Article Text
PDF
Statistics from Altmetric.com
The Alzheimer field is in desperate need for an effective treatment. After decades of research, the available drugs treat only symptoms, and even their effectiveness is disputed. Because brain changes precede the clinical symptoms by years to decades, disease-modifying treatments should probably be started early, when the first symptoms occur—or even before. But how to determine who to treat? In this issue, Erik Gustavsson c.s. approach this question by addressing the benefits, harms and ethical issues encountered when using different modes of screening for ‘preclinical’ or early symptomatic Alzheimer disease (AD).1 Their overall conclusion is clear—screening for high risk of developing AD dementia to select those who are eligible for treatment is ethically problematic, unless extremely effective treatment becomes available.
An additional major challenge is that diagnostic test accuracy is generally poor, with a particularly high risk of false-positive results, that is, biological evidence of Alzheimer pathology in persons who will never develop dementia. The risk of overmedicalisation is serious, and the potential harms of screening for AD should not be ignored, as Le Couteur c.s. previously argued.2 In short, there is no evidence base for any form of screening for AD whether in a preclinical stage (an …
Footnotes
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Commissioned; internally peer reviewed.
Linked Articles
Read the full text or download the PDF:
Other content recommended for you
- FDA’s dilemma with the aducanumab approval: public pressure and hope, surrogate markers and efficacy, and possible next steps
- How many patients are eligible for disease-modifying treatment in Alzheimer’s disease? A French national observational study over 5 years
- Safety and efficacy of plasma transfusion from exercise-trained donors in patients with early Alzheimer’s disease: protocol for the ExPlas study
- Blood-based high sensitivity measurements of beta-amyloid and phosphorylated tau as biomarkers of Alzheimer’s disease: a focused review on recent advances
- Characterization of accelerated approval status, trial endpoints and results, and recommendations in guidelines for oncology drug treatments from the National Comprehensive Cancer Network: cross sectional study
- The China Alzheimer Report 2022
- 28 A perfect storm: expanded disease definitions in alzheimer’s disease and the new era of disease-modifying drugs in mild cognitive impairment
- Effect of reductions in amyloid levels on cognitive change in randomized trials: instrumental variable meta-analysis
- Cognitive symptoms of Alzheimer’s disease: clinical management and prevention
- FDA calls for investigation into industry influence during Alzheimer’s drug approval