Alzheimer disease and associated disorders
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Alzheimer Dis Assoc Disord · Jan 2006
Review Comparative StudyThe role of biomarkers in clinical trials for Alzheimer disease.
Biomarkers are likely to be important in the study of Alzheimer disease (AD) for a variety of reasons. A clinical diagnosis of Alzheimer disease is inaccurate even among experienced investigators in about 10% to 15% of cases, and biomarkers might improve the accuracy of diagnosis. Importantly for the development of putative disease-modifying drugs for Alzheimer disease, biomarkers might also serve as indirect measures of disease severity. ⋯ Imaging biomarkers including volumetric magnetic resonance imaging and positron emission tomography assessing either glucose utilization or ligands binding to amyloid plaque are discussed. Additionally, biochemical biomarkers in blood or cerebrospinal fluid are assessed. Currently appropriate uses of biomarkers in the study of Alzheimer disease, and areas where additional work is needed, are discussed.
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Population aging is a process that is especially accelerated in some parts of the world. One example is in Latin America. As with other developing regions, Latin America has to confront population "graying" in the context of an emerging economy. ⋯ The burden of dementia is significant for patients, families, health systems, and public health. The aim of this paper was to summarize data from the scarce dementia epidemiological studies available in Latin America, the diagnostic criteria used in most countries and the most widely used diagnostic tools and neuropsychological assessment instruments (some of them translated, validated, and harmonized). Reference is made to the approval process and availability in Argentina of dementia and cognitive decline-related drugs.
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Conflicts of interest and other ethical dilemmas occur in Alzheimer disease (AD) patient care and research but often are underrecognized by physicians. One or more bioethical principles of autonomy, confidentiality, truth telling, beneficence, and justice, which apply to demented individuals as they do to other patients, may conflict in everyday clinical situations. For example, when demented patients wish to continue driving, autonomy (the patient's right to self-determination) conflicts with beneficence (the duty to promote the patient's welfare). ⋯ Full disclosure of financial interests increasingly is an accepted requirement in the conduct of biomedical research. In AD, less obvious potential conflicts of interest arise when physicians recruit their patients for antidementia drug trials sponsored by a pharmaceutical company (that provides the physician with research funding) or when investigators fail to acknowledge the patient's withdrawal of assent when attempting to complete a research protocol. The recognition of both financial and nonfinancial conflicts should lead to measures to reduce bias, which in turn will improve the integrity of research findings and promote patient welfare.