Are we ready to use anti-amyloid therapy in Alzheimer's disease?

Brucki, Sonia Maria Dozzi; César-Freitas, Karolina Gouveia; Spera, Raphael Ribeiro; Borges, Conrado Regis; Smid, Jerusa

doi:10.1590/0004-282X-ANP-2022-S117

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NEUROLOGY OF COGNITIVE AND BEHAVIORAL DISORDERS • Arq. Neuro-Psiquiatr. 80 (5 Suppl 1) • May 2022 • https://doi.org/10.1590/0004-282X-ANP-2022-S117 linkcopy

Are we ready to use anti-amyloid therapy in Alzheimer's disease?

Estamos prontos para o uso de terapia anti-amiloide na doença de Alzheimer?

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Alzheimer’s disease (AD) is the most common neurodegenerative disease. Biomarkers have demonstrated that AD pathology exists over the disease continuum from a stage preceding symptoms over 15-25 years to the progressively more impaired symptomatic states, mild cognitive impairment (MCI), and dementia. Biomarkers include: amyloid (Aß), phosphorylated tau, and neurodegeneration. The plasma assays for Aß and tau show great promise for clinical and research use. This review has aimed not only to present the ATN diagnostic classification and the preclinical AD concepts in addressing some possibilities of cognitive assessment instruments, but also to briefly summarize the main anti-amyloid monoclonal antibodies studied in clinical trials. In addition, this paper presents a critical analysis by experts in cognitive neurology while addressing the question as to whether we are prepared for the anti-amyloid therapy era or not.

Keywords:
Alzheimer Disease; Biomarkers; Dementia

AT(N) profiles	Biobiomarker category
A-T-(N)-	Normal AD biomarkers	AlzhAlzheimer’s continuum
A+T-(N)-	AlzhAlzheimer’s pathologic change
A+T+(N)-	AlzhAlzheimer’s disease
A+T+(N)+	AlzhAlzheimer’s disease
A+T-(N)+	AlzhAlzheimer’s and concomitant suspected non-non-Alzheimer’s pathologic change
A-T+(N)-	Nonnon-AD pathologic change*
A-T-(N)+	Nonnon-AD pathologic change*
A-T+(N)+	Nonnon-AD pathologic change*

Stage	Clinical characteristics	Syndromic stage
1	Normal cognitive performance, No reported cognitive decline or new onset of neurobehavioral symptoms	Cognitively unimpaired
2	Normal cognitive performance, Subjective cognitive decline, or Documented evidence of decline, or Newly acquired neurobehavioral symptoms	Cognitively unimpaired or SCD
3	Performance in impaired range, and Cognitive decline from baseline in any domain, and ADL independent, but may be less efficient	MCI
4	Mild dementia: Substantial cognitive impairment affecting several domains, and Clearly evident functional impact on daily life, and No longer fully independent	Dementia
5	Moderate dementia: Progressive cognitive impairment or neurobehavioral changes No longer independent and requires frequent assistance with ADL	Dementia
6	Severe dementia: Progressive cognitive impairment or neurobehavioral changes, Clinical interview may not be possible, Complete dependency due to severe functional impact on ADL with impairment in basic activities, including basic self-care.	Dementia

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[TFN1] *suspected non-Alzheimer’s pathophysiology or SNAP.