State of the science in Alzheimer's research

7/26/2019 State of the science in Alzheimer's research

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Alzheimers Disease:

Impact, Policy and Science


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State Policy: Examples of Topics Early Detection and Diagnosis Care and Case Management Q ality o! Care "or#!orce De$elo%ment and &raining Caregi$er ' %%ort (ome) and Comm nity)*ased 'er$ices +ong)&erm Care

'a!ety +egal ,ss es


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How !ch "ederal "!ndin# is$e%!ired for Ade%!ate Pro#ress&

Alzheimers Association'or(#ro!ps)oncl!sion:

At least -2 .illion %eryear

/ea!!irmed additional

gro %s o$er %astse$eral years


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*+ -

*./ + x


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Alzheimers f!ndin# on 0cr!isecontrol1


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'hat has happened to Alzheimersf!ndin# instead


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The Senates $ecent Actionon Alzheimers "!ndin#


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The Senates $ecent Actionon Alzheimers "!ndin#


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Ad2ances in Alzheimers$esearch

Maria Carrillo DC ie! 'cience !!icer

l eimer s ssociation


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3!tline l eimer s ssociation o r leaders i% in

science Dementia $s l eimer s disease /is# !actors associated it l eimer s

Moderni ing g idelines !or l eimer s andad$ances in early detection : .iomar#ers

ossi.le %re$ention ; ne


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Alzheimers Association:

'ho 'e Are

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,n!ormation and re!erral ' %%ort gro %s Care cons ltation

'a!ety ser$ices Ed cation local con!erences

.+45 6ationwide Helpline 800)272)3900 ,n!ormation and re!erral $er 140 lang ages

6ationwide 6etwor( of S!pport


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$eso!rces to help 738

*y % one9-- .5. ;


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=ar#est 6on>Profit "!nder of Alzheimers ?$elated Dementia $esearch In 'orld

C rrently ! nding -80>million to ?300 acti$e%ro@ects in 20 co ntries

Most ,m%act! l Aon) ro!it= nder o! l eimer s Dementia & om%son /e ters "e. o!'cience 2015


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@oal: Accelerate and f!nd what otherswont or cant to ad2ance Alzheimers ?

related dementia research:

Early )areer In2esti#ators

Inno2ati2e Ideas Accelerate Hi#h $is( Trials


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'hat is )o#niti2e A#in#

*la er et al B M 2015 313 21 F2121)2122


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)o#niti2e "!nction, /y A#e

,nstit te o! Medicine 2015


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De2elopin# /rain @i2es )l!es to/rain )han#e with A#e

Corel B+ (ar$ardGni$ersity ress 1975


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A#e $elated )han#es Many c anges o! o r .odies as e age incl ding

o r .rains E


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Alzheimers Disease ? $elatedDementia


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4million mericans o! A== agesill a$e l eimer s in 2016

The Alzheimers Epidemic)ontin!es to @row

*236/I==I36 I6 .-BC

*1 1T$I==I36 I6 .- -

Total cost of care for those with Alzheimers,with more than two>thirds paid y edicare and edicaid

l eimer s ssociation "acts ?"i#!res 2016


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Alzheimers Pla%!es ? Tan#les

tangles

plaques


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)6 )I Dementia

TA8

Fasc!larDisease

AlphaSyn!clein

TDP>+;

AG

)linicalSpectr!m

3ther i e3xidation,

Inflammation,Ins!lin

)linical/rain )han#es

da%ted !rom Dr /onald etersen Mayo Clinic


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ge (eart) ead connection

,ncreased ris# s s%ected i!

ig .lood %ress re eartdisease stro#e dia.etes and

ig c olesterol (ead in@ ry r HenesF Family History

and Sex (XX or XY)

$is( $elated to )o#niti2e Decline ?Alzheimers Disease


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8nderstandin# @enetics ?Alzheimers

/elati$ely rareF 1)3I o! allcases o! l eimer s

Deterministic $is(

APOE

In the 6ews: Falidation of Ethnicity


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In the 6ews: Falidation of EthnicitySpecific @enetic $is( "actor

,n 2013 *C 7 s o n to increaseris# in !rican mericanss%eci!ically

Gna.le to $alidate d e to lac# o! !rican merican %artici%ants inclinical st dies

l eimer s ssociation %ro$ided! nding to s %%ort $alidationst dies

=irst con!irmation o! t is lin#age$alidated in inde%endent%o% lation

C #ier et al 2016Nature Genetics


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=ifetime $is( for Alzheimers is@reater for 'omen

D /is# D Caregi$er D /is# > Caregi$er

Jang and +e$ey "omen s(ealt ,ss es 2015


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D!ration ? )o!rse of Illness:Different for en and 'omen

D ration o! D A rsing (ome 'tay Comm nity

Jang and +e$ey "omen s(ealt ,ss es 2015

'omens Alzheimers


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'omens Alzheimers$esearch Initiati2e

Con$ened t in# tan# on@ender F!lnera ilities !or l eimer s in May 2015

=oc s on .iological

mec anisms li!estyle !actors +a nc ed Sex & Gender in

Alz eimer!s (SAGA) ; /ecei$ed o$er 150> a%%lications ; E


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Baumgart et al. 2016 Alzheimers &

" h I 4 D


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"actors that Increase4 Decrease$is( of )o#niti2e Decline



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"actors that Increase4 Decrease$is( of Dementia



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Statement of E2idence: odifia le $is("actors for )o#niti2e Decline ? Dementia

1 /eg lar % ysical acti$ity and management o!cardio$asc lar ris# !actors dia.etes o.esitysmo#ing and y%ertension a$e .eens o n to red ce t e ris# o! cogniti$e declineand may red ce t e ris# o! dementia

