A global, collaborative research effort based on public-private partnerships, similar to the projects in the 1950s and 1960s that successfully reduced polio worldwide, will advance the prevention, diagnosis and treatment of Alzheimer's disease, according to two articles written by leaders of the Alzheimer's Association and published in the July issue of Alzheimer's & Dementia: The Journal of the Alzheimer's Association.
The authors call for the research community to work in partnership to accelerate Alzheimer's and dementia research through funding high-impact research, collaborating with appropriate partners and convening top experts to answer important research questions.
"A coordinated global research agenda is needed to drive the advances necessary to improve the lives of the millions worldwide with Alzheimer's now and to meet the U.S. National Alzheimer's Plan's goal of preventing and effectively treating Alzheimer's by 2025," said Maria Carrillo, Ph.D., Alzheimer's Association vice president of medical and scientific relations. "This coordination is essential when considering the limited resources currently allocated to Alzheimer's and dementia research and the magnitude of the impact of the disease in individuals, families and societies."
"The development of tangible interventions for the detection, cure and care of those at-risk or affected with Alzheimer's is our foremost task," said Carrillo. "We must improve the process by which we manage the research enterprise. The field must articulate a unified and integrated vision. The need for new multi-national partnerships is critical."
A third article in the journal presents modifications to guidelines established collaboratively by the Alzheimer's Association and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) for brain amyloid imaging using positron emission tomography (PET) as a tool for Alzheimer's diagnosis.
The modifications were sent to CMS in advance of recent draft decision, in which the agency agreed to cover one PET scan per person to exclude Alzheimer's in very limited circumstances. The Alzheimer's Association will continue to engage the scientific and healthcare communities, as well as advocates, to educate CMS on behalf of constituents about the benefits of coverage for brain amyloid imaging—in limited populations as defined by the scientifically-driven appropriate use criteria—as CMS develops a final decision.
Leveraging Global Resources to End the Alzheimer's Pandemic, an editorial by Carrillo in the journal, looked back at past research initiatives and forward toward the organization's current and future public-private research partnerships. Carrillo said the publication of the Five-Five, Ten-Ten Plan for Alzheimer's Disease editorial in 1992 inspired decades of Alzheimer's research and collaboration among academia, industry, government and patient-family advocacy groups. One of the breakthroughs resulting from this joint effort, she writes, was the development of amyloid imaging. Another has been the coming together of researchers, clinicians and regulators to establish new diagnostic criteria and promote the development of early-stage therapies.
Carrillo reviewed the Alzheimer's Association's current global public-private partnerships, including the Worldwide Alzheimer's Disease Neuroimaging Initiative (WW-ADNI), in which investigators from many different nations are extending the work of the original North American ADNI in investigating new imaging techniques and biomarkers for Alzheimer's disease; the Alzheimer's Association International Conference(AAIC), which gives investigators from around the world an opportunity to exchange information and build cooperative networks; and the Alzheimer's Association Research Roundtable (AARR), an international forum for public-private dialogue on forward-looking scientific and policy issues.
Carrillo wrote no single entity or country "has the capability, resources or knowledge to solve or mitigate the disease." Issues for which the Alzheimer's Association is actively seeking new collaborative partners, she said, include the expansion of "very large genetic, ethnically and culturally diverse populations" for multi-national studies, and the need for new computer analytical methods for ongoing studies.
In the same issue, Heather Snyder, Ph.D., Alzheimer's Association director of medical and scientific operations, reviewed global nonprofit public-private partnerships in Alzheimer's disease research. Noting the prevalence of dementia worldwide is expected to exceed 115 million by 2050, Snyder and colleagues called for global public-private research collaborations similar to those that came together in the 1950s and 60s to provide the polio vaccine and then between 1988 and 2012 to reduce polio by more than 99% worldwide.
Like polio, wrote Snyder, Alzheimer's represents a problem "too big for any one entity to address." Her paper is an initial inventory, to be updated annually, of public-private partnerships of nonprofit organizations invested in Alzheimer's research worldwide.
Snyder reviewed more than a dozen such partnerships and the organizations that oversee them. Among them is Alzheimer's Australia, which partners with government, care providers, philanthropic organizations, research centers and industry partners to sponsor research aimed at effecting change in hospital dementia services, clinical guideline development and appropriate medication management, and construct and maintain a national network of Dementia Collaborative Research Centers, which coordinate research and translate findings into accessible form for policy makers and service providers.
Also highlighted is the Alzheimer's Drug Discovery Foundation (ADDF), which collaborates with scientists, foundations, industry partners and CROs to rapidly accelerate drug discovery by providing seed funding to academic centers and technology companies. Other partnerships include the Accelerate Cure/Treatments for Alzheimer's Disease coalition, Alzheimer's Research U.K., BrightFocus Foundation, Critical Path Institute and the Alzheimer's Association.
A third paper in the July issue, Update on appropriate use criteria for amyloid PET imaging: Dementia experts, mild cognitive impairment and education, amended previously published appropriate use criteria for amyloid PET imaging as a diagnostic tool for Alzheimer's disease.
The criteria, first published in January, are the product of a collaborative effort between the Alzheimer's Association and SNMMI, which assembled an Amyloid Imaging Taskforce (AIT) that reviewed scientific literature and developed consensus recommendations for clinical use of PET in diagnosing Alzheimer's. The AIT concluded that amyloid imaging could potentially be helpful in the diagnosis of people with cognitive impairment when considered along with other clinical information, when performed according to standardized protocols by trained staff, and if the presence or absence of amyloid would increase certainty in the diagnosis and alter the treatment plan.
"This update is a refinement based on reviews from the field," said article co-author Dean Hartley, Ph.D., Alzheimer's Association director of science initiatives. "Clinicians, after using this technology for some months, had suggestions, which we have incorporated into the criteria in order to increase the value and cost-effectiveness of this breakthrough technology as a tool for use in diagnosing Alzheimer's."
The update refines the criteria in three areas: (1) dementia expert and documentation, (2) mild Cognitive Impairment (MCI) and (3) education.