Moderator of 1 Session
Presenter of 2 Presentations
Balancing innovation and access: how do we optimize a standard of care and equity in Alzheimer’s?
PATIENT STRATIFICATION IN ALZHEIMER’S DISEASE: OPPORTUNITIES AND CHALLENGES
Abstract
Aims
Alzheimer’s disease (AD) is the most common cause of dementia, affecting over 50 million people globally. Patient stratification may be used to identify individuals who may experience greater benefit from treatment options, particularly with emerging disease-modifying treatments (DMTs). Here, we discuss the importance, challenges, and evolution of patient stratification in AD.
Methods
In January 2021, a panel of clinicians and AD experts met to discuss the current application of patient stratification in AD. Subsequently, a qualitative literature review was conducted for highly important topics in stratification.
Results
Vital applications for patient stratification include differential diagnosis of AD from other dementias, staging of disease severity, identifying people at risk of clinical progression or amyloid-related imaging abnormalities, tailoring individual treatment pathways, and determining eligibility for clinical trial participation. A variety of methods are used for stratification according to demographics, vascular risk factors, genotyping, and symptomatology (cognitive and functional assessments). AD pathology biomarkers available (amyloid or tau assessed by positron emission tomography or cerebrospinal fluid ascertainment) can also help in patient stratification; but availability and application vary across countries, hampering correct identification of patients at risk. Similarly, stigma for patients or clinicians, misdiagnosis, and poor coordination of the diagnostic process between primary care and memory clinics challenge utilisation of patient stratification. Moreover, current diagnostic testing may be cost-prohibitive or perceived as invasive.
Conclusions
Despite major challenges, patient stratification is an important tool in AD treatment that can help determine which individuals would benefit from treatment, especially as DMTs become more widely available.