Unraveling the Amyloid Enigma: Reframing Alzheimer’s Narratives in a New Era of Biomarkers and Lifestyle Interventions

 

From AAIC Amsterdam: A Renewed Emphasis on Amyloid and a Fresh Look at Disease Staging in Alzheimer’s Research

Interesting times at the Alzheimer’s Association International Conference (AAIC) in Amsterdam last week. Some positive findings with amyloid lowering drugs in early stages of Alzheimer’s were welcomed and seem to have led to the launch of a new 7 part staging process to measure the disease. This should amuse the researchers at New York University who published the Global Deterioration Scale back in 1988. This was used commonly at first, especially in clinical trials, but drifted out of use. But now something broadly similar is back, this time bolstered by the inclusion of biomarkers. In fact there is a stage A0, which is biomarker change, but no symptoms.

Amyloid: Biomarker, Warning Sign, or Both? Delving Into the Implications for Alzheimer’s Disease Prognosis and Early Detection

This starts to raise questions. It is known that amyloid accumulation affects tau proteins and leads to the tangles that are another hallmark of AD. The Lilly study was successfully conducted in people with raised amyloid, but minimal change in tau. This could suggest that raised amyloid is a problem, but if lowered in time may prevent further serious illness. This is very much like cholesterol and heart disease, where another physiological protein can cause problems if overproduced. So is amyloid a biomarker for Alzheimer’s disease pathology or a warning that you are at high risk? This is important going forward, because measuring amyloid and tau in the blood is close to normal clinical practice, so if we start to test, what do we tell people prognostically? Is A0 Alzheimer’s disease? This could be identified 20 years before symptoms. Do people want to have that label for that long? And what is the prognosis? We know many people have raised amyloid in the brain with no symptoms; indeed some very high performing ninety plus year olds have more than expected levels of amyloid.

In spite of that, detecting overproduction of amyloid and lowering it early is now looking to be a good strategy. But what causes this overproduction? There are many suggestions and of course genetics shows how changes in amyloid genes cause younger people to develop Alzheimer’s disease. But some of these suggestions are interesting. Is amyloid part of an innate immune system? If it is, lowering it could pose risk. Does it have other protective purposes? It is released after head injury. More interestingly, is it involved in homeostasis of the vasculature and metabolic activity of the brain? If that were the case, it would be affected by lifestyle factors such as nutrition, exercise and sleep. Is there evidence for this? Last year a study from Zurich did show a relationship, so that should help develop our thinking more. Especially as also lauded at AAIC was the success of the FINGERS network at reducing the incidence of dementia through intensive lifestyle training and activities.

Decoding the A0 Stage: Emphasizing Proactive Measures and Personalized Interventions in Alzheimer’s Disease Management

So, do we need to have A0 as a stage of Alzheimer’s disease, or should we be informing people that they have a raised blood amyloid and now need to take action — and what shape would that action take? The obvious answer is a lifestyle review and recommendations, based on evidence to date, to adjust any potential contributors to a raised amyloid. This is a normal primary care response and at this stage a perfectly reasonable strategy. If this were combined with regular cognitive assessment, then early signs of progression could be picked up sooner and more aggressive treatment considered.

At OptiChronix, we have developed a lifestyle coaching app and combined cognitive assessment to match this purpose. myAVOS is designed to measure personal risk and offer solutions now.

Managing raised amyloid and very early cognitive change in this way makes sense and is affordable. Many people know what there blood pressure and cholesterol level are and increasing numbers use lifestyle changes to reduce dependence on medication. We need to encourage that level of observation for Alzheimer’s disease. If raised amyloid is a risk and we have blood tests to measure that, then we should be offering that knowledge to anyone that wants to find out — and discussing prevention rather than diagnostic labels. What they then do is down to personal choice, but being able to do something positive before getting worse has to be a plan. It also enhances the selection of people for amyloid lowering drugs and poses answerable research questions for this group of people.

Reimagining Amyloid: A Call to Question, Understand, and Control the Unseen Aspects of Alzheimer’s”

It is time to reconsider the narrative on amyloid. It clearly plays an important role in developing dementia, but it is a physiological protein, which may be responding to factors that we can control. We may be celebrating success for the wrong reasons. So let’s consider all explanations. After all research is about questioning the science. Politics is about following it.

credits: Meet Roger Bullock MD, a highly accomplished geriatric psychiatrist with over 30 years of experience in the field of psychiatry. Roger completed his medical training at Keble College, Oxford University, and clinical medical training at St Bartholomew’s Hospital in London. He specialized in psychiatry, specifically geriatric psychiatry, and established the Kingshill Research Centre. With an extensive career, Roger has published over 100 peer-reviewed papers, several books, and chapters. He also served as Clinical Tutor and Academic Secretary of the Royal College of Psychiatrists Faculty of Old Age Psychiatry for 8 years. Roger is a member of the Royal College of Psychiatrists and has received awards and recognition for his contributions to the field of mental health.