Rethinking the detection and diagnosis of Alzheimer's disease: Outcomes of a European Brain Council project.

Alzheimer's disease (AD), the most common form of dementia, is a progressive and debilitating neurodegenerative condition which robs people of their memory, their independence, their relationships and, ultimately, their lives. It affects close to 7 million people in the European Union (EU) alone. The detection and diagnosis of AD relies on a system that remains focused on the late stage of the disease, despite a better understanding of the disease progression. Clinical practice and healthcare systems' readiness to detect, diagnose and treat the disease effectively are still lagging. The use of biomarkers (cerebrospinal fluid tests (CSF) and positron emission tomography scans (PET)), which are central to a diagnostic assessment for people with AD symptoms, as well as relevant diagnostic facilities are under-utilised. PET imaging is expensive and of limited availability, and CSF sampling may be considered invasive. The European Brain Council's 'Rethinking Alzheimer's disease: Detection and diagnosis' White Paper has looked at the barriers to early diagnosis and how the healthcare systems infrastructure for detection and diagnosis of AD need to be transformed in order for people with AD to benefit from innovative solutions once they become approved for use.

Mathematical modeling and analysis of the heat shock protein response during thermal stress in fish and HeLa cells.

The climate change has the potential to dramatically affect species' thermal physiology and may change the ecology and evolution of species' lineages. In this work, we investigated the transition of dynamics in the heat shock response when the thermal stress approaches the upper thermal limits of species to understand how the climate change may affect the heat shock responses in ectotherms and endotherms. The heat shock protein 70, HSP70, prevents protein denaturation or misfolding under thermal stresses. When thermal stress increases, the number of misfolded proteins increases, which leads to high levels of HSP70 protein. However, when temperatures approach limits of thermal tolerance (i.e., the critical thermal maximum, CTmax, for ectotherms and the superior critical temperature, SCT, for endotherms), levels of HSP70 protein synthesis start to decrease. Thus, we hypothesized that the temperature at the first reduction of HSP abundance indicates the thermal limits of the species. In this work, we provide a mathematical model to investigate the behavior of the heat shock responses related to HSP70 protein. This model captures the dynamics of HSP70 protein and Hsp70 mRNA, in HeLa cells (i.e., representative for endotherms) and multiple species of fishes (i.e., representative for ectotherms) with different acclimation histories. Based on our hypothesis of the relationship between the HSP70 protein level and CTmax/SCT, our model provides three methods to predict the CTmax of fishes with varying acclimation temperature and the SCT of HeLa cells. The CTmax increases as the acclimation temperature increases in fishes, however the CTmax plateaus when the acclimation temperature is higher than 20°C in brook trout, a representative cool water salmonid. Our model also captures the situation that the heat shock reaction in fish is more sensitive to the heat shock temperature than HeLa cells, when the heat shock temperature is lower than the upper thermal tolerance. However, both fish and HeLa cells are sensitive to the heat shock temperature when the temperature reaches the thermal tolerance limits. Additionally, our sensitive analysis result indicates that the status of some components in the heat shock reaction changes when the temperature reaches the thermal tolerance resulting in failure in protein refolding in fish and speeding up the refolding process in HeLa cells. Mathematical analysis is also applied on a simplified mathematical model to investigate the detailed dynamics of the model, such as the steady states of the substrate, Hsp70 mRNA, and HSP70 protein, at different thermal stresses. The comparison between the original model and simplified model shows that the inhibition on HSP70 protein transcription by thermal stresses leads to the reduction in HSP70 protein at extreme temperatures.

A Cost-Consequence Analysis of Different Screening Procedures in Alzheimer's Disease: Results from the MOPEAD Project.

BACKGROUND: For care planning and support, under-detection and late diagnosis of Alzheimer's disease (AD) is a great challenge. Models of Patient-Engagement for Alzheimer's Disease (MOPEAD) is an EU-funded project aiming at testing different strategies to improve this situation. OBJECTIVE: To make a cost-consequence analysis of MOPEAD. METHODS: Four screening strategies were tested in five countries (Germany, the Netherlands, Slovenia, Spain, and Sweden): 1) a web-approach; 2) Open-House initiative; 3) in primary care; and 4) by diabetes specialists. Persons-at-risk of AD in all strategies were offered referral to a hospital-based specialist. The primary health-economic outcome was the cost per true-positive case (TP) of AD from the screened population. RESULTS: Of 2,847 screened persons, 1,121 screened positive (39%), 402 were evaluated at memory clinics (14%), and 236 got an AD diagnosis (8%). The cost per TP of those screened was €3,115 with the web-approach, €2,722 with the Open-House, €1,530 in primary care, and €1,190 by diabetes specialists. Sensitivity analyses that more likely reflect the real-world situation confirmed the results. The number-needed-to-screen was 30 with the web-approach, 8 with the Open-House and primary care, and 6 with the diabetes specialists.There were country differences in terms of screening rates, referrals to memory clinics, staff-types involved, and costs per TP. CONCLUSION: In primary care and by the diabetes specialist, the costs per TP/screened population were lowest, but the capacity of such settings to identify cases with AD-risk must be discussed. Hence new diagnostic strategies such as web-solutions and Open-House initiatives may be valuable after modifications.

General practitioners' attitude toward early and pre-dementia diagnosis of AD in five European countries-A MOPEAD project survey.

INTRODUCTION: General practitioners (GPs) play a key role in early identification of dementia, yet diagnosis is often missed or delayed in primary care. As part of the multinational Models of Patient Engagement for Alzheimer's Disease project, we assess GPs' attitude toward early and pre-dementia diagnosis of AD and explore barriers to early diagnosis. METHODS: Our survey covered general attitude toward early diagnosis, diagnostic procedures, resources, and opinion on present and future treatment options across five European countries. RESULTS: In total 343 GPs completed the survey; 74% of GPs indicated that an early diagnosis is valuable. There were country-specific differences in GPs' perceptions of reimbursement and time available for the patient. If a drug were available to slow down the progression of AD, 59% of the GPs would change their implementation of early diagnosis. DISCUSSION: Our findings provide insight into GPs' attitudes by exploring differences in perception and management of early diagnosis.

The MOPEAD project: Advancing patient engagement for the detection of "hidden" undiagnosed cases of Alzheimer's disease in the community.

In most, if not all health systems, dementia is underdiagnosed, and when diagnosis occurs, it is typically at a relatively late stage in the disease process despite mounting evidence showing that a timely diagnosis would result in numerous benefits for patients, families, and society. Moving toward earlier diagnoses in Alzheimer's disease (AD) requires a conscientious and collective effort to implement a global strategy addressing the multiple causes hindering patient engagement at different levels of society. This article describes the design of the Models of Patient Engagement for Alzheimer's Disease project, an ongoing EU-funded public-private multinational initiative that will compare four innovative patient engagement strategies across five European countries regarding their ability to identify individuals with prodromal AD and mild AD dementia, which are "hidden" in their communities and traditionally not found in the typical memory clinic setting. The strategies include an online AD citizen science platform, an open house initiative at the memory clinics, and patient engagement at primary care and diabetologist clinics.