Alzheimer’s Disease Prevention Initiative

No Disease,No Symptoms

Early BrainChanges,

No Symptoms

Mild MemoryLoss

Mild, Moderate and Severe Impairment

Disease ProgressionDisease Progression

Mild Cognitive

Impairment

Pre-symptomatic

ADNormal AD

PrimaryPrevention

SecondaryPrevention Treatment

Risk of Developing Alzheimer’s Disease in Persons with MCI

Survival curve of persons characterized as having a mild cognitive impairment for 6 years. Approximately 80% have converted to dementia during this time.

Peterson RC, et al., Arch Neurol. 58:1985-1992, 2001.

Normal, 75 years old

Alzheimer’s disease, 75 years old

Volume of Hippocampus and Rate of Shrinkage Predicts Crossover from MCI to AD

Percent Annual Decline in Hippocampal Volume

0

0.5

1

1.5

2

2.5

3

3.5

4

Control MCI AD

StableDecliner

Jack CR, et al, Neurology 55: 484-489, 2000De Leon MJ, 1999

PET Imaging of Amyloid Deposits in Alzheimer’s Disease vs Normal Controls

Source: Klunk, et al. Ann Neurol 2004: 55:306-319.

PET imaging with a novel tracer, Pittsburgh Compound-B (PIB), can provide quantitative information on amyloid deposits in living subjects.

Current Drug Treatments for AD

• Acetylcholinesterase inhibitors for mild to moderate AD− Tacrine (Cognex)− Denepezil (Aricept)− Rivastigmine (Exelon)− Galantamine (Reminyl)

• Neuroprotective agent for moderate to severe AD− Memantine (Namenda)

Funded AD Prevention and Selected Treatment Trials

Vitamins E, Aricept

Aspirin, Vitamin E

Estrogen

B-Carotene, Vit. E, C

Celecoxib, Naproxen

Ginkgo Biloba

Vitamin E, SeleniumSimvastatin

1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008

Vitamin E, C, B6, B12, Folate, B-Carotene

April 2002

Complementary & Alternative Therapies for AD

• Ginkgo Evaluation of Memory (GEM) study

• Clinical trial of huperzine• Traditional Asian medicines• High intensity light therapy

REACH II Intervention

The REACH II intervention is a multi-component

intervention designed to address five areas

linked to caregiver risk profile:

• Safety• Social Support• CR Problem Behaviors• Emotional well-being• Self-care and Health Behaviors