Study suggests it's possible to predict cognitive decline in Alzheimer's patients

(CN) — Scientists with the Amsterdam University Medical Center’s Alzheimer Center published a study Wednesday in the medical journal Neurology, claiming to have developed prediction models for Alzheimer’s-related cognitive decline.

The models are based on data collected from almost 1,000 people with Alzheimer’s and are designed to predict decline in patients with mild Alzheimer’s-related cognitive impairment or dementia. They use cognitive test scores, MRI scans, cerebrospinal fluid samples and other biomarkers to create an individualized prognosis.

“At our memory clinic, a standardized 1-day diagnostic workup is performed, including medical history; neurologic, physical, and neuropsychological tests; MRI; and lumbar puncture. This includes measurements of height, weight, systolic and diastolic blood pressure, and information on depression with the Geriatric Depression Scale, education on the Verhage scale and smoking history,” the study’s authors explained. “Diagnosis of dementia due to Alzheimer’s Disease and mild cognitive impairment was made in a multidisciplinary meeting.”

The study’s authors added that information such as the patient’s age and sex was also taken into account.

“As a result, it gives a prediction that is really tailored to each individual person,” Pieter van der Veere, one of the lead researchers on the project, said in a prepared statement.

No prediction model is perfect, the researchers stressed, given the vagaries of every patients’ health history. But scientists are hopeful that the Amsterdam model can predict roughly how Alzheimer’s patients’ cognitive decline will progress over the course of five years.

“This can be a starting point for conversations between doctor, patient and family about the pros and cons of treatments, so that they can come to an appropriate decision together,” Wiesje van der Flier, Research Director at Alzheimer Centre Amsterdam, said in a prepared statement.

The Amsterdam researchers’ models are not the only ones that have been put forward to predict cognitive decline, though they boasted in Wednesday’s paper that theirs outperformed similar efforts.

“Compared with other studies that predicted [cognitive] decline, our models showed similar or even better predictive performance while requiring less or similar information,” the study authors wrote.

The Amsterdam scientists said the next step in the project would be to develop an app that uses the prediction models; one that takes input from patients, family members and medical professionals. A prototype is already available for research purposes, but van der Veere said it would be beneficial for patients to have access to the program as well.

“Previous research shows that people still want information about their prognosis, even if this information is uncertain. An app with our prediction model can therefore meet an important need,” van der Veere said.

Van der Flier also said the models could prove beneficial if and when Alzheimer’s becomes a more treatable disease. Doctors could use the prediction models to better understand the effects of other medication on the disease, she said, or to better explain to patients what they could expect from treatment.

“In the communication of prognostic information to patients, a link needs to be made between the answers models can provide and the questions patients and their care partners have such as ‘how long can I still drive a car’ or ‘how long can I in my hobby [sic],’” the study authors emphasized.

In June 2022 the Alzheimer’s Association estimated that about 416 million people across the globe, or about 22% of all people over the age of 50, suffer from some form of Alzheimer’s. The disease is slightly more prevalent in women and the risk of developing symptoms increases with age, though not all patients develop symptoms.

“Indeed, most of the persons in our estimates are in the preclinical stage of Alzheimer’s disease, meaning that they do not have any overt symptoms and may never develop symptoms,” the authors of the 2022 study wrote.

According to the 2023 World Alzheimer’s Report, major but modifiable risk factors for dementia include poor diet, smoking, alcohol, lack of exercise, social isolation, air pollution, diabetes and lack of mental stimulation. Non-modifiable risk factors include age, genetics and sex hormones.

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