospinal Fluid (CLIC) group, within the Vascular Professional Interest Area (PIA) of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART). The overarching objectives of the CLIC group are to: (1) understand the age-related physiology changes that underlie impaired clearance of interstitial fluid (ISF) and cerebrospinal fluid (CSF) (CLIC); (2) understand the cellular and molecular mechanisms underlying intramural periarterial drainage (IPAD) in the brain; (3) establish novel diagnostic tests for Alzheimer's disease (AD), cerebral amyloid angiopathy (CAA), retinal amyloid vasculopathy, amyloid-related imaging abnormalities (ARIA) of spontaneous and iatrogenic CAA-related inflammation (CAA-ri), and vasomotion; and (4) establish novel therapies that facilitate IPAD to eliminate amyloid β (Aβ) from the aging brain and retina, to prevent or reduce AD and CAA pathology and ARIA side events associated with AD immunotherapy.

In Case You Haven't Heard…

Scientists have known for some time that addressing hearing loss can reduce a person's chances of developing Alzheimer's disease, but a study released on July 18 shows just how much, a news release from UsAgainstAlzheimer's stated. According to the ACHIEVE study, “A landmark study of the effect of hearing intervention on brain health in older adults,” published in The Lancet, treating hearing loss in older adults who had more risk factors for cognitive decline slowed down the loss of thinking and memory abilities by 48% over three years. The study's findings were also presented by its author, Frank Lin, M.D., Ph.D., of the Johns Hopkins University School of Medicine and Bloomberg School of Public Health, at the annual Alzheimer's Association's International Conference. One in three Americans between the ages of 65 and 74 has hearing loss, according to the National Institutes of Health. Worldwide, mid‐ and late‐life hearing loss is identified as the single largest potentially modifiable risk factor for dementia. The ACHIEVE study is the first randomized clinical trial to investigate whether treating hearing loss in older adults reduces the cognitive decline that can occur with aging.

Consensus recommendations for clinical assessment tools for the diagnosis of posterior cortical atrophy syndrome from the Atypical AD PIA of ISTAART.

Delay in diagnosis of posterior cortical atrophy (PCA) syndrome is common, and the lack of familiarity with assessment tools for identifying visual cortical dysfunction is a contributing factor. We propose recommendations for the approach to the evaluation of PCA clinical features during the office visit, the neuropsychological evaluation, and the research setting. A recommended screening battery for eye clinics is also proposed. Recommendations were developed using results from a web-based survey of members of Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment (ISTAART) Atypical Alzheimer's Disease Professional Interest Area (PIA), literature review, and consensus by the PCA assessment working party of the Atypical Alzheimer's Disease PIA. Survey results revealed robust agreement for assessment tool preferences for PCA features, and many respondents indicated that they reserve assessment tools for use only when PCA is suspected. For some PCA features, curated tools were preferred over validated battery tools, particularly for the office visit. Consensus recommendations superseded survey preferences for two core cognitive features within the 2017 PCA diagnostic criteria. These consensus recommendations provide an evaluation framework for PCA clinical features and can facilitate timely and accurate recognition and diagnosis of PCA. Broader use of these tools should be sought, and development and validation of novel PCA clinical outcome assessments are needed to improve our understanding of atypical AD and other dementias and support the inclusion of those with PCA in treatment trials.

Gaps in clinical research in frontotemporal dementia: A call for diversity and disparities-focused research.

Frontotemporal dementia (FTD) is one of the leading causes of dementia before age 65 and often manifests as abnormal behavior (in behavioral variant FTD) or language impairment (in primary progressive aphasia). FTD's exact clinical presentation varies by culture, language, education, social norms, and other socioeconomic factors; current research and clinical practice, however, is mainly based on studies conducted in North America and Western Europe. Changes in diagnostic criteria and procedures as well as new or adapted cognitive tests are likely needed to take into consideration global diversity. This perspective paper by two professional interest areas of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment examines how increasing global diversity impacts the clinical presentation, screening, assessment, and diagnosis of FTD and its treatment and care. It subsequently provides recommendations to address immediate needs to advance global FTD research and clinical practice.

