Early recognition of Alzheimer's disease gains in importance.

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Alzheimer's disease Alzheimer's disease

Alzheimer’s basics

Alzheimer’s disease is the most common form of dementia. It was first described by Alois Alzheimer in 1906 (Berchtold et al. 1997), hence the name. Alzheimer’s disease is a chronic and progressive disease. Unfortunately, no curative drugs are available at present. But the pharmaceutical industry and scientific community together are working very hard on developing curative drugs that might become available to the market within a decade. These efforts are heavily supported by state and government, public and private organisations.

Early diagnosis will then be key to any early and adequate treatment and care. Therefore we have developed an automatic tool for the routine measurement of hippocampal volume in any hospital, clinic or clinical practice.

The hallmark of Alzheimer’s disease is clinically a memory deficit, anatomically signs of degeneration of the brain (local structural defects, reduction in oxygen consumption and reduced blood flow) and histologically the presence of tangles and plaques, which are the cause of a pathological degradation of certain membrane-bound proteins. Further parallel processes, like inflammation, also have a role.

As is the case with most brain diseases, anatomical and functional findings are related. The hippocampus is responsible for our long-term memory and as such functions as ‘hardware’ that stores all the information and data from our conscious memory. Since Alzheimer’s disease starts in the medial temporal brain, the site of the hippocampus, memory deficits are among the earliest signs that become apparent to the patient, relatives or the doctor.

We provide a means of measuring hippocampal volume in MRI of the brain in clinical practice to support the doctor’s decision regarding early Alzheimer's disease diagnosis or differential diagnosis.

Diagnosing Alzheimer’s disease requires careful evaluation. This includes a thorough medical history, mental status testing, a physical and neurological examination and some additional tests (typically blood tests and imaging) to rule out other causes of dementia-like symptoms. The diagnosis is based on the sum of the compiled clinical and laboratory findings. Only the combination of all these can give a sufficiently broad and clear picture of the underlying disease and rule out other causes.

The symptoms and biomarkers appear in a temporally ordered manner as described by the author Clifford R. Jack in 2013 in his dynamic biomarkers model of the Alzheimer’s disease pathological cascade. While Tau and Abeta amyloid are the first biomarkers to appear but are assessed by invasive and expensive methods, structural volume defects in the brain constitute the first sign that can be assessed using non-invasive methods and that appears before cognitive impairment. As structural MRI is generally appropriate for most patients with memory deficits in clinical diagnostic evaluation, the quantitative volumetric evaluation of the hippocampus provides useful and complementary information, and with appMRI Hippocampus Volume Analyser it is readily available. It is a relatively cheap and a cost-effective way to objectivise and support the radiologist’s assessment. Additionally, the results can be used for quantitative comparison in later examinations.

Also, recent studies have shown that the predictive value of cognitive examinations is significantly increased when combined with the information from structural volumetric imaging.

That said, quantitative, objective, reliable volume determination is of clear benefit. With appMRI Hippocampus Volume Analyser, the appropriate service is now available. More information on the appMRI Hippocampus Volume Analyser is available on the product site.

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Add Neuro Med

AddNeuroMed, as part of InnoMed, is a precursor of the Innovative Medicines Initiative.

AddNeuroMed is a cross European study, funded by the European Union and members of the European Federation for Pharmaceutical Industries and Associations (EFPIA) designed to find biomarkers or in general tests for Alzheimer's disease. The imaging work package of AddNeuroMed was intended to provide data from a longitudinal MRI study on a pan-European cohort of subjects with probable Alzheimer’s disease, normal elderly controls and those at risk of developing Alzheimer’s disease. Structural 3D-MRI, T1/T2 relaxometry and MRS were acquired in the clinical study. Scans were performed for each subject at baseline, subsequent after 3 months, respectively 12 months.

The scans were kindly provided to generate normative values of appMRI Hippocampus Volume Analyser. The clinical trial centres included University of Kuopio, Finland; Università degli Studi di Perugia, Italy; Aristotle University of Thessaloniki, Greece; King's College, London; United Kingdom; Centre Hospitalier Universitaire de Toulouse, France and Medical University of Lodz, Poland. The data coordination centre at the Karolinska Institutet performed the data management, processing, analysis and quality control. Please have a look at the reference list about AddNeuroMed here.

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