The largest analysis to date of amyloid plaques in people’s brains confirms that the presence of the substance can help predict who will develop Alzheimer’s and determine who has the disease.
Two linked studies, published in JAMA, also support the central early role in Alzheimer’s of beta amyloid, the protein that creates plaques. Data from nearly 9,500 people on five continents shows that amyloid can appear 20 to 30 years before symptoms of dementia, that the vast majority of Alzheimer’s patients have amyloid and that the ApoE4 gene, known to increase Alzheimer’s risk, greatly accelerates amyloid accumulation.
The findings also confirm that amyloid screening, by PET scan or cerebral spinal fluid test, can help identify people for clinical trials of drugs to prevent Alzheimer’s. Such screening is increasingly used in research. Experts say previous trials of anti-amyloid drugs on people with dementia failed because their brains were already too damaged or because some patients, not screened for amyloid, may not have had Alzheimer’s.
Dr. Samuel Gandy, an Alzheimer’s researcher at Mount Sinai Hospital, who was not involved in the research, said doctors “can feel fairly confident that amyloid is due to Alzheimer’s.” But he and others cautioned against screening most people without dementia because there is not yet a drug that prevents or treats Alzheimer’s, and amyloid scans are expensive and typically not covered by insurance.
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