Alzheimer's Association International Conference (AAIC) 2022. San Diego – July 31-August 4, 2022

Alzheimer's Association International Conference (AAIC) 2022. San Diego – July 31-August 4, 2022

In Case You Haven't Heard…

Eating ultra‐processed foods such as hot dogs, sausages, burgers, French fries, soda, cakes and candies can contribute to overall cognitive decline, including areas of the brain involved in executive functioning, i.e., the ability to process information and make decisions, according to a new study. Presented Aug. 1 at the 2022 Alzheimer's Association International Conference in San Diego, the study followed over 10,000 Brazilians for up to 10 years. Those in the study who ate the most ultra‐processed foods were “more likely to be younger, women, white, had higher education and income, and were more likely to have never smoked, and less likely to be current alcohol consumers,” the researchers reported. Men and women who ate the most ultra‐processed foods had a 28% faster rate of global cognitive decline and a 25% faster rate of executive‐function cognitive decline compared with people who ate the least amount of overly processed food, CNN Health reported about the study. Researchers also have found that eating ultra‐processed foods can raise the risk of obesity, heart and circulation problems, diabetes and cancer.

Alzheimer's disease research progress in the Mediterranean region: The Alzheimer's Association International Conference Satellite Symposium.

As research and services in the Mediterranean region continue to increase, so do opportunities for global collaboration. To support such collaborations, the Alzheimer's Association was due to hold its seventh Alzheimer's Association International Conference Satellite Symposium in Athens, Greece in 2021. Due to the COVID-19 pandemic, the meeting was held virtually, which enabled attendees from around the world to hear about research efforts in Greece and the surrounding Mediterranean countries. Research updates spanned understanding the biology of, treatments for, and care of people with Alzheimer's disease (AD_ and other dementias. Researchers in the Mediterranean region have outlined the local epidemiology of AD and dementia, and have identified regional populations that may expedite genetic studies. Development of biomarkers is expected to aid early and accurate diagnosis. Numerous efforts have been made to develop culturally specific interventions to both reduce risk of dementia, and to improve quality of life for people living with dementia.

The role of dyadic cognitive report and subjective cognitive decline in early ADRD clinical research and trials: Current knowledge, gaps, and recommendations.

Efficient identification of cognitive decline and Alzheimer's disease (AD) risk in early stages of the AD disease continuum is a critical unmet need. Subjective cognitive decline is increasingly recognized as an early symptomatic stage of AD. Dyadic cognitive report, including subjective cognitive complaints (SCC) from a participant and an informant/study partner who knows the participant well, represents an accurate, reliable, and efficient source of data for assessing risk. However, the separate and combined contributions of self‐ and study partner report, and the dynamic relationship between the two, remains unclear. The Subjective Cognitive Decline Professional Interest Area within the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment convened a working group focused on dyadic patterns of subjective report. Group members identified aspects of dyadic‐report information important to the AD research field, gaps in knowledge, and recommendations. By reviewing existing data on this topic, we found evidence that dyadic measures are associated with objective measures of cognition and provide unique information in preclinical and prodromal AD about disease stage and progression and AD biomarker status. External factors including dyad (participant–study partner pair) relationship and sociocultural factors contribute to these associations. We recommend greater dyad report use in research settings to identify AD risk. Priority areas for future research include (1) elucidation of the contributions of demographic and sociocultural factors, dyad type, and dyad relationship to dyad report; (2) exploration of agreement and discordance between self‐ and study partner report across the AD syndromic and disease continuum; (3) identification of domains (e.g., memory, executive function, neuropsychiatric) that predict AD risk outcomes and differentiate cognitive impairment due to AD from other impairment; (4) development of best practices for study partner engagement; (5) exploration of study partner report as AD clinical trial endpoints; (6) continued development, validation, and optimization, of study partner report instruments tailored to the goals of the research and population.

Alzheimer's disease research progress in Australia: The Alzheimer's Association International Conference Satellite Symposium in Sydney.

The Alzheimer's Association International Conference held its sixth Satellite Symposium in Sydney, Australia in 2019, highlighting the leadership of Australian researchers in advancing the understanding of and treatment developments for Alzheimer's disease (AD) and other dementias. This leadership includes the Australian Imaging, Biomarker, and Lifestyle Flagship Study of Ageing (AIBL), which has fueled the identification and development of many biomarkers and novel therapeutics. Two multimodal lifestyle intervention studies have been launched in Australia; and Australian researchers have played leadership roles in other global studies in diverse populations. Australian researchers have also played an instrumental role in efforts to understand mechanisms underlying vascular contributions to cognitive impairment and dementia; and through the Women's Healthy Aging Project have elucidated hormonal and other factors that contribute to the increased risk of AD in women. Alleviating the behavioral and psychological symptoms of dementia has also been a strong research and clinical focus in Australia.

Expanding Representation of Low and Middle Income Countries in Global Dementia Research: Commentary From the Alzheimer's Association.

