Risk of Developing Alzheimer’s Disease

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					 Alzheimer’s Disease Prevention

         Primary              Secondary
        Prevention            Prevention     Treatment

                  Pre-           Mild
  Normal       symptomatic     Cognitive        AD
                   AD         Impairment
 No Disease,    Early Brain   Mild Memory   Mild, Moderate
No Symptoms      Changes,         Loss       and Severe
               No Symptoms                   Impairment

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

                                  Percent Annual Decline in
                                    Hippocampal Volume

        Normal,          3.5
      75 years old        3
  Alzheimer’s disease,         Control             MCI                AD
      75 years old
     De Leon MJ, 1999              Jack CR, et al, Neurology 55: 484-489, 2000
  PET Imaging of Amyloid Deposits in
Alzheimer’s Disease vs Normal Controls

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

                                                Source: Klunk, et al. Ann Neurol 2004: 55:306-319.
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
Vitamin E, C, B6, B12,
Folate, B-Carotene
  Vitamins E, Aricept
     Aspirin, Vitamin E
           B-Carotene, Vit. E, C
                         Celecoxib, Naproxen
                     Ginkgo Biloba
                          Vitamin E, Selenium
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
                                                    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