Accurate diagnosis and prognosis of Alzheimer’s disease in primary care

Project Information

ADetect

Grant agreement ID: 101061836

DOI

10.3030/101061836

Project closed

EC signature date 1 August 2022

Start date 1 October 2022

End date 30 September 2024

Funded under

• Marie Skłodowska-Curie Actions (MSCA)

Total cost

No data

EU contribution

€ 206 887,68

Coordinated by

LUNDS UNIVERSITET
Sweden

Periodic Reporting for period 1 - ADetect (Accurate diagnosis and prognosis of Alzheimer’s disease in primary care)

Reporting period: 2022-10-01 to 2024-09-30

Summary of the context and overall objectives of the project

Alzheimer's disease (AD) is a significant and growing global health challenge, with dementia expected to affect 150 million individuals by 2050. As the primary cause of dementia, AD has profound health, social, and economic implications. Despite the urgent need, effective treatments are lacking, and the disease is often misdiagnosed, especially in primary care settings, where misdiagnosis rates exceed 50%. These inaccuracies in diagnosis delay optimal care and treatment, a critical issue as disease-modifying therapies become more widely available.

The project aims to address the pressing need for improved diagnostic tools to facilitate early and accurate detection of AD. The current gold-standard biomarkers, such as PET imaging and cerebrospinal fluid (CSF) analysis, are effective but face significant barriers, including high costs, invasiveness, and limited accessibility in primary care. Recent advancements in plasma biomarkers and digital cognitive tests offer promising, cost-effective, and scalable alternatives that can address these challenges. However, these tools remain largely unvalidated in unspecialized centers such as primary and secondary care clinics, where the patient population is more diverse and the prevalence of AD is lower compared to specialized memory clinics.

This project will evaluate the utility of plasma biomarkers and digital cognitive tests in 800 participants presenting with cognitive complaints in primary care centers. By comparing these innovative biomarkers to established gold standards, the study seeks to:

Enhance Diagnostic Accuracy: Validate plasma biomarkers' performance in primary care settings, enabling accurate differentiation between AD and other causes of cognitive impairment.
Promote Accessibility and Equity: Develop cost-effective, minimally invasive tools that can be widely implemented across diverse populations, irrespective of socioeconomic or cultural background.
Integrate Digital Solutions: Introduce standardized, self-administered digital cognitive tests that reduce reliance on specialized personnel, allowing for earlier and broader screening.
Improve Clinical Outcomes: Facilitate timely diagnosis and intervention, which is critical for optimizing treatment and care, especially as disease-modifying therapies become accessible.

The project aligns with global priorities to tackle the dementia crisis by enabling earlier, more precise, and equitable AD diagnoses. By focusing on primary and secondary care, where the majority of patients are assessed, this work addresses a critical gap in the current diagnostic pathway. The integration of plasma and digital biomarkers has the potential to revolutionize AD management, extending diagnostic capabilities to resource-limited settings and reducing the societal and economic burden of dementia.

In summary, this project will establish a robust foundation for implementing innovative diagnostic tools in primary care, contributing to a paradigm shift in how AD is detected and managed, ultimately improving outcomes for millions of individuals worldwide.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

During the course of the project, a series of impactful scientific and technical activities were undertaken, paving the way for significant advancements in Alzheimer’s disease diagnostics. Central to these efforts was the validation of blood-based biomarkers, which emerged as a groundbreaking tool to assess AD pathology accurately. This work was meticulously carried out in both primary and secondary care populations, with a particular focus on addressing the diagnostic challenges prevalent in primary care. By comparing these innovative biomarkers with established gold-standard methods, such as cerebrospinal fluid analysis and PET imaging, the research demonstrated that blood-based biomarkers offer equivalent diagnostic performance while being far less invasive and more cost-effective.

One of the most notable milestones was the publication of a landmark study in JAMA, which provided definitive evidence supporting the use of blood biomarkers in routine clinical care. This study not only advanced the scientific understanding of AD but also had a profound clinical impact, simplifying the diagnostic process for cognitively impaired patients. Beyond this key achievement, the research expanded into novel territory, validating new biomarkers that target specific AD pathologies, such as aggregated tau, one of the disease’s hallmark proteins. This work, published in Nature Medicine, represents a critical step toward refining diagnostic tools for both research and clinical applications.

The project also addressed the critical need to streamline clinical trials in AD by demonstrating that blood biomarkers can efficiently identify participants in the earliest stages of the disease. This finding, supported by a large-scale collaborative study involving over ten independent cohorts, was detailed in a forthcoming publication in Nature Aging. By tackling one of the most challenging aspects of clinical trial design—participant recruitment—this research has the potential to accelerate the development of new treatments for AD.

In addition to focusing on biomarkers, the project developed innovative diagnostic models based on several cerebrospinal fluid biomarkers. This integrated approach, published in Nature Aging, provides a more nuanced understanding of disease staging and could significantly improve patient management.

The outcomes of these activities have been transformative. The project not only produced a series of high-impact publications but also laid a strong foundation for the clinical translation of these diagnostic tools. By demonstrating their feasibility in real-world settings, particularly in primary care, this research has opened new avenues for early and precise diagnosis of AD. Furthermore, the integration of blood biomarkers into clinical workflows is set to reduce the reliance on invasive and expensive diagnostic methods, making AD diagnosis more accessible to a broader population.

In summary, this project has advanced the field of AD research by validating innovative diagnostic tools, improving clinical workflows, and addressing barriers to trial design. These achievements mark a significant step forward in the fight against Alzheimer’s disease, with the potential to transform how the disease is diagnosed and managed worldwide.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

The results of the project led by Dr. Salvadó during the Marie-Curie fellowship have been transformative for both scientific advancement and clinical practice in Alzheimer’s disease (AD) diagnostics. The most significant achievement is the publication of a landmark study in JAMA, demonstrating that blood-based biomarkers have sufficient accuracy to assess the presence of AD pathology in primary and secondary care populations. This work has received exceptional scientific recognition (>125,000 reads) and widespread media attention, highlighting its immediate and global relevance.

-This study provided robust evidence that blood biomarkers are non-invasive, cost-effective, and scalable alternatives to current invasive methods (e.g. CSF analysis and PET imaging) in clinical settings.
-Other studies published in Nature Medicine and Nature Aging validated other fluid biomarkers for the assessment of Alzheimer's disease pathology and suggested possible applications for the clinical setting and recruitment in clinical trials.

The validation of blood biomarkers represents a paradigm shift in the management of cognitive impairment. These tools allow earlier and more accurate AD diagnosis in primary and secondary care, where diagnostic challenges are most pronounced. Patients benefit from less invasive diagnostic methods, while healthcare systems can reduce costs and improve resource allocation. The ability to use blood biomarkers for participant selection in early disease stages simplifies and accelerates recruitment, addressing a major bottleneck in clinical trial design. The scalability and low infrastructure requirements of blood biomarkers promote accessibility in low-resource settings, reducing disparities in diagnostic capabilities worldwide. The findings lay the groundwork for further studies to refine and optimize biomarker-based diagnostic tools. Future research should focus on integrating these biomarkers with digital cognitive tools, enhancing diagnostic precision.

In summary, the project has yielded groundbreaking results with immediate clinical relevance and substantial potential for improving AD diagnostics globally. By addressing the outlined needs, the findings can be fully realized, leading to widespread adoption and profound societal impact.

Schematic description of the project