Alzheimer's disease (AD) and all other dementia represent a global challenge, with an estimated 50 million individuals in the world living with dementia today. In low and middle income countries (LMICs), the burden of disease often is greater, and some of these countries are projected to have some of the largest increases in dementia prevalence during the next few decades. As the world's largest voluntary health organization dedicated to AD and all other dementia, the Alzheimer's Association is committed to its vision of a world without dementia and recognizes the needs, challenges, and opportunities for dementia research in all parts of the world, and especially in LMICs. Currently, the Association is devoting more than $215 million in funding to nearly 600 best-of-field projects in 31 countries, including a significant number of projects that advance and support LMIC-specific research. The innovative work in LMICs is focused on addressing unmet needs or challenges associated with the many unique cultural, demographic, and economic characteristics of these countries. The Association also is expanding leading global forums such as the Alzheimer's Association International Conference (AAIC). In an effort to create new learning and participation opportunities, the Association also has been partnering with other international organizations and collaborating with local leadership to provide AAIC Satellite Symposia (AAIC SS) in LMIC regions around the world. In 2021 and beyond, the Association is committed to continuing these LMIC-focused initiatives, identifying gaps in LMIC research and resources, and enhancing collaboration and communication among researchers in these regions.

Alzheimer's Association International Conference Neuroscience Next focused on early career researchers across all of neuroscience.

Alzheimer's Association International Conference Neuroscience Next focused on early career researchers across all of neuroscience.

Alzheimer's Association International Conference 2021. Denver/Virtual - July 26-30, 2021

Alzheimer's Association International Conference 2021. Denver/Virtual - July 26-30, 2021

Do infections have a role in the pathogenesis of Alzheimer disease?

The idea that infectious agents in the brain have a role in the pathogenesis of Alzheimer disease (AD) was proposed nearly 30 years ago. However, this theory failed to gain substantial traction and was largely disregarded by the AD research community for many years. Several recent discoveries have reignited interest in the infectious theory of AD, culminating in a debate on the topic at the Alzheimer's Association International Conference (AAIC) in July 2019. In this Viewpoint article, experts who participated in the AAIC debate weigh up the evidence for and against the infectious theory of AD and suggest avenues for future research and drug development.

Theoretical frameworks and approaches used within the Reserve, Resilience and Protective Factors professional interest area of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment.

IntroductionReserve, resilience, maintenance, and related concepts are intensely debated in aging and Alzheimer's disease research.MethodsThrough a short survey, we gathered information about theoretical concepts and methodologies used among research groups of the Reserve, Resilience, and Protective Factors Professional Interest Area of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment.ResultsOverall 53 research groups responded. Reserve and resilience were the most frequently used conceptual frameworks. Education, occupation, leisure, and social activities were frequently used as measures, as were longitudinal designs. Neuropsychological assessments were almost universal, and usage of imaging biomarkers was frequent. In observational‐epidemiological study designs, resilience and reserve together (vs reserve alone) were commonly used as theoretical frameworks.DiscussionWe provide a first description of concepts and methodologies used among reserve and resilience researchers. This will inform initiatives aiming to reach consensus on terminology and applications to establish common definitions.

Alzheimer's Association International Conference 2020. Virtual Conference - July 27-31, 2020

The Alzheimer's Association International Conference (AAIC) is the world's largest scientific platform to discuss Alzheimer's disease and dementia aimed at advancing science in these research areas Despite the COVID-19 pandemic preventing an in-person meeting this year, the virtual alternative set up by the association, continued with this aim, noting that this option had the potential to reach a larger global audience, with the information made available through free registration to the event The conference consisted of over 50 live sessions, 100 on-demand sessions with live QAadditionally there were networking opportunities through dedicated chatrooms in a 'networking lounge' and a virtual exhibition hall with approximately 60 exhibitors available live to discuss their products This report covers presentations on drugs in development presented throughout the conference

Clearance of interstitial fluid (ISF) and CSF (CLIC) group-part of Vascular Professional Interest Area (PIA): Cerebrovascular disease and the failure of elimination of Amyloid-β from the brain and retina with age and Alzheimer's disease-Opportunities for Therapy.