2 (ealt y diet and li!elong learning:cogniti$etraining may also red ce t e ris# o! cogniti$edecline

3 & ere are still many nans ered K estionsand signi!icant ncertainty it res%ect to t erelations i% .et een indi$id al ris# !actorsand dementia



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B-'ays

to=3FE

7o!r/rain

d i i # h Di # i f


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odernizin# the Dia#nosis ofAlzheimers /ased on a )ontin!!m

.-BB


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)ontin!!m of Alzheimers Disease

6ormal Alzheimers disease

da%ted !rom '%erling et al 2011


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Aormal re)clinical MC, l dementia

Clear de!icits in 2 or more core cogniti$e

domains D+s a!!ected

' .@ecti$e %ro.lemin memory or anot er

domain in!ormantcorro.orated and

meas ra.le on testsnormal o$erallcognition and D+s

*iological c angesCogniti$ely normal

odernizin# the Dia#nosis ofAlzheimers /ased on a )ontin!!m


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A

TAU

Other

VascularDisease

AlphaSynuclein

TDP-43

)6 )I Dementia

)linicalSpectr!m

PET/CS

PET/CS

!

"#$

!CS

!CS


/iomar(er


l d


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PET Amyloid Ima#in#

6 o r m a l

A #

i n #

A l z h e i m

e r s

D i s e a

s e

/ +

D F $ J

B : -

. : -

"i#!res co!rtesy of

Drs Keith Lohnson4$eisa Sperlin#


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HealthyIndi2id!al

ild )o#niti2eImpairment

ildAlzheimers

Se2ereAlzheimers

B& C ien et al "ournal o# Alz eimer!s $isease 2013

Alzheimers disease: Ta! Ima#in#

9 - m

i n ! t e s

B - -

m i n !

t e s

Acceleratin# Pro#ress: /ench to /edside


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Acceleratin# Pro#ress: /ench to /edsidePET Amyloid Ima#in#

2001F =irst l eimer s ssociation grant to Dr"illiam Ll n# i* 2006F l eimer s ssociation ! nding o! i* dd

n in DA, -2 1M 2010F =D &estimony on standard !or a%%ro$al o!

myloid ,maging 2012F =D a%%ro$al o! !irst amyloid imaging

agent 2013F &estimony to CM' on %%ro%riate Gse o!

myloid ,maging 2013F =D a%%ro$al t o additional amyloid

imaging agents 2015F CM' %%ro$al o! t e ,DE ' 't dy

IDEAS Imaging Dementia Evidence


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2013 CM' denied co$erage e


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HoalF &o determine clinical se! lness $al e indiagnosing l eimer s and ot er dementias o! a.rain E& scan t at detects amyloid %laK es ; acore !eat re o! D

18 488 Medicare .ene!iciaries 65 or older :ncertain diagnosis ill .e enrolled at a%%ro


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IDEAS>St!dy or#

" ere are amyloid agentsa$aila.le in G' N

How Do People Enroll in the


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IDEAS>St!dy or#

How Do People Enroll in theIDEAS St!dy&

Enrollment t ro g a Dementia'%ecialist o is %artici%ating in t est dy

nce enrollment .egins e


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IDEAS>St!dy or#

@o to:

ideas>st!dy or#

"or Information and $e#istration

Pre2ention of Alzheimers&


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Pre2ention of Alzheimer s&

) ll ti f Al h i


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)olla oration for AlzheimersPre2ention )AP

DIA6 T8 DIAD T i l


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DIA6>T8: DIAD Trial Dominant ,n erited l eimer s

Disease D, D Aet or# &rials Gnit 2 %re$ention trial .iomar#er

$alidation & o dr gs .eing testedF

'olane ma. Hantener ma. -4 2 million in$ested .y t e ssociation to la nc t e trial

dditional -500 000 to initiate taimaging in D, A)&G trial

=irst re%ort o t antici%ated late 2016*iomar#ers and late 2017Cognition

Accelerates DIA6 6e @en Trial ith


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Accelerates DIA6 6ex@en Trial with*+ ; illion Award

ard s %%orts !o ndation !orne


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Alzheimer s Pre2ention Initiati2e:AP3E+ St!dy

& o Co%ies o! /is# Hene 1 300 ad lts age 60)75 artnering it Ao$artis ; t o

dr gsF ; C D106F acti$e imm not era%y ; *eta secretase in i.itor

/ecei$ed A,( -33 2 million

l eimer s ssociation lead! nder in %artners i% !or a -10million commitment

#%!


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A

TAU

Other

VascularDisease

AlphaSynuclein

TDP-43

)6 )I Dementia

)linicalSpectr!m

PET/CS

PET/CS

!

"#$

!CS

!CS

#%!

#%!

#%!

#%!

#%!


/iomar(er Therapy


l eimer s Com ination & era%ies


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l eimer s Com.ination & era%ies%%ort nity C&

Com.ination t era%ies treatcom%le< diseases cancer(,O: ,D' &* eart diseases

+a nc ed A% O in %artners i%it DD= and l eimer s

'ociety in t e GL HoalF &o !acilitate la nc

clinical trials it nein$estigational dr gs in com.oin late 2016:early 2017

If Al h i t i d l d


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If Alzheimers onset is delayedy years

In S!mmary


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In S!mmary l eimer s ssociation is t e glo.al leader in

researc %ro$iding care and s %%ort to all o!t ose a!!ected and leading t e % .lic %olicye!!orts

'igni!icant increases in researc ! nding aremo$ing in rig t direction

l eimer s disease is a contin m need toidenti!y earliest .iological c ange and inter$eneat t at time %oint

& ere is hope in researc P


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State of the science in Alzheimer's research