Three Important Findings in Alzheimer Disease

Jeffrey Cummings, MD


May 02, 2012

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Hello. I am Jeffrey Cummings, the Camille and Larry Ruvo Chair for Brain Health at the Neurological Institute of Cleveland Clinic, and the Director of the Lou Ruvo Center for Brain Health in Las Vegas, Nevada.

I would like to review some of the material presented at the American Academy of Neurology 2012 Annual Meeting. Two autopsy studies in particular caught my attention.

In one study, Marwan Sabbagh and colleagues[1] reported the sensitivity and specificity of florbetaben, one of the amyloid imaging compounds for autopsy confirmation of the presence of amyloid plaques in the brain. The sensitivity was 77%, and the specificity was 94%. This indicates that florbetaben is, with a high degree of accuracy, identifying the amyloid plaque burden present in the brains of patients with Alzheimer disease (AD). This is consistent with the recent US Food and Drug Administration (FDA) approval of AV-45 (Amyvid™) for the detection of amyloid plaque burden in individuals with cognitive impairment.

Another autopsy study that caught my attention was one by Bin Wang and colleagues[2] from Vancouver, British Columbia. The investigators looked at the autopsy confirmation of the diagnosis of patients who had participated in AD clinical trials. This is a very important group because in clinical trials, we try to enroll patients with disease that is as "pure" as possible so that as we are testing a therapeutic compound, we know we are testing it against AD pathology. In this particular study, nearly all of the patients had confounding pathology of other types, including Lewy bodies and vascular changes. This suggests that despite our best efforts, we are still enrolling patients with mixed pathology in our clinical trials.

Finally, I wanted to talk about an abstract that I presented that involved our work with the Neuropsychiatric Inventory, and the effects of memantine on behavior in patients with AD.[3] Using the 28-mg extended-release preparation, we showed that both the placebo group and the memantine group had an improvement in behavior. The memantine group continued to have improved behavior over time, whereas the placebo group gradually declined behaviorally.

Thank you.


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