Two of the key functions of arteries in the brain are (1) the well‐recognized supply of blood via the vascular lumen and (2) the emerging role for the arterial walls as routes for the elimination of interstitial fluid (ISF) and soluble metabolites, such as amyloid beta (Aβ), from the brain and retina. As the brain and retina possess no conventional lymphatic vessels, fluid drainage toward peripheral lymph nodes is mediated via transport along basement membranes in the walls of capillaries and arteries that form the intramural peri‐arterial drainage (IPAD) system. IPAD tends to fail as arteries age but the mechanisms underlying the failure are unclear. In some people this is reflected in the accumulation of Aβ plaques in the brain in Alzheimer's disease (AD) and deposition of Aβ within artery walls as cerebral amyloid angiopathy (CAA). Knowledge of the dynamics of IPAD and why it fails with age is essential for establishing diagnostic tests for the early stages of the disease and for devising therapies that promote the clearance of Aβ in the prevention and treatment of AD and CAA. This editorial is intended to introduce the rationale that has led to the establishment of the Clearance of Interstitial Fluid (ISF) and CSF (CLIC) group, within the Vascular Professional Interest Area of the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment.

Neurogenetic Traits Conferring Vulnerability to Cortical Progression of Parkinson's Disease

Background: The genetic traits that underlie vulnerability to neuronal damage across specific brain circuits in Parkinson’s disease (PD) remain to be elucidated. In this study, we characterized the brain topological intersection between propagating connectivity networks in healthy controls (HC) and PD participants and gene expression patterns across the human cortex – such as the SNCA gene (encoding alpha-synuclein protein, a hallmark of PD pathology). Methods: To characterize the functional scaffolding of connections emanating from PD-related pathology epicenters in the brainstem, we first performed Stepwise Functional Connectivity (SFC) analysis using intrinsic connectivity as revealed by neuroimaging. We then leveraged the Allen Human Brain Atlas (AHBA) to examine the spatial intersection of the observed SFC patterns with genetic transcription profiles. Findings: A rich set of genes were transcriptionally associated to PD-related biologic processes, including dopamine secretion, neuropeptide transmission, and axonal and synaptic assemblies, for which the gene SNCA played a central role. As hypothesized, we further confirmed that brain connectivity originated from PD-related pathology epicenters in the brainstem largely recapitulated the anatomical distribution of alpha-synuclein histopathology in postmortem data. Finally, we discovered that the gene set most related to cortical propagation patterns of PD-related pathology was primarily involved in microtubule cellular components. Interpretation: This study sheds light on exciting new avenues for enhancing detection of PD neuronal vulnerability via an evaluation of in vivo connectivity trajectories across the human brain and successful integration of neuroimaging-genetic strategies. Funding Statement: This research was supported by grants from the National Institutes of Health (NIH; R01AG061811, and R01AG061445 to J.S.), the Ministry of Education, Science, and Technological Development of the Republic of Serbia (grant number 175090), the Italian Ministry of Health (grant number RF-2018-12366746) and Carlos III Institute of Health (PI11/02109) Spain, the Basque Government through the BERC 2018-2021 program and by the Spanish State Research Agency through BCBL Severo Ochoa excellence accreditation SEV-2015-0490 and the Spanish Ministry of Economy and Competitiveness (RYC-2017- 21845 and PID2019-105520GB-100 to C.C-G.). Declaration of Interests: S.B. reports no disclosures. F.A. is Section Editor of NeuroImage: Clinical; has received speaker honoraria from Philips, Novartis and Biogen Idec; and receives or has received research supports from the Italian Ministry of Health, AriSLA (Fondazione Italiana di Ricerca per la SLA), and the European Research Council. I.D. reports no disclosures. E.B. reports no disclosures. F.d.O.U. reports no disclosures. M.D-A. report honoraria for lectures, travel, and accommodation to attend scientific meetings from Alter, Bial, Merk, Novartis, Sanofi Genzyme, UCB, and Zambon. C.C-G. reports no disclosures. M.R-O. reports honoraria for lectures, travel and accommodation to attend scientific meetings from Boston Scientific and Bial. T. Stojkovic has received speaker honoraria from Actavis and Alzheimer's Association International Research Grant. V.S. Kostic has received speaker honoraria from Actavis and Solveo. M. Filippi is Editor-in-Chief of the Journal of Neurology; received compensation for consulting services and/or speaking activities from Bayer, Biogen Idec, Merck-Serono, Novartis, Roche, Sanofi Genzyme, Takeda, and Teva Pharmaceutical Industries; and receives research support from Biogen Idec, Merck-Serono, Novartis, Roche, Teva Pharmaceutical Industries, Italian Ministry of Health, Fondazione Italiana Sclerosi Multipla, and ARiSLA (Fondazione Italiana di Ricerca per la SLA). J. Sepulcre reports no disclosures. Ethics Approval Statement: Both studies were approved by the local ethics committees at University of Belgrade and Gipuzkoa Clinical Research Ethics Committee respectively and written informed consent to participate in the study was obtained from all